ASSIGNMENT OF PATIENT CARE

ASSIGNMENT OF PATIENT CARE:- There are generally four types of

assignment system for patient care. These are:-

A)CASE METHOD/ TOTAL PATIENT CARE:- It is an oldest method for

patient Care. It is also known as allocation method. In this method one patient one
patient can be considered as one Case. Here one nurse is assigned or allocated for
the total care of a patient . She is responsible for all the activities of the Patient.
She must do the checking for TPR of the patient, administration of medication, NG
tube feeding or oral feeding etc. In her off duty she must handover all the
responsibilities for the patient to another nurse and she must look after the patient
name like the previous one. In this method one nurse can look after more than one
patient at a time.

ADVANTAGES:-

i) The work load of a Ward can be equally divided among all the staffs.

ii) Good interpersonal relationship is developed between the Nurse and the patient.

iii) The Nurse can be identify the problems of the patient properly as she is taking
total care of the patient.

iv) The nurses can develop their knowledge more by studying about the case,
related to the patient.

DISADVANTAGES:-

i) In a staff crisis situation, it is difficult to manage a ward.

 (2)

ii) Need more efficient and experienced nurses

B) FUNCTIONAL NURSING METHOD:- It is another method of patient care.

In this method the nurses can work as per their particular function. A nurse is
responsible for a specific job, related to patient care. For example suppose a nurse
is responsible for taking TPR. So, it is her duty to check TPR of all the patients in
her ward. She will not take any other responsibilities of any patient.

ADVANTAGES:-

i) Fast nursing services can be provided as everyone is doing their duties.

ii) Nurses become efficient in a particular job by doing it regularly.

iii) Quality of care can be maintained in this method.

DISADVANTAGES:-

i) No one is bothered much about patient’s problem as everyone is busy with their
own function.

ii) Less communication with the patient.

iii)Nurses can’t increase their skill, as they are doing same duty daily.

C) TEAM NURSING METHOD:- In this method of nursing care, every nurses do

work in a team basis. The superior leads the team by checking doctor’s order and
others, the subordinates just follow the orders.

ADVNTAGES:-

i) Everybody can develop team spirit by this method.

 (3)

ii) The team leader can develop her leadership capability.

iii) Very fast nursing care is possible as everyone is working as a team.

DISADVANTAGES:-

i) No one can take responsibility for any job.

ii) Communication with patient is very less.

iii) Quality of care is not possible.

PRIMARY NURSING: In this method nurse is responsible for a patient from his
admission to till discharge or till the end of his treatment. The nurse should work in
a 24 hours basis for her patient.

ADVANTAGES:-

i) As the nurse is taking total care of the patient from the beginning so, she is more
knowledgeable about the patient’s problem.

ii) Any patient can rely on a nurse as she/he is looking her/him daily.

Iii0 High quality of nursing care is possible.

DISADVANTAGES:-

i) The nurse may feel isolated from her colleagues

ii) It’s quite difficult to work in 24 hours schedule.

iii) Need more expert or efficient nurses to handle the total treatment process of a
patient.
 (4)

GOALS:-To identify the goals of nursing service department, we must find out:-

i) Hospital as an institutional goal.

ii) Nursing departmental goal

iii) Nursing as a unit and goal.

HOSPITAL AS AN INSTITUTIONAL GOAL:-

a) To provide quality of health care to the patients.

b) To maintain all the rights of patients and maintain privacy.

c) To arrange education system for professionals like Doctors, nurses, dentists,

dietician etc.

d) To do in-service and continue education classes for staffs.

e) To maintain the standard of hospital.

NURSING DEPARTMENTAL GOAL & NURSING AS A UNIT AND GOAL:-

a) To provide best possible nursing care to the patients.

b) To find out the needs for the client, whether he/she is totally dependent or
partially dependent to nursing care.

c) To look after, whether the physician’s orders are strictly followed or not.

d) To encourage staffs for in service education classes for their own update.

e) To encourage staff nurses for doing specialization courses.

 (5)

f) To provide job- description to all the nursing staffs, so that they can feel their
self actualization and job satisfactions.

PRINCIPLES:-

i)The basic principles of nursing service department is to provide care to all the
clients irrespective of it’s age, sex, socio- economic condition, Nationality etc.

ii) The nursing department must have to maintain good interpersonal relationship
with any other department in the hospital. To maintain a good standard of the
hospital. It is very important to maintain good nursing intervention.

iii) There are some particular code of ethics. Every nursing department must follow
the ethics while treating patients.

iv) Not only in hospital setup but also in community area the nursing services
should be increased.

v) The nurses should be empathetic to the patients but not to be sympathetic, while
giving care.

3) Nursing is the act of utilizing the environment of the patient to assist him in his
recovery. Nursing is all about management and art.

Management is art of knowing what you want to do and then seeing it is

done in the best and cheapest way. Nursing and management are interdependent to
each other. So, nurses must know the management principals.

i) EFFECTIVE COMMUNICATIONS:- For providing optimal level of nursing

service, effective communication is very important. The nurse should know how to
 (6)

communicate with patient, patient parties as well as other departments of the

hospital.

ii) DIVISION OF WORK:- The nursing-in-charge or supervisor must know how to

divide the work among the subordinates. The working should be divided in such a
manner, that any staff should not get over load. On the other hand, the supervisor
should manage the task in the way that the critical most patient can get efficient
and experienced nursing care.

iii) UNITY OF COMMAND:- While working in any department the nursing staffs
should follow a particular command from any of their subordinates. If there is
various commands, then everybody become confused. It is the responsibility of the
nursing department to make a single decision and that must be followed.

iv) UNITY OF DIRECTION:- It is also same like the previous principal, that
nurses should follow. The nursing department should take decision about which
direction supposed to be followed and only then instruct the staffs.

v)a) SELF MANAGEMENT:- Every nurses should know the self management.
They must be empathetic for their patient but not be sympathetic. They must
respect the various patient’s religious beliefs, values and Nationality.

v)b) HEALTH CARE DELIVERY SYSTEM IN INDIA:- Health care delivery

means providing multiple of services related to health to individuals or community
people in order to promote good health, reduce illness and alleviate the suffering.
The healthcare delivery system also provides health education.

In our country there are three levels of health care delivery:- Primary,
Secondary, Tertiary .
 (7)

PRIMARY HEALTH CARE DELIVERY:- It provides the basic level of health

care delivery, like First Aid, Providing health education, taking care of postnatal
mothers etc.

SECONDARY HEALTH CARE DELIVERY:- It is the first referral unit for the
primary health care system. Secondary health care delivery provides, care for the
antenatal mothers, normal vaginal delivery, medical aseptic dressing etc. These are
done by Sub-Divisional Hospital, District hospital etc.

TERITARY HEALTH CARE DELIVERY:- All the critical patients from both
primary and secondary health care delivery can be referred to here. The services,
that are provided here are lower uterine caesarean section, any surgical procedure,
medical emergencies etc. mainly any medical College and Hospital are
responsible for providing these services.

ELEMENT OF PRIMARY HEALTH CARE:- Maternal and allied health care,

immunization, availability of drugs , treatment, safe water supply and sanitations ,
nutrition’s, educations, prevention of chronic deceases.

PRIMARY HEALTH CARE:- Primary health care is essential. It is universally

accessible to individuals and acceptable to them, through their full participation
and at a cost the community and Country can afford.

PRINCIPLES:- i) The basic principle for primary healthcare is equitable

distribution. The services should be provided to every individuals irrespective of
its age, sex or socio- economic condition.
 (8)

ii) INTERSECTORAL CO- ORDINATION:- It is an important factor.

Coordination from all other is very important to maintain a successful primary
health care like agriculture, education, food industry etc.

iii) ACTIVE COMMUNITY PARTICIPATION:- All the members of a

community should participate. They should use their primary health care services
for their need. They should involve their family members in their own health of
people.

iv) APPROPRIATE TECHNOLOGY:- Which is scientifically sound and

adoptable at local level, that must be used. The National health policy is being
reformed and recognized in terms of health infrastructure and health team
functionaries.

v) MAN POWER DEVELOPMENT:-

a) CHANGING TRENDS IN HEALTH CARE:- i) Earlier in the 20th century, the

treatment for various diseases were given in the home only. Treatment was given
by some physician or nurses.

ii) Later in the 20th century, there was some specialization for courses like
Pediatrician, Psychiatrist , Medical, surgical etc.

iii) Last in the 20th century there was no boundaries in patient care. For any
treatment, patient can avail hospital (24x7)

iv) Now-a-days there is advancement of technology. We can do any investigation

for any part of our body. So, treatment is very specific now.
 (9)

v) Attitude of the peoples are also changing day by day. They prefer any accredit
or standard hospital for their relative’s treatment. Money is not a bar now-a-days
for treatment.

ROLE OF NURSES IN CHANGING TRENDS:-

i)CHANGING IN DEMOGRAPHICAL STRUCTURE:- In the early years, there

was large family structure. Peoples were not that much concern about their regular
health. But now-a-days the family has become constricted and concern about
health. So now nurses have the role to do the remote health check up. In the remote
area peoples are not at all concern about various disease condition. Nurse should
provide health education to them and make them aware about changing trends of
health and health care.

ii) ADVANCEMENT OF TECHNOLOGY:- Through advancement of technology,

now it is possible to investigate and treat any disease. Here the nurses should work
as an educator. They must make themselves update about the technology as well as
give education to clients, so that patients can have an idea about treatment to
various disease.

iii) ALTERNATIVE THERAPIES:- Today’s Nurses are already highly skilled,

trained and educated in the ways of traditional medical care. But they can receive
an increased amount of training and education through alternative therapies. By
this knowledge they can act as a therapist and take care for the patients.

4) RELATIONSHIP BETWEEN HEALTH CARE QUALITY AND COST:-

Now-a-days there is an advancement of technology. Various investigation related
to health is possible today but that is obviously cost effective. Various health care
 (10)

organizations or hospitals are providing best possible health care to us. Their
principle is to do the optimum level of cost but without compromising the quality.

PURPOSE:- To review systematically evidence of the association between health

care quality and cost.

In a review of the evidence currently available there was no clear

relationship between the two. Lead author Peter S. hussy and his colleagues
conducted a systematic reviewof61 studies and found inconsistence evidence on
both the direction and the magnitude of the association between health care quality
and cost.

These results are a stark reminder of how little researchers and

caregivers know about the optimal allocation of scarce health care resources to
achieve the best health outcomes. To assess quality measures, the reviewers used 5
categories defined by the national quality measures. Structure, process, outcome,
patient experience and access. They also added a sixth category that included
composites of measures in 2 or more of those categories. Cost measures were
divided into 4 categories:- accounting costs, charges, expenditure and a care
intensity index, used in some studies as a measure of resource use relative to the
services provided.

Of the 61 studies that met the inclusion criteria, higher cost was
associated with better quality of carein34% indicating a positive or mixed positive
association between the two. In 18 studies(30%) the association was negative or
mixed negative (lower cost was associated with higher quality) and in 22 studies
( 36%) the association was non existents, mixed, imprecise or indeterminate.
 (11)

Still more data are needed for clinicians and policy makers to make
effective decisions that effect the clinical and fiscal health of the Nation. Payers
should reconsider the extent to which they shift financial risk onto provider
organizations and incentives for quality targets should be offered to promote
process of care that are well supported by evidence or conversely to discourage
care shown to be inappropriate or of poor value.

Finally, they write all parties should participate in ongoing monitoring

of access, care process, patient experiences and outcome to ensure that we not
only detect any unfairness problems but that we can also continue to learn what
works to produce value in health care.

COMPONENTS OF HEALTH CARE DELIVERY SYSTEM:-

1. STRUCTURE OF HEALTH SYSTEM:- Aspect of health services that

influence the way in which they are delivered includes:- i) Number and type of
personnel and staff.

ii) Way of these personnel organized to work

iii) Nature and extent of facility and equipment.

iv) Financing.

v) Governance and decision making.

2. PROCESS OF HEALTH CARE DELIVERY:- It consists of two parts-

Behavior of professionals and participation of people.

BEHAVIOR OF PROFESSIONALS:-
 (12)

Diagnostic Procedure.

Appropriate follow up.

Recommendation of treatment or management.

PARTICIPATION OF PEOPLE:-

Utilization of services

Understanding the recommendations.

Participation in decision making

3. OUTCOMES OF HEALTH CARE:- Aspects of health that results from

interventions provided by the health system.

4. FLOWOF PATIENTS IN HEALTH CARE SYSTEM:-

Varies from Country to Country Indian system is more cost effective if health
workers are skilled and effectively supervised.
Name : Sukannya Auddy

Roll number : 18900001

Module no. 2 ( Basic principles of management).

1) Define planning. Differentiate between strategic and tactical

planning and elaborate steps in planning.

Ans. Planning:- Planning can be defined as the process of identifying any particular
problem or situation, look after the premises, where the situation or problem is actually exists,
selecting goal or objective to solve the situation and prioritize them and then ultimately
monitoring and evaluation to solve it. Before taking any decision , whether it is official or not
proper planning is very important. Planning helps us to do any work in a systematic and
organized manner. It reduces the uncertainty of future. By doing planning we can get an
approximate estimation and accordingly we can do our job.

For doing planning properly at first we have to select objectives then accordingly the
process will be forwarded.

Planning is of two types: strategic planning and tactical planning.

Strategic Planning:- Strategic planning means to identify major objectives of the

Organization and to achieve them. It is a broad perspective.
Tactical planning- Tactical planning means to utilize the available resources to achieve the
strategic planning. It is a specific and detailed prospective.

Difference between the two:-

a) Strategic planning means to identify a) Tactical planning means to utilize the

major objectives and to achieve them. available resources to achieve the strategic
planning

b)Top level of management. b)Middle & lower level of management.

c) Broad prospective c) Minute and detailed prospective.

d) long term process d) Short term process

e) Based on long term forecasting. e) Based on past Data.

Steps of planning:- By doing proper planning, we can reduce the uncertainty of future.
But proper planning requires various steps to be followed:-

i) Selecting objective:-Before doing planning firstly we have to know for what we are going
to do planning. For that reason selecting objective is very important. By knowing the objective,
we can chalk out about what we are going to do and approximately how much time is required.
Values of organization play a vital role in it. After selecting the objectives, prioritizing them is a
difficult task. People must know what to do first and what to do next. Wrong prioritization will
hamper the total planning process.

ii) Selecting planning premises:- After selecting the object, we must identify the
premise in which the planning can be implemented. It may be inside of the Organization or
outside of the organization.
iii) Tangible & intangible premises :- Tangible premises means it is quantitative in
nature. It can be measurable. Growth of the population can be tangible.

On the other hand intangible premise means it is qualitative in nature. It can’t be

measured. Attitude of the people is intangible in nature.

iv) Controllable and uncontrollable premises :- When the planning premise is

controllable by the planner or by the organization, then it is called Controllable premise. For
example:- resource policies, strategic etc.

But when the planning premise can’t be controlled by any one, then it is named as
uncontrollable planning process. For example:- Any type of natural calamities.

v) Selecting planning time period:- When we are doing planning then we must know the
given time period to implement the planning. It may be short

term planning or long term planning, where period may be extended up to 5 to 10 years. The
factors influencing the planning period areas under:-

a) Lead time :-In Developing and Commercial Launching of a Product. For example:-
Pharmaceutical Company develops a drug for some disease. Everything is finalized, tests are
carried out, suitable permissions are obtained, the Company may go in for commercial
production. The intervening period is the lead time.

b) Pay back period- Time requirement to recover capital investment machinery, equipment
etc. For example:- A machine costing Rs. 10,00,000/-, generates cash flow of Rs. 2,00,000/- per
year. Then the length of planning period should be at least 5 years.

vi) Selecting alternative course of action- Planning is nothing but choosing from
alternatives. After selecting the planning premises or time period, if it is not suited for the
organization or it is not good for all- then we must think an alternative planning. Planning must
be done in such a way, so that it must fulfill everybody’s need as well as fulfill organizational
objective.
vii) Evaluation:- After thinking for alternative course of action, the planner must evaluate the
planning. He/she must look after every steps of it. Once the planning is implemented, it can’t be
changed.

viii)Implementation of planning:- Once the course of action is finalized, plans are drawn/

formulated to derive it. Now, it lies the main action, operations and process. Usually it is done
by middle and lower level of management.

ix) Measuring and controlling:- This is the process of monitoring. Any midway
corrections if necessary are carried out to ensure the success of planning.

2) Explain Henry Fayol’s fourteen ‘Principles of management’ with

examples.

Ans. Henry Fayol was known as father of Administrative/ operational management. Based upon
his studies, he established principles of management. According to his principle, management is
not rigid but it is flexible. The principles are as follows:-

i) Division of works:- In any organization there are multiple goals to be achieved. It is not
possible for a person to achieve all the goals efficiently at a time. So, it is the principle of
management to divide all the responsibilities among all the employees, so that the organizational
goals must be fulfilled. For example:- in hospital the nursing department has the objective to
provide the optimum possible care to patients. For that reason the nursing Director or nursing
Superintendent is responsible for recruiting efficient and knowledgeable nurses. Nursing
supervisor or in-charge are responsible for doing communication with other departments, related
to patient care, look after for available resources and indent them as per need. Nursing staffs are
responsible directly for patient care and his/her regular activities. All the works can’t be possible
for a single individual. So, division of work is very important.

ii) Authority and responsibility:- Management is dividing work among all the employees.
Then every employee must have the authority or power for their job. They should responsible
enough for doing their own job. For example:- Every nursing staff must have the power or
authority to take prompt decision in emergency situation. If she has to wait for the supervision of
higher authority then it is impossible to handle critical situation. At the same time they all must
be responsible to their own job. They should handle patients with full of responsibilities. While
in the off duty they must handed over the full responsibilities to other on duty staffs to handle it
carefully.

iii) Discipline:-_ An important principle of management is discipline. Without maintaining

discipline it is difficult to run any Organization. All the employees

should follow particular rules and regulations to work together. For example: in hospital every
nurses should wear uniform while doing their duty. They should come to their duty on time.
Without prior information they can’t take leave. These are the disciplines.

iv) Unity of command:- In every organization there are various departments and
departmental heads. Bur before passing any information or command to the subordinates the
superiors must discuss with each other’s and the subordinate should receive information or
command from only the superior. If they receive different in formations from different superiors,
then there will be chaos and confusion. For example:- When any policy or protocol is changed in
hospital then the nurses or other employees should be conveyed by one supervisor only. Every
employees should know whose advice to be followed.

v) Unity of direction:- It is same like the previous principle. All the employees should
receive directions from one supervisor only. Supervisors should decide who will direct the
employees and how will be directed. By providing various direction to the subordinates will
increase chaos and confusion.
vi) Subordination of individual interest to general interest:- In any organization,
interest or need of the organization will have more priority than the need or interest of any
employee. Everybody in concern about the goals of the organization to be fulfilled. For
example:- if any employee needs 2 days leave on any particular date due to some personal issue.
At the same time the hospital has some audit programme on the particular date. So the
management will not sanction any leave for the employee and he/she must participate in the
organization. So the organization is always the priority.

vi) Scalar chain:- It means maintaining proper channel. Every communication or passing of
any information must be done through proper channel only. For Example:- If any nursing staff
need any leave then firstly she should contact with her Sister-in-charge. If she agrees then only
she can go to nursing supervisor for sanctioning the leave. At the same time the while passing
any information from the higher authority , the department must pass it to their direct subordinate
and from them the information must be passed to other subordinates in a proper and orderly
manner.

vii) Order:- The principle of management is to do any job or duty in any arranged and
organized manner. If there is no organized or ordered way to do the functions then chaos or
confusion will arise. For example:- While checking the store or available resources in the ward
or department the nursing- in-charge must note down what are in crisis and what are needed
extremely in daily basis, then she can do the indent. Without checking the store the indent will
be of no use. So, everybody should do their duties in orderly manner.

ix) Equity:-The principle of management is to do work without doing any discrimination

among people. Most commonly it is applicable in hospitals. The hospitals should not do any
discrimination of patients according to their age, sex socio economic condition, Nationality or
caste. Every patients should have the treatment according to their illness only.

x) Stability of tenure:-Employees can have much interest in their job if they have stability in
their work or job security. So management must provide job security to their employees to fulfill
organizational goal.
xi) Centralization:- It is the principle of management to take decision or do any process
centrally. For example:- In hospital when any policy is implemented hen the decision of the
superior or supervisors is final. The decision of subordinates is not applicable.

xii) Remuneration:- Management should provide proper remuneration to their employees to

improve their interest and increase the standard of organization . For example:- in hospital if
nurses are provided adequate salary according to their work then the standard of patient care will
be increased.

xiii) Initiative:- Employees should give freedom to conceive and carry out their ideas and
plans, even if there are mistakes in their work. This will encourage them to innovate and take
decisions.

xiv) Esperit de corps:- Promoting team spirit will give the organization a sense of unity and
unity in strength. Fayol says that even small factors should help to develop team spirit. He
suggested use of verbal communication to develop team spirit.

Thus Fayol for the first time systemized the managerial behavior. He focused on total
organizational management. Fayol advocated that management can be taught and need not be
inborn.

3) What is directing? Discuss the needs and obstacle in

coordination?

Ans. Directing:- An important principle in the management process is directing. It means

doing the planning in to action. In this step the managers instruct, guide and oversee the
employees to achieve the desired goals. Directing is said to be importance if direction function
does not take place. Directing includes building an effective work climate and creating
opportunity for motivation, supervising, scheduling and discipline.
An important element of directing is co-ordination. While making the planning
into implementation, the managers must follow the basic principle of management i.e.
division of work. They must divide their employees in a small groups, but every group
members must have good understanding and effective communication for fulfilling the
organizational goal. This is known as co-ordination.

Need for co-ordination:-

i) Specialization- Division and sub-division of work into specialized functions and
departments lead to diversity of tasks and lack of uniformity. Specialists in charge of
various departments focus on their own functions. For example:- Production department
may insist on the manufacturer of those products which are convenient and economical
to produce overlooking their stability to consumers. It becomes necessary to synchronize
the diverse
and specialized activities of different units to create unity in the midst of diversity.

ii) Clash of interests:- Individuals join an organization to fulfill their personal goals
(Physiological or psychological). Often individuals fail to appreciate how the
achievement organizational goal will satisfy their own goals.
They tend to work at cross-purposes. Co-ordination helps to avoid conflict
between individual and organizational goal. It brings about harmony between the two
types of goals by making individuals see how their jobs contribute to the common goals
of the organization.

iii) Conflict:-In an organization, conflict may arise between line managers and staff
specialists or between management and workers. Human nature is such that a person
emphasizes his own area of interest and does not want to get involved in the activities of
the others. Co-ordination avoids potential sources of conflict.

iv) Different outlooks:- Every individual in the organization has his own way of
working and approach towards problems, capacity, talent and sped of people differs
widely. It becomes imperative to reconcile differences in approach, timing and effort of
different departments to secure unity of action. Cooperation serves as the binding force in
 an organization in the face of narrow and sectional outlook. Coordination becomes
difficult due to differences in the attitudes and working styles of personnel.

v) Interdependence of unit:- Various units of an organization depend upon one

another for their successful functioning. The output of one unit serves as the input of another unit
in reciprocal interdependence ,different units are reciprocally related and there is a give and take
relationship among them. The need for coordination increases with an increase in the
interdependence between organizational unit.

Obstacles of coordination:- Even though co-ordination is desired in

successfully achieving the objectives of the organization, it is not that simple. There are certain
obstacles;

i) Uncertain behavior:- Co-ordination is concerned with human efforts. Human

behavior is uncertain and can’t be predicted accurately. There is difference between a man and a
machine. A man has a mind as such a man has feelings, emotions, likes, dislikes etc. A man may
want recognition and appreciation. This makes human behavior highly individualistic subject
and has to be handled properly.

a) Lack of knowledge, skill, experience, initiative.

b) Confused and complicating policies.

c) resistance to change.

ii) Absence of co-ordination:- It will lead to

a) Chaos
b) Confusion
c) Inefficiency.
d) Expenditure on time, money and energy.
e) Either goals are not reached or difficulties are encountered in achieving the goals.
4) Describe steps in quality circle working and explain Just in Time
(JIT).
Ans. A quality circle is a group of workers who do the same or similar work, who meet
regularly to identify, analyze and solve work related problems. Quality circles are typically more
formal groups.

Quality circle working is used as a main process to achieve it’s objectives. Member’s
creativity is tapped to solve their day to day work related problems. It is through this process
they become cohesive team and their organizational owner ship get developed. Hence it is
necessary that the group member should understand this process very early.

The various steps are:-

1) Identifying work related problem:-

a) Generate a list of problem using brainstorming

b)Prioritize the problems by using A,B,C analysis.

2) Selection of problem from a list:-

a) Rating based of post data

b) Register the selected problems with coordinator.

3) Defining the problem by flow diagram

4) Analyze the problems : Data collection is important from all the possible aspects.
5)Identification of causes:- For this purpose we can use brainstorming and cause
and effect diagram.
6) Finding the root causes:-The method is to identify the main relevant causes in
cause & effect diagram by data collection and discussion.
7) Data analysis:- The method is:-
a) Using techniques like bar, pie, areal graph, histogram, stratification, scatters diagram
etc.
b) Why-why analysis
8) Developing solutions
9) Forecasting the probable resistance:- The method is:-
a) identifying the probable constraints and finding ways to overcome them.
b) Make a presentation to all involved employees to explain the solution selected, like
departmental head, facilitator.
10) Trial implementation and checking performance:- Method is:-
a) Data Collection after implementation.
b) Comparison of old and new data with histogram, control charts.
c) Watch process trends
d) Analyzed the results
e) Discuss and incorporate the changes needed.
11) Regular implementation
12) Follow up and review:-
a) Implementation evolution Procedure, use central charts.
b) Make modification if required.

JIT (JUST IN TIME): It is an inventory strategy Companies employ to increase

efficiency and decrease waste by receiving goods only as they are needed in the
production process, thereby reducing inventory costs. This inventory supply system
represents a shift away from the older just in case strategy, in which producers carried
large inventories in case higher demands had to be met.
o A good example would be a car manufacturer that operates with very low
inventory levels, relying on its supply chain to deliver the parts it needs to
build cars. The parts needed to manufacture the cars do not arrive before
or after they are needed, instead, they arrive just as they are needed.

Advantages:-It has several advantages over traditional models:-

i) Less space needed:- With a faster turnaround of stock, we don’t need as much
ware house or storage space to store goods. This reduces the amount of storage. An
organization needs to provide rent or buy feeing up funds for other parts of business.

ii)Smaller investment:-JIT inventory management is ideal for smaller companies

that don’t have the funds available to purchase huge amounts of stock at once. Ordering
stock as and when it’s needed helps to maintain a healthy cash flow.
iii)Waste reduction:- A faster turnaround of stock prevents goods becoming
damaged or obsolete while sitting in storage , JIT inventory management is ideal for
smaller companies that don’t have the funds available to purchase huge amounts of stock
at once. Ordering stock as and when it’s needed helps to maintain a healthy cash flow.
reducing waste.
This again saves money by preventing investment in unnecessary stock and reducing the
need to replace old stock.

Disadvantages-
i) Risk of running out of stock:- By not carrying much stock, it is imperative. We
have the correct procedures in place to ensure stock can become readily available and
quickly. To do this we need to have a god relationship with the supplier. imperative that
companies understand their sales trends and variances in close detail. Therefore one need
a factor that in to planning for inventory levels, ensuring supplies are able to meet
different volume requirements at different times.
If run properly JIT inventory management is seen as one of the best ways of
managing inventory. While it is not without risks, it has significant rewards and is ideal
for those who are able to plan carefully in advance and build strong relationship with
suppliers.
JIT means that one become extremely reliant on the consistency of supply chain.
ii) Lack of control over frame:- Having to rely on the timeliness of suppliers for
each order puts one at risk of delaying the customer’s receipt of goods. If anyone don’t
 meet customer’s expectations, they could take their business elsewhere, which would
have a huge impact on business.
iii) More planning is needed:- With JIT inventory management, it’s imperative
that companies understand their sales trends and variances their close detail. Therefore
one need a factor that into planning for inventory levels, ensuring supplies are able to
meet different volume requirements at different times.

5) a) Write short notes on Managerial skills.

Ans. Managerial skill :- In the process of management, the basic quality of all the
managers must be skill. A skillful manager can take prompt decision in any situation and handle
the situation to overcome from it.

Management can be defined as ‘the process of designing and maintaining an

environment, in which individuals working together in groups, efficiently accomplish selected
aims’ It is a process of knowing what you want to do and then seeing it is done in the best and
cheapest way.

Skill can be defined as the process of utilizing one’s knowledge in to action. In any
organization, skill full person is very necessary. Bookish knowledge is sufficient for completion
of any study. When we are implementing that knowledge into action, then that is our
achievement or key to success.

For maintaining a successful management, some managerial skill is very important.

i) Technical skill:_ Now a days, the advancement of technology is going on. The
technology is becoming critical and advance day by day. In any organization if we can use the
advancement of technology then success can be achieved. For that reason the management or
the managers must know the technical skill properly to handle the technology. Technical skill
includes many more procedure, policies and techniques. If the managers know the techniques
and policies then only they can utilize the technology for their organization. Generally drivers,
surgeons must know the technical skill. For example:- Knowing anatomy is only the bookish
knowledge but by the best use of scalpel and other surgical instruments a surgeon can operate
human body. That is the technical skill. A surgeon should become skill full enough to fulfill the
organizational i.e. Hospital’s goal.

ii) Human skill:- It means the ability to communicate with peoples. Communication
should be done with all the levels. By a successful communication we can get to know other’s
feelings towards us and obviously our management and organization. If there is any criticism in
the management process that can be identified only by communication with others. So the
managers in any organization must adopt the human skill. For example:- In any hospital, nursing
department is the key to maintain successor standard of organization. If the nursing services are
good, then the quality of the hospital automatically be good. So, it is the responsibility of the
nurse managers to do communication with the clients to short out the limitations of their
services. Nurse managers must have the communication skill to communicate
interdepartmentally to improve the quality of services.

iii) Conceptual skill:- It means the ability to know the concept of the job. This skill is
necessary mainly for the top level of the managers. It is the ability to take broad and futuristic
view, to analyze various forces and ability to assess environment and deciding about the changes
to be implemented. It is the creative and innovative ability and having a vision. These skills
enable them to set for themselves the organizations and the people.

All these skills are necessary for all the managers, their relative importance depends
mainly upon the rank of the manager in the organization.

5) c)Write short notes on SWOT analysis.

Ans. SWOT analysis:- SWOT analysis is the best way to identify one’s own strength,
weakness opportunities as well as threats. It is generally used in business, deals and large
organizations but it can be used by individual also to find out his personal views. Here

S- Strength

W- Weakness

O- Opportunities

T- Threats

Before doing a large business deal or before launching a new product in market, one
should look after the SWOT for success and his achievement.

How to use SWOT analysis:- Here S stands for Strength

i) If you can’t find any strength for your organization or your business product then write down
the characteristics of it. Definitely one can find strength from it.

ii) Look at your competitor and the strength of his/her product. It will help to find out own
strength.

iii) What do people in your market see as your strength?

iv) What is the USP ( Unique selling proposition) of your Organization? When looking at your
strength, think about them in relation to your competitors. For example:- if all of your
competitors provide high quality products, then a high quality production process is not a
strength in your organization market, its necessity.

Weakness:- i) What could you do improve?

ii) What should you avoid?

iii) What factors lose you sales?

iv) What are people in your market likely to see as weaknesses?

 Again, consider this from an internal and external perspective:- Do other people seem to
perceive weakness that you don’t see? Are you competitors, doing any better than you.

It’s best to be realistic now, and face any unpleasant truths as soon as possible.

Opportunities:- i) What good opportunities can you spot?

ii) What interesting trends are you aware of?

 Useful opportunities can come from such things as:- Changes in technology and markets
on both abroad and narrow scale.
 Changes in Govt. policy related to your field.
 Changes in social patterns, population profiles, life style changes and so on.
 Local events
Threats:-i) What obstacles do you face?
ii) What your competitors are doing?
iii) Are quality standards or specifications for your job, products or services changing?
iv) Do you have bad debt or cash-flow problems?
v) Could any weakness seriously threatening your business?
SWOT analysis is a simple but useful framework for analyzing organization’s
strength and weakness and the opportunities and threats that
can be faced. It will help to focus on the strengths, minimize weakness and threats and
help for greatest possible advantage of opportunities.
When carrying out this analysis, one should be realistic and vigorous. It should be
applied at the right level and supplement it with other option generation tools where
appropriate.
 Name:- Sukannya Auddy
Roll no. :_18900001
Module no. 3 (Financial Management)

1) Explain in detail basic financial statements.

Ans. In every organization, investment is done to achieve some amount of profit. There is a
financial manager in every organization and his responsibility is to analyze various financial
activities and plan for further investment accordingly. For that reason basic financial statements
are used very commonly. These are:-
* Balance sheet
* Profit and loss statement.

i)Balance sheet:- Balance sheet is a statement, that is prepared by the organization at the
end of the particular financial time period, which shows the total investment to the organization
during that financial period, how the investment is applied in which area and how much profit or
loss is occurred from the total investment.
 Objective of preparing balance sheet:- To find out how much investment is
done.
 To notify detail informations that how much money is spent in which area.
 To get information about profit and loss statement.
 To take further decision accordingly.

Types:- Balance sheet is of two types:- Horizontal balance Sheet & Vertical Balance sheet.
Horizontal balance sheet:-
Source From where money is collected Amount
 Total:

Application From where money is used Amount

Total:

The total of both source and application must be same.

Vertical balance sheet:-

Liabilities Amount Assets Amount

Total: Total:
Here also the total of both the column must be same.

Now various terminologies are used in balance sheet. Let us concentrate on that:-

a) Capital:- When any business or organization is started then a particular amount of

money must be invested. That money is known as Capital. It is of two types:-
 * Owned capital:- When the owner of the organization himself invests money in the
business then it is known as Owned Capital.

* Borrowed capital:- When the owner is borrowing the money from others, then it is
known as Borrowed Capital.

b) Reserves:- The profit that is done from the total investment of the money, that is
added up with the capital amount, it is known as reserves.

c) Assets:- Assets mean the property of the Organization/ business. It may be tangible
or intangible. These assets will help the organization to make further income. Assets may be of
various types:-

* Fixed assets:- By doing large amount of investment, organization can have assets,
which is of long term use or permanent. These are called fixed assets. Like:- any land, building
etc.

* Current assets :- These are some major components, like cash, inventories, loans
etc.

d) Liabilities:- Liabilities means the payable amount, by which the properties or assets
can be gained. It is the claim of getting the properties for the organization These can be further
divided in to:-

* Secured loans:- Borrowing of the firm against which collateral is provided are
referred to as secured loans.

* Unsecured loans:- Borrowings of the firm against which no specific security has
been provided are referred to as unsecured loans.

These two types of loans are under long term liabilities.

Current liabilities:- These are short term liabilities, that needed to pay against the
goods purchased on bank credit or a bank draft.
 ii) Profit and loss statement:- In a business deal or in an organization, if the
investment is more than the income, that means they are having loss. But if the income is more
than the investment that means they are having profit. Various profit and loss statements are:

a) Revenue:- The income that is gaining from the organization/ business is known as
revenue.

b) Expenditure:-The amount of money that is spent by the organization in various

segment is termed as Expenditure. It is of two types:-

* Capital Expenditure:- When the money is used for any long term purpose, then it
is known as Capital Expenditure. For Example:- buying a land buying a machinery etc.

* Revenue expenditure:- When the money is used for any short term investment by
the organization or for any regular purpose then it is known as revenue expenditure. For
example:- paying electric bills etc.

c) Depreciation:- Depreciation means gradual, continuous and permanent declining

of the value of any asset. Generally depreciation is charged in any fixed assets Furtherly this
amount is helpful for the profit of the organization.

d) Interest:- This includes interest on various forms of borrowings like debentures,

fixed deposits, working capital, advances etc. Commissions for guarantees and other finance
charges.

e) Sales:-Sales is activity related to selling or the amount of goods or services sold in a

given time period. This is usually defined as gross sales inclusive of excise duty.

f) Profit after tax:- The difference between income and expenditure is the profit after
Tax.

g) Provision for taxes:- This represents the estimated income Tax liability for the
period.
2) a) Write short note on depreciation.
Ans. Depreciation:- Whenever money is spent ,it is spent due to any long term or short
term investment. When money is spent due to any long term investment, then it is known as
Capital expenditure. For example:- If an organization buy a land or buy a machinery then it is
obviously for long
term use. When an organization spent money for their regular use or any short term
investment, then it is known as revenue expenditure. For Example:- Paying electricity
bills, buying any new materials etc.
Now let us concentrate on the concept of Depreciation.
Depreciation means gradual, continuous and permanent decline of the value of any
asset. In any organization depreciation is charged in the fixed assets. The amount of
depreciation is then taken as an expense. So, it reduces the profits in the profit & loss
account.

Objectives of depreciation:-
1.

For the replacement of assets: The fund equal to the amount of the
depreciation is created which will remain in the firm. After the expiry of the life of
asset, the same fund can be utilized to replace the new asset.

2. For the determination of true profit or loss: Depreciation is also an expense like
repair and maintenance which must be included in profit and loss account to ascertain
the correct profit or loss of a business for the year.

3. For the presentation of assets in the balance sheet at their proper

value: Depreciation must be charged to each fixed asset for the true and fair
presentation of assets in the balance sheet. The depreciation is deducted from the cost
or book value of assets each year.
4. For the determination of correct cost of production: Correct cost of production
can not be ascertained if the depreciation is not charged to the fixed assets. Thus, it is
necessary to include amount of depreciation in the calculation of cost of each product.

Other objectives include :

 To calculate proper profits.

 To show the assets at its reasonable value.
 To maintain the original monetary investment of the asset intact.
 Provision of depreciation results in some incidental advantages also.
 Depreciation is permitted to be deducted from profits for Tax purposes.

Causes of depreciation:-
Internal causes:- Wear & tear maintenance, change in production, restriction of
production, reduced demand. Any asset will gradually break down over a certain usage
period , as parts wear out and need to be replaced . Eventually the asset can no longer be
repaired and must be disposed of .
Perishability. Some assets have an extremely short life span. This
condition is most applicable to inventory , rather than fixed assets.
External causes:- Obsolescence and effluxion of time. Some equipment will be
rendered obsolete by more efficient equipment , which reduces the usability of the
original equipment.
When there is damage to or impairment of an asset , it can be
considered a cause of depreciation , since either event changes the amount of depreciation
remaining to be recognized.

Methods of recording depreciation:-

 Straight line method or fixed installment.
 Sum of years digit Method.
 Inventory or revaluation Method.
  Annuity Method.
 Depreciation fund Method
 Depletion Method.
An example of depreciation is:- If a company purchase a delivery truck of Rs.
1,00,000/- and the expected use of the said truck is 5 years, the business might depreciate
the asset under depreciation expense of Rs. 20,000/- every year for a period of 5 years.

For the purpose of keeping books of account, the choice of amount of depreciation is with the
management. For companies, the minimum amount of depreciation is suggested by schedule 14
of the Companies Act, 1956. This is the minimum to be charged. A business could change
different rates for different assets, based on life, use and other factors.

2) b) Write short note on determinants of working capital.

Ans. The determinants of working capital are not uniform in all enterprises and therefore
factors responsible for a particular size of working capital in one company are different than in
other enterprise. Therefore a set pattern of factors determining the optimum size of working
capital is difficult to suggest. Some of more important working capital are:-

i) Nature of business:- It is an important factor for determining the amount of

working capital needed by various companies. The trading or manufacturing concerns will
require more amount of working capital along with their fixed investment of stock, raw materials
and finished products.

Public utilities and railway Companies with huge fixed investment usually the lowest
needs for current assets, partly because of cash, nature of their business and partly due to their
selling a service instead of a commodity.

ii) Length period of manufacture:- The average length of the period of

manufacture, that is the time which elapses between the commencement and end of the
manufacturing process is an important factor in determining the amount of the working capital. If
it takes less time to make the finished product, the working capital required will be less.
 iii) Volume of business:- Generally the size of the company has a direct relation
with the working capital needs. Big concerns have to keep higher working capital for investment
in current assets and for paying current liabilities.

iv) The proportion of the cost of raw materials to total cost:- Where the
cost of raw materials to be used in manufacturing of a product is very large in proportion to the
total cost and its final value, working capital required will also be more.

That is why, in a cotton textile mill or in a sugar mill, huge funds are required for
this purpose.

v) Use of manual labour or mechanisation:- In labour intensive industries,

larger working capital will be required than in the highly mechanized ones. The latter will have a
large proportion of fixed capital. It may be remembered however, that to some extent the
decision to use manual labour or machineries lies with the management. Therefore it is possible
in most cases to reduce the requirements of working capital and increase investments in fixed
assets and vice-verse.

vi) Terms of credit:-A company purchasing all raw materials in cash and selling on
credit will be requiring more amount of working capital. The essence of this is that the period
which elapses between the purchase of materials and sell of finished goods and receipt of sale
proceeds, will determine the requirements of working capital.

vii)Requirements of cash:- The need to have cash in hand to meet various

requirements, that is payment of salaries, rents etc. has an effect on the working capital. The
more the cash requirements the higher will be working capital needs of the company and vice-
versa.
2)c) Write short note on functions of financial manager.

Ans. A financial manager is one, who is responsible for looking the financial activities of an
organization, selecting budget for their next financial year, checking the assets and liabilities and
also profit and loss of the organization.

The financial manager must have to follow various activities. These are:-

i) Long term/short term investment:- In any big business deal or in any

organization, at first the owner/ proprietor must invest a particular amount of money. It is the
duty of the financial manager to look after that how much amount of investment is done and how
can it be used. If it is a low amount of money then that can be used for any short term
management. For example:- If some furniture’s are needed for the organization, that can be done
by the low amount of money. It is a short term use of money, because furnitures can be changed
or replaced after a year or so but if there is a large amount of money, that can be used in long
term management, like buying of a land or building etc. the financial manager must look after
about the investment and it’s uses.

ii) Analyzing the financial activities:- In every organization financial

activities are done as per financial year. Every financial year is started from 1st April and end at
31st March. The financial manager is responsible for checking the financial activities each year.
He should prepare report about every financial activities of the year. After seeing the report
information, can be calculated about profit & loss in a financial year, availability of resources,
assets and liabilities from these information further decision can be taken about investment of the
next year, need for up gradation of resources etc.
 iii) Operation and working capital management:-This area would

look at:-

 Setting up of financial procedures and systems.

 Looking at ways to increase revenue and reduction of expenses and costs.
 Working capital Management like managing current assets and current liabilities. This
needs decision on whether to give credit, payment to supplier, managing cash flow,
managing inventory etc.

iv) Profit allocation:- If the income from the organization/business is more than
the investment, then it is known as profit. Now, it is the duty of the financial manager to
make the appropriate utilization of the profit. He should select that how much amount
should be distribute among the employees and how much should retain for further use.

v) Risk management:- In all the functions and analysis, there is always going to
be risk involved, which cannot be ignored. The aim to be to balance the risk taken and to
ensure that the returns are in tune with the risk.
Thus the financial management is an important function for the success of any
business. It has to be given adequate if not equal importance as other fields as in this
competitive scenario.

vi) Estimating the amount of capital required :- This is the foremost

function of the financial manager. Business firms require capital for purchase of fixed
assets , meeting working capital requirements and modernization and expansion of
business. The financial manager makes estimates of funds required for both short term
and long term.

vii) Choice of sources of funds :-Before the actual procurement of funds ,the
financial manager has to decide the sources from which the funds are to be raised. The
management can raise finance from various sources like equity shareholders , preference
shareholders , public deposits , financial institutions etc.
viii) Financial control:- Evaluation of financial performance is also an
important function of financial manager. The overall measure of evaluation is Return on
Investment (ROI). The other techniques of financial control and evaluation include
budgetary control , cost control , internal audit. The financial manager must lay emphasis
on financial planning as well.

Name :- Sukannya Auddy

Roll No.:- 18900001
Module :- 4 ( Resource management in nursing )

1) Describe various budgeting approaches.

Ans.) Budget is the written financial plan of any organization, aiming at controlling and
allocating resources.
In any of the described approaches to budgeting, the key point is that the
budget is a management tool to assess the business on track or adjustments are required.
Budgets should take account of market conditions, such as margin pressure,
macroeconomic factors, such as changing tax legislations as well as internal factors such
as resource allocation.
There are generally two approaches of budgeting. These are:-
i) Top down approach
ii) Bottom up budgeting.
 i) Top down approach:- It is called top-down approach because the budgets are
made by the top executed and then the money is passed down the line to various
departments. This approach is applied in affordable method percentage of sales,
competitive parity method of budgeting (ROI)

TOP DOWN BUDGETING

TOP MANAGEMENT SETS THE SPENDING LIMIT

PASSED TO PROMOTION BUDGET

ADVANTAGES OF TOP – DOWN BUDGETING APPROACH

 1. Budget will have an overall corporate functional approach rather than divisional
approach since management’s concern will be overall growth of the
organization.
2. Budget will be in the experienced hands and management if required can take
help of outsider.
3. Budget preparation will be fast and inter departmental issues shall be ignored.
4. Budget will be aggressive towards the growth of the organization.

DISADVANTAGE OF TOP- DOWN BUDGETING APPROACH

1. Managers / Lower management will be d-motivated as they don’t have

ownership over the budget and tends to feel that management have set targets
which are practically impossible.
2. Top management may not have close information about the organization and
that may impact their budget.
3. Inter departmental communication will take a hit as they will have no idea how
the management set targets for each of them.
4. Management’s considerable time will go into this and may lose from the path of
strategy.
5. Budget shall be feared less accurate as the top level management cannot have
idea of unit wise expenditures.

TOP DOWN APPROACH BUDGETING EXAMPLE

ABC Limited prepares their budget through Top- down Approach. The management,
to increase the overall profitability of the organization sets a target for sales team to
sell 12000 units at a lower price for the year. However the production unit does not
have the capacity to produce 12000 units in a year and this may leads to a day to
day clash between sales and production. If the management would have taken inputs
from the production unit too this situation would not have been arise. On the other
hand sales team has if achieved the target, they will expect a raise or incentive for
their order book even though the same was not delivered due to lower production. The
management may have to bear this cost without any addition in the top line.
Do have a look at this course on Financial Modeling where you learn all about
projecting Income Statement, Balance sheets and Cash flows along with its key
business, revenue and cost drivers.

ii) Bottom up budgeting:- In this method promotion adjectives are set for the tasks to be
performed. All the necessary activities to achieve the objectives are planned. The cost of these
activities are ascertained and budgeted. The total promotion budget is then approved by top
management. This is also known as the buildup approach of budgeting.

Bottom up budgeting

Promotion objectives are set

Activities needed to achieve the objectives are planned

Cost of promotion estimate

Total promotion budget is approved by top management.

ADVANTAGES OF BOTTOM – UP BUDGETING APPROACH

1. The managers shall be motivated as the ownership of budget is in their hands.

2. The budget will be more realistic as managers will have a better knowledge of
the operations of the organization.
 3. Managers will be more committed towards the organization and targets set by
them as they are the owners of the same.
4. Senior management will now only have to concentrate on the overall business
strategy rather than a business unit wise.
5. The budget can be quite accurate for the individual task which leads to overall
accuracy over the total budget.

DISADVANTAGE OF BOTTOM – UP BUDGETING APPROACH

1. Budget may not be at par with the overall objective of the organization as it
was been prepared by the managers on the business unit level.
2. Budget preparation will be slow and dispute between inter department may
arise.
3. Management may lose the control over the organization’s forecasting.
4. Managers may set targets which are easy to achieve to reduce pressure from
them.

BOTTOM-UP APPROACH BUDGETING EXAMPLE

At a lower price sales team budgeted sale of 20000 units, and the same units
budgeted by production too with the additional incentive to all the workers @ $1.
Eventually the sales team achieved the target at a lower price and production team
too, but the overall profitability of the organization will take a hit as incentive given to
production as well as sales team will sit into the cost. So the overall objective of the
organization to maximize the profit will not suffice even if increase in sales and
production.

Apart from the above there is some sub – approaches towards the budgets are also
there. They are as below;

#1 – INCREMENTAL
BUDGETING
It is also called traditional method of budgeting whereby the budget is prepared by
taking the current period’s budget as a benchmark, with incremental amounts then
being added for the new budget period.

In Incremental Budgeting the figures of each expenditures and income starts with
previous years actual numbers and adjusted for inflation, overall market growth and
other factors management deems fit. For example in an organization total salary paid
to employees in a particular year is $500,000. When the budget is prepared for the
next year the management thing that they need five more new employees who will be
paid $30,000 each and also an increment of 10 % to existing employees shall be given.
Therefore, in incremental budgeting the budget for salary would be Rs. $700,000
($500,000 + 10% raise to existing employees + ($30,000*5 new employees).

#2 – ZERO BASED
BUDGETING (ZBB)

In ZBB, all the numbers reset to zero and given a fresh thought over all the items of
budget. The new numbers of every item shall be justified with proper reasoning and
shall not be ad hoc figures.

This kind of budgeting helps the management to avoid traditional expenditures which
are no longer required. As the base is zero, management can actually give a new
thought to each and every item of expense and reassess the requirement or possible
cost saving.

#3 – BASE BUDGETING (BB)

In BB, budget prepared to know how much expenditures will be there for just to
survive (going concern). However any incremental spending over and above that level
shall be justified on cost vis-a-vis benefit from the same.

It’s been generally prepared in companies running into cash crunch. To cut costs the
management may just prepare a budget for the survival and any expenditure over and
above shall be cut off. For example – rent, electricity and basic staff are essential to
run the company but training, picnic and celebration expenditures are not required for
survival of the company.

Money is the main source of working in all organization. So, budget should be in
accordance with the objectives and the chosen media. The other approaches include :-

a) Competitive parity method:- Many firms base their advertising expenditure to compete
with their rivals or their competitions. The information regarding this is found in business
magazines, journals and annual reports of the company. They not only try to have the same
expenditure but also try to choose media accordingly. They also choose the media vehicle and
the frequency of advertisement to match with that of the competitors. The effect of expenditure is
know after the advertisement has been re-based and one does not know the next move of the
competitor for expenses on the advertisement and promotion.

b) Affordable method:- This simply means what the firm can afford after meeting all their
expenses. The firm allocates the amounts to be spent on production and after that allocation is
done for advertising and promotions. The

tasks to be performed by advertising is not considered. In this method there can be chances of
overspending or understanding.
c) Objective and task method :- In this method objectives are defined and the specific
strategies are formulated to achieve them. The cost of implementing these strategies is estimated.
The strategies may include advertising in various media and other elements of promotion mix.
Then the cost of various media chosen is estimated. It is also necessary to monitor the expenses
and evaluate the results.

d) Method of percentage of unit cost:- It is accost of a unit of Rs. 1000/-. If 1000 units
are sold, revenue generated is 10,00,000 If the %decided is 10%, 1,00,000 advertising budget
1,00,000.

The percentage of expenditure allocated differs from one company to another. Some
companies go for a higher percentage and others for lower, depending upon their needs and
situations faced by them. This method is simple to calculate and is safe.

2) Explain process of credentialing and privileging.

Ans.) Credentialing:- Credentialing means the collection, verification and assessment of

information regarding three critical parameters, current licensive, education and relevant training
and experience ability and current competence to perform the requested privilege(s).

Privileging means granting the authority of a health care personnel to perform his/her
responsible duties in the specific organization.
Process of Credentialing and privileging:- In the process of ‘C’ & ‘P’, the
first step is collection of information. It means the organization collects all the necessary
documents from the health care practitioner for verification of it’s reliability.

The second step is verification. Verification can be done by two sources.

i) Primary sources verification:- It means the verification of the documents from it’s
original sources. The organization can verify internet verification, telephonic verification from
the previous organization, where he/she was working, verification from the organization, where
formal training was done for the verification of the registration etc.

ii) Secondary sources verification:- It is method of verifying a credential which is not

considered an acceptable form of primary source verification. Examples are the notarized copy
of the credential, the original credential etc.

The process of credentialing and privileging is started from the advertisement of the
recruitment of the organization.

The final step of credentialing and privileging is assessment

. It is also occurring in step by step:-

 Step-1:- Determining the identity:- In this step the details of the applicant is
checked like name, age, sex, address, institution of formal education etc.

 Step-2:- Form filling step:- It is the step in which a form is given to the applicant
from the organization to give the details of his/her formal training, internship, experience
etc. If it is found reliable by the HR department, then it is forwarded furtherly for next
procedure.
 The head of the medical practitioner assessed all the details of the documents and if
found reliable after his verification, then call the applicant for interview.
 The organization arrange a structural interview for the applicant in a particular date.
 If he/she performs well in the interview then the organizations grant the authority of the
applicant to perform his/her schedule duty.
 It is the responsibility of the organization to check, if there is any medico legal case or
not against the staff.

Purposes of the process of credentialing and privileging:-

i) To maintain the patient’s safety and protection.
ii) To provide the optimum level of health care services to the patients.
iii) To maintain and improve the standard of the organization
iv) To maintain the flexibility and stability of the working environment.

Barriers of the process:- Certain barriers and limitations are present :-

a) Gaps in the form filling:- While the organization is providing form to the
applicant, then there are various gaps can be found, like name of
the organization of the formal training. Some of the health care practitioner don’t have
the so called formal training from any recognized organizations, but they have much
experiences of working, so sometimes it become difficult to rely.
b) Huge paper works:- In the total process of ‘C’ &’P’, the HR department must do
a huge number of paper works. They are responsible for document verification,
assessment of all. For doing all these ,they must maintain paper work.
c) Difficult call:- It means to deny any applicant for his/her post. For example:- A
practitioner may not have that formal training but he/she has huge working experiences
and record shows that his/her performance is good. But the organization will not accept
him/her for the lack of formal training. So, it is difficult to announce it.
d) Urgent recruitment:- Sometimes the HR department has pressure from the top
level management to make immediate recruitment of staffs. To perform all the
procedures immediately is quite impossible.
e) Updates rules:- There are various certifying agencies that update the terms &
conditions for a practitioner to remain in practice. One needs to be evaluated on these
terms & conditions. Credentialing committee also evaluate on the same points.

3) Discuss challenges and importance of human resource

planning in nursing.

Ans. Within many health care systems worldwide, increased attention is being focused
on human resources management. Specifically human resources are one of three principle
health system inputs, with the other two major inputs being physical capital and
consumables.

Importance of human resource planning in nursing:-

i) Recruitment and retention:- A proper human resource planning will help the
hospital for recruiting new staffs and their retention. Retention is an important factor in
patient care as experienced staff members can be less likely to make errors and typically
have the skills. And knowledge to deliver high quality care, even in more challenging
cases.
For the recruitment process, the nurse managers can arrange for a thorough
interview process, so that they can assess a candidate’s attitude towards patient’s care.
ii) Best practices in building a positive work culture :- By doing a proper
human resources planning the nursing managers can develop a significant impact on
employee satisfaction, retention and productivity. Effective managers offer staff nurses
the opportunity to participate in decision making, which gives nurses a sense of
responsibility. Nursing managers can build a positive work culture and environment by
clearly defining roles and responsibilities, being responsive to changes in staffing.
iii) Collaborative and interpersonal teaming:- It is another effective site of
having proper human resources planning. These help in team structure, sometimes called
collaborative practice or interdisciplinary collaboration, encourage partnership and a
multi disciplinary approach to patient care.

Challenges of human resource planning:-

i) Staffing:- Growing demand , dividing simply:- One challenge that the health
care HR professionals are currently facing revolves around the staffing of nurses. As
demand around the country continues to increase, candidates are finding that they have
various options when it comes to choose their work location ultimately causing a large
shortage in staff in certain area of the Country. With the rising trend towards performance
based career models in the health care industry, many HR departments are at struggling
to recruit and retain high performing workers.

ii) Regulations:- Reporting and compliance:- Another challenge in health care

HR is the introduction of the affordable care act (ACA). Other areas in which regular
reporting and tracking is needed is that of annual reviews. In order to receive federal or
state funding, hospital based employees are required to have annual reviews and
performance evolutions. Employees must also have background checks, certification
renewals and tracking is needed is that of annual reviews. In order to receive federal or
state funding, hospital based employees are required to have annual reviews and
performance evolution. Employees must also have back ground checks, certification,
renewals and tracking of inoculations.

iii) Cost: Investment in talent management:- It is another biggest challenge by

the health care HR is securing funding for talent management initiatives. It means that
salaries must be competitive while also fitting in to hospital’s financial plans. As funding
 gets cut and insurance reimbursements are negotiated, hospital must stay on top of costs
to remain profitable. In the health care industry, talent management programmes offering
competitive salaries to hire and retain high performing workers. Technology can support
HR managers in overcoming challenges related to staffing, regulations, reporting and
talent management, but can’t overcome poor human capital strategy and poor strategy
worth force planning. So, all the health Care HR managers must have right strategy and
right technology.

4) Write in detail about inventory control.

Ans. Inventory control and it’s maintenance is generally occurred in hospitals care
sectors. In every hospital there is a store or stock where all the necessary equipment, articles,
drugs, consumable items,

disposable items can be stored in sufficient amount. This is called inventory. Inventory must be
stored in sufficient amounts, so that it can be used as and when required. Excessive stock should
be avoided, otherwise it will be cost effective and there must be a chance of stock out.

In every organization, there is some particular rules and regulations for ordering items. It
is known as procurement.

Objectives of inventory control:-

i ) To preserve various equipment, articles and drugs in sufficient amount for using as and when
required.

ii) To maintain the standard of the organization.

iii) To avoid stock out.

iv) To provide the optimum level of health care facilities to the patients.

v) To cope up with various emergency situation n the hospital.

Various cost for inventory control :- There are 4 types of costs, that every
organization must maintain for inventory control. These are:- Purchase cost, carrying cost,
ordering cost.

i) Purchase cost :- For buying every items, some particular amount of cost must be paid by
the organization to the supplier. This is called the Purchase cost.

ii) Carrying cost:- It means the cost of interest of any product like insurance cost, Staff
involved in buying the product etc.

iii) Stock out cost :- It means end of the stock. If any emergency situation arises at the time
of stock out ,then it is much costlier to arrange the drug or product as early as possible than to
preserve it as stock earlier.

So it is the duty of the organization to preserve their stock in sufficient amount.

Classification of inventory control:- The German economist Pareto classified the

inventory control system in several types. According to him in a town 80% of peoples share 20%
of money and 20% people share 80% of the money This is his 80/20 rule for classification of
inventory. The various classifications are:-

i) ABC analysis:- Here all the necessary drug items are stored. A items are 20% of all the
drugs but it costs 70% of the total costs of drugs. So, it should be handled by top level of the
management very carefully.

B items are 20% of all the drugs and costs 20% of the total costs of drugs. It can be managed by
middle level managers.
C items are the 70% of all the drugs and it costs only 20% of the costs of drugs. So, it can be
handled by lower level of management.

ii)VED Analysis:- It means vital, essential and desirable items.

V items includes various equipment and articles, dressing materials, life saving drugs etc.
without which the hospital can’t run a single moment.

E items includes some essential antibiotics and others without which a hospital can run 2-3 days.
But as early as possible these items should be arranged.

D items includes some consumable or non consumable products. Without which a hospital can
maintain it’s regular duty, but replacement is needed.

By compiling these two classifications of inventory control, there are three categories of
items. These are:-

Category- I:- These are the most important articles and drugs needed in a hospital like life
saving drugs, equipment and others. These are to be kept in double safety method under top level
management control system.

Category-II:- These are important items but not more than category –I. These are the medium
cost items and without these items hospital can continue it’s duty for 1-2 days.

Category_III:- These are least important items and can be controlled by lower level of
management system. Other classifications of inventory control are:-

i) FSN Classification:- These are fast moving, slow moving and non-moving items.

ii) HML Classification :- High, medium and low based unit price.

iii) SOS:- season and off season requirement.

Functions of inventory control:-i) Inventory organization, in the process of

procurement, a particular time is needed. This is called as lead time. Inventory should supply
necessary items in this lead time.
ii) Some items should be stored in reverse stock for safety. This is called as safety stock.

iii) If there is any improper procurement system, then safety stock should be increased for
emergency need.

Techniques of inventory control :-

 Fixed interval method:- In this method the organization order items in a gap of
fixed interval every time. The amount of order doesn’t matter here, but the interval
should the same.
 Fixed order method:- In this method of inventory control, every time the amount of
ordering items should be same.
 Economic order quantity:- This idea was proposed by Harris in 1915. Here EOQ=
2AD
H
A= Fixed cost of ordering ( Rupees/order)
D=Average annual demand ( Unit/year)
H- Holding cost (Unit/year)

5a) Write short note on types of competencies.

Ans. Competence can be defined as standardized requirement of an employee or individual to

perform a specific job properly with adequate knowledge, attitude and skill. Competencies are
particular qualities that a company’s recruiters have decided are desirable for employees to
possess. During interviews and assessment process competencies are used as benchmarks that
assessors use to evaluate candidates.
  Competence map means to list down the required competencies of an individual to
perform a given job in a specific time period.

The use of competencies:- Modern employers generally view competency

frame works as an essential vehicle for :

* Measuring a candidate’s potential future effectiveness at interview.

* Reviewing an employee’s capability , potential and performance.

There are several types of competencies. These are:-

i) Organizational:- Every organization must have some particular standard to be

maintained to reach to the customer’s satisfaction. For maintaining that standard every
organization should concentrate to fulfill the predetermined objective of the organization. For
example:- If a hospital is an organization then every employee should concentrate to provide the
optimum level of health care facilities to all the patients. Here, the patients are the customers of
the hospital.

ii) Job oriented:- To perform a specific job, every individual should know the
details of that job. Without having any depth concept, no one will able to perform his job or
duties. For example:- If someone is performing the job of a computer operator, then he must
know languages of computer, Microsoft and other details. He should handle all the parameters
skillfully. These are the competencies

iii) Personal:- Every individual must have some self competencies to improve
his/her self position. He/ she must develop skill and positive attitude. This is known as personal
competency. For example:- In a hospital both nurse ‘A’ and nurse ‘B’ doing the same duty, like
inserting an IV canula. While nurse ‘A’ is inserting then she is doing it with a single prick and
patient doesn’t feel that much

of pain. But when nurse ‘B’ is inserting, patient is feeling pain and she is doing it in her second/
third prick. So, automatically, while doing performance appraisal nurse ‘A’ will get more grade.
This is possible only due to her personal competence.
 Some other competencies are there. These are:-

a) Managerial:- An employee working in a designated post of a renowned

organization must adopt the managerial competence. This can be achieved by positive attitude
and skill towards his/her own work. For example:- Nurses working in a specific department
should know how to handle emergency situation without the supervision of others. They must
know how to deal with patient parties in various situations. This is the managerial competence.
On the other hand nurses should know the leadership capability because nursing is a team work.
If the nurse knows the leadership competency then she can leader team.

b) Technical:- This is a specific competence that is essential for performing any job
in the organization with a defined technical or functional area of work. For example:- Human
resources management , investment management etc.

c) Generic:- These are competencies that are considered essential for all staff
members regardless of their function like communication, processing tools etc.

d) Behavioral :- These competencies are usually an expression of the softer skills

involved in an employees effective performance at a company.

e) Technical :- These competencies are usually concerned with effective use of IT

systems and computers , or any technical skills which are necessary for a job role.

5)b) Write short note on ‘principles of nursing staffing’.

Ans. After the infrastructure development of an organization the main objective is to run the
organization and fulfills it’s objective. For that reason, adequate numbers of employees are
needed to work. This process of recruiting employees for the organization to fulfill it’s objective
is known as staffing. In the process of nursing , also the matter of staffing is same. Here, the
hospital is the organization and nurses are responsible to provide optimum health care to the
patients and maintain the patient’s satisfaction. Staffing in nursing does not only depend on the
manage of the number of nurses but also from the process of recruitment, document verification,
interview etc. All are related with staffing in nursing. The 2012 ANA Principle of nurse staffing
identify the major elements needed to achieve optimal staffing , which enhances the delivery of
safe , quality care. These principles apply to all types of nurses staffing at every practice level
and in any health care or practice setting. Appropriate nurse staffing is a match of registered
nurse expertise with the needs of the recipients of the nursing care services in the context of the
practice setting and situation. The provision of appropriate nurse staffing is necessary to reach
safe , quality outcomes.

Principles for Nurse Staffing

The nine principles identified by the expert panel for nurse staffing are listed below. A
discussion of each of the three categories follows the list.

PATIENT CARE UNIT RELATED

 Appropriate staffing levels for a patient care unit reflect analysis of individual and
aggregate patient needs.
 There is a critical need to either retire or seriously question the usefulness of the concept of
nursing hours per patient day (HPPD).
 Unit functions necessary to support delivery of quality patient care must also be considered
in determining staffing levels.

STAFF RELATED

 The specific needs of various patient populations should determine the appropriate clinical
competencies required of the nurse practicing in that area.
 Registered nurses must have nursing management support and representation at both the
operational level and the executive level.
 Clinical support from experienced RNs should be readily available to those RNs with less
proficiency.

INSTITUTION/ORGANIZATION RELATED

 Organizational policy should reflect an organizational climate that values registered nurses
and other employees as strategic assets and exhibit a true commitment to filling budgeted
positions in a timely manner.
 All institutions should have documented competencies for nursing staff, including agency or
supplemental and traveling RNs, for those activities that they have been authorized to
perform.
 Organizational policies should recognize the myriad needs of both patients and nursing
staff. DISCUSSION OF PRINCIPLES

Patient Care Unit Related

 There is a critical need to either retire or seriously question the usefulness of the concept
of nursing HPPD. It is becoming increasingly clear that when determining nursing hours
of care, one size (or formula) does not fit all. In fact, staffing is most appropriate and
meaningful when it is predicated on a measure of unit intensity that takes into
consideration the aggregate population of patients and the associated roles and
responsibilities of nursing staff. Such a unit of measure must be operationalized to take
into consideration the totality of the patients for whom care is being provided. It must not
be predicated on a simple quantification of the needs of the

TABLE 1. MATRIX FOR STAFFING DECISION MAKING

Items Elements and Definitions
Patients Patient characteristics and number of patients for whom care is being provided
Intensity of Individual patient intensity; across-the-unit intensity (taking into account the heterogeneity
unit and care of settings); variability of care; admissions, discharges, and transfers; and volume
Architecture (geographic dispersion of patients, size and layout of individual patient
Context rooms, arrangement of entire patient care unit(s), and so forth); technology (beepers,
cellular phones, computers); same unit or cluster of patients
Learning curve for individuals and groups of nurses; staff consistency, continuity, and
Expertise cohesion; cross-training; control of practice; involvement in quality improvement
activities; professional expectations; preparation and experience

“average” patients but must also include the “outliers.” The following critical factors must be
considered in the determination of appropriate staffing (see Table 1):

 Number of patients,
 Levels of intensity of the patients for whom care is being provided,
 Contextual issues including architecture and geography of the environment and available

technology, and

 Level of preparation and experience of those providing care.

Appropriate staffing levels for a patient care unit reflect analysis of individual and
aggregate patient needs. The following specific patient physical and psychosocial
considerations should be taken into account:

 Age and functional ability,

 Communication skills,
 Cultural and linguistic diversities,
 Severity and urgency of admitting condition,
 Scheduled procedure(s),
 Ability to meet health care requisites,
  Availability of social supports, and
 Other specific needs identified by the patient and by the registered nurse.

Unit functions necessary to support delivery of quality patient care must also be
considered in determining staffing levels:

 Unit governance,
 Involvement in quality measurement activities,
 Development of critical pathways, and
 Evaluation of practice outcomes.

Staff Related

The specific needs of various patient populations should determine the clinical
competencies required of the nurse. Role responsibilities and competencies of each
nursing staff member

© 1999 American Nurses Association. All rights reserved.

6 Principles for Nurse Staffing

should be well articulated, well defined, and documented at the operational level (Aiken, Smith,
and Lake 1994). Registered nurses must have nursing management support and representation
(first-line manager) at both the operational level and the executive level (nurse executive)
(Aiken, Smith, and Lake 1994). Clinical support from experienced RNs should be readily
available to RNs with less proficiency (McHugh et al. 1996). The following nurse characteristics
should be taken into account when determining patient care unit staffing:

 Experience with the population being served;

 Level of experience (novice to expert);
 Education and preparation, including certification;
 Language capabilities;
 Tenure on the unit;
 Level of control of practice environment;
 Degree of involvement in quality initiatives;
 Measure of immersion in activities such as nursing research that add to the body of
nursing

knowledge;

 Measure of involvement in interdisciplinary and collaborative activities regarding patient

needs in which the nurse takes part; and

 The number and competencies of clinical and nonclinical support staff the RN must

collaborate with and supervise.

 Institution/Organization Related

Organizational policy should reflect an organizational climate that values RNs and other
employees as strategic assets and exhibits a true commitment to filling budgeted positions
in a timely manner. In addition, personnel policies should reflect the agency’s concern for
employees’ needs and interests (McClure et al. 1983).

All institutions should have documented competencies for nursing staff, including agency
or supplemental and traveling RNs, for those activities that they have been authorized to
perform (Joint Commission on the Accreditation of Healthcare Organizations 1998).
When floating between units occurs, there should be a systematic plan in place for cross-
training of staff to ensure competency (Joint Commission on the Accreditation of
Healthcare Organizations 1998). Adequate preparation, resources, and information
should be provided for those involved at all levels of decision making. Opportunities
must be provided for individuals to be involved to the maximum amount possible in
making the decisions that affect them (Williams and Howe 1994). Finally, any use of
disincentives for reporting near misses and errors should be eliminated to foster
continuous quality improvement (Leape 1994).

In addition, the organizational policies should recognize the myriad needs of both
patients and nursing staff and provide the following:

 Effective and efficient support services (transport, clerical, housekeeping,

laboratory, and so forth) to reduce time away from patient care and to reduce the
need for the RN to engage in “re-work” (Prescott et al. 1991);
 Access to timely, accurate, relevant information provided by communication
technology that links clinical, administrative, and outcome data;

© 1999 American Nurses Association. All rights reserved.

 Sufficient orientation and preparation including nurse preceptors and nurse experts to
ensure RN competency;
 Preparation specific to technology used in providing patient care;
 Necessary time to collaborate with and supervise other staff;
 Support in ethical decision making;
 Sufficient opportunity for care coordination and arranging for continuity of care and
patient

and family education;

 Adequate time for coordination and supervision of UAP by RNs;

 Processes to facilitate transitions during work redesign, mergers, and other major changes
in

work life (Bridges 1991);

  The right for staff to report unsafe conditions or inappropriate staffing without personal

consequence; and

 A logical method for determining staffing levels and skill mix.

So, while doing the staffing, the nurse administrator must follow various
principles;-
i) Every staff should have adequate knowledge, skill and positive attitude.
ii) The nurse manager must know that if the nurses are more experienced and skillful then they
can handle various emergency situations.
iii) Nurse administrator should strive to meet the technical and humanistic care of the critically
ill patient.
iv) Nurse administrator should maintain the principle of knowledge of the nurses, to meet the
health teaching and rehabilitation of chronically ill patients.
v) Nurse administrators ensures that patient assessment, work qualification and jobs analysis are
used to determine the number of personnel in each category to be assigned to the care of patients
of each type ( such as coronary care, renal failure etc.
vi) Nurse administrators ensures that there is a master staffing plan and policies to be
implemented in all units and this is to be developed centrally by the nursing head of the hospital.
vii) Nurse administrators must ensure that the staffing plan details such as shift time, the number
of staff members assigned on holidays and the member of employees assigned to each shift can
be modified to accommodate the unit’s work load and work flow.
 (57)

MODULE-5

1)Nursing service is the heart of the health care services. The customer’s
satisfaction depends largely upon the nursing services and care towards the
patients. Nursing department is the only department in any health care organization
that must maintain interpersonal relations among all the departments in the
organization.

There must be some essential characteristics of nursing services. These are:-

i) WRITTEN STATEMENT OF POLICY:-In every hospital there must be some

particular rules & regulations to be followed. For nursing services there should be
written statement of objectives of the hospital. It must includes various policy,
protocols and other rules & regulations of the hospital. If these are written, then it
will become easy to understand and any one can take help from it, whenever
needed.

ii) MANUALS OF NURSING PRACTICES:- Every nurses in their daily day to

day activities must perform various duties and responsibilities to save the patient’s
life. So, it must be the characteristics of the hospital to provide a manual to the
nurses, mentioning the details of the various nursing practices. By maintaining this
character, all the nurses can follow the manuals and perform according to that.
Then it become easy for the administration to evaluate the performances of the
nurses. Nurses can discuss with each other about their performances, as they are
practicing in an uniform manner.
 (58)

iii) NURSING BUDGET:- Budget is a statement of plan for nursing services,

expressed in accounting terms; it is one segment of the overall hospital budget. The
nursing service budget is concerned primarily with four budget forms: salary,
supplies, equipment and capital expenditure. Steps involved in preparation of the
budget includes analyzing past operations and anticipating factors that will affect
future income and expense. The analysis of operations required in budget- making
help the director of nursing services weigh values and established priorities for the
nursing programmes.

iv) MASTER STAFFING PATTERN:- in every organization , a particular staffing

pattern should present. It includes, how much staffs are required in each shift,
rotation of the nurses, nurse and patient ratio in various departments, leave of the
staffs etc. Every departmental head must follow this pattern of staffing while doing
duty schedule.

v) PERFORMANCE APPRAISAL :- It’s an important character of the nursing

administration to do periodic performance appraisal to all the nurses. Performance
appraisal may include interview schedule, structured questionnaire , observations
of daily duties etc.

vi) NURSING ADMINISTRATION AND WARD NURSES MEETING:- The

opportunity for free communication and a share in planning and evaluation is
provided through regular meetings of the director of nursing or her representatives
with day, evening and night assistants with supervisors, head nurses and total
nursing staffs. Records of these meetings include reports of decisions,
recommendations and help to assure that recommendations will be considered and
administrative decisions will be reported.

(59)

vii) WRITTEN JOB DESCRIPTIONS:- Written job descriptions and job

specification will help all the nurses to perform their regular duties. Qualification
of each category of personnel are defined in terms of responsibilities to be
assumed. These job descriptions and specifications help assure the objective
selection of personnel.

2) EVIDENCE BASED NURSING:- Evidence based nursing means providing

nursing care to the patients by using personal expertise and by taking help from
current relevant research studies from the related tropic/case. It will improve the
quality of care. Evidence based nursing practice requires new skills of the
clinician, including efficient literature searching and the application of formal rules
of evidence in evaluating the clinical literature.

STEPS OF EBN PROCESS:-

i) Assess the patient:- Start with the patient- a clinical problem or question arises
from the care of the patient.

ii) ASK THE QUESTION:- Construct a well built clinical question derived from
the case.

iii) ACQUIRE THE EVIDENCE:-Select the appropriate resource(s) and conduct a

search.

iv) APPRAISE THE EVIDENCE:- Appraise that evidence for it’s validity
(Closeness to the truth) and applicability(usefulness in clinical practice)
v) APPLY:-Return to the patient integrate that evidence with clinical expertise,
patient performances’ and apply it to practice.

(60)

vi) SELF EVALUATION:- Evaluate the performance with this patient.

BENEFITS OF EVIDENCE BASED PRACTICE:- The ultimate goal of the

evidence based nursing to standardize and improve access and quality of care
across the health care system.

i)IMPROVED PATIENT OUTCOME:- The heavy focus on raising the overall

quality of care may lead to improve outcomes and health for patients. Using the
most current health care research can help minimizing complications associated
with chronic illness and prevent additional illness or disease.

ii) LOWER COST OF CARE:- Roughly one in four Americans are living with
multiple chronic illnesses and the cost of caring for these patients can often be
substantial. Using EBN’s patient centered approach may help eliminate
unnecessary costs linked to treating chronically ill patients as well as reduce
expenses for healthier patients too.

iii) SUPERIOR NURSING SKILL:- Incorporating EBN throughout a nurse’s

education and clinical experiences develop more advanced critical thinking and
decision making skills. Nurses are better able to adopt to situations, utilize
informatics and work in interdisciplinary teams. They also feel a greater sense of
confidence and pride in their work.

Evidence based practice has become an integral component of delivering

high quality, patient entered care. Nursing students in an RN to BSN programme
will learn EBN theories and apply this knowledge in their career. Offering benefits
to both patient and nurses, evidence- based practice is helping to lead the way in
advancing patient care.

(61)

5) c) RESPONSIBILITIES OF STAFF NURSE IN WARD:-

Nurses are heart of the health care system. In any health care
organization, staff nurses are the main health care workers for providing care to
the patients. So, the staff nurses should follow responsibilities in many aspects.
These are:-

i) DIRECT PATIENT CARE:-

a) Providing care for daily day to day activities for the patient.

b) Administration of medication.

c) Follow the doctor’s orders.

d) Assist the doctors in O.T.

e) Apply dressing to patient, wherever required.

f) Giving NG tube feeding to completely dependent patient and assist in feeding to

partially dependent patient.

g) Write the reports of patients accurately and handing over to the next shift.

h) Inform the patient about his/her treatment progress and take consent before any
invasive procedure.

i) Give health education to patient and patient parties etc.

j) Document all the details of his/her shift.

(62)

k) Maintain good interpersonal relationship with patient and make proper nursing
diagnosis.

ii) WARD MANAGEMENT:-

a) Check inventory periodically and inform the stock out to the supervisor.

b) Make proper disposal of wastes to maintain cleanliness of the Ward.

c) Arrive in duty on time to avoid chaos in the next duty shift.

d) Inform the higher authority before taking leave.

e) Check the available medicines and equipments of assigned patients and write to
superior for further indent to the supervisor.

f) Wear proper uniform of duty to maintain dignity of the profession.

g) Talk politely with all the clients to maintain the silence of the unit.

iii) RELATED TO EDUCATION:-

a) Give appropriate health education to patients and patient’s relatives regarding

patient’s care.

b) Attend meeting with supervisors for up gradation of him/her self.

c) Attend in service education classes to improve knowledge , attitude & skill.

d) Do personal studies for higher education.

(63)

e) Guide new joiners or juniors ,whenever needed.

f) Avoid rigging.

3) As a nurse, it has become an important necessity to be aware of the legal aspect

associated with caring and helping people in the health industry today.

Nurses must take as many precautions as they can during their daily shifts.
Recording, documenting and reporting daily routines and decisions is one of the
most common ways to make sure on track with patience and in the right.

GENERAL LEGAL CONCEPTS OF NURSING:- Law can be defined as those

rules made by humans who regulated social conduct in a formally prescribed and
legally binding manner. Laws are based upon concerns for fairness and justice.

FUNCTIONS OF LAW IN NURSING:-

i) It provides a frame work for establishing which nursing actions in the care of
client are legal.

ii) It differentiates the nurses responsibilities from those of other health

professionals.

iii) It helps to establish the boundaries of independent nursing action.

iv) It assist in maintaining a standard of nursing practice by making nurses

accountable under the law.
REGULATIONS OF NURSING PRACTICE:- Nursing practice falls under both
public law and Civil law. In all the states, nurses are bound by rules and
regulations stipulated by the nursing practice Act as determined by the legislature.

(64)

Public Laws are designed to protect the public. When these Laws are
broken, a nurse can be punished by paying a fine, losing her license or being
incarcerated .

Civil laws deal with problems occurring between a nurse and a client. For
example:- If a nurse catheterizing a client perforates the bladder, the client sustain
injury. No Law affecting the populations as a whole has been broken, but the client
may bring a Civil Suit against the nurse. The client may receive compensations for
injuries, but the nurse receives no jail time.

CONTRACTUAL ARRANGEMENTS IN NURSING:- A contract is an

agreement between two parties as to what will transpire and the rules and
regulations governing the service that will be provided. The legal agreement is
enforceable by Law and those who sign the agreement must be able to legally enter
into a contract. This means they must be of legal age and they must have the
mental capacity to sign a contract.

SELECTEDLEGAL ASPECTSOF NURSING PRACTICE:- Nurses need to know

and apply legal aspects in their various roles:-

INFORMED CONSENT:- Informed consent is an agreement by a client to accept

a course of treatment or a procedure after being fully informed of it. Consents are
either expressed or implied. Express consent could be oral or written. If the
procedure is more invasive / high risk, then written consent is needed.

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Implied consent exists when the clients non-verbal behavior indicates agreement
such as in positioning their bodies for an injection or when their vital signs are
recorded.

MAJOR ELEMENTS FOR INFORMED CONSENT:-

i) The consent must be voluntary.

ii) The consent must be given by a client, who is capable and competent to
understand.

iii) The client must be given enough information to be the ultimate decision-
manner.

The nurse is not responsible for explaining the medical or surgical procedure
but for witnessing the client’s signature on the consent form. The nurse’s signature
means:-

 The client gave voluntary consent.

 The client’s signature is authentic.
 The client appears competent to give consent.

VIOLENCE, ABUSE & NEGLECT:- Violent behavior can include

domestic violence ,human abuse and sexual abuse.
 Neglect is the absence of care, necessary to maintain the health safety
of a client. Nurses are in position to identify and assess cases of violence.
When any injury appears to be present resulting from abuse, neglect
or exploitation the nurse must report the situation to the appropriate
authority.
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DELEGATION:- Delegation is the entrusting of responsibility to someone
to perform it, when there is excessive workload and that can’t be performed
by a person at a time efficiently. In USA the process of delegation is
governed by laws and regulations such as the nurse practice Act (NPA), job
description and skill level. The NPA defines and describes the scope of
nursing practice.

When delegation is to occur the nurse needs to determine the answers

to the following questions:-
 Does the NPA permit delegation?
 Is there a list of procedure that a nurse can delegate?
 Are there guide lines explaining the nurse’s responsibilities when
delegating?

5) a) There are several important factors, that influence decision making.

Significant factors include past experiences, a variety of cognitive biases, an
escalation of commitment and sunk out comes, individual differences,
including age and socio-economic status a belief in personal relevance.

SIX C’s of decision making:-

i) Construct a clear picture of preciously, what must be decided.
 ii) Compile a list of requirements that must be met.
iii) Collect informations on alternatives that meet the requirements.
iv) Compare alternatives that meet the requirements.
v) Consider the ‘what might go wrong’ factor with each alternative.

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FACTORS AFFECTING DECISION MAKING IN ORGANIZATION:-
Whenever we are involved in making decisions a number of factors can
affect the process we follow and ultimately the decision we make.
They can be organized in to three major groups:-

 Perception issues
 Organizational issues
 Environmental issues.

PERCEPTION ISSUES:- perception can be influenced by the following:-

i) The Perceiver:- The types of personal characteristic that can affect an
individual’s perception include:- Background and experience, personal
values, personal expectation, personal interests.
ii) The situation:- Time, location and other situational factors can influence
our perception of an object. For example:- a team leader may notice team
members who work late on the same evenings as the team leader. However, ,
team members who work late on other evenings may not be noticed by the
team leader.

ISSUES WITH THE ORGANIZATION:- A number of organizational issues

can impact on the decision making process. These issues include:-
  Policies and procedures
 Organizational hierarchy
 Organizational politics.

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Many organization have formalized policies and procedures which
have been developed to resolve common problems and to guide managers
when making decisions. For example:-
Many organizations have documented disciplinary procedures which
guide managers through a process of resolving issues with staff members.
Organizational hierarchy refers to the management structure of the
organization. Most organizations have different levels of management which
carry with them different degrees of authority. The degree of authority
directly impacts on the nature of the decisions an individual can make.
Organizational politics refers to behaviors displayed by individuals
and groups which is designed to influence others. Individuals and team will
often use politics to:- Advance their careers, advance their interests and
ideas, increase their rewards. Organizations are made up of individuals with
different believes, values and interests. These differences are often driving
forces behind organizational politics.

ENVIRONMENTAL ISSUES:- These are the external factors that affect the
organization. The types of external factors that can have an affect on decision
making include:- The market in which the organizations operates

 The Economy
 Government legislation
  Customer’s reaction to the organization’s products and services.
Other factors include personal factors ( like age, gender, stages in life- cycle,
education, occupation, economic position etc.) Personal psychographics
includes(life style, attitudes, self concept, concern about status, value system,
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beliefs etc.) Cultural factors(Culture combined resulted of factors like
Religion, traditions, taboos , languages, education, upbringing, established pattern
of social behavior, values etc.) Influence of reference group (e-g family, friends,
peer groups, close colleagues, close knit, organizations) psychological
factors(Motivation, perception, learning process, memory process).

4) Conflict resolution is conceptualized as the methods and process involved in

facilitating the peaceful ending of conflict and retribution. The term conflict
resolution may be used interchangeably with dispute resolution, where arbitration
and litigation process are critically involved. Furthermore, the concept of conflict
resolution can be thought to encompass the use of nonviolent resistance measures
by conflicted parties in an attempt to promote effective resolution.
Various steps in conflict resolutions:-

i) CLARIFY WHAT THE DISAGREEMENT IS:- Clarifying involves getting to

the ear of the conflict. The goal of this step is to get both sides to agree on what
the disagreement is. To do this, we need to discuss what needs are not being met
on both sides of the conflict and ensure mutual understanding. During the process,
obtain as much information as possible on each sides point of view. Continue to
ask questions un till we are certain that all parties involved.
ESTABLISH A COMMON GOAL FOR BOTH PARTIES:- In this step of the
process, both sides agree on the desired outcome of the conflict. When people
know that they are working towards the same goal, then they are more apt to
participate truthfully to make sure that they reach that end goal together. To
accomplish this, discuss what each party would like to see happen and find a
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commonality in both sides as a starting point for a shared outcome. That
commonality can be as simple as both sides want to end the conflict.
iii) DISCUSS WAYS TO MEET THE COMMON GOAL:- This involves
listening, communicating and brainstorming together. Continue with both sides
working together to discuss ways that they can meet the goal they agreed in step 2
(ii) . Keep going until all the options are exhausted.

iv) DETERMINE THE BARRIERS TO THE COMMON GOAL:- In this step of

the process, the two parties acknowledge what has brought them into the conflict
and talk about what problems may prevent a resolution. Understanding the
possible problems that may be encountered along the way lets we proactively find
solutions and have plans in place to handle issues.

v) AGREEON THE BEST WAY TORESOLVE THECONFLICT:- Both parties

need to come to a conclusion on the best resolution. Start by identifying solutions
that both sides can live with. Ask both sides and see where there is common
ground. Then start to discuss the responsibility each has in maintaining the
solution. It’s also important to use this opportunity to get the root cause to
ensurethis conflict will not come-up again.
vi) ACKNOWLEDGE THE AGREED UPON SOLUTION ND DETERMINE
THE RESPONSIBILITIES EACH PARTY HAS IN THE RESOLUTION:- Both
sides need to own their responsibility in the resolution of the conflict and express
about what they have agreed to. After both parties have acknowledged a win-win
situation, ask both parties to use phrases such as ‘I agree to’………….. and ‘I
acknowledge that I have responsibility for………………..’
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Epidemic means sudden increase of any disease or health related state in a given
population, that exceeds the normal frequency.
Epidemic means constantly presence of any disease or health related state in a
given population for a long period of time.