NURSING MANAGEMENT

SUMMER 2016

SECTION 1

Q. 1. Long Question Answer:

Explain Controlling under following heads

a) Define planning and control

PLANNING AND CONTROL:

Planning means the determination of what is to be done, how and where it is to be done, who is
to do it and how results are to be evaluated. -James Lundy

It is an organized attempt to anticipate and to make rational arrangement for dealing with future
problem by projecting trends.

-Dimock and Dimock

b) Difference between operational plan and strategic plan:

Items Operational plan Strategic plan

Need Accurately forecast hiring and Develop the best talent strategies for
training needs longer- term success
Time frame Planning usually 12 months with a Usually 3 years or longer matches
quarterly focus-matches the yearly the organizational strategic plan
business plan

Integrated with Annual or quarterly financial/ Strategic planning process

budgeting process
 Input Mostly internal data, some Wide range of internal and external
management decisions information including demographics,
business strategies, global trends etc.

Output Staffing plans, skill gaps Human resource

Planning Uses variables to explore different Uses futuring techniques to question

approach models of staffing current paradigms and explore
alternative futures not necessarily
based on today’s approach
Forecasting Key focus Only part of the process- forecasting
is too limited in terms of timeline
and scope to be the core of the
process.
Segmentation Internal demand Internal and external demand and
focus supply
Skills Competencies may be audited or Strategic capabilities analyzed and
gathered at an individual level gathered at the group level.

( Textbook of Nursing Management-B.T Basavanthappa)

c) Explain planning process in health services.

The process of planning usually comprises the following steps.

1) Identification of situation

Gathering data: Before carrying out the actual planning, one needs to explore and gather the
relevant and related information regarding possible opportunities.

2) Formulation or setting of objectives

Based on the availability of opportunities and resources, the objectives are framed. Objectives
specify the results expected and indicate the end point of what is to be done, where the
preliminary emphasis is to be placed and what is to be accomplished.
3) Developing premises or conditions (Forecast future)

These are expected environmental or external and internal conditions under which planning
activities will be undertaken.

4) Identification of alternatives

After determining the various planning assumptions, the next step is to work onto find out
maximum alternatives based on empirical evidences or experiences or intuitions. Then a
shortlisting of alternatives is done for detailed analysis.

5) Evaluation of alternatives

In this step, an attempt has been made to evaluate the selected alternatives as per the criteria
required for achieving particular objectives .All the merits and demerits of the alternatives are
listed.

6) Formulation of supporting plans

After selecting the best plan various derivative plans such as policies, procedures, schedules,
methods, budgets, etc are put into practices.

7) Defining various activities and preparations of action plans

Various related activities according to plans are developed and defined. Time plans are prepared
by using various managerial techniques eg. PERT and CPM. These planning cum control
techniques are important to minimize the time and cost and for ensuring the completion of
projects.

8) Communication and plans and securing cooperation

The supportive 0lans should be properly communicated to the lower levels in the organization.
The staff should be made aware of the plans, its scope and benefits. Participation at this stage
helps them to boost their morale to implement the plans effectively to the best of their skills and
abilities.

9) Follow up and review

After the plan has been put into practice, it is essential to follow it up so as to remove difficulties
in its implementation. Thus planning is a continuous process and so as its appraisal or review.

(Comprehensive Textbook of Nursing Management-Deepak K)

Q. 2. Long Answer Question:

Explain leadership under following heads.

a. Define Group Dynamics

The group dynamics refers to changes which take place within groups and is concerned with the
interaction and forces obtained between group members in social settings .It is a study of forces
operating within a group. A group doesn’t simply mean individuals possessing same identical
features. For instance, a collection of students or beggars doesn’t form a group. These are class.
A group is formed when the “Two or more individuals, interacting and interdependent, who have
come together to achieve particular objectives. – Deepak K

b. Characteristics of effective leadership

Leadership is the ability of a manager to include subordinate to work with zeal confidence.

(Koontz& O Donnell)

Leadership may be defined as the process of influencing the activities of a group or individual
towards the achievement to goal in a given situation.

 Leaders motivates people

A leader motivates employees for higher output through motivational techniques. The leader
himself acts as a motivating factor.

 Leader counsels employees

In an organization people needs counseling to reduce the emotional disequilibrium and to

remove barriers to effective performance. A leader solves such type of problems and makes
employees happy.

 Leader develop team spirit

A leader creates confidence in his subordinates and gains their faith & cooperation. Besides, the
leader provides environment conducive to work which results in team spirit

 Leader aims at time management

Leader is in a position to utilize time productivity in an organization. A leader gets things done
by people by proper time management

 Leader strives for effectiveness

A leader brings effectiveness to organization by providing the workers with the necessary
resources in terms of money, methods, climate, work etc.

(Textbook of Nursing Administration- J. Vati)

c. Explain the types of leadership and their merits and demerits

Types of leadership styles in nursing

Leadership theorists typically categorize nursing leadership styles into two categories:
transactional and transformational.

Transactional leaders:-

i. Are most effective in crisis situations or for projects that need to be carried out in a
specific way.
ii. Are more concerned with increasing the efficiency of established routines and procedures
and following rules within an organization rather than making changes.
iii. Are often seen in health care organizations.
iv. Nurse Managers may find success with this style when leading lower-skilled workers.
v. Thwart creativity and innovation with higher-skilled workers.

Transformational leaders

I. Are more complex, but are also more effective in enhancing the morale and performance
of employees and driving change within an organization.
II. Explain the “how” and “why” of hospital procedures in addition to helping nurses
understand the facility’s vision.
III. Trust others, are honest and act responsibly.
IV. Lead by example and inspire others to perform at higher standards.
V. Are effective communicators and motivators who focus on team-building and
collaboration among employees and encourage innovation and creative thinking.

Applying the transactional style in nursing

Transactional leaders give orders, expecting followers to comply. This style is most effective
during a crisis or when managing lower-skilled workers who require closer supervision.

Pros

a) Best style to use during an actual emergency.

b) Provides clear direction for new nursing graduates.
c) Can work with nurses who have poor performance.
Cons

a) Employees can feel that their opinions are not valued.

b) Can condition employees to be more passive.
c) Can create a climate of fear.

Applying the transformational style in nursing

Authoritative leadership

Authoritative leaders mobilize people toward a vision and, according to Goleman, are considered
the most effective overall leadership style. This leader paints a vivid picture of an end goal and
motivates people by showing how their work fits in with the larger vision. The employees are
given latitude on how to achieve the vision.

Authoritative leadership is not to be confused with authoritarian or autocratic leadership.

Pros

a) Effective when a clear direction or a turnaround is needed.

b) People who work for these leaders understand that what they do matters and why.
Cons

a) This style can be seen as overbearing.

Democratic leadership

Democratic leaders seek input from employees and, as a result, build consensus through
participation. Also known as participative leaders, this style encourages participation from
everyone, but the leader has the final say in the end decision. This leadership style is best used
when a leader is unsure about next steps and needs ideas from others.

Pros

a) Employees feel that their opinions are heard.

b) Builds morale.
c) May reduce the amount of workplace bullying and disruptive behavior.
Cons

a) This approach takes more time, and there can be endless meetings.
b) Can appear as if the nurse manager is not in charge.

Affiliated leadership

Affiliated leaders seek to form emotional bonds with followers by offering positive feedback and
creating a sense of belonging. This style is effective when trying to build team harmony, increase
morale or repair broken trust. According to Goleman, this style works best in conjunction with
the authoritative style.

Pros

a) Effective in restoring trust and boosting morale.

b) Improves communication among team members.
Cons

a) This style should not be used exclusively.

b) Can allow poor performance to go uncorrected.
Coaching leadership

Coaching leaders focus on developing people for the future. They help employees identify their
strengths and weaknesses, set development goals and help plan how to achieve them. This leader
is concerned with employees’ personal and career aspirations and achieving personal growth.

An example of a coaching style would be nursing pioneer Imogene King’s theory on goal
attainment. King emphasized the importance of nurses setting goals with patients instead of
planning their care without patient involvement.

Pros

a) Helps employees develop personally and professionally.

b) Delivers results for the long term.

Cons

a) Is time intensive, especially in the beginning.

b) Works only when an employee is receptive.

(Textbook of Nursing Administration-B.T Basavanthappa)

Q.3. Write short answer on any three

1. Staff Development Program

Staff development is the process directed towards the personal and professional growth of nurses
and other personnel which they are employed by health care agency.

- Basavanthappa

Need for staff development

• Social change and scientific advancement.

• Advancements in the field of science including medical science and technology.
To provide the opportunity for nurses to acquire and implement the knowledge, skills, attitude,
ideals and valued essential for the maintenance of high quality of nursing care.
Functions

- To provide educational activities for all nurses employed by the health care agency
directed towards change in behavior related to role expectations.
- It concerned with the growth and development of personnel from their initial concerned
with a health care agency until termination of services.
Steps of staff development program

• Assess the educational needs of all staff members

• Set priority
• Develop general objectives for the staff development program
• Determine the resources needed to reach the desired objectives
• Develop a master calendar for an entire year
• Develop and maintain staff development record system
• Establish files on major educational topics
• Regularly evaluate the staff development program
Types of staff development program

1. Induction training

2. Job orientation
3. In-service education
4. Continuing education
1. Induction training:

Induction training is a type of training give as an initial preparation upon taking up a post.

Forms of induction:

• Internship
• Preceptorship
• Mentorship
2. Job Orientation
The process of creating awareness within the individual of his/her roles, responsibilities and new
relationships in new work situation.

3. In-service education:

It is a planned educational experience provided to the job setting and closely identified service in
order to help the person to perform more effectively as a person and as a worker.

4. Continuing education:

It is all learning activities that occur after an individual has completed his basic education.
- Cooper

2. Management by Objectives:

Definition - " MBO is defined as a process whereby the superior and subordinate managers of an
organization jointly identify its common goals, define each individual's major area of
responsibilities in terms of the results expected of an individual, and use these measures as
guides for operating the unit and assessing the contribution of each of its members "
(Odiorne)

Features of MBO

 Objectives at all level

 Emphasis on all significant priority areas
 Participation of concerned managers in objective setting and performance review
 Periodic review of performance
 Appropriate systems and procedures
 Role clarity
 Multiple accountability

Objectives of MBO

 To translate mission statements into operational terms

 To give directions and set standards for the measurements of performance
 To set both long term and short term goals
Process of MBO

MBO is essentially a philosophy of management based on identifying purposes, objectives,

strategy, and desired results, and evaluating performance in achieving them. It has nine steps:

 Setting of objectives at the top- First step is setting objectives is for the top manager is to
determine the purposes or mission of the organization under given appropriate planning
premises. These are based on the analysis and judgement
 Identifying key result area (KRA)- It indicates the priorities for organizational
performance. It also indicates the present state of an organizational health and the top
management perspectives for the future.
 Clarifying the organizational roles- Each goal and sub goal should be of one person's
clear responsibility. Hence the specific parts of each coordinating manager's contribution
to the program goals should be identified.
 Setting subordinates objectives- After setting all the levels, identifying KRA, the superior
can then proceed to work with subordinates in setting their objectives. The action plan is
made with them. The subordinates' contribution or participation is very important at
every stage.
 Holding periodical meetings- Periodical meetings are conducted by the superior to
discuss the progress of work and implementation of the plans with their subordinates.
 Assess strengths and weaknesses of key resources- The strength and resources like
human, financial, physical are assessed. The allocation and movements of resources are
done in consultation with subordinate managers.
 Evaluation of results or performance appraisal- This aspect of MBO tries to measure
whether the subordinate is achieving the objectives or not. If not, what are the problems
and how these problems can be overcome? This is continuous process and view to find
out the deficiencies in the work, and also to remove those deficiencies.
 Recycling or reevaluating the process- The result of performance appraisal is used as an
input for recycling objectives setting is a joint process through interaction between
superior and subordinates, each level may affect other levels also.

(Textbook of Nursing Management-Deepak K)

 c) ABC Analysis

ABC analysis also known as “Always better Control” is a basic supply chain technique in
inventory control. It is a system of categorization of items/inventory in three classes with each
class having a different management control associated and is based on cost factor or on their
annual consumption value.

ABC analysis is based on Pareto’s principle of “Vital few and trivial many” based on the capital
investment of the item and cost criteria/annual consumption value of the item.

Principles of ABC Analysis

 Analysis depends on its annual consumption values rather than unit cost
 The limits for ABC categorization is not uniform and depends on the size of the
organization, its inventory as well as number of items controlled
 The analysis is based on material price, material credibility and available status of
material, material physical characteristic and frequency of material usage
 It also depends on degree and characteristics of controls to be exercised by the
management: the necessity of control, the necessity of which material to be placed under
control and the particular characteristics of material

Advantages

- Investment in inventory can be maintained

- Easy to control the wastage of costly items
- Easy to maintain stock and turnover rate
- Shows visible results in a short span of time
- Helps to pinpoint the obsolete stocks
- Helps in reducing clerical cost

Disadvantages

- Proper standardization and codification of inventory items is required

- Considers only the money value and not the importance of items for functioning
 - Periodic reviews becomes difficult if only ABC analysis is recalled

Applicability

- It has universal application for fields requiring selective control

- It extends in almost all aspects of material management such as purchasing, receiving and
inspection
- It can be used in any setting to control the cost
(Textbook of Nursing Management-Deepak.k)

e) Disaster management

Definition- The disaster as a serious disruption of the functioning of a community or a society.

Disasters involve widespread human, material, economic or environmental impacts, which
exceed the ability of the affected community or society to cope using its own resources.

Types of disasters
 Natural disasters: including floods, hurricanes, earthquakes and volcano eruptions that
have immediate impacts on human health and secondary impacts causing further death and
suffering from (for example) floods, landslides, fires, tsunamis.
 Environmental emergencies: including technological or industrial accidents, usually
involving the production, use or transportation of hazardous material, and occur where these
materials are produced, used or transported, and forest fires caused by humans.
 Complex emergencies: involving a break-down of authority, looting and attacks on
strategic installations, including conflict situations and war.
 Pandemic emergencies: involving a sudden onset of contagious disease that affects
health, disrupts services and businesses, and brings economic and social costs.

Disaster Management can be defined as the organization and management of resources and
responsibilities for dealing with all humanitarian aspects of emergencies, in
particular preparedness, response and recovery in order to lessen the impact of disasters.

Disaster management cycle

 Emergency Response

Disaster

Preparedness Response/ Relief

Prevention/ Rehabilitation
Mitigation

Reconstruction
Pre- disaster: risk reduction
Post- disaster: recovery

Disaster mitigation

 Disaster mitigation refers to actions or measures that can either prevent the occurrence of
a disaster or reduce the severity of its effects. (American Red Cross).

 Mitigation activities include awareness and education and disaster prevention measures.

Preparedness

 Disaster mitigation refers to actions or measures that can either prevent the occurrence of
a disaster or reduce the severity of its effects. (American Red Cross).

 Mitigation activities include awareness and education and disaster prevention

Response

 The level of community preparedness for a disaster is only as high as the people and
organization in the community make it.

 Community must have adequate warning system and a back up evaluation plan to remove
people from the area of danger

Rehabilitation phase
  The level of community preparedness for a disaster is only as high as the people and
organization in the community make it.

 Community must have adequate warning system and a back up evaluation plan to remove
people from the area of danger

Triage

A predetermined triage should be undertaken to classify the causalities.. For large number of
casualties the triage team should incorporate a surgeon, an orthopedic surgeon, physician and an
anesthesiologist and nurses.

 French verb “trier” means to sort.

 Assigns priorities when resources limited.

 Do the best for the greatest number of patients.

Priority one – needing immediate resuscitation, after emergency treatment shifted to intensive
care unit

Priority two – immediate surgery, transferred immediately to operation theatre

Priority three – needing first aid and possible surgery – give first aid and admit if bed is
available or shift to hospital

Priority four- needing only first aid-discharge after first aid.

Disaster management committee

The following members would comprise the disaster management committee under the
chairmanship of medical superintendent/ director,

 Medical superintendent/ director.

 Additional medical superintendent.

  Nursing superintendent/ chief nursing officer.

 Chief medical officer (casualty).

 Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology

neurosurgery

 Blood bank in charge.

 Security officers.

 Transport officer.

 Sanitary personnel.

(Textbook of Nursing Management-B.T Basvanthappa)

SECTION II

Q. 4. Long answer questions:

Explain human resources for health under following heading:

a) Define human resource management

Human resource management is the management of human resources. It is designed to maximize

employee performance in service of an employer’s strategic objectives. HR primarily concerned
with the management of people within organizations, focusing on policies and on systems.

b) Discuss the recruitment process in nursing services of a multi speciality hospital.

Recruitment Process
Recruitment process involves a systematic procedure from searching the candidates to arranging
and conducting the interviews and requires many resources and time.
Recruitment process for the appointment of nursing staff
1. Identify Vacancies: It begins with the human resource department receiving
requisitions for recruitment from different departments in the organization. It
includes the post to be filled, number of vacancies, duties to be performed, and
qualification with experience.

2. Preparing Job and Person Specification : Job specification is helpful to think of the
job under broad heading; main characteristics of the training, background of the job,
main responsibilities, and job boundaries, expectation of holder, resources and
constraints affecting the job. It has to be decided what type of candidates is to be
invited and what would be their characteristics. This need is too based on job
description. Hence it is important to have job analysis, before put forward the
recruitment. Hence it is important to look at nature of job and its requirements.
Whereas personal specification can be divided into personal requirement, e.g. work
experience and qualification seen as essential and desirable and personal qualities.

3. Advertising Vacancies: This is the method by which the candidates will be located it
is either through internal sources or external sources and also decided the method of
advertising for the post.

4. Managing Response: This step is to the way adopted to receive the applications and
scrutinized each application as per the requirement by the scrutiny committee.

5. Short Listing and Identifying the Prospective Candidates: After the scrutiny the
eligible candidates are shortlisted and a list is prepared.

6. Arranging the Interview with the Shortlisted Employees: Interview dates are
finalized. Criteria for the merit list are prepared by the committee and candidates are
informed. The selection committee is formulated.
7. Conducting the Interview and Decision Making: Interview is conducted on the
scheduled date by the selection committee, there and then the candidates are selected.
( Textbook of Nursing Management-J. Vati)
 c) What are the quality assurance programmes used in the selection of staff nurse in a
hospital?

Quality assurance is the measurement of provision against expectations with declared intention
and ability to correct any demonstrated weakness. -Shaw

Quality assurance is a management system designed to give maximum guarantee and ensure
confidence that the service provided is up to the given accepted level of quality, the standards
prescribed for that service which is being achieved with a minimum of total expenditure.

British Standards Institute

It involves large governing or official bodies evaluating a person or agencies‘ability to meet

established criteria or standard during a given time. The quality assurance programs used in the
selection of staff nurse in a hospital are;

a) Credentialing- It is the formal recognition of professional or technical competence and

attainment of minimum standards by a person and agency. Credentialing process has 4
functional components
 To produce a quality product
 To confirm a unique identity
 To protect the provider and public
 To control the profession
b) Licensure- It is a contract between the profession and the state in which the profession is
granted control over entry into an exit from the profession and over quality of
professional practice.
c) Accreditation- It is a process in which certification of competency, authority, or
credibility is presented to an organization with necessary standards.
d) Certification
e) Charter- It is a mechanism by which a state government agency under state law grants
corporate state to institutions with or without right to award degrees.
f) Recognition- It is defined as a process whereby one agency accepts the credentialing
states of and the credential confined by another.
g) Academic degree
 (Comprehensive Textbook of Nursing Administration- Deepak.k)

Q. 5. Long answer question:

Explain material management under following heads

a) Discuss briefly the elements of material management.

Definition - It is concerned with planning, organizing and controlling the flow of materials from
their initial purchase through internal operations to the service point through distribution. OR
Material management is a scientific technique, concerned with Planning, Organizing &Control
of flow of materials, from their initial purchase to destination.

Elements of material management

1. Demand estimation
2. Identify the needed items
3. Calculate from the trends in Consumption during last 2 years.
4. Review with resource constraints

Sub- Systems

Demand estimation, Procurement, Receipt and inspection, Storage, Issues and use, Maintenance
and repair, Disposal

Demand estimation:- A large verity and numbers of materials are used in hospitals and others
health care institutions. The advisor y committee for development of surgical instruments,
equipment and appliances (1963) identify 3 200 items of instruments equipment being used in
hospital. As less numbers of materials less will be the problems of planning and management of
the same.

Procurement:- The list of requirement, the next step in material planning and management
system is the process of procurement of these materials. Most of the states and other organization
have laid down detailed set of rules and regulations regarding the procedure of ordering
materials. Organization like “directorate general of supplies and disposals “(DGSD) play a
crucial role in purchase which involves in
Organizations for Procurement

1. Directorate general of supply & disposal (DGS & D, Govt. Of India]

2. Medical stores depot (M. S.D. Government of India, Ministry of H & FW]
3. Private or public sector undertakings.
4. Receiving donations.

Procurement cycle

(a) Review selection

(b) Determine needed quantities
(c) Reconcile needs & funds
(d) Choose procurement method
(e) Select suppliers
(f) Specify contract terms
(g) Monitor order status
(h) Receipt & inspection

Objectives of procurement system

(a) Acquire needed supplies as inexpensively as possible

(b) Obtain high quality supplies
(c) Assure prompt & dependable delivery
(d) Distribute the procurement workload to avoid period of idleness & overwork
(e) Optimize inventory management through scientific procurement procedures

Procurement of Equipment: - Points to be noted before purchase of equipment:

(a) Latest technology

(b) Availability of maintenance & repair facility, with minimum down time
(c) Post warranty repair at reasonable cost
(d) Upgradeability
(e) Reputed manufacturer
(f) Availability of consumables
(g) Low operating costs
 (h) Installation

Storage

(a) Store must be of adequate space

(b) Materials must be stored in an appropriate place and in a correct way
(c) Group wise & alphabetical arrangement helps in identification & retrieval
(d) First-in, first-out principle to be followed
(e) Monitor expiry date
(f) Follow two bin or double shelf system, to avoid stock outs
(g) Reserve bin should contain stock that will cover lead time and a small safety stock
Issue & use can be centralized or decentralized

Equipment Maintenance & Condemnation

Maintenance & repairs:

(a) Preventive maintenance

(b) Master maintenance plan
(c) Repair of equipment

Condemnation & Disposal

Criteria for condemnation: The equipment has become:

(a) Non-functional & beyond economical repair

(b) Non-functional & obsolete
(c) Functional, but obsolete
(d) Functional, but hazardous
(e) Functional, but no longer required

Disposal

(a) Circulate to other units, where it is needed

(b) Return to the vendor, if willing to accept
(c) Sell to agencies, scrap dealers, etc
 (d) Auction
(e) Local destruction

(Textbook of Nursing Management-J. Vati)

b) Discuss the methods of inventory control in a hospital

Inventory control is the process by which inventory is measured and regulated according to
predetermined norms such as economic lot size for order, safety stock, minimum level,
maximum level, order level etc.

Following are the popular methods of selective inventory control:

a. ABC analysis

b. VED analysis

ABC Analysis

ABC analysis also known as “Always better Control” is a basic supply chain technique in
inventory control. It is a system of categorization of items/inventory in three classes with each
class having a different management control associated and is based on cost factor or on their
annual consumption value.

ABC analysis is based on Pareto’s principle of “Vital few and trivial many” based on the capital
investment of the item and cost criteria/annual consumption value of the item.

Principles of ABC Analysis

1. Analysis depends on its annual consumption values rather than unit cost
2. The limits for ABC categorization is not uniform and depends on the size of the
organization, its inventory as well as number of items controlled
3. The analysis is based on material price, material credibility and available status of
material, material physical characteristic and frequency of material usage
4. It also depends on degree and characteristics of controls to be exercised by the
management: the necessity of control, the necessity of which material to be placed under
control and the particular characteristics of material
Advantages

 Investment in inventory can be maintained

 Easy to control the wastage of costly items
 Easy to maintain stock and turnover rate
 Shows visible results in a short span of time
 Helps to pinpoint the obsolete stocks
 Helps in reducing clerical cost

Disadvantages

 Proper standardization and codification of inventory items is required

 Considers only the money value and not the importance of items for functioning
 Periodic reviews becomes difficult if only ABC analysis is recalled

VED Analysis
VED Analysis means Vital, Essential and Desirable Analysis. The materials are classified based
on criticality that on functional basis. The degree of criticality can be stated as whether a material
vital to the process, essential or desirable for the process.
 ‘V’ is for vital items without which a hospital cannot function, e.g. Oxygen supply. Its
shortage can cause havoc. These are stocked adequately to ensure smooth operation.
 ‘E’ for essential items without which an institution can function but may affect the
quality of the services. For these items reasonable risk can be taken. If not available,
work will not stop but the efficiency of operations adversely affected due to expediting
expenses. These items should be sufficiently stocked to ensure regular flow of work.
Examples are antibiotics, intra venous fluids etc.
 ‘D’ stands for desirable items, unavailability of which will not interfere with functioning
because they can be easily purchased as and when required. They may be stocked very
low or not stocked. Examples are tonics, cough syrups, B complex etc.

The categories can be changed based on the demand of items.

The VED ranking may be done on the basis of shortage costs of materials, which can either be
quantified or qualitatively expressed. However it is subjective analysis. For vital items the
shortage cannot be tolerated; for Essential items the shortage can be tolerated for a short period
whereas for desirable items the shortage will not adversely affect, but may be using more
resources and these must strictly be scrutinized.

Advantages of VED Analysis

 It is useful for monitoring and control of stores and spares inventory by classifying them
into 3 categories viz., Vital, Essential and Desirable.
 Determine the criticality of an item and its effect on production and other services.
 It is specially used for classification of spare parts / items. If a part is vital it is given ‘V’
classification, if it is essential, then it is given ‘D’ classification. For ‘V’ items, a large
stock of inventory is generally maintained, while for ‘D’ items, minimum stock is
enough.
 It is useful in controlling and maintaining the stock of various types.
(Comprehensive Textbook of Nursing Administration-Deepak.K)

Q. 6. Write short answers:

a) Methods of performance appraisal

Performance appraisal means the systematic evaluation of the performance of an expert or his
immediate superior.

Appraise means ‘estimate the value or quality of’ Oxford English Dictionary Personnel appraisal
is a comparatively formal, systematic programme of individual employee evaluation.
-Yoder Dale

Performance appraisal is the systematic, periodic and an impartial rating of an employee’s

excellence in the matters pertaining to his present job and his potential for a better job.
-Flippo

Methods of Performance Appraisal

Multiple – person evaluation methods
  Ranking Method

This is one of the oldest, simple, quick and the most convenient methods of appraisal in which an
employee is ranked against others on the basis of their relative levels of performance. The
evaluator is asked to evaluate the employees from highest to lowest on certain overall criterion.
The relative position of each employee is expressed in terms of her numerical rank. The
employee scoring the highest is first and then selects the next highest and so on. This method has
limited value for performance as it is not easily determined and differences in ranks do not
indicate absolute or equal differences among the employees.

Advantages of Ranking Method

 Each employee or worker can be compared with other.

 A small organization can get maximum benefit through ranking method.

Limitations of Ranking Method

 A big organization is not able to get sizable benefit from ranking method
 Ranking method does not evaluate the individuality of the employee
 It lacks objectivity in the assessment of the employee
 Paired Comparison Methods

This method is a part of ranking method. Paired comparison method has been developed by the
big organization. Each employee is compared with other employees in the group for only one
trait at a time. The evaluator is asked to put a tick mark against an employee to whom she
considers the better of two and final ranking is done by the number of times the employee is
judged better than others. This can be calculated by a formula N(N-1)/2 where N is the total
number of employees to be compared.

Advantages

 This method is suited for big organizations

 Individual traits are evaluated under this method

Disadvantages
  The understanding of this method is difficult one
 It involves considerable time

 Forced Distribution Method

In this method the appraisal is forced to evaluate the staff according to predetermined
distribution scale. Usually two criteria are taken for rating and on five points scale and
employees are placed between two extremities. This method is more objective but difficult to
construct a set of statements.
Individual Evaluation Methods

 Confidential reports

This method is mostly used in government organizations. This is one of the old and traditional
methods of evaluating the employees. A confidential report is a descriptive report about the
employee and generally prepared at the end of every year by the immediate superior. It contains
information about the employee’s strengths, weaknesses, major failure and achievements. It also
contains information about the employee’s personality traits (qualities) and about his/her
behaviour.

 Essay appraisal method

This is the simplest method of rating an employee. Under this method, the rater expresses in
detail, the employee’s strong and weak points. She also gives suggestions for improvement. This
method is highly subjective and not free from bias.

 Critical incidence technique

Under this method the appraise rates the employee on the basis of critical events or takes
snapshots of the incidence and writes a brief report about the incidence. It includes both negative
and positive points. This method provides an objective basis for conducting a discussion of the
performance but some supervisors may also be biased while recording the incidents.

 Checklist and weighted checklists

A checklist is a set of descriptive statements about the employee and her behaviour. The rater has
to tick mark ‘yes’ or ‘no’ or each statement. This method is very simple, convenient, less time
consuming, and more economical. But it requires time to prepare structured statements.

 Graphic rating scales

These are widely used performance appraisal techniques. The appraisee indicates along a
continuum quality and qua quality and quantity of work of the employee being assessed. It
indicates different degrees of a particular trait. The continuum has anchors as ‘outstanding’,
‘good’, ‘fair’, and ‘unacceptable’ to help in the rating process. The factors taken into
consideration include both the personal characteristics and characteristics related to the on the
job performance of the employees. This method is easy to understand and simple to use, but it
also not free from bias.

 Behaviourally anchored rating scales

Behaviourally anchored rating scale (BARS) is relatively a new method. BARS are
systematically developed checklists using critical incidents in combination with graphic rating
scales. It consists of predetermined critical areas of job performance or sets of behavioural
statements describing important job performance qualities as good or bad. These statements are
developed from critical incidence. They consuming and costly to construct. The scales need
validation to be updated.

 Forced choice method

This method is developed to reduce the bias. This method makes use of several sets of pair
phrases, two of which may be positive and two negative an appraise is asked to indicate which of
four phrases is the most and least descriptive of a particular employee, and thereby increasing the
objectivity in evaluation of the employees’ performance.

 Management by objective method

Management by objective (MBO) is participative goal setting, choosing course of actions and
decision making process. The employees and the superiors sit together, identify common
organizational goals, and set their goals to be achieved, the standards to be taken as the criteria
for measurement of their performance of the employee is measured and compared with the
standards set and feedback is provided to rectify the mistakes and plans are modified. The
appraise should record directly and immediately observed job related behaviours.

( Textbook of Nursing Management-J. Vati)

b) Patient’s rights

The patients’ rights are based on ethical beliefs as to what constitutes high quality care. These
are concerned with supporting optimum health in the patient, not merely with ensuring the
absence of harming, most cases, a court would not uphold these rights. If these are violated, it
will be dealt within the organization or health care system on appeal.

Ethical Rights of Patients:

1. Rights of personal dignity: these rights describe the personal dignity of the patients while
providing care.

Patients are to be considered as human beings-

- Calling the person by name that he/she chooses to have

- Maintaining privacy
- Modesty by knocking on closed doors, pulling curtains,
providing appropriate garments etc.
- Helping the person to have the best possible appearance through
careful attention to personal hygiene and personal care

Mannerism and positive attitude towards the patients-

- Listening to the thoughts and concerns of the patient

- Explaining expectations and new situations
- Accepting the individual’s feelings as real without judging them
2. Right to individualized care:
- Every patient has rights according to his/her needs and life style
 - Adapt a method of bathing or other nursing procedure to respect
a patient’s attitude about modesty
- Alter if possible, visiting hours to help maintain an important
family bond
- Plan diet modifications to fit the patient’s cultural background
3. Right to assistance towards independence: it is the ethical right of a patient that he or she
should be helped to be independent in carrying out activities of daily living, to build their
self-esteem and encouraging them. E.g.:- allow patient to perform self- care whenever
possible.

4. Right to complain and obtain changes in care: the patient has the right to complain when
care has not been of high quality and to obtain changes that are important to improve the
quality of care.

(Textbook of Nursing Management-J.Vati)

c) Infection control measures in ICU

Effective Infection Control Measures

1. People: It is the people in hospitals rather than the physical environment which constitutes
the reservoir of infection. Nurses should follow hand washing techniques properly and they
should also guide other staff, students to follow the procedure of hand washing which
includes social hand washing, following by procedural hand wash. All the steps of hand
washing should be followed properly. Always use liquid soap instead of solid soap for hand
washing.
2. Aseptic Techniques: Strict adherence to aseptic techniques in various invasive procedures.
Insertion and removal of catheters, surgical tubings, drainage tubes and packs need strict no-
touch techniques should be practiced.
3. Segregation of contaminated instruments: There must be a system for keeping the
contaminated pieces of linen, sputum cups, bedpans, urinals, and similar items separately to
minimize chances of getting mixed up with clean items.

4. Isolation policy: Availability of adequate number of trained nurses is crucial for prevention
of nosocomial infection. Isolation facilities for patients with communicable diseases and
those vulnerable to infection. Strict control on wearing of mask, gown and gloves must be
exercised while attending to such patients. All articles taken for patient use must be treated
appropriately.

5. Masking and Gowning and Glowing

 Gloves should be worn especially while dealing with HIV infected patients, invasive
procedures and when in contact with body fluids.

 As for any surgical procedure (eg: dressing change, lumbar puncture) Gown and Glove
should be worn by the person who conducts the procedure.

6. Disinfection Practices: Different kinds of disinfectants vary in their reaction to different

kinds of micro-organisms. Phenolic compounds are active against gram-negative organisms.
Quaternary ammonium compounds against staphylococci, streptococci, and Iodophores and
hypochlorites have a broad spectrum of action. Selection of appropriate disinfectant for
different purpose is important. The following should be checked.

 Appropriate choice

 Appropriate concentration

 Appropriate contact time

 Appropriate method of use

7. Sterilization Practices: Each sterilization must be monitored through the use of heat-sensitive
tapes. All instruments, linen which come in contact with patient body fluids should be
autoclaved or gas sterilized.
8. Prevention of Injuries

 After using the disposable needles, never recap them to potential risk of injury they
should be disposed off uncapped.

 Injection files and cotton swabs should be used for breaking ampoules

 Scissors and blades should be handled with extreme care

 Needles should never be left on the bed, table, chair, nurse’s station etc.

 Heavy duty gloves should be used while handling and washing sharp instruments and
glass ware.

9. Handling the laboratory specimens: The specimens should be collected in screw capped
plastic disposable container without soiling laboratory forms.

10. Handling the blood spills

 To spill should be covered with cotton, news paper or other absorbent material.

 Pour 1% of Hydro chlorate solution or bleach solution over the spill

 Wipe the spill soaked area after 20 minutes

 Discard the soiled materials in a polythene lined waste bag (red bag)

 The soiled floor should be cleaned with detergents.

11. Housekeeping routines

 Dry dusting and sweeping should be avoided; it is preferable to vacuum cleaner to

suck the dust from the floor, walls and equipments.

 Wet mopping of floors with soap and water containing 3% phenol should be carried
out at least thrice daily.
  The waxing of surfaces and use of oil in water for mopping may limit dissemination
of microorganisms.

 The walls should be wiped or sprayed with 2% bacillocide once a week.

 The sinks should be washed with 3% phenol or 5% Lysol at least once a day.

12. Termination Disinfection: Termination disinfection of isolation rooms must be carried out
thoroughly before permitting the room for reuse. At such times, the staff must use the same
precautions (cap, mask, gown, gloves) used for nursing in such isolation rooms.

13. Developing a sense of awareness: Developing in all hospital workers a high sense of
awareness, and training and retraining in the precautionary measures, prevention and control.

 Health care workers with skin condition must seek the advice of occupational health
nurse.

 Advice junior staffs and students to inform to seniors to be reported for any sign of
occupational exposure.

14. Management of patient care equipment

 Do not re-use single patients equipments to other patients

 Patient care equipments should be decontaminated as per the decontamination

policy.

 Wear protective clothing’s when handling the contaminated articles.

 Do not use single use equipments again

 Patient related equipments such as pumps, drip stands etc. must be kept clean.

15. Waste disposal

 Nurses should have thorough information and knowledge regarding Biomedical and
general waste management.
  There should be provision for foot operated bins adjacent to each baby unit for
disposal of used materials and soiled linens.

 Plastic bags should be kept as hampers in the dust bins and they should be sealed
before their removal.

 The dust bin should be mopped with 3% of phenol every day.

 To have supervision over segregation of waste in appropriate color bags according to

CDC recommendations.

 Knowledge and practice regarding transportation of waste should be essential.

(Textbook of Nursing Management- J.Vati)

d) Primary nursing

Primary Nursing is a system for delivering nursing care that is based upon the four elements:
Responsibility for Relationship and Decision-making. Work Allocation and Assignments.
Communication with the Health Care Team

This is distinguished from the practice of team nursing, functional nursing, or total patient care,
in that primary nursing focuses on the therapeutic relationship between a patient and a named
nurse who assumes responsibility for a patient’s plan of care for their length of stay in a
particular area.

Primary Nursing is a delivery system for nursing at the station level that facilitates professional
nursing practice despite the bureaucratic nature of hospitals. The practice of any profession is
based on an independent assessment of a client’s needs which determines the kind and amount of
service to be rendered: services in bureaucracies are usually delivered according to routine pre-
established procedures without sensitivity to variations in needs.”

(Textbook of Nursing Administration-B.T Basvanthappa)

e) Ethical issues in nursing

The first nursing law created was that of nursing registration in 1903 and they have only evolved
and expanded over the years to create a thick book. Laws and regulations as they affect nurse in
India are controlled by state legislation, as state registration acts and a central act the Indian
nursing council act which was enacted in 1947.

Ethical implications are as follows:

 Torts: torts are when others interfere in individual’s privacy, mobility, property, or
personal interests.
 Assault: assault occurs when a person puts another person in fear of a harmful or
offensive contact. The victim fears and believes that harm will result as a result of
threat.
 Battery: it is an intentional touching of anothers body without the others consent.
 Negligence: it is conduct that falls below the standard of care that a reasonable person
ordinarily would use in a similar circumstances or it is described as lack of proper
care.
 Malpractice: failure to meet the standards of acceptable care which results in harm to
another person.
 Fraud: it results from a deliberate deception intended to produce unlawful gains.
 False imprisonment: it occurs when a client is not allowed to leave a health care
facility when there is no legal justification to detain the client.
 Invasion of privacy: it includes violating confidentiality intruding on private client or
family matters, and sharing client information with unauthorized persons.

Legal issues in nursing practice reflect the changing trends in technology, medical advancements
and increased awareness among the patients. The following are examples of recent development
in the law:

 Controlled Substances: One of the legal issues that might arise for nurses involves the use of
controlled substances. The two acts that control the use of poisons in medicine is: Misuse of
drug Act 1971 and Dangerous Drug Act 1965 and 1967. The misuse of drug act aims at
checking the unlawful use of the drugs liable to produce dependence or cause harm if
misused. Drugs affected by this act are referred as controlled drugs. The common controlled
 drugs under the dangerous drug act include cocaine, heroin, methadone, morphine, opium,
pethidine, hallucinogens, etc.
 Caring Patients with AIDs (Acquired Immuno Deficiency Syndrome): The care of AIDs
and HIV+ patients has legal implications for nurses. Confidential information must be
protected of HIV+ patients. An infected person cannot be discriminated against based on
contagiousness. The courts have upheld the employer’s right to fire a nurse who refused to
care for an AIDS patient.

 Deaths and Dying: There are many legal issues regarding definition of death. The law
identifies that death occurs when there is a greatly diminished brain function, despite
function of other body organ. Even though the client may be legally is brain dead, the actual
pronouncement of death is usually the legal responsibility of the physician, nurses must be
aware of legal definition of death.

 Autopsy and Organ Donation: Legally competent persons are free to donate their bodies or
organs for medical use. Consent forms are available for the purpose. The nurse must be
aware of policies and procedures of institutions and laws of the state where they are asked to
serve as a witness for a person who wishes to give consent for a donation.

 Living Wills and Health Care Surrogates: Living wills are documents instructing physician
to hold or withdraw life-sustaining procedures whose death is imminent. Each state
providing for providing living will need two witnesses, neither of whom can be a relative or
doctor, are needed when the client signs the documents, medical special directives also must
be legally prepared with the appropriate witness of the client’s signature. Client executes
these documents to appoint someone to make health care decisions if and when they are no
longer table to make decision on their own behalf, e.g. in terminally ill state and persistently
vegetative state. Nurse should be aware of institutional policies with the patient’s self-
determination act.

 Patient’s Property: Many of unconscious patients admitted in emergency their belongings

should be listed, checked by two nurses and put in safekeeping. While a patient is in
hospital, the nurse has no right to go through his locker or personal property without his
consent unless it is suspected that the patient intends to injure him or others and has the
 means to do so. When the patient dies in hospital, his possessions must be recorded in the
property book, but money and valuable should be listed and packed separately. Also write the
color of ornaments, and also inform to administrative officers. Preoperatively and during
delivery, these things should be taken care of.

(Comprehensive Textbook of Nursing Administration- Deepak.k)