Leadership
EATING
Category 1- feeds self or needs little food
Category 2- needs some help in prepare food tray and meal planning
Category 3- Can't feed self but able to chew and swallow
Category 4- can't feed self and may have difficult swallowing - Category 4: Enteral feeding when mouth is not available
GROOMING
Category 1- self sufficient
Category 2- need some help in hygiene
Category 3- unable to do much for self
Category 4- completely dependent - Category 4: patient in ICU
EXCRETION
Category 1 - almost alone
Category 2 - assist the patient in walking in rising up in going in and out of bed, opening the door of the comfort room
Category 3 - complete bed rest, offer urinal, bed pan - Category 3: Complete bed rest then offer urinal or bed pan
Category 4 - patient is having catheter, attached adult diaper in client, changing diaper is yours, stroke, unconscious, icu cva
COMFORT
Category 1 - self sufficient - move about, change position according to what he likes
Category 2 - need some help in adjusting positions in bed - persons who are too weak to have the appropriate position in bed, problems in proprioception, nahulog na wala kabalo na nahulog na ang tiil, place the leg back to the bed
Category 3 - cant turn without help, get drink, adjust positions of extremities and mobility - dili pwede makakuha sa dispenser
Category 4 - completely dependent - everything will be urs
TREATMENTS
Category 1 - simple-supervised ambulation simple dressing vital sign per shift - patient out of bed ex. dialysis,
Category 2 - any category 1 treatment more once per shift foley cath, I&O - the one found in cat 1 + patient having catheter and I and O measurement - all in category 1+ catheter+ intake and output measurement
Category 3 - any treatment more than twice per shift IV meds, complicated dressing, tracheostomy
Category 4 - any complex procedure requiring 2 nurses, vital functions
Distribution of nurses per shift
Why there has to be higher percentage in morning shift?
Doctor’s round, there are orders that must be carried out and given to the client
most of the orders and medications must be started given in the morning
many of the treatments, laboratory examinations are done, almost all examinations are done
Surgeries
Afternoon
Why?
Most of the orders have been carried out
Only few doctors makes their round
Night
Why?
monitoring of patient with high acuity, preparing the patient for surgery in the following day morning, there are also patient does not need close monitoring, ngt for infant and proper alignment when positioning patient with skeletal traction because u can't order that to nursing attendant
Nursing Attendant
changing the linen
making an occupied bed
not all are given by NA, nurses should do it specially on patient with spine problems to keep alignment
Not allowed to fed neonate
Work hour for the week - 80 hours
Variables affecting staffing
types of patient - categorize the patient, self care, intermediate etc.
fluctuations in admission - there are ups and down and are seen through the bed capacity in relation to occupancy
length and stay of the patient - how much monetary consideration are to be charge to the patient, compute how many days will the patient will stay
complexity of care - what treatments are carried out, how serious the patient is, is the patient having complications
personnel policy - it is not appropriate that all personnel must go on leave
Absenteeism -
Competitive market - Salary, madona one sack of rice, free meal while on duty, good benefits
Assignment System for Staffing
a. Case method or Total Patient Care - each patient is assigned to a nurse for total patient care while the nurse is on duty
EX. - all yours from the start of the duty until the last hour
endorsed patient after your shift you ARE NOT bothered anymore
Not necessary that you will have the same patient the following day
b. Functional nursing also called Task Nursing
most commonly in army station hospital
Nurse A will be in charge of all oral, Nurse B IV, etc.
Only focused on the assign task
it is task nursing
fragmented
does not encourage patient and nurse satisfaction
results to dissatisfaction
Advantages of functional
Skilled in giving IV, IM and any form of parenteral
Team Nursing
a group of nursing personnel provides total patient care to a group of patients. - example: You are only a student, allow the RN to do IVTT instead of doing it all yourself
Students are part of this, you are not the primary responsibility of the patient
Primary Nursing
features a RN who gives total patient care to 4-6 patients on duty and remains responsible of those patients 24 hrs in a day
associate nurses cares for the patient while the RN is on off duty
it is designed to place the RN back at the patients bedside
Decentralized decision-making by the staff nurses is the core principle of this method, with authority, responsibility and accountability (ARA) for nusring care allocated to staff nurses at the table
Advantages:
the nurse sees the client and family as one system and ARA is increased
the nurses a wide range of skills, knowledge and expertise and develops creativity
increase trust and satisfaction by the clients
excellent communication between the primary nurse and associate nurses
primary nurses are able to hold associate nurses accountable for implementing the nursing care as prescribed
Disadvantage
Because of transfer to different units, critically ill patients may have several primary nurses disrupting the continuity of care inherent in this model
5.) Case Management Method
care is directed by a case manager focused on achievement of outcome and appropriate time frame and resources
the nurse focuses on an entire episode of illness and the method is therefore episode-based rather than unit based
is used to organize patient care according to diagnosis
manager does not provide direct patient care but rather supervises the care provided by the RNs and non RNs
*Patient cooperation is vital to the success of this method
Employee Discipline
the process of generating employee compliance to institutional rules and regulations
Must be properly communicated
Be done privately, promptly and consistently progressive in nature
Should be preceded by counseling
Disciplinary procedures should be instituted with extreme caution
Steps to addressing disciplinary problems
coaching
confrontation
disciplinary conference
Measures
counseling
verbal reprimand
written reprimand
short suspension
longer suspension
discharge/dismissals
Generation Work Groups
Generation Year of Birth
Silent generation or veteran generation 1925-1942
Baby boomer 1943-early 1960
Generation X early 1960-early 1980
Generation Y early 1980-mid 1990
Generation Z 1996-2015
Staff Development
Activities Normally carried out for the following reasons
to establish competence
to meet new learning needs
to satisfy interests the staff may have in learning in specific areas
Evaluation of Staff Development Activities
Learner’s reaction
Behavior Change
Organizational impact
Cost-effectiveness
Justification for Career Development
Reduced employee attrition
Equal employment opportunity
Increased opportunities for employment growth
Improved quality of work life
Improved competitiveness of the organization
Obsolescence can be avoided and new skills acquired
Evidenced-base practice promoted
Training vs. Education
Training - is an organized method of ensuring that people have knowledge and skills for a specific purpose
assist employees with their training needs, the manager must first determine what those needs are
Is a leadership role
Education - more formal and broader scope than training
recognition of educational needs and encouraging educational pursuit are roles and responsibilities of the leader and manager