1

Patients Rights
1. Right to competent care
2. Freedom from harm
3. Right to Informed Consent
4. Right to Withdraw from Participation
5. Right to Confidentiality of Information
6. Right to be Treated with Dignity and
Respect

5.

Historical Information

Factors Affecting Time Requirement of

Nursing Care
1.
Acuity if the patients illness
2.
Degree of dependence if the patients on
the caregivers
3.
Communicability of the ailment
4.
Rehabilitation needs and special
treatments and procedures

Organizational Ethics - a broad concept that

includes not only culture and trust, but also
processes, outcomes, and character and
Patient Classification System
denotes a way of acting, not a code of
I.
Self care or minimal care patients
principles. [and] is at the heart, pumping II.
Intermediate or moderate care
blood that perfuses the entire organization III.
Total care patients
with a common sense of purpose and a
IV.
Intensive care patients
shared set of values (Pearson, Sabin, &
Emmanuel, 2003, p42)
Nursing Care Models
1.
The Case Method or Total Patient Care
Patient's Care Standards
2.
The Functional Method
principle A - Each patient shall be treated as
3.
Team Nursing
4.
Primary Nursing Method
a whole, irreplaceable, unique, and worthy
5.
Progressive Client Care
person.
6.
Managed Care Method

principle B - The patients safety,

7.
Practice Partnership
health, or welfare shall be protected and shall
8.
Case Management Method
not be subordinated to organizational, staff,
9.
Modular Method
educational, or research interests or to any
other end.
principle C - The privacy of the patient
and the confidentiality of every case and
record shall be maintained.

principle D - Patients and/or

responsible family shall be informed at all
stages of care about personnel responsible
for the patients care; treatment plans and
activities for the patient; facilities; services
available to the patient; and responsibilities of
the patient and family (referred to collectively
as patients care).

principle E - Behavior reflecting the

dignity, responsibility, and service orientation
of health care professionals, worthy of the
publics respect and confidence, shall be
practiced by all individuals.

principle F - Each patient shall have a

responsible attending physician or dentist.
HUMAN RESOURCEMANAGEMENT
Staffing follows a predictable pattern before
a nurse can be hired: preparing to recruit,
attracting staff, recruiting and selecting staff
through interview, induction, orientation, and
job offer.

Steps in Staffing
1.
Determine the number and types of
personnel needed
2.
Recruit Personnel
3.
Interview
4.
Induct or Orient the Personnel
5.
Job Offer
Staffing Pattern
1.
Benchmarking
2.
Regulatory Requirements
3.
Skills Mix
4.
Staff Support

Formula to Determine Staffing Patterns

1.
Full Time Equivalent (FTE)
2.
Forty-Hour Week Law
a. Standard Value for NCH
b. Percentage (%) of Professional and
Non-Professional (in ratio)
c. Distribution per shift
d. 40 hour/week
e. 48 hour/week
Guidelines for Determining the Nursing
Personnel Needed
Step 1. Determine type of hospital whether it is
primary, secondary or tertiary.
Step 2. Categorize patients according to levels
of care
Step 3. Find the NCH needed by patients per
day and get the SUM.
Step 4. Find the Total NCH x 365 days.
Step 5. Find number of working hours per year.
Step 6. Find the nursing personnel needed.
Step 7. Categorize into Professional and NonProfessional.
Step 8. Distribute by shifts.
Job Descriptions
1.
recruitment,
2.
placement and transfer,
3.
guidance and distribution,
4.
evaluation of performance,
5.
reduction of conflict and frustration,
6.
avoidance of overlapping of duties,
7.
facilitating working relationships with
outside bodies such as professional
associations, and
8.
serving as basis for employees salary
range.
TQM

INFORMATION MANAGEMENT
- collection and management of information from
one or more sources and the distribution of that
information to one or more audiences
NURSING INFORMATICS
- the use of information and technology to support
all aspects of nursing practice
- facilitate integration of data, information and
knowledge

DATA MANAGEMENT
Data Integrity - data that make up the
database of information must be maintained
with optimal assurance that quality of data
exist

Educating Staff - institute of medicine has

strongly emphasized that informatics is the
core competency required of healthcare
professions including nursing

System Prompts - managers, staffs and

informatics nurses can work with the IS
department to develop prompts that alert the
user to recheck the data that fall in specific
range, confirm that the data fall in specific
range, confirm that data have been entered
correctly

Verifying Data - very crucial to having

quality data that can be utilized for clinical
decision making

Data Mining - Technology has aided in rapid

advances in data capture and storage
resulting in large databases of data

Data Cleansing - used to clean up

erroneous data that have been captured and
stored in databases

ROLES OF INFORMATIC NURSES

Project Manger - analyze, design, develop,
select, test, implement and evaluate new or
modified informatics project that support
optimal data and delivery of quality patient
care

Consultant- project manager, market

research, planning conferences, strategic
information technology, reviewing clinical
software, redesigning the workplace and
others

Educator - may educate the staff nurses,

managers and others using health care
information system

Researcher - research clinical situations that

arise, help implement evidenced-based
practice, evaluate the current system for
improved outcomes, and conduct research to
improve clinical information systems and
outcomes

Product Developer - may develop software

applications for clinical and nonclinical
healthcare environment

COMMUNICATION
FHTH

2
- transmission of infromation, opinions, and
intentions between and among individuals
- binds organization together to ensure common
understanding
Lines of Communication

Downward - primarily directed and

coordinates activities at various levels of
organization what they need to know, what
to do and why they are to these; includes
policies, rules and regulations, memos,
handbooks, interviews, job description and
performance appraisal

Upward - primarily directed and

coordinates activities at various levels of
organization what they need to know, what
to do and why they are to these.

Reimbursement of Health
Insurance

Legal

Health Care Analysis

III.

IV.

Horizontal - it is used most frequently in

the form of endorsement, between shifts,
nursing rounds, journal meetings and
conferences or referrals between
departments or services.
Outward - informations that flows from
care-givers to the patients, and his family.
V.

II.

Reporting and Documentation

Accurately

Completely

Timely

Effective

Pertinent

Concise

Reflective

patients needs, problems,

capabilities and limitations

Quality Care

Guidelines for Good Reporting and

Documentation

Factual

Accurate

Confidential

Complete

Current

Organized

Ethical
Precautions to Observe in
Documentation
o
Only the nurse
o
Charting
o
Chart all important information..
o
Do not make erasures

Nursing Health History and

Assessment Worksheet
Graphic Flowsheets
Medicine and Treatment Record
Nursing Kardex
Discharge Summary
Nursing Progress Notes
Chronological Narrative
Charting
SOAP Charting

TOTAL QUALITY MANAGEMENT

- is an approach that seeks to improve quality and
performance which will meet or exceed customer
expectations.
PROCESSES INVOLVED IN TQM
Managing quality design and
development

Quality control and maintenance

Quality improvement

Quality assurance

3 PRINCIPLES OF TQM
1.
Focus on achieving customer
satisfaction.
2.
Seek continuous and long-term
improvement.
3.
Take steps to ensure the full involvement
of the work force in improving Quality.

VI.

Reports
1.
Change-of-Shift Reports
a.
Oral Report
b.
An audio-tape report
c.
Nursing Rounds
2.
Telephone Reports and Orders
3.
Transfer Reports

VII.

Documentation
is anything printed or written that can
be used as record or proof for
authorization.
a medical record is a comprehensive
description of the clients health
status and needs as well as
evidence of each health care
members accountability in giving
that care.
pertinent and concise and should
reflect patients status.

3 PARADIGMS OF TQM
1.
Total
2.
Quality
3.
Management

Purpose of Records

Communication

Legal evidence of care

Education

Financial Billing

Evaluation of quality of care

rendered

Research and Statistical

Information

SAFE PRACTICE AND ENVIRONMENT

CREATION OF A THERAPEUTIC
ENVIRONMENT
Therapeutic Environment
Comfortable environment
Good ventilation
Free from odors
Controlled noise level
Proper lighting
Orientation to patients and families

Creation of a Therapeutic Environment

I.
The Patients Clinical Record

Chart

Formal legal document

Treated confidentially

VIII.

Purpose of the Documentation

Communication

Planning Patient Care

Research

Education

Audit
IX.

Forms for Nursing Documentation

TQM

IMPLEMENTATION STEPS OF TQM

Develop new strategic thinking
Know the stakeholders
Determine quality requirements
Plan for contingency
Reduce waste
Develop a continuous improvement
strategy
Reduce variation
Balance the approach
Apply the improvement process

Quality Assurance
Achieving a sense of accomplishment and
implies a guarantee of excellence.
Process of evaluation that is applied to the
health care system and the provision of
health care services by health workers.
Quality Improvement
FHTH

3
-

A process of continuously improving a system

by gathering data or performance and using
multi-disciplinary team to analyze the system,
collect measurements, and propose changes.

Nursing Audit Committee

Composed of a representative from all

levels of the nursing staff:

Member of the Training staff

Supervising Nurse

Head/Senior Nurse

Staff Nurse

determine training and developmental

needs of employees
improve the performance of work groups
by examining , improving and correcting
interrelationship between members.
improve communication between
supervisors and employees
establish standards of supervisory
performance
discover the aspirations of employees and
reconcile these with goals of institution.
inform employees where they stand
Factors Contributing to an Effective
Performance Appraisal System

PATIENT CARE AUDITS

Concurrent audit - one in which patient care is
observed and evaluated.

given through:

A review of the patients charts while the

patients are still confined in the hospital.

Observation of the staff as patient care

is given

Inspection of patients and/or observation

of the effects of patient care where the
focus is on the patient.

Retrospective Audit - one in which patient care is

evaluated

given through:

A review of discharged patients charts

Questionnaires sent to or interviews

conducted on discharged patient
Peer Review
Patient care audits maybe done by
peers evaluating anothers job
performance against accepted
standards

Performance Appraisal, Development,

Planning and even Positive
Discipline.

It is a step-to step tool that line

manager can use to improve the
performance and productivity of
employees

It is also a way for employees to have a

clear understanding of what is expected
from them in terms of work performance.

The key, Rupert says, is in

understanding and properly using the
process.

Compatibility between criteria for

individual evaluation and organization
goals.
Direct application of rated performance
to performance standards and objectives
expected of the worker.
Development of behavioral expectations
which have been mutually agreed upon by
both the rater and the worker.
Understanding the process and effective
utilization of procedure by the rater.
Rating the individual by the immediate
supervisor.
Concentration in the strengths and
weaknesses to improve individual
performance.
Encouragement of feedback from the
rated employees about their performance
needs and interests.
Provision for initiating preventive and
corrective action and making adjustments
to improve performance.

INFORMAL ACTIONS
Coaching and counselling : in many
cases, informal coaching and
counselling will be all that is necessary
to facilitate improved performance.

RATIONALE AND STEPS FOR PERFOMANCE

IMPROVEMENT

The Objective of coaching is to help the

employee to recognize and solve-the
problem early on.

Quality Circles
A group of workers doing similar work
who meet regularly and voluntarily on
PERFORMANCE IMPROVEMENT
normal working time, under the
Is the concept of measuring the output of a
leadership of their supervisor to identify,
particular process or procedure,
analyze and solve work-related
then modifying the process or procedure to
problems and to recommend solutions to
increase the output, increase efficiency, or
management.
increase the effectiveness of the process or
Utilization of Results
procedure.
The Nursing Staff in the unit is given a
The concept of performance improvement
feedback on the results of the quality
can be applied to either individual
assurance study.
performance.
Positive Feedback - reinforces desirable
performance.
Performance Improvement Process
Negative Feedback - should tactfully be
( Positive Discipline)
conveyed in a face-to-face solution so
It is ORNL POLICY to identify,
that assessment results may easily be
communicate and address as early as
clarified.
possible when job performance is below
expected standards.
PERFORMANCE APPRAISAL
Performance improvement intervention
should be initiated as soon as it becomes
Purposes of Performance Appraisal
apparent that an employee is not meeting
expected performance standards.
determine salary standards and merit
ORNL: Oak Ridge National Laboratory
increases
select qualified individuals for
Performance Improvement Process
promotion/transfer
David Rupert, ORNLs Director of
identify unsatisfactory employees for
Workforce Diversity, says that - The
demotion or termination
Performance Improvement Process,
make inventories of talents within the
is part of the overall Performance
institution
Management System, which includes:

THE PERFORMANCE IMPROVEMENT

COMPONENT OF PERFORMANCE
MANAGEMENT PROCESS
Consist of both:
Informal actions
Formal actions
(While it is recommended that all actions
relatives to correcting performance be
documented, the level of documentation
is critical at the formal actions stage.)
Employee may enter the process at
either state depending on the
circumstances.

TQM

When the problem occurs or begins to

develop regarding work performance, the
manager should discuss the situation
with the employee before it becomes
serious.
During such a discussion, the manager
should explain exactly what the performance
expectation is and specifically how the
employee is failing to meet it.
Once the employee agrees ( or at least
understands) that he or she is accountable
for meeting expectations, the employee and
manager should jointly explore steps, the
employee might take to ensure he or she
meet expectations in the future.
Ideally, the employee and manager will
agree on the approach that will be taken to
solve the problem.
If the agreement cannot be reach, it is the
managers responsibility to ensure that the
employee understands what he or she must
do to solve the problem, and the
consequences for the employee, if the
problem is not resolved.
FHTH

4
The manager also needs to tell the
employee how and when he or she will
follow up to provide additional feedback on
progress against the agreement.
FORMAL ACTIONS
The formal action for performance
improvement includes:
An Oral Reminder
A Written Reminder
A Formal Warning
accompanied by a DecisionMaking Leave.
At each step, managers must
meet with the employee.
Managers should consult with
the Human Resource Generalist
for assistance before initiating
formal action

Normally, each step would last from 30

to 90 days. No matter what the stated
duration of the step, additional action may
be taken before the stated end of the step
if the performance continues to decline
noticeably or the employee does not make
a good faith effort to meet expectations.

Actions should be more

immediately .

Is a coaching session in which manager

and employee discuss problem,
clarifying expectations and develop
solutions that will lead to
improvement.

Step 2 : WRITTEN REMINDER

If after the oral warning, performance
does not improve to the level
necessary to meet expectations or if
performance continues to decline, a
written reminder session will be
conducted.
During this session, the employee will be
reminded of prior commitments that
not been met.
Performance expectations will be
clarified and steps for improvement
developed.
The supervisor should seek to obtain the
employees commitment to resolve
the problem, if possible

The duration of each step will vary

depending on the performance issue and
on the employees progress.

A session will be held in which the

employee will be reminded of prior
commitments that have not been
met and performance expectations
will be clarified.

The employee will then be given

one day off with pay ( a Decision
Making Leave) during which time
he or she will decide whether he or
she can meet performance
expectations.

Initiations of this step requires the

concurrence of the Division Director and
review with the Director of Human
Resources.

The employee will be told of the

consequences for failure to correct the
problem, which, in most cases, would be
termination of employment.

Or in the given job for only a short time

(< 1 year). By acting promptly and
decisively, the organization can avoid long
term problems

PERFORMANCE APPRAISAL PROCESS

- Performance appraisal should also be viewed

as a system of highly interactive processes
which involved personnel at all levels in
TQM

Increase motivation to perform

effectively.
Increase staff self esteem
Gain new insight into staff and
supervisors
Better clarify and define job functions
and responsibilities
Develop valuable communication among
appraisal participants.
Encourage increased self-understanding
among staff as well as insight into the
kind of development activities that are of
value.
Distribute rewards on a fair and credible
basis.
Clarify organizational goals so they can
be more readily accepted.
Improve institutional/departmental
manpower planning, test validation, and
development of training programs.

FACTORS AFFECTING THE EFFECTIVENESS

OF PERFORMANCE APPRAISAL
1.
2.
3.
4.
5.

Documented process
Communication
Training
Evaluation of results
Follow-up and performance
improvement

Documented process - Effective

performance appraisal is formal and not
left to chance. More than just asking
supervisors and managers to evaluate
staff, effective systems provide step-bystep guidance and standardized
evaluation forms for all managers to
evaluate all employees. This not only
lends to consistency, but also allows the
results of the evaluations overall to be
reviewed and compared to identify areas
of strength and areas where there may be
opportunities for improvement. Making
the process as easy as possible for
managers to follow will help ensure that
performance appraisal is effective.

Communication - Communicating the

performance appraisal process, not only
to new managers but on an ongoing
basis, can help remind all supervisors that
the process exists, what it is, how it works
and where to get advice and assistance if
needed. In addition, business leaders and
human resources staff should make sure
managers and supervisors understand
why performance appraisal is important-to employees, managers and the
organization.

Is part of an organizations overall

performance management system.
Performance Appraisals: are regular
evaluations of employees job
performance.
They are used to grade employee
performance according to the
employees expectations, foster twoway communications between
employees and supervisors and
establish attainable goals for
organizational and individual success.

Consequences for failure to correct the Performance Appraisal Process

- Performance Appraisal is an organizational
problem should be stated and the
employee should be told.
system comprising deliberate processes for
Note : if the employee will not agree upon
determining staff accomplishments to
the steps required to improve performance,
improve staff effectiveness
this must be noted by the manager and
compliance with performance standards
Rationale for Policy on Performance Appraisal
will be mandated.
- Can be viewed as the process of assessing
and recording staff performance for the
purpose of making judgments about staff that
DURATIONS OF STEPS
lead to decisions.

OBJECTIVES FO PERFORMANCE
APPRAISAL (MOHMAN, RESNICK-WEST
AND LAWCER,1989)

Steps 3 : FINAL WARNING

Step 1: ORAL REMINDER

The employee will be asked to commit to

correcting the performance problem
and will be told that this is an ORAL
WARNING.

differing degrees in determining job

expectations, writing job descriptions, selecting
relevant appraisal criteria developing
assessment tools and procedures, and
collecting interpreting, and reporting results.

FHTH

Training - Supervisors and managers

automatically know how to conduct
performance appraisals. In addition,
processes and philosophies at companies
differ, so training and education is critical.
Training should take place regularly to
provide refreshers and updates on any
changes to the process or the evaluation
forms.
Evaluation of Results - While
performance appraisal generally focuses
on one individual, looking at the
aggregated results of performance
appraisals can tell a company a lot about
the general level of performance of its
staff, areas where there may be training
or development needs and trends within
and between departments.
Follow-Up and Performance
Improvement - The greatest affect on
performance appraisal effectiveness is
how the business uses the results.
Employees both individually and across
the organization should use the appraisal
system as a tool to improve performance.
STEPS AND RATIONALE
FOR PERFORMANCE IMPROVEMENT

I. PROBLEM RECOGNITION / ASSESSMENT

1. Identify current turnover rate.
Rationale: Identifying the turnover rate helps a
facility determine areas for improving staff stability,
and provides a benchmark for developing a quality
improvement action plan.
II. CAUSE IDENTIFICATION
2. Seek and identify causes underlying staff
turnover.
Rationale: Identifying trends, patterns, and
causes can help alert the facility to readily address
issues that may be resolved with simple
approaches, as well as helping to identify other
cause-specific interventions.
III. MANAGEMENT
3. Identify goals for improving turnover rates.
Rationale: Goal setting allows the facility to
envision potential achievements through their
quality improvement efforts.
4. Develop an action plan to address causes
and attain identified goals.
Rationale: An action plan provides a roadmap to
meeting goals.
5. Implement the action plan.
Rationale: The success of the plan depends on
various factors, including understanding by
involved parties and the support given to making
definitive changes in work environment, work flow,
care processes, etc.
IV. MONITORING
6. Evaluate the implementation of the action
plan.
Rationale: Evaluation of the progress of
implementation allows the facility to determine if
they are on the right track or need to take a
different path to try to meet their goal.
7. Update and revise the action plan as
indicated by the evaluation process.

Rationale: Positive changes need continuing

support in order to be sustained.
8. Determine ongoing methods of monitoring
the satisfaction and needs of staff.
Rationale: Sustained improvement requires
monitoring both results and the status of
processes and issues that influence those results.

7.

Feedback to practitioners is essential to

improve practice. It perpetuates good
performance and replaces unsatisfactory
interventions with more effective
methods.

8.

Peer pressure provides the impetus

effect prescribed changes based on the
results of assessment and needed
improvements on the quality of care.

9.

Reorganization in the formal

organizational structure may be required
if assessment reveals the need for a
different pattern of health care.

QUALITY ASSURANCE
Quality Circle - a participatory management
technique that enlists the help of employees in
solving problems related to their own job
Quality - is the degree of excellence and
assurance means formal guarantee of a degree
of excellence; Gives people with different
functions in the organization a common
language for improvement.
Assurance - Means achieving a sense of
accomplishment and implies a guarantee of
excellence

Quality Assurance
- Achieving a sense of accomplishment and implies
a guarantee of excellence
- Process of evaluation that is applied to the health
care system and the provision of health care
services by health workers.
- It promotes collegial and sharing relationships
among workers instead of a feeling of threat
when observed and evaluated
Total Quality Management - a way to ensure
customer satisfaction by involving all
employees in the improvement of the quality of
every product or service.
Continuous Quality Improvement - process of
continuously improving a system by gathering
data or performance and using multidisciplinary team to analyze the system, collect
measurements, and propose changes.
Principles Underlying
Quality Assurance Efforts
1.

All health professionals should

collaborate in the effort to measure and
improve care.

2.

Coordination is essential in planning a

comprehensive quality assurance
program.

3.

Resource expenditure for quality

assurance activities is appropriate.

4.

There should be focus on critical factors

such as functions and activities that
promise to yield the greatest help and
financial benefit to reveal significant
findings.

5.

Quality patient care is accurately

evaluated through adequate
documentation.

6.

The ability to achieve nursing objectives

depends upon the optimal functioning of
the entire nursing process and its
effective monitoring.
TQM

10. Collection and analysis of data should

be utilized to motivate remedial action.
Nursing Audit Committee - Composed of a
representative from all levels of the nursing staff:

Member of the
Training staff

Supervising Nurse

Head/Senior Nurse

Staff Nurse
PATIENT CARE AUDITS
A concurrent audit is one in which patient care is
observed and evaluated.
It is given through:

A review of the patients charts

while the patients are still confined in the
hospital.

Observation of the staff as

patient care is given

Inspection of patients and/or

observation of the effects of patient care
where the focus is on the patient.
A retrospective audit is one in which patient care
is evaluated through:

A review of discharged
patients charts

Questionnaires sent to or
interviews conducted on discharged patient
Peer Review - Patient care audits maybe done by
peers evaluating anothers job performance
against accepted standards
Quality Circles - A group of workers doing similar
work who meet regularly and voluntarily on normal
working time, under the leadership of their
supervisor to identify, analyze and solve workrelated problems and to recommend solutions to
management.
Utilization of Results - The Nursing Staff in the
unit is given a feedback on the results of the
quality assurance study.
POSITIVE FEEDBACK reinforces desirable
performance.
NEGATIVE FEEDBACK should tactfully be
conveyed in a face-to-face solution so that
assessment results may easily be clarified.

TOTAL QUALITY MANAGEMENT

IMPLEMENTATION STEPS
FHTH

6
Define the Problem - Identification of the
problem to be address by the health care
team.
Develop New Strategic Thinking - Utilizing
brainstorming and brain writing strategies as
effective tools for the development of the
solution to the problem.
Know The Stakeholder - Focuses on the
clients and their expectations to meet their
health care needs by doing a survey,
interviews and gathering of data

Determine Quality Requirements - Result of

your survey will give you a description what is
the need of the client and expectations. This
will be helpful to determine quality

Reduce Variations - Set of tools to reduce

variation in quality of the product and to
optimize used of project resources and to
minimize quality deficiencies.

Plan For Contingency - Plan for contingency

and develop risk response strategy to manage
potential threats and uncertainties the
surrounds your project.

Balance The Approach - The implementation

should run smoothly should not lack of
resources and continuous monitor and tracking
of project is needed.

Reduce Waste - Minimize waste of resources

and reduce a source of waste.
Develop A Continuous Improvement
Strategy - Ensure the process with multiple
iterations and buffers.

TQM

Apply The Improvement Process - The use

of the improvement process in every facet of
project to start improving the quality of project.

FHTH