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ELECTIVE II.

• A WORKFORCE USING PDCA CREATES A CULTURE OF


PROBLEM SOLVERS USING PDCA AND CREATING A CULTURE
1. Republic Act No. 9173 "Philippine Nursing Act of 2002." OF CRITICAL THINKERS

AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, WALTER SHEWHART - DISCUSSED THE CONCEPT OF THE CONTINUOUS
REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE IMPROVEMENT CYCLE (PLAN DO CHECK ACT) IN HIS 1939 BOOK,
KNOWN AS "THE PHILIPPINE NURSING ACT OF 1991" AND FOR OTHER "STATISTICAL METHOD FROM THE VIEWPOINT OF QUALITY CONTROL“
PURPOSES
W. EDWARDS DEMING - MODIFIED AND POPULARIZED THE SHEWART
Section 2. Declaration of Policy. – It is hereby declared the policy of CYCLE (PDCA) TO WHAT IS NOW REFERRED TO AS THE DEMING CYCLE
the State to assume responsibility for the protection and improvement (PLAN, DO, STUDY, ACT).
of the nursing profession by instituting measures that will result in
relevant nursing education, humane working conditions, better HE IS CONSIDERED TO BE THE FATHER OF QUALITY CONTROL.
career prospects and a dignified existence for our nurses. The State
hereby guarantees the delivery of quality basic health services PDCA SOLVING CYCLE – involve customers satisfaction
through an adequate nursing personnel system throughout the
country.

2. BON Res. # 220 s. 2004 – Promulgation of the Code of Ethics for


Registered Nurses (amended code of ethics for nurses)

PL
T I NVESTIGATE
C

A
CORRECT &
Preamble: A STANDARDISE DETERMINE NEEDS

N
Sec. 1 – Health is a fundamental right of the individual (4-fold  REVIEW FEEDBACK &  DIAGNOSTIC:
responsibilities & if not possible assistance towards a peaceful death MAKE CORRECTIONS  REVIEW CURRENT
PRACTICES.
 STANDARDISE DO,
CHECK, ACT  BENCHMARKING:
Sec 2 – Nurses have to gain knowledge & understanding of man’s  SUMMARISE AND
COMPARE BEST
cultural, social, spiritual, psychological, & ecological aspects of illness PRACTICES.

utilizing the therapeutic process. EVALUATE & VALIDATE ENLIGHTEN &


IMPLEMENT
 PILOT TRAINING
Sec. 3 – The desire for respect & confidence of clientele, colleagues, PROGRAM  DEFINE
RESPONSIBILITIES:
co-workers, & the members of the community provide the incentive  FEEDBACK WHY, WHAT & HOW

to attain & maintain the highest possible degree of ethical conduct.  RECOGNITION.
RECOGNISE THE

C
CONTRIBUTION OF

O
H
Article II - Registered Nurses and People (Service to Others)
OTHERS.

EC
1. Values, customs & spiritual beliefs held by the individual shall D
2.
be represented
Individual freedom to make rational & unconstrained decision shall
K
be respected. PROBLEM SOLVING PROCESS
3. Personal information acquired in the process of giving nursing care
shall be in strict confidence.  PLAN-ESTABLISH THE OBJECTIVES AND PROCESSES
NECESSARY TO DELIVER RESULTS IN ACCORDANCE WITH THE
Article III – Registered Nurse and Practice (Integrity and Objectivity) EXPECTED OUTPUT
1. Human life is inviolable
2. Quality & excellence in the care of the patients are the goals of • STEP 1 : IDENTIFY THE PROBLEM
nursing practice
3. Accurate documentation of actions & outcomes of delivered care is • STEP 2: ANALYZE THE PROBLEM
the hallmark of nursing accountability
4. RN’s are the advocate of the patients: they shall take appropriate  DO -IMPLEMENT THE PLANE, EXECUTE THE PROCESS, MAKE
steps to safeguard their rights & privileges. THE PRODUCT. COLLECT DATA FOR CHARTING AND ANALYSIS
5. RN’s are aware that their actions have professional, moral & legal
dimensions. They strive to perform their work in the best interest of all • STEP 3: DEVELOP SOLUTIONS
concerned.
• STEP 4: IMPLEMENT A SOLUTION
Article IV – Registered Nurses and Co-Workers (Solidarity and Teamwork)
1. The RN is in solidarity with other members of the health care team in  CHECK-STUDY THE ACTUAL RESULTS AND COMPARE AGAINST
working for the patient’s best interest. THE EXPECTED RESULTS TO ASCERTAIN ANY DIFFERENCES
2. The RN maintains collegial & collaborative working relationship with
colleagues & other health care providers. • STEP 5: EVALUATE THE RESULTS
Article V – RN, Society and Environment (Social and Civic Responsibility) • DO YOU ACHIEVE YOUR DESIRED GOAL?
1. The preservation of life, respect for human rights & promotion of a  ACT-REQUEST CORRECTIVE ACTIONS ON SIGNIFICANT
healthy environment shall be a commitment of a RN DIFFERENCES BETWEEN ACTUAL AND PLANNED RESULTS.
2. The establishment of linkages w/ the public in promoting local, ANALYSE THE DIFFERENCES TO DETERMINE THEIR ROOT CAUSE.
national & international efforts to meet health & social needs of the
people as a contributing member of society is a noble concern of a
• STEP 6: STANDARDIZE THE SOLUTION
RN
REMINDERS
Article VI – RN and the Profession (Professional Competence; Global
Competitiveness; Equality of all Professions)
• PROBLEMS CAN STEM FROM OVER PLANNING OR UNDER
1. Maintenance of loyalty to the nursing profession & preservation of its
PLANNING—IMPORTANT TO FIND THE RIGHT PDCA BALANCE -
integrity are ideal
IT MAY TAKE A DECADE TO LEARN TO “PLAN,” AND/OR A
2. Compliance w/ the by-laws of the PNA, & other professional
DECADE TO LEARN TO “DO”
organizations of w/c the RN is a member is a lofty duty
3. Commitment to continual learning and active participation in the
• CONSTRAINED RESOURCES CAN LEAD TO A LOT OF DOING,
development & growth of the profession are commendable
AND NOT MUCH ELSE
obligations
4. Contribution to the improvement of the socio-economic conditions
• DOCUMENTATION IS KEY TO PDCA, SO THAT KNOWLEDGE
& general welfare of nurses through appropriate legislation is a
CAN BE RECORDED AND INTERNALIZED
practice & visionary mission.

The Plan-Do-Check-Act (PDCA) Cycle


a.k.a. Continuous Improvement Cycle Also called: PDCA, plan–do–study–act (PDSA) cycle, Deming cycle,
Shewhart cycle
• PDCA WAS POPULARIZED BY W EDWARDS DEMING IN THE
1950’S AS AN EASY TO FOLLOW PROBLEM SOLVING CYCLE The plan–do–check–act cycle (Figure 1) is a four–step model for
carrying out change. Just as a circle has no end, the PDCA cycle
• THE CONCEPT OF PDCA IS BASED ON THE SCIENTIFIC should be repeated again and again for continuous improvement.
METHOD WRITTEN AS “HYPOTHESIS-EXPERIMENT-EVALUATION”

• REPEATING THE PDCA CYCLE CAN BRING US CLOSER TO THE When to Use Plan–Do–Check–Act
GOAL, USUALLY A PERFECT OPERATION AND OUTPUT
 As a model for continuous improvement.
 When starting a new improvement project. teaching goals. Within set parameters, teachers vary the delivery of
 When developing a new or improved design of a process, product instruction based on each student’s learning rates and styles and
varying teaching methods.
or service.
 When defining a repetitive work process.
 When planning data collection and analysis in order to verify and Check. The “check” step is called “assess” in this example. Formal
prioritize problems or root causes. and informal assessments take place continually, from daily teacher
“dipstick” assessments to every-six-weeks progress reports to annual
 When implementing any change. standardized tests. Teachers also can access comparative data on
the electronic database to identify trends. High-need students are
Plan–Do–Check–Act Procedure monitored by a special child study team.

1. Plan. Recognize an opportunity and plan a change. Throughout the school year, if assessments show students are not
2. Do. Test the change. Carry out a small-scale study. learning as expected, mid-course corrections are made such as re-
3. Check. Review the test, analyze the results and identify what you’ve instruction, changing teaching methods and more direct teacher
learned. mentoring. Assessment data become input for the next step in the
4. Act. Take action based on what you learned in the study step: If the cycle.
change did not work, go through the cycle again with a different
plan. If you were successful, incorporate what you learned from the Act. In this example the “act” step is called “standardize.” When
test into wider changes. Use what you learned to plan new goals are met, the curriculum design and teaching methods are
improvements, beginning the cycle again. considered standardized. Teachers share best practices in formal
and informal settings. Results from this cycle become input for the
Plan–Do–Check–Act Example “analyze” phase of the next A+ cycle.

The Pearl River, NY School District, a 2001 recipient of the Malcolm Excerpted from Nancy R. Tague’s The Quality Toolbox, Second
Baldrige National Quality Award, uses the PDCA cycle as a model for Edition, ASQ Quality Press, 2004, pages 390-392.
defining most of their work processes, from the boardroom to the
classroom.

PDCA is the basic structure for the district’s overall strategic planning, TOTAL QUALITY MANAGEMENT
needs–analysis, curriculum design and delivery, staff goal-setting and
evaluation, provision of student services and support services, and is defined as a continuous effort by the management as well as
classroom instruction. employees of a particular organization to ensure long term customer
loyalty and customer satisfaction.
Figure 2 shows their “A+ Approach to Classroom Success.” This is a
continuous cycle of designing curriculum and delivering classroom Total Quality management is indeed a joint effort of management,
instruction. Improvement is not a separate activity: It is built into the staff members, workforce, suppliers in order to meet and exceed
work process. customer satisfaction level.

Total quality management ensures that every single employee is


working towards the improvement of work culture, processes,
services, systems and so on to ensure long term success.

Total Quality management enables employees to focus on quality


than quantity and strive hard to excel in whatever they

THE DOCUMENTATION-EVALUATION-ACTION TREND

A. DOCUMENTATION

What is documentation?
Figure 2: Plan–do–check–act example
 It is the proper, systematic and permanent recording of
Plan. The A+ Approach begins with a “plan” step called “analyze.” In information
this step, students’ needs are analyzed by examining a range of data  It is an organized way of documenting data as per time
available in Pearl River’s electronic data “warehouse,” from grades place, circumstances, and attribution
to performance on standardized tests. Data can be analyzed for  Nursing documentation serves many diverse, complex and
individual students or stratified by grade, gender or any other important functions from ensuring consistency of clinical
subgroup. Because PDCA does not specify how to analyze data, a care and good communication between practitioners, to
separate data analysis process (Figure 3) is used here as well as in providing evidence in a court of law that patients have
other processes throughout the organization. received appropriate, high-quality, evidence-based care

Important concepts that play a role in documentation:

 Safety. In documentation, safety is to provide care for the


client and to yourself by means of recording all the
assessments, planning, actions, and the interventions you’ve
done with the client.

 Consistency of purpose. Recording all the assessment,


planning, implementation, and other procedures done with
the client, from the diagnosis to prognosis.

 Standardization. Using the standard way of recording all the


data gathered for the patient’s care and all the procedures
Figure 3: Pearl River: analysis process done to him/her

Do. The A+ Approach continues with two “do” steps:  Improvement. Assessing whether the client’s condition has
improved with all the interventions done to him/her to meet
1. “Align” asks what national and state standards require and how they your goal.
will be assessed. Teaching staff also plans curriculum by looking at
what is taught at earlier and later grade levels and in other
disciplines to assure a clear continuity of instruction throughout the B. EVALUATION
student’s schooling. Teachers develop individual goals to improve
their instruction where the “analyze” step showed any gaps. Reflection and Analysis:
2. The second “do” step is, in this example, called “act.” This is where
instruction is actually provided, following the curriculum and
 It is instrument is designed to assess learning progress and BOARD OF NURSING
behavioral change through analysis of written statements
in reflection papers. The open-ended nature of the writing Board Resolution No. 220
is intended to encourage self-directed reflection and
expression of both feelings and thoughts. Series of 2004
 Examining the activity or event for trends and patterns and
for evidence of teacher or student strengths and
weaknesses are the key element of analysis. The analysis PROMULGATION OF THE CODE OF ETHICS FOR REGISTERED NURSES
has to include reflection on the intended learning
outcomes of the lesson and the real outcomes of it. It has WHEREAS, the Board of Nursing has the power to
to show the essential strengths and weaknesses of the promulgate a Code of Ethics for Registered Nurses
lesson, as well as a reflection on what can be done to in coordination and consultation with the
improve the delivery of the lesson and the learning accredited professional organization (Sec. 9, (g),
outcomes. Art. III of R.A. No. 9173, known as the “Philippine
Nursing Act of 2002);
To achieve these goals the analysis has to answer to the following
questions: WHEREAS, in the formulation of the Code of Ethics for
Registered Nurses, the Code of Good Governance
for the Professions in the Philippines was utilized as
 What were the essential strengths and weaknesses of the the prinicipal basis therefor: All the principles under
lesson? the said Code were adopted and integrated into
 What specifically might have been changed to improve the the Code of Ethics as they apply to the nursing
delivery of the lesson? profession;
 What specifically might have been changed to improve the
learning outcomes? WHEREAS, the promulgation of the said Code as a set of
 What were the unintended and unanticipated learning guidelines, regulations or measures shall be subject
outcomes of the lesson? to approval by the Commission (Sec. 9, Art. II of
 What factors negatively or positively affected the success of R.A. No. 9173); and
the lesson?
 What specifically was learned as a result of developing, WHEREAS, the Board, after consultation on October 23, 2003
planning and teaching this lesson? at Iloilo City with the accredited professional
 Why is this experience significant in order to become an organization of registered nurses, the Philippine
effective teacher? Nurses Association, Inc (PNA), and other affiliate
organizations of Registered Nurses, decided to
This type of analysis requires in-depth, honest self-appraisal and adopt a new Code of Ethics under the afore-
focused introspection. mentioned new Law;

Integrative: NOW, THEREFORE, the Board hereby resolved, as it now


resolves, to promulgate the hereunder Code of
Ethics for Registered Nurses:
 A learning theory describing a movement toward
integrated lessons in helping students make connections ARTICLE I
across curricula. This higher education concept is distinct
from the elementary and high school "integrated PREAMBLE
curriculum" movement.
SECTION1. Health is a fundamental right of every individual.
 Integrative Learning comes in many varieties: connecting The Filipino registered nurse,
skills and knowledge from multiple sources and experiences;
applying skills and practices in various settings; utilizing believing in the worth and dignity of each human being,
diverse and even contradictory points of view; and, recognizes the primary responsibility to preserve health at all
understanding issues and positions contextually. cost. This responsibility encompasses promotion of health,
prevention of illness, alleviation of suffering, and restoration
C. Action of health. However, when the foregoing are not possible,
assistance towards a peaceful death shall be his/her
obligation.

Three Levels of Organization: SECTION 2.

To assume this responsibility, registered nurses have


to gain knowledge and understanding of man’s cultural,
 Organizational Level - strategic, design/structure, and social, spiritual, physiological, psychological, and ecological
deployment of resources aspects of illness, utilizing the therapeutic process. Cultural
 Process Level - process improvement and reengineering diversity and political and socio-economic status are
interventions inherent factors to effective nursing care.
 Job/Performer Level - coaching, performance
management, and training interventions SECTION 3.

The desire for the respect and confidence of


Three Performance needs that need to be met at each level of clientele, colleagues, co-workers, and the members of the
organization: community provides the incentive to attain and maintain
the highest possible degree of ethical conduct.

 Goals - specific standards or expectations that customers


have for products or services a. know the definition and scope of nursing
 Design - configurations that enables goals to be met practice which are in the provisions of R.
efficiently A. No. 9173, known as the “Philippine
 Management - practices that ensure goals are up-to-date Nursing Act of 2002” and Board Res. No.
and are achieved 425, Series of 2003, the “Rules and
Regulations Implementing the Philippine
Nursing Act. of 2002”, (the IRR).
 Combining the three levels of organizations with the three
performance needs results in nine performance variables.
Failure to manage these nine performance variables will b. be aware of their duties and
lead to a failure to manage the business holistically. Thus, responsibilities in the practice of their
every performance improvement effort must be viewed profession as defined in the “Philippine
through this matrix. Nursing Act of 2002” and the IRR.
c. acquire and develop the necessary
competence in knowledge, skills, and
attitudes to effectively render
appropriate nursing services through
varied learning situations.