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NURSING MANAGEMENT

PRACTICAL TOPIC ON
IDENTIFY THE PROBLEMS OF
THE SPECIALITY UNITS TO
DEVELOP PLAN OF ACTION BY
USING PROBLEM SOLVING
APPRAOACH

Submitted to Submitted by

Mrs. G. Kamala G.Sravanthi

Assistant Professor Msc nursing IIndYR

Mrs. Jyothi GCON

Lecturer

GCON
General Objectives:

By the end of the session the group will be able to understand how to
develop a plan of action for child health nursing and community departments by
using problem solving approach.

Specific Objectives:

 Define the problem solving


 Identify the problems in Child Health nursing Department
 Identify the problem in Community Health Nursing Department
 Make a plan of Action according to the problem
PROBLEM SOLVING

INTRODUCTION

Problem solving is a mental process and is part of the larger problem process that
includes problem finding and problem shaping. Considered the most complex of
all intellectual functions, problem solving has been defined as higher-order
cognitive process that requires the modulation and control of more routine or
fundamental skills. Problem solving occurs when an organism or an artificial
intelligence system needs to move from a given state to a desired goal state.

DEFINITION

A nurse manger’s most effective leadership skill is problem solving ability. A


problem is a situation for which an individual has no ready response in her or his
behavioral repertoire. An optimist might see a problem as a poorly defined
opportunity for improvement in a situation. Although a problem is a provocative
situation for which a person has no ready response, the problem’s solution need not
consist of wholly new knowledge, skills, or attitudes. Often, an effective problem
solution is merely a new combination of existing ideas and abilities.

Or

At this point, one may be wondering about the relationship between decision-
making and problem-solving. The first step in decision-making was to identify the
problem. But problem-solving can involve the making of several decisions. The
best way to define the relationship between the two is to define the steps of
problem-solving.
PRINCIPLES OF PROBLEM SOLVING

Problem solving like other managerial activities is facilitated by proper


organization. In organizing subordinates, problem-solving efforts, a manager
should observe the following principles:

 To resolve problems affecting organizational efficiency, the manager should


separate large problems from small ones, use policy to solve the smaller
problems, and conserve managerial time for solving major problems.
 The manager should delegate smaller problems to subordinates and teach
them to solve these by applying existing agency rules.
 In resolving operational problems, the manager should consult internal and
external experts, so that solutions will be based on current knowledge.
 Problem solutions are most effective when the manager approaches
problems in relaxed fashion and refuses to solve problems under stress.
 It is impossible to anticipate all eventualities or to expect 100 percent
accuracy in diagnosing and resolving problems. Therefore, it is unwise to
agonize over selecting a solution.

CHARACTERISTICS OF SKILLFUL PROBLEM-SOLVING

 In decentralizing authority for clinical decisions, a manager should delegate the


responsibility to the most capable nurses.
 Creative solutions are generated by nurses with clinical expertise, understanding of the
problem’s long-range effects and skill in symbolic expression.
 Highly creative persons are characterized by their wide range of interests and their
knowledge of several subjects. Persons with research skills are inclined to be politically
liberal, cognitively complex, and reflective.
 Nurses use different approaches to problem-solving. Some prefer a serial approach, in
which they tackle problems in sequence, completely resolving one before turning to the
next. Others survey all existing problems, rank them by importance, and solve one at a
time in order of priority. Still, others group problems according to the resources needed to
investigate and remedy each, then solve a group of related problems simultaneously.
 Creative persons become intrigued by related problems during investigation of the
primary problem and, so redesign the search to branch in several directions and work on
several problems at once, each at a different stage of resolution.

IDENTIFY THE PROBLEMS OF CHILD HEALTH NURSING UNITS

As in all areas of nursing practice, negligence involving pediatric clients is


possible. Paediatric nurses are responsible for preventing children, in their care,
from accidentally harming themselves. Cribs which sometimes have a restraining
device over the top are designed to keep infants and toddlers from climbing out of
bed and injuring themselves. All poisonous substances and sharp objects should be
kept out of the reach of children. Children should be kept under constant
surveillance to minimize opportunities for accidental harm.

It is advisable that the health care professional including nurses should report to the
concerned authority if they come across the suspected cases may be liable for civil
or criminal legal action. Every state and province with child abuse legislation
requires that suspected child abuse or neglect be reported. HealthCare
professionals such as nurses are mandated to report suspected cases. Healthcare
professionals who don‘t report suspected child abuse or neglect may be liable for
civil or criminal legal action. Paediatric nurses are responsible for protecting
children from accidently harming themselves. All poisonous substances and sharp
objects should be kept out of reach to the children. Children should be kept under
constant surveillance to minimize opportunities for accidental harm.
1. Moving from “Novice to Expert”

One of the challenges for beginning nurses is pressure to function as an expert without adequate
knowledge and skills.

Janice (2004) identified six different roles which nurses perform while they move from the sate
of being a Novice to Expert.

 The helping role


 The teaching-coaching function
 The diagnostic and monitoring function
 Effective management of rapidly changing situation
 Administering and monitoring therapeutic interventions and regimens
 Monitoring and ensuring the quality of health care practice and organizational work-role
competencies.

2. Reality shock

One problem confronted by the new graduates is the seeming impossibility of delivering quality
care within the constraints of the system as it exists. The person undergoing such stress is less
able to perceive the entire situation and to problems effectively.

3. Burnout

Burnout is a form of chronic stress related to one’s job. It can be identified by feelings of
hopelessness and powerlessness, and is accompanied by a decreased ability to function both on
the job and in personal life. Burnout is more frequent in nurses who work in particularly stressful
areas of nursing. It also occurs when staffing is inadequate or interpersonal relationships are
strained. The main causes for burnout are conflict between ideals and reality, practicing nursing
in areas that have high mortality rates, inadequate staffing, staying overtime, skipping breaks and
lunch and running throughout the shift.

4. Discrimination

Discrimination relates to treating other differently based on stereotypes about groups of


people.Discrimination may occur regarding racial or ethnic background, gender or sex, sexual
orientation and/ or age. Men in nursing have expressed concern about sex discrimination. They
are not allowed to care for women clients, or restrictions are placed on them in terms of
obtaining consent from each client. Female nurses care for men clients in all situations. This has
been accepted because women are commonly seen in nursing and the public associates
mothering role with nursing.

5. Mandatory overtime

Mandatory overtime is another way that hospitals deal with poor staffing. It creates a loss of
control for the nurse over the ability to schedule non-work activities, including essential family
functions. This also puts safe patient care at risk because of nurse’s fatigue and subsequent loss
of ability to concentrate and make good decisions.

6. Floating

Nurses are sometimes required to ‘float’ from the area in which they normally practice to another
nursing unit. It reduces nurse’s competence also affects quality nursing care.

7.Poor communication between providers.


Suggestions: The hospital has assigned a clinical nurse leader to micro-units of
around 12 beds throughout the hospital, where the CNL acts as a liaison between
physicians and patients and mentors other nurses. "[We think] this will reduce
length of stay, eliminate some rework and get better information flowing faster for
decisions to be made,". By installing a nurse leader to increase communication
between providers, she thinks patients will have a better healthcare experience with
fewer redundancies, and physicians will have a better understanding of what
happens to a patient when another provider takes over

8. Physician and nurse shortages: Sometimes we will manage the ICU’S from
taking medical ward staff. This is the major problem in our profession.
Government has to recruit more staff for Quality of care. Manpower plays a
important role in care.
9. Shortage of Equipment: Due to shortage of equipment the nurse can not give
appropriate care to the clients sometimes due to shortage of oxygen cylinders the
nurse can adjust one oxygen cylinder to many clients.

Shortage of Nebulization machines, and central supply shortages, Phototherapy


machines, Incubators this will effect on client care.

10. Water supply: Continuation of water supply should be there in wards and
Icu’s to care the clients. Some of the institutions will store the water for continuity
of care.

11. Sanitation: Sanitation plays a major role to prevent infectious rate.


Adequate staff must be present in ICU’S and wards.

12. Overcrowding: In Hospital OPD’s there may be a flowing of patients and


some of the clients may not aware of route maps in buiding, they need to show the
pathways or symbols. If possible they need to keep enquiry area to give directions
and solutions.

13. Informed consent: Granted freedom, written or oral form


(procedures, expected outcome, complication, side effects, and alternative
treatment.

14. Contracts: Exchange of promises between two parties. The agreement may
be written or oral. (E.g. patient and his family and health care team.)

15. Collective bargaining: Policies, legal procedures, up to date knowledge.


16.Competent practice: It is most important and best legal safeguard

17.Injury due to administration of wrong medicine, wrong dosage and wrong


concentration. Administration of medicine without prescription by the concerned
authority, mixing up of poisonous and non poisonous drug in cupboards leading to
errors, and failing to identify right medication for right patient, in right dosage, at
right time, considered as negligent act can be liable to be used.

18.Assault and battery: Failure to take the informed consent of the patient prior
to any procedure, treatment, investigation or operation, the nurse be held liable.
19.Failure to report accidents The nurse has a moral and legal responsibility to
report to the concerned authority any accidents, losses or unusual occurrences.
Failure to do this is an act of negligence.

20. Maintenance of records and reports Failure to maintain accurate record and
reports or removing a position of record may also make the nurse liable. Nurses
working in critical care units are also legally accountable for performing their
duties. Critical care nurses require additional training and ongoing intensive
education to provide them with information about advances in care methods to
handle high- tech- machines and electric and electronic apparatus in addition to
other critical care nursing measures. The possible legal problems for critical care
nurses are associated with use of electronic monitoring devices. No monitor can be
considered totally reliable and nurse must not completely depend on it. These may
be electrical hazards. The equipment should be checked routinely by engineers to
ensure that a patient will not receive any electrical shock.

21. Critical care units: Nurses working in critical care settings are legally
accountable for performing their duties. Critical care nurses require additional
training and ongoing in service education to provide them with information about
advances in methods of patient care. Possible legal problems for critical care
nurses are associated with the use of electronic monitoring devices. No monitor
can be considered totally reliable, and the nurse must not completely depend on it.
There may also be electrical hazards. The equipments should be checked routinely.
22. Burns The professional nurse is required to know the cause and effect of any
heat application so as to avoid burns. Some of the common heat applications are
applications, of hot water bags, heating pads, double sitz bath etc. The nurse could
be held liable if she/he neglects to take proper safety measure prior to application
of such measures.

23 Falls: The nurse could be held liable if a patient falls from the bed or due to
improper securing of patient on examination table or improper application of
restraint or provision of a proper bed for an unconscious patient or a child.

24. Problems of medication: Nurses are authorized to administration of


medication. So many allegations against nurses with regard to medication dosage,
route or time, and failure to monitor side effects,.

25. Failure in adequate client monitoring: Nurses are expected to monitor their
clients at appropriate time intervals that depend upon the client‘s condition. Nurses
have legal responsibilities regarding fetal monitoring during labour. And prompt
monitoring will be continued during natal period, postnatal period to prevent
complication related to mother and child in respective periods.

26. Failure to adequately assess the client: Every nurse regardless of the area of
practice is expected by virtue of his or her licensure to be capable of performing
assessment. The nurse is an important member of the health care team who is the
client constantly, and responsible for the minute by minute evaluation of the client
progress. Nurses in all specialty areas must maintain the higher level of assessment
skills.

27. Rights to Privacy


The nurse is responsible for keeping all patient records and personal information
private and only accessible to the immediate care providers, according to the
Health Insurance Portability and Accountability Act of 1996 (HIPAA). If records
get out or a patient's privacy is breached, the liability usually lies on the nurse
because the nurse has immediate access to the chart.

28. Document, Document, Document

It is the nurse's responsibility to make sure everything that is done in regards to a


patient's care (vital signs, specimen collections, noting what the patient is seen
doing in the room, medication administration, etc.), is documented in the chart. If it
is not documented with the proper time and what was done, the nurse can be held
liable for negative outcomes. A note of caution: if there was an error made on the
chart, cross it out with one line (so it is still legible) and note the correction and the
cause of the error.

29. Invasion of privacy Clients have claims for invasion of privacy‘, e.g. their
private affairs, with which the public has no concern, have been publicized. Clients
are entitled to confidential health care. All aspects of care should be free from
unwanted publicity or exposure to public scrutiny. The precaution should be taken
sometimes an individual right to privacy may conflict with public‘s right to
information for e.g. in case of poison case.

30. Nurse Practice Act Each state has what is called a Nurse Practice Act. The
guidelines and laws outlined in the act pertain to all nurses who are licensed in that
particular state. Nurse limitation is one of those laws. Each nurse has a limitation
on what he is allowed and trained to do. He must follow the chain of command,
especially with the care of a patient. If he does not have the authority or knowledge
to give a prescription, analyze a lab report, or advise the patient on treatment, he
may not legally do so. Any wrong information or practice he commits is
punishable by the law and the patient or family may file a suit against him and the
health agency or hospital he works for.

31. Malpractice Malpractice is a term used for negligence. Malpractice specifically


refers to negligence by a professional person with a license. You can be sued for
malpractice once you have your LPN license. If you are a nursing assistant right
now, you may be negligent, but it wouldn‘t be malpractice because you are not
licensed.

32. Fraud Few cases of fraud exist in nursing, but it does need to be mentioned.
Fraud is a deliberate deception for the purpose of personal gain and usually is
prosecuted as a crime. Most courts are harder on cases of fraud compared with
cases of negligence or malpractice because fraud is deliberate and results in
personal gain.

33. Unsatisfactory work performance and termination of employment

The Courts have time and again reiterated that employees enjoy security of tenure
of employment. The maxim "easy to hire difficult to fire" is a truism even in the
case of probationers. No employer having hired a person at considerable cost and
having exposed the person to training, formal or otherwise, will want to terminate
the person. However, when an employee has an attitude problem or whose work
performance is not up to the expectations he cannot be terminated by the employer
simply by invoking the termination clause in the employment contract. The
employer has to follow certain rules and procedures and only at the end of it can he
terminate the services of a non-performing employee
B. Physical problems:

1. Harassment and violence

Violence includes a range of behavior from verbal abuse, threats and unwanted sexual attacks to
physical assault and at the extreme, homicide. According to OSHA, two thirds of non-fatal
workplace assaults happen in health and social services facilities, the majority of these are
assaults by clients on nursing staff, and more in psychiatric mental health setting than in other
settings. The WHO has identified violence as a worldwide problem, which threatens the effective
delivery of health care (WHO 2002). Both men and women may be the objects of sexual
harassment.

Sexual harassment is a concern in nursing. Harassers in the health care workplace may be clients,
coworkers, or physicians. The most dangerous settings for violence are psychiatric units and
nursing homes, where patients are often confused, disoriented or suffering from mental ailments
as well as emergency rooms, where long waits for care can anger patients, and the people with
them.

2. Infection as an Occupational hazard

Transmission of infection is a major concern for the nurses when caring for infected clients. The
higher danger for nurses lies in those clients who have not been diagnosed as having an infection
and for whom specific infection-control measures have therefore not been prescribed.

3. Needle stick injuries

Needle stick injuries especially those with large-bore needles (e.g. bone-marrow aspiration
needles) continue to be the most frequent source of infection transmission.

4. Hazardous chemical agents

Nurses working in operation rooms should seek information regarding anaesthetic gases that can
increase the risk of foetal malformation and spontaneous abortion in pregnant women who are
exposed to them on a regular basis. Chemotherapeutic agents used in the treatment of cancer are
extremely toxic and nurses who work in setting where such agents are prepared and administered
should seek additional education regarding their administration, not only in relation to the
client’s safety but also personal safety. Contact with any medication, especially antibiotics,
during preparation and administration may cause the nurse to develop sensitivity leading to
hand-rash for example. Some medications are absorbed through the skin and may produce an
undesirable effect. Cleansing agents and disinfectants used in the hospital may also be hazardous
if used improperly.

5. Back injuries

Nursing includes providing direct care to incapacitated individuals; hence back injuries are a
common occupational hazard.

6. Bioterrorism

Most biological attacks will be covert, meaning that there will be no warning. Therefore, it is
important that nurses should know and understand what bioterrorism is and how to identify a
potential event because health care workers in hospitals and clinics may have the first
opportunity to recognize the covert event. An alert nurse can save lives, including her own.
Anthrax, botulism, plague and smallpox are considered the four top agents for potential
bioterrorism because plague and smallpox can be disseminated to a population via airborne
release.

IDENTIFY THE PROBLEMS OF COMMUNITY HEALTH NURSING UNITS

1. Not Aware of Health services and facilities

2. Not Allowing of Health care members

3. Lack of Sanitation

4. Manpower

5. Overcrowding in community leads to increase disease rate

6. Inadequate Rooms in community

7. Lack of Hygiene
8. Lack of Time

9. covering of large population

10. communication: The public health nurse communicates effectively in a variety


of formats in all areas of practice.

11. Resource utilization: The public Health Nurse utilizes appropriate resources to
plan and provide nursing and public health services that are safe, effective, and
financially responsible.

12. Collaboration: The public Health nurse collaborates with the population and
others in the conduct of nursing practice

13. Assessment The public health nurse collects comprehensive data pertinent to
the health status of populations.

14. Population Diagnosis and Priorities The public health nurse analyzes the
assessment data to determine the diagnoses or issues.

15. Outcomes Identification The public health nurse identifies expected outcomes
for a plan specific to the population or situation.

16. Planning The public health nurse develops a plan that prescribes strategies
and alternatives to attain expected outcomes.

17. Implementation The public health nurse implements the identified plan.

18. Coordination of Care The public health nurse coordinates care delivery.

19. Health Teaching and Health Promotion The public health nurse employs
multiple strategies to promote health and a safe environment.
20. Consultation The public health nurse provides consultation to influence the
identified plan, enhance the abilities of others, and effect change.

21. Regulatory Activities The public health nurse participates in applications of


public health laws, regulations, and policies.

22. Evaluation The public health nurse evaluates progress toward attainment of
outcomes.

23. Ethics The public health nurse practices ethically.

24. Education The public health nurse attains knowledge and competence that
reflect current nursing practice.

25. Evidence-Based Practice and Research The public health nurse integrates
evidence and research findings into practice.

26. Quality of Practice The public health nurse contributes to quality nursing
practice.

27. Leadership The public health nurse demonstrates leadership in the professional
practice setting and the profession.

28. Professional Practice Evaluation The public health nurse evaluates his or her
own nursing practice in relation to professional practice standards and guidelines,
relevant statutes, rules, and regulations.

29. Environmental Health The public health nurse practices in an environmentally


safe, fair, and just manner.

30. Advocacy The public health nurse advocates for the protection of the health,
safety, and rights of the population.
The Seven Steps of Action Planning

We have outlined a seven-step process to assist in solving problems.

APPROACHES TO PROBLEM SOLVING

Approaches to problem solving

Desired results

Management problems

Approaches

Routine Scientific Decisional Creative Quantitative

Traditional Identify proposition Define desired results Define problem Define problem
S.O.P Acquire prelim. Observation Define problem Prepare for creativity Construct a model

Abide by superior’s State tentative solutions Draw alternatives Encourage ideas Evaluate model

Order Investigate propositions Evaluatealternatives Permit innovation Place needed constraints

using current knowledge over use of methods.

and experiments

Classify data Select best one Verify & evaluate Implement the solution

Implement the best one

Evaluate Implement Terminal solution

Tentative sol. to proposition

Adjust and state soln. to proposition

Implement

Evaluate

There are five main approaches to problem solving

1. Routine
2. Scientific
3. Decisional
4. Creative
5. Quantitative

These approaches are strategies for problem solving and any one approach may be suitable for
the given situation.

1. Routine approach

This approach deals with problem solving on traditional methods.

a. What has always been in the past, when such situation occurred? If we do it now the
same way we may succeed.
b. There is Standard Operating Procedures (SOP) in many departments of the hospital.
These SOPs tell that what should be in a particular situation. How is it done? Who does
it? When will it be done? Step by step approach to deal with the problems.
c. Another way of problem solving based on the traditional methods is, to have regards for
the superior officer’s opinion and orders. Whatever they direct, instruct or order, presume
that they are correct and follow it 100%. Such methods are of great value in medical care
setting, like where the treatment of the patient is concerned.

2. Scientific approach

The first step in this approach is to identify the problem. Second step is preliminary observation
regarding the proposed scheme. Then we have to derive solutions to the problems. With the use
of current knowledge and with controlled experiments investigate the proposition. The data so
collected are classified and analyzed. On the basis of analysis a tentative solution is drawn. The
solution so derived is implemented in that situation. After implementation it is evaluated for its
relevance.

3. Decisional approach

This is one of the most popular and also common approaches to deal with the problems. First of
all we have to state as to what is the desired result. After making definition of the problem,
various possible alternatives are sorted out then each alternative is evaluated from the point of
view of its suitability and relevance. The best alternative is selected and implemented in the
given situation. For any given situation several decisions can be made.

4. Creative approach

First step is to define the problem and decisions makers study the information, people and
facilities involved and concentrate on interactions and outputs from the inputs. Creativity and
innovations of idea is given due consideration. This method uses the ability to develop new ideas
and to implement them. The core theme is to create and apply new idea. It represents a new way
of achieving the desired result without being prejudice.

5. Quantitative approach

Problem solving is done by construction of mathematical models. First define the problem and
construct a mathematical model and derive a solution from the model. Evaluate the model as
well as the solution drawn from the model and implement the solution to solve the problem. The
computer is of great help, when the mathematics is complex and the calculations are of large
volume.

Conclusion:

In problem solving, the nurse obtains information that clarifies the nature of the problem and
suggests possible solutions. The nurse then carefully evaluates the possible solutions and chooses
the best one to implement. The situation is carefully monitored over time to ensure its initial and
continued effectiveness. The nurse may also encounter a similar problem in a different client
situation where an alternative solution is determined to be the most effective. Therefore problem-
solving for one situation contributes to the nures’s body of knowledge for problem solving in
similar situations.

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