RF8-CONTROLLING , for leadership and management nursing

For knowledge

2. DEFINITION:
∞ It is the management function in which performance is measured and
corrective action is taken to ensure the accomplishment of organizational
goal
∞ It is assessing/regulating performance in accordance with the plans that
have been adopted, the instruction issued and the principles established.

∞ (Peter Drucker) – The management function that aims to keep activities
directed in such a way that desired results are achieved.
∞ It aims to verify whether activities and performances of employees are in
conformity with the adopted plans, principles, and practices.
IT is also known as EVALUATING and it is an ongoing function of
the management which occurs during planning, organizing and
directing activities.
IT plays an important role in identifying opportunities for
improvement, comparing performances against set standards and
providing information about how well people are doing, so that they can be
motivated to perform better in the future.

3. The control process can be expressed in a formula:
Ss + Sa + F + C = I
Standard set + Standard applied + Feedback + Correction will yield
Improvement
OBJECTS OF CONTROL
•Control is always performed in relation to something like the following:
1.FUNCTIONS
Specific or assigned duties in the performance of a given task
2. PROCEDURES
These are established as the prescribed way of doing something is a
business

3. STRUCTURES
These are the activities in various units or departments of business
organizations are observed, supervised and made subject to control in the
light of company objectives

4. 4. PERSONNEL
It includes the performance of the work force as well as their behavior
5. RESOURCES
These would include objects, machines, and materials
Reasons for conducting Evaluation:
1.Ensures quality nursing care is provided
2.Sets sensible objectives and comply with them
3.Provides standards for establishing comparisons
4.Provides visibility and a means for employees to monitor their own
performance
5.Highlights quality problems related to quality care and determined the
areas that require priority attention
6.Gives an indication of the costs of poor quality
7.Justify the use of resources
8.Provides feedback for improvement

5. Characteristics of an Evaluation tool
1.Objective – free from bias
2.Reliable – refers to the accuracy or precision of the tool that if
administered twice, will produce the same results
3. Validity – relevancy of the measurement to the performance of the
employee
4. Sensitive – ability to measure the fine lines of differences among the
criteria being measured
BASIC COMPONENTS OF THE CONTROL PROCESS
1.Establishing standards for measuring performance
**STANDARDS – are desirable sets of conditions and performance
essential in ensuring quality of nursing care services
There are 3 types of Standard structure:
a.Structure Standards
Focus on the structure or management system used by the agency to deliver
care which includes the number and categories of nursing personnel, their
education, personal and professional qualities and proficiencies, their function
and physical facilities and equipment.

6. b. Process Standards
Refers to decisions and actions of the nurse relative to the nursing
process, which are necessary to provide good nursing care.
c. Outcome standards
Are designed to measure the results of care provided in terms of change in
health status of clients served, change in the level of their knowledge, skills
and attitudes and satisfaction of those served including the members of
nursing / health team.
2. Establishing Objectives and methods for measuring performance
The establishment of the objectives provides clear direction and
communication of expected levels of achievement.
The most common used method for measuring nursing care are:
a.TASK ANALYSIS
Actions and procedures such as written guides, schedules, rules, records
and budgets are inspected.
b. QUALITY CONTROL
Activities and techniques are employed to achieve and maintain the quality
of a product, service or process.

7. 3. Measuring actual performance
It is ongoing, repetitive process with the actual frequency dependent on the
type of activity being measured.
4. Comparing results of performance with standards and objectives
If performance matches standards and objectives, managers are assured
that the needs of patients are being met, otherwise, necessary actions is
needed.
5. Reinforcing strengths or successes and taking corrective action as
necessary
Positive feedback stimulates motivation, consistently high performance and
growth of employee. Corrective actions are applied to improve performance.
RESPONSIBILITY OF HEAD / SENIOR NURSE
1.Instruct subordinates in the appropriate methods and procedures in
providing nursing care
2.Inform likely causes of errors or defects and the preventive measures
necessary
3.Initiate and / or facilitate any steps necessary to improve methods,
equipments, materials and conditions in the work area for which they are
responsible.

9. A.PERFORMANCE APPRAISAL
It is the control process in which employees performance is evaluated
against standards.
It is the most valuable tool in controlling human resources and
productivity
Reflect how will the person have performed during or at a specific
period of time.
METHODS OF MEASURING PERFORMANCE
a.INFORMAL APPRAISAL
Incidental observation of performance while worker engaged in
performing nursing care or by responses made by the worker during
conferences, as well as, interacting with clients, their families, visitors,
and co-workers.
b. FORMAL APPRAISAL
Accomplished regularly and methodically by collecting objective facts
that can demonstrate the difference between what is expected and
what was done. These methods would include:
1.ESSAY
Appraiser writes a paragraph or more about the worker’s strengths,
weaknesses and potentials

10. 2. CHECKLISTS
A compilation of all nursing performances expected of a worker
3. RANKING
Evaluator ranks the employees according to how she/he fared with co-
workers with respect to certain aspects of performances or qualifications.
4. RATING SCALES
It includes series of items representing the different tasks or activities in
the nurse’s job description or the absence or presence of desired behaviors
and the extent to which these are possessed.
5. FORCED-CHOICE COMPARISON
Evaluator is asked to choose the statement that best describes the nurse
being evaluated.
6. ANECDOTAL RECORDING
It describes the nurse’s experience with a group or person, or in validating
technical skills and interpersonal relationship.

11. B. QUALITY ASSURANCE
“Quality” – degree of excellence
“Assurance” – formal guarantee of a degree of excellence
•It is the estimation of the degree of excellence in patient health outcomes
and in activity and other resource outcomes.
•(Williamson) It is the measurement of the actual level of service provided
plus the efforts to modify when necessary the provisions of these services
in light of the results of such measurement
•It assures patients that an acceptable standards or care will be provided to
them.
QUALITY ASSURANCE vs PERFORMANCE EVALUATION
Performance Evaluation
Focuses on the worker, it shows how well the worker satisfies the
requirement of his / her job within the organization
Quality assurance
Focuses on the care and service the patient receives than on how well the
professional performs the duties that the position requires

12. DEVEOPING QUALITY ASSURANCE CRITERIA
Common approaches to evaluation
a.Structure approach
This include physical setting, instrumentalities and conditions through which
nursing care is given
b. Process approach
This includes steps in the nursing process in compliance with established
standards of nursing practice.
c. Outcome approach
It identifies desirable changes in the patient’s health status.
QUALITY ASSURANCE METHODS
Purpose of QA programs in nursing is to measure and improve the quality of
nursing delivered in the agency.
NURSING AUDIT COMMITTEE
It is composed of all levels of nursing staff – Training staff, Supervising
nurse, Head-senior nurse, and a staff nurse.

13. 1.PATIENT CARE AUDITS
a.Concurrent audit
Patient care is observed and evaluated. It is given through:
•Review of patient’s chart while still admitted
•Observation of staff as patient care is given
•Inspection of patient and / or observation of the effects of patient care
where the focus is on the patient. This is done during rounds or patient
interview.
b. Retrospective audit
Patient care is evaluated through:
•Review of discharged patient’s chart
•Questionnaire sent to or interviews conducted on discharged patients
2. PEER REVIEW
Patient care audit maybe done by peers, evaluating another’s job
performance against accepted standards.
3. QUALITY CIRCLES
Introduced by the Japanese
It is a group of workers doing similar work who meet regularly, voluntarily,
on normal working time, under the leadership of their supervisor, to identify,
analyze and solve work-related problems and to recommend solutions to
management

14. C. CONTROL OF RESOURCES
Periodic review of the utilization of materials and supplies in various
nursing units
•Consumptions of supplies and materials should be proportionate to the
number of patients served (dressings, treatments done, injections, etc.)
•Requisition of stocks, HN must know the average daily usage and time
required to receive the supplies.
•Inventory of supplies, ordering correct materials to prevent overstocking
items not frequently
•Equipment utilization report including frequency of breakdown, to evaluate
the quality of equipment purchased, what it is handled, used or operated.
•Preventive maintenance, regular inspection of equipments
•Absence of staffs
D. DISCIPLINE
> It is an employer’s action against and employee for violation of company
policies or rules. It connotes rigid obedience to rules and regulation, the
violation of which results to punitive actions.

15. General guidelines:
1.Be sure of the facts
2.Listen
3.Control your feelings
4.Avoid entrapment
5.Keep records
6.Know your authority
7.Keep others advised
DISCIPLINARY APPROACHES
Develop a sound disciplinary program tailored to the objectives of the
institution / organization. These should include:
1.A set of disciplinary policies and procedures
2.Uniform application of disciplinary rules
3.A disciplinary committee
4.An orientation program for all new employees where expectations of
appropriate performance and behavior emphasized
DISCIPLINARY ACTIONS
Discipline is something to use to help correct behavior that interferes
with the work group achieving its purpose in an orderly manner. It is a
rational action taken by you – not an emotional reaction.

16. •When working with a discipline problem, use the idea of progressive
discipline. It is based on the principle that a person is entitled to an
opportunity to improve. These steps are as follows:
1.Counseling and oral warning
2.Written warning
3.Suspension
4.Dismissal
•Today, discipline is regarded as a constructive and effective means by which
employees take personal responsibility for their own performance and
behavior. This is termed as self discipline.
Factors influencing self discipline:
1.Strong commitment to the vision, philosophy, goals and objectives of the
institution.
2.Laws that govern the practice of all professionals and their respective
Codes of conduct.