IDENTIFY THE PROBLEMS OF THE

SPECIALITY UNITS TO DEVELOP

PLAN OF ACTION BY USING
PROBLEM SOLVING APPRAOACH

Submitted To Submitted By

Mrs.R.Anitha Ms.B.Blessy Madhuri

Lecturer Msc nursing IIndYr

Government College Government College

of Nursing of Nursing
 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 MATERNAL AND 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
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
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
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.