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LEADERSHIP AND MANAGEMENT OF PORTFOLIO

Submitted by:

MUSTAFA ALI

BSN/Sp21/023

Leadership & Management

Submitted to:

Madam Aisha Parveen

May 27, 2024

Foundation University College of Nursing Islamabad

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OVERVIEW
PART 1

Patient overview:
 Total no. of patients: 17
 Average length of stay :3 to 4 days
 No. of discharges: 4
 Procedures performed in ward: cannulation, passing foley’s, arterial
line, CVP line, vitals sign

PATIENT 1
 Patient name: Sughra Bibi
 Age: 48
 Diagnosis: Hematemesis
 Admission date: 21/4/24
 Current condition: vomiting 3 days , Decreased appetite

PATIENT 2
o Patient name: Danial
o Age: 56 yrs.
o Diagnosis: Triple vessel coronary artery disease, aortic valve replacement
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o Admission date: 23/5/24

o Current condition: Bilateral edema, chest pain.

PATIENT 3
o Patient name: Muzzamil
o Age: 48 yrs.
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o Diagnosis: atrioventricular failure

o Admission date: 23/5/24
o Current condition: shortness of breath

Nursing interventions:
1. Medication administration:
• Ensure timely administration of prescribed medications.
• Monitor for any adverse reactions and report to the attending physician.

2. Vital signs monitoring:

• Regularly monitor vital signs including temperature, pulse, respiration, and blood pressure.
• Notify healthcare team of any significant changes.

3. Patient assessment:
• Conduct thorough patient assessments including neurological, cardiovascular, respiratory, gastrointestinal,
and genitourinary systems.
• Document findings accurately and report any abnormalities promptly.

4. Mobility assistance:
• Assist patients with mobility as needed to prevent complications such as pressure ulcers and deep vein
thrombosis.
• Encourage early ambulation and provide support devices as necessary.
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5. Hygiene and comfort measures:

• Ensure patients are provided with adequate hygiene and comfort measures, including assistance with
bathing, oral care, and positioning for comfort.
• Monitor and manage pain effectively.

6. Nutritional support:
• Collaborate with dieticians to ensure patients receive appropriate nutritional support based on their
dietary needs and restrictions.
• Monitor intake and output closely.
• Patient 1:

• Focus: vomiting 3 episode, decreased appetite

• interventions: perform cannulation
• Monitor vital signs
• Passing folly
• Pharmacological management: Inj avil 3ml stat
• Inj sulocurtif 100mg stat
• Inj norapression 1mg OD
• Inj Laprot
• Tab eziday 50 mg
• Inj fortexone 2g OD

Goals:
After 6 hours of nursing intervention patient will feel better and get rid of pain and feel better.
• Patient 2:

• Focus: angina ,heart failure

• interventions: perform cannulation
• Monitor vital signs
• Passing folly
• Pharmacological management: inj heparin, inj Lasix 60mg.

Goals:
After 2 hours of nursing intervention patient will feel better and get rid of pain and feel better.
• Patient 3:

• Focus: shortness of breath

• interventions: perform cannulation
• Monitor vital signs
• Passing folly
• Pharmacological management: inj Lasix 80mg, neb atem ..clenil and atem

Goals:
After 6 hours of nursing intervention patient will feel better and get rid of pain and feel better.
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Question # 2:

a) Spend a day at the nursing counter and try to deal with issues related to diet,
Pharmacy, medical treatment, nursing care and visitors’ issues and concerns.

As a nursing student, spending a day at the nursing counter can be a valuable learning experience.

Dietary Issues: You may come across patients with specific dietary needs or restrictions due to their medical
conditions. Your problem-solving skills would involve understanding each patient's dietary requirements,
coordinating with the kitchen staff to ensure the right meals are provided, and addressing any concerns or
complaints about the food.

Pharmacy Concerns: Patients may have questions about their medications, experience side effects, or need
refills. As a nursing student, you'd need to communicate effectively with the pharmacy staff, double-check
medication orders, and assist patients in understanding their medications and how to take them properly.

Medical Treatment Challenges: Patients might require adjustments to their treatment plans or experience
complications that need immediate attention. Your problem-solving skills would involve collaborating with
doctors and other healthcare professionals to address these issues.

Visitor Management: As visitor traffic increases, I monitor the visiting areas to ensure compliance with
hospital policies and address any disruptions or concerns raised by patients or visitors.

c) Observe the head nurse requesting extra staff as necessary from the
manager/supervisor.

In a healthcare setting, the head nurse plays a crucial role in managing the nursing staff and ensuring that patient
care runs smoothly. When the head nurse observes that there's a need for extra staff due to increased patient
volume, acuity, or any other reason, they typically follow a protocol for requesting additional personnel from
the manager or supervisor.
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Here's how the interaction might unfold:

Assessment of Staffing Needs: The head nurse assesses the current workload, patient acuity, and staffing levels
to determine if additional staff are necessary. They consider factors such as the number of patients, their
conditions, and any special needs requiring more attention.

Documentation of Staffing Shortage: If the head nurse determines that there's a shortage of staff to adequately
meet patient needs, they document the situation, including the reasons for the shortage and the potential risks to
patient care if additional staff are not allocated.

Communication with Manager/Supervisor: The head nurse then communicates with the manager or
supervisor responsible for staffing. This communication could happen in person, via phone call, or through a
messaging system, depending on the urgency of the situation.

Request for Additional Staff: During the communication, the head nurse presents their assessment of the
staffing needs and requests additional staff members to address the shortage. They may provide specific details
such as the number of extra staff required, the shift(s) affected, and the duration for which the additional
staffing is needed.

Justification and Explanation: The head nurse explains the reasons behind the staffing request, such as
increased patient admissions, complex cases, staff absences, or unexpected emergencies. They may also outline
the potential consequences of not addressing the staffing shortage promptly, such as compromised patient safety
or decreased quality of care.

Collaborative Decision-Making: The manager or supervisor evaluates the staffing request based on available
resources, budget constraints, and organizational policies. They may discuss potential solutions with the head
nurse, such as redistributing staff from other units, calling in extra personnel from a float pool, or approving
overtime shifts.

Confirmation and Implementation: Once a decision is reached, the manager or supervisor confirms the
allocation of additional staff and communicates this information to the head nurse and relevant personnel. The
head nurse then coordinates the deployment of the extra staff members to ensure that patient care needs are met
effectively.

Overall, effective communication, collaboration, and a proactive approach are essential for the head nurse to
request and obtain extra staff as necessary to maintain high-quality patient care standards.
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Question # 3:

Under supervision evaluate and supervise patient care.

a) Do patient rounds with the Head nurse or In-charge nurse, and conduct one unit round
independently.

i) Conducting Patient Rounds

Purpose: Observing and learning from experienced nursing staff.

Activities:

1.Review patient charts and current treatment plans.

2.Discuss patient conditions, progress, and any concerns with the nursing team.
3.Understand the rationale behind specific treatments and interventions.
4.Observe patient-nurse interactions and communication methods.
5.Note the use of medical equipment and monitoring devices. ii) Independent Unit

Round:

Purpose: Applying learned skills and knowledge independently.

Activities:

1. Conduct thorough assessments of each patient.

2. Review and update patient records and treatment plans as necessary.
3. Communicate effectively with patients, addressing their concerns and providing information about their
care.
4. Identify and report any changes in patient conditions to the appropriate healthcare providers.
5. Ensure adherence to clinical guidelines and protocols.

b) Identify hospital policies e.g. Narcotics, medications Takeover of crash cart and
narcotic cupboard.
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1. Narcotics Policy:

Purpose: Ensuring safe and controlled use of narcotic medications

Key Points:

• Understand the storage, handling, and administration procedures for narcotics.

• Familiarize with the documentation requirements for narcotic usage.
• Know the protocols for reporting and addressing discrepancies or issues.
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2. Medications Policy:

Purpose: Ensuring safe and accurate medication administration.

Key Points:

• Review the procedures for medication ordering, dispensing, and administration.

• Understand the protocols for verifying patient identity and medication details.
• Familiarize with the policies on handling medication errors and adverse reactions.
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3.Takeover of Crash Cart and Narcotic Cupboard:

Purpose: Ensuring readiness and accountability for emergency and controlled substances.

Key Points:

• Learn the procedures for checking and maintaining the crash cart, ensuring all necessary equipment and
medications are present and in working order.
• Understand the responsibilities involved in managing the narcotic cupboard, including regular inventory
checks and securing access.
• Follow protocols for documenting any changes or usage of supplies and medications.

c) Submit summary for any five policies

1. Narcotics Management Policy

• Purpose: Ensure safe and controlled handling of narcotic medications.

• Key Points: Secure storage, limited access, precise administration documentation, regular inventory
checks, and immediate reporting of discrepancies.
2. Medication Administration Policy

• Purpose: Guide safe and accurate medication administration.

• Key Points: Verify patient and medication details, thorough documentation, patient education, and
prompt error reporting.

3. Infection Control Policy

• Purpose: Reduce healthcare-associated infections (HAIs).

• Key Points: Strict hand hygiene, use of PPE, isolation for infectious patients, regular cleaning and
disinfection, and proper waste disposal.
4. Patient Confidentiality Policy

• Purpose: Protect patient privacy and confidentiality.

• Key Points: Limit access to information, controlled sharing, secure data practices, and immediate breach .
5. Emergency Response Policy

• Purpose: Standardize medical emergency handling.

• Key Points: Ready crash carts, established emergency protocols, regular staff training, clear
communication channels, and post-emergency reviews.
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Question # 4
Observe and discuss risk management as it is applied in the units.

a. Especially for fire, electric shocks, accidents, falls, infection etc.

Risk management in various units, particularly in healthcare settings, involves identifying, assessing, and
mitigating risks to ensure the safety of patients, staff, and visitors. Here’s an overview of how risk management
is applied specifically to address risks such as fire, electric shocks, accidents, falls, and infections:

1. Fire Safety

• Regular maintenance and testing of smoke detectors, fire alarms, and sprinkler systems to ensure they
are functional.
• Conducting regular fire drills and having clear evacuation routes and procedures.
• Proper storage of flammable materials and ensuring that electrical equipment is used safely to prevent
sparks and overheating.

• 2. Electric Shocks

• Routine checks and maintenance of all electrical equipment and wiring to prevent malfunctions.
• Installing GFCIs in areas where electrical equipment is used near water sources.
• Educating staff on the safe use of electrical equipment.
3. Accidents and Falls

• Keeping floors clean, dry, and free of obstacles to reduce slip and trip hazards.
• Providing and maintaining assistive devices like handrails, non-slip mats, and mobility aids.
• Ensuring adequate lighting in all areas, especially stairwells, hallways, and patient rooms.
• Training staff on proper lifting techniques, patient handling, and immediate response to spills or hazards.
4. Infection Control

• Implementing and enforcing strict hand hygiene protocols using soap and water or hand sanitizers.
• Providing appropriate PPE (gloves, masks, gowns) and ensuring proper use and disposal.
• Regular sterilization of medical instruments and disinfection of surfaces and equipment.
• Establishing protocols for isolating patients with contagious diseases to prevent the spread of infections.
• Ensuring staff vaccinations are up-to-date and conducting regular health screenings to detect and manage
infections promptly.
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Additional Risk Management Practices

• Creating and updating policies and procedures to address various risks and ensure compliance with
safety standards and regulations.
• Conducting regular risk assessments to identify potential hazards and implement corrective actions.
• Encouraging the reporting of incidents and near-misses, and analyzing them to prevent future
occurrences.
• Providing ongoing training to staff on safety practices, emergency procedures, and risk management
strategies.
• Promoting open communication and collaboration among different units and departments to ensure a
cohesive approach to risk management.
• By implementing these risk management practices, healthcare units can significantly reduce the
likelihood of fires, electric shocks, accidents, falls, and infections, thereby creating a safer environment
for everyone.
• The in-charge nurse, often known as the head nurse or charge nurse, has a multifaceted role that is vital
for the smooth operation of a hospital ward and the education of nursing students and new staff. Their
responsibilities can be broadly divided into two main areas: ward management and teaching.
Ward Management:

• The in-charge nurse oversees the overall patient care within the ward. They ensure that each patient
receives appropriate and timely medical attention.
• They allocate tasks to nursing staff based on the needs of the patients and the skills of the nurses,
ensuring efficient and effective care delivery.

Supervision OF Staff:

• They supervise the nursing team, providing support and guidance as needed. This includes mentoring
junior nurses and helping them develop their skills.
• They are responsible for conducting performance evaluations and providing constructive feedback to
staff members.
Resource Management:

• Managing the ward’s resources, such as medical supplies, equipment, and medication, is a key duty.
They ensure that these resources are available and properly maintained.
• They also manage the staffing schedule to ensure that there are enough nurses on duty at all times to
provide adequate patient care.
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Quality and Safety Assurance:

• The in-charge nurse ensures that all care practices meet established healthcare standards and protocols.
They monitor compliance with infection control measures and safety procedures.
• Effective communication is crucial. The in-charge nurse acts as a liaison between the nursing staff,
doctors, patients, and their families. They ensure that everyone is informed about patient care plans and
any changes in a patient’s condition.
• They also collaborate with other healthcare professionals to develop and implement patient care plans.
Teaching and Mentorship

• Guiding Nursing Students: The in-charge nurse plays a pivotal role in the education of nursing
students.
They provide hands-on training, demonstrating clinical procedures and patient care techniques.
• They create a supportive learning environment, encouraging students to ask questions and seek
guidance.
• Professional Development: They support the ongoing professional development of the nursing staff by
organizing and conducting training sessions, workshops, and continuing education programs.
• They stay updated with the latest in nursing practices and healthcare innovations, sharing this knowledge
with the team to enhance their skills and knowledge.
• Providing Feedback: Constructive feedback is essential for growth. The in-charge nurse regularly
observes the performance of nursing students and new staff, offering feedback that helps them improve
their practice.
• They also recognize and reinforce good practice, which boosts morale and encourages a high standard of
care.

• Role Modeling: As experienced professionals, in-charge nurses serve as role models. They exemplify
best practices in patient care, professional behavior, and ethical standards.
• By demonstrating a commitment to excellence and a compassionate approach to patient care, they
inspire and motivate others to follow suit.
• Evaluating Progress: The in-charge nurse monitors the progress of learners, assessing their competence
in various clinical skills and their understanding of nursing concepts.
• They provide evaluations that help learners understand their strengths and areas needing improvement.
• In summary, the in-charge nurse is integral to both the management of the ward and the education of
nursing students and new staff. Through effective coordination, supervision, and mentorship, they ensure
high standards of patient care while fostering the development of future nursing professionals.
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Observe and discuss about the qualities/characteristics of a leader

• A good leader in a healthcare setting, such as an in-charge nurse, should exhibit the following qualities:
• Communication: Clearly and effectively communicates with staff, patients, and families.
• Empathy: Understands and responds to the emotional needs of patients and staff.
• Decisiveness: Makes quick, informed decisions, especially in emergencies.
• Integrity: Upholds ethical standards and honesty in all actions.
• Adaptability: Adjusts to changing situations and challenges with flexibility.
• Problem-Solving: Identifies issues and implements effective solutions.
• Team Building: Fosters a cooperative and supportive work environment.
• Mentorship: Guides and supports the professional growth of team members.
• Resilience: Maintains composure and effectiveness under pressure.
• Vision: Provides clear direction and goals, inspiring others towards common objectives.

Question # 5:

5. Discuss with your unit in charge budgeting and the measures to control expenses

In discussing budgeting and expense control measures with the unit in charge at the Fouji Foundation Hospital
surgical ward, several key considerations should be addressed to ensure financial sustainability while
maintaining high-quality patient care standards.

1. Establish Clear Budget Goals: Begin by reviewing the current budget allocation for the surgical ward
and identifying areas where expenditures can be optimized without compromising patient care. Set specific
financial targets and performance indicators to track progress towards cost-saving objectives.

2. Analyze Expenditure Patterns: Conduct a thorough analysis of historical expenditure patterns to

identify areas of overspending or inefficiency. This includes reviewing expenses related to medical supplies,
staffing, equipment maintenance, and facility operations.

3. Prioritize Spending: Prioritize spending based on the critical needs of the surgical ward. Allocate
resources to essential services such as surgical equipment, medications, and staffing levels required to maintain
patient safety and quality of care.
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4. Implement Cost-Effective Practices: Explore opportunities to implement cost-effective practices

without sacrificing quality. This may include standardizing procurement processes, negotiating bulk purchase
discounts with suppliers, and implementing evidence-based protocols to streamline clinical workflows and
reduce waste.

5. Monitor Resource Utilization: Implement systems for monitoring resource utilization in real-time to
identify potential cost-saving opportunities and prevent unnecessary expenditures. This may involve regular
audits of inventory levels, staffing ratios, and equipment usage to ensure optimal resource allocation.

6. Staff Training and Engagement: Provide on-going training and education to staff members on cost-
conscious practices and the importance of resource stewardship. Engage frontline staff in identifying areas for
improvement and encourage them to contribute ideas for cost-saving initiatives.

7. Collaboration and Benchmarking: Collaborate with other departments within the hospital and
benchmark against industry standards to identify best practices for cost containment. Learn from successful
cost-saving initiatives implemented in other healthcare settings and adapt them to the unique needs of the
surgical ward.

In summary, effective budgeting and expense control in the Fouji Foundation Hospital surgical ward require a
strategic approach focused on optimizing resource utilization, prioritizing spending, and implementing cost-
effective practices while maintaining high-quality patient care standards. By establishing clear budget goals,
analyzing expenditure patterns, and engaging staff in cost-saving initiatives, the surgical ward can achieve
financial sustainability and deliver optimal outcomes for patients. Regular monitoring and collaboration with
other departments will ensure on-going improvement and adaptation to changing healthcare environments.