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Role of head-nurse of dialysis unit護理長的任務護理長的任務

翁 淑 滿 Chang Gung Memorial Hospital Oct. 29 , 2011

透析品質管理經驗分享

22

基本屬性

不穩定過程

結果

高罹病率高死亡率低生活品質1.免疫功能缺陷

2.長期併發症

1.年齡層偏高2.伴隨其他系統疾病3.生活活動能力低

病人部份

疾病部份

1.1. 透析中急性併發症透析中急性併發症2.2. 透析中意外事件透析中意外事件

Character and prognosis Character and prognosis of Dialysisof Dialysis

3

專業知識

人員管理

服務態度專業技能汰舊換新

設備管理資料庫維護

維修保養

環境維護

品質管理

品質指標監控

QCC

專案改善病人安全

分工整合引進新治療

服務創新

實證醫學 創意獎勵制度

團隊合作

安全及時公平有效效率

安全及時公平有效效率

Management by objectivesManagement by objectives of Dialysisof DialysisManagement by objectivesManagement by objectives of Dialysisof Dialysis

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Four major missions of Four major missions of head nurse head nurse

• 責任 責任 / / RESPONSIBILITYRESPONSIBILITY

• 品質 品質 / / QUALITYQUALITY

• 創新 創新 / / INNOVATIONINNOVATION

• 關懷 關懷 / / CARINGCARING

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責任 / RESPONSIBILITY

6

護理管理領導模式護理管理領導模式

Journal of Nursing Management,2008, 16, 525–534.

ChallengesDemends

Expectation

Nursing leaders of tomorrow

Outcome-orientation Quality of work and outcomes Innovation Orientation towards the future

Understading nursingPractice Direct and indirect nursing care Experitis in nursing Handyman tasks

Accountability activities Supporting staff Ensuring staff xompetencies developing

Responsibility activities communicating organizing cooperating

Recognition of underlying premises of one‘s work

*Framework of one‘s competence,well-being at work and the basis for one‘s work as nurse manager

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• Nurse Managers (NMs) have an important role in the health care organization and are responsible both for the staffs quality of care and for quality of work life.

• In Sweden, the NMs have the responsibility for the management of the ward and are responsible for personnel (recruitment, selection of staff, development, work environment), budgets (budgeting, cost control and financial result), nursing practice (introducing and maintaining standards) and the development of the services.

• The increased responsibility of NMs is supposed to lead to organizational effectiveness and efficiency.

Canadian Medical Association Journal, 1993, 148 (4), 501–4.Journal of Nursing Management, 2008, 16, 1012–1020.

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以病人為中心之照護責任

Retraining Time

定期評核 腹膜炎

導管感染 中斷再開始

追蹤照護衛教衛教

9

危機思考 / Critical thinking

NURSING ECONOMIC/March-April ,2009, 27, 2.

Clinical KnowledgeClinical KnowledgeManagement

Knowledge and Skills

Management

Knowledge and Skills ExperienceExperience

Antecedents

Reflective Thinking

IntentionedOutcome/Goal

Context/Situation

Consequences of Empirical Referents

Achievement of GoalsPatient satisfactionQuality careOn budget

Satisfaction of Nurse Manager RoleNurse manager retention Nurse manager recruitment

Advancement of PracticeEvidenced-based practice

1010

品質 / QUALITY

1111

• When health care is under pressure to provide quality care at the same time as their economic resources are being reduced, nurses in managerial positions are granted more control over management in the hope of improving cost effectiveness while retaining a focus on the quality of care.

Journal of Nursing Management, 2008, 16, 1012–1020.

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Peer review

Journal of Nursing Management,2011, 19, 254–259.

•Implies that the nursing care delivered by a group of nurses or an individual nurse is evaluated by individuals of the same rank or standing according to established standards of practice.

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• The process by which practicing registered nurses systematically access, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice.

• The development of management peer review will be challenging. The meaningful use of peer review at all levels of nursing will help close the gaps in quality and safety and ensure positive outcomes for patients, families and society.

Journal of Nursing Management,2011, 19, 254–259.

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QCC/專案改善

持續不斷的品質改善

掌握住出院動態 人性化空間設計 先進的透析設備

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創新 / INNOVATION

1616

• The National Health Service (NHS) Institute for Innovation and Improvement (2011) state

Innovation is about doing things differently or doing different things to achieve large gains in performance. It is a myth that most innovations come from laboratories, policy makers or senior leaders. Most innovations, whether in the public sector or the private sector, come from staff working within those organisations.

• Boyd (2011) a recognized authority on IiP makes claims to leaders and managers to see innovation not as a gift, but a skill that everyone in the organization can master.

Journal of Nursing Management, 2011, 19, 165–169.

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創新 創新 // Creation caseCreation case

腹膜透析導管固定帶 血液透析瘻管偵測儀

林口長庚腹膜透析提供林口長庚腹膜透析提供 奇美醫院血液透析提供奇美醫院血液透析提供

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漸進改善與躍進創新漸進改善與躍進創新

Continuous Improvement

•Enhance process management/ PDCA

–P (Plan): A well organized, detailed plan with solutions and regulations

–D (Do): Implementation according to the organized plan, with records for review

–C (Check): Regular follow-up /analysis of implementation outcomes, with an improvement plan made subsequently

–A (Action): Specific results after implementing the improvement plan

Continuous Improvement

DD

CC

PP

AA

DD

CC

PP

AA

DD

CC

PP

AA

InnovationInnovation

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關懷 / CARING

2020

2121

激勵 激勵 / Motivation/ Motivation

•護理管理者應激勵員工內在的工作動機，產生高度意願及特定行為，以持續性地朝向組織目標前進 。

•研究發現 : 當一個人被激勵後，發揮的能量是激勵前的 3~4倍。

•剛剛好完美的管理 ---- <<足感心 >>

中國醫院管理 ,2002,22(5),32.護理雜誌 , 2007,54(1) ,83-89.

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病患病患 // 家家屬屬

內部工作人內部工作人員員

外部工作人員外部工作人員

護理長護理長

協調者 協調者 / / CoordinatorCoordinator

2323

• Nurse Managers (NMs) can help fill the need for their employees to feel connected and competent at work.

• Nurse Managers NMs can provide recognition for good performance.

• In the sometimes-thankless world of healthcare, it is the NMs who can show appreciation and praise employees for the hard work they put in each day.

JONA, 2009, 39( 2), 60-63

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ConclusionConclusion

責任 責任 / / RESPONSIBILITYRESPONSIBILITY 品質 品質 / / QUALITYQUALITY創新 創新 / / INNOVATIONINNOVATION關懷 關懷 / / CARINGCARING

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謝謝參與