Introduction:

As we all know, effective leadership motivates others to act in the way that is wanted and
accomplishes tasks. Leaders focus on the goal and do the right thing. They are focused on
the future, challenged by change, able to design strategies, and help people reach their
full potential. We are taking a leadership and management course this semester. As
nurses, this course is important for us because it teaches us how to be effective leaders
and managers. As part of the leadership and management project, we perform an
interview with sister Maya the in charge of the female ward on 9 February 2023 to ask
her some questions about the organization. In this project, we mention the history, vision,
mission, values, goals, and objectives of the organization. We also speak about the
strategic and operational plans, organizational structure, and chart. The staff development
initiative and staff motivation. Finally, the potential conflict in the organization.
The history of the organization:

In order to build the infrastructure of health services, the North East governorate got a
network of health institutions from the Sultanate. It concentrated on keeping the Ministry
of Health in control of successive health plans, overall development, and modernization
of the level of health services, and it created Ibra Hospital in March 2005 to provide
secondary health care. The hospital was built with the best architectural design, bending
form, and function to meet the highest quality of medical care. In addition to that, they
build an extended Ibra Medical Complex behind Ibra hospital which is related to the
clinic of Ibra hospital that to reduce the overload clinic in Ibra hospital. The hospital
contains Out-patients Department, Accident & Emergency Department, Diagnostic and
Therapeutic Services, In-patient Wards, and Critical Care Units in addition to
Administration Block, Public Services, and Staff Accommodation. In 2005, the female
ward contained 56 beds for the surgical and medical wards. During covid-19, it contained
24 beds because the female surgical ward has been converted into a male ward and
merged the female surgical ward and female medical ward into one ward. Now, It
contains 44 beds. FSW has 10 beds for general surgery, 6 beds for orthopedic, 3 beds for
ophthalmology, 1 bed in a private room, and 1 bed in the isolation room. FMW has 18
beds, 1 bed in a private room, and 1 bed in the isolation room.
Vision, values, purpose or mission statement, philosophy, goals and
objectives, policy & procedure:
Vision:
(Ibra hospital)
A society that enjoys high quality care and sustainable health.
(Female ward)
it will be rated among the best nursing department where competitive and comprehensive
care is rendered to its patients/clients.
Mission:
(Ibra hospital)
Reach the health status of the community to the best possible extent by quality health
care at all levels.
(Female ward)
maintain high quality of patient care by making available holistic and continuous quality
nursing services to all clients of the hospital in the region and its surroundings.

Values:
(Ibra hospital)
 Quality and excellent in performance
 Ethical standard of behaviors
 Patient safety
 Creativity and innovation
 Good communication
(Female ward)
 We are committed to meeting the holistic needs of our patients /clients.
 Respect them as individuals irrespective of their religion or creed.
 We also believe in equity and fairness and in building trust and integrity with all our
patients/clients.
Philosophy:
Not available
Goal :
To be recognized as clients friendly department.
Objective:
1. To maintain an evidence based standard nursing practice which is based on both
MOH internal policies.
2. To have a continuous and active participation in CNE/CME activities both internally
and externally
3. To maintain a quality control management system
policy & procedure:
In Ibra hospital, there are policies for staff nurses and medical orderly practice.
Policy of hand hygiene
 Policy :
 All health care workers to be implemented the HH policy in the hospital.
 Procedure:
Indications for HH
 Before touching a patient
 Before clean/aseptic procedures
 After body fluid exposure risk
 After touching a patient
 After touching patient’s surroundings or any unknown surface/object
Other Opportunities for Hand Hygiene
 When hands are visibly soiled
 After contact with a source of microorganisms (body fluids and substances,
mucous membranes, non-intact skin, surfaces that are likely to be contaminated)
 Before wearing glove and After removing gloves
 Before and after smoking, eating or preparing food
 Before leaving the patient’s room
 After bodily functions (e.g., using the toilet, blowing one’s nose, sneezing)
 When moving from a contaminated body site to a clean body site during patient
care.
Techniques
 Hand washing: (Wash hands for a minimum of 40-60 seconds).
 Hand rubbing: Use alcohol-based hand antiseptic rub for a minimum of (20-30
Seconds).
Policy & Procedure of Informed Consent
 Policy:
 All patients have the right to make decisions regarding their healthcare and to be
provided sufficient information in order to make informed decisions.
 It is the policy of Ministry of Health that the patient must be given the opportunity
to give an Informed Consent" prior to the administration of anesthesia by an
anesthesiologist and prior to the performance of operative and/ or invasive
procedures, or situations when I is seemed advisable to have formal
documentation of the patient's consent for treatment.
 Procedure:
 Elements of Informed Consent
 Specifically, the physician/ proceduralist must manner all significant medical
information that is relevant to making an informed decision by the patient.
 This information should include all of the following:
A. The nature of the patient's condition
B. The proposed treatment, possible treatment alternatives, including no
treatment:
C. The benefits, as well as frequently occurring and significant risks of the
proposed treatment and alternatives;
D. If applicable, the possible use in education and/or research of blood or tissue
removed from the patient not needed for further medical care.
E. The individuals who will be providing treatment and the role of everyone in
providing the proposed treatment.
F. The patient or patient's legal representative should be given the opportunity to
ask questions and receive additional information as requested.
 Documentation
 Ministry of Health approved forms are completed on all cases.
 If preoperative medication (sedation or pain medication) is to be administered,
informed consent or verification of informed consent must be obtained prior to the
administration of such medication.
 Informed consent documentation should not include any abbreviations.
 Obtaining Informed Consent
 It is the treating physician's responsibility to obtain the informed consent.
 Only the physician/proceduralist and/or anesthesiologist can provide the
information; other staff cannot be involved in providing information for informed
consent.
 Informed consent discussed with the patient by the physician; with verbal
discussion and/or supplemented through written additions that give further
information relevant to the patient's condition.
 Age to give consent is 18 years provided that at the time of giving consent, the
patient is competent to understand the nature and purpose of the procedure or
operation proposed, and the risks involved.
 If the person cannot sign his/her name; then a thumb mark is acceptable
documentation for agreement.
 The nurse witnessing the process of informed consent signs as a witness.

Policy & Procedure of Safe Surgery pre-operative communication

 Policy:
 It is the policy of Ministry of Health to improve effective communication and
continuity of patient care through initiating standards and guidelines for
documentation and safe practice within the Operating Theatre environment.
 Procedure:
1. The pre-operative checklist (see attachments) is included on the patient medical
record and be completed, signed and dated.
2. The pre-operative checklist is reviewed between the nurse delivering the patient
to the Operating Theatre and Operating Theatre Nurse receiving the patient into
the area.
3. The pre-operative checklist remains a permanent part of the patient record.
 4. Hygiene: Patient cleanliness prevents cross infection.
5. Time of last voiding: Time of voiding is important for pelvic operations and
anticipated lengthy surgery.
6. Presence of jewelry: to prevent skin damage to patient when they are moved
and to prevent burn from electro-cautery appliances.
7. Special pre-operative preparation e.g. bowel preparation: to ensure a clean
surgical field.
8. Availability of blood or blood products: essential prior to commencing major
surgical procedures.
9. Identification band is present and correct: to ensure correct patient receive and
correct treatment.
10. Operative site is prepared: to ensure a clean surgical field free from abrasions.

Policy & Procedure of Patient Identification

 Policy
 It is the policy of Ministry of Health to ensure that patients are properly identified
prior to any care, treatment or services taking place.
 Exception: Patients unable to provide identifying information, who experience
conditions requiring emergency care will receive treatment prior to identification
if such care and treatment is necessary to stabilize the patient's condition
(Example: Patient arriving comatose to Emergency Department).
- Small infants and patients with a disease process, injury, or treatment that
prevents safe placement of the Identification (ID) hand on any extremity.
 Procedure:
1. The identification band must include the following:
 Patient full name (Given Name, Father Name, Grandfather Name and tribe name
for Omani patients).
 Medical Record Number.
 Date of birth.
2. In the rare event of the patient being unknown, the identification band
should state:
 Emergency number (emergency1, emergency2, etc.). 5.2.2 Medical Record
Number.
 Gender.
 Approximate age
 Ward or Location.
3. In absence of electronic printing of ID band, all information should be written
clear in blue or black pen and checked with the patient prior to application of the
identification band.
4. Before any procedure is carried out, check the identification band for the
following two identifiers to ensure that the correct patient is involved:
 Patient full name.
 Patient medical record number.
 5. Staff verbally assesses the patient to assure proper identification, asking the
patient's name and date of birth and matching the verbal confirmation to the
written information on the identification band and medical record.
6. Procedures Requiring Correct Identification Of Patients: The list below is
not exclusive, Patients should be identified before:
 Blood sampling.
 Blood transfusion.
 Collecting of patient bodily fluid samples.
 Confirmation of death.
 Administration of all medications.
 Surgical intervention and any invasive procedure.
 Transport/transfer of the patient.
 X-rays and imaging procedures.
7. Placement of Patient's ID Bands
 The name band shall be sited as follows:
A. First choice Right wrist
B. Second choice Left wrist.
 C. Third choice Ankles, right or left e.g. if wrist/arm is swollen/injured. D. Ensure
that it cannot be self-removed. If limbs are too large to use 1name band then 2
may be joined together.
E. Patients who are at risk of or likely to remove their ID band should ideally
have two ID bands in place, one on the wrist and the second on the ankle. The ID
band shall only be removed when the discharge procedure is complete.
8. Identification in Out Patient Department (OPD):
 Patients who visit OPD are identified through their National ID (for Omani) and
Resident Card (for non-Omani) that medical record already contains, patient
introduce his National ID to the nurse that confirms the details with his medical
record (National ID contains Patient Name, Date of Birth), No ID band in OPD.
9. Identification in Hemodialysis Unit:
 Hemodialysis patients are identified through ID card containing patient name,
date of birth and Medical Record Number.
10. Transfer between Wards
 Patients who are transferred from one ward to another should have their ID band
checked as part of the admission/transfer process. If details are incorrect/missing
they must be given a new ID band with the correct details and the old one must be
removed, an incident form should also be completed. Do not write over the old ID
band.
11. Blood Transfusion
 The bedside check is a vital step in preventing transfusion error.
 Two practitioners are responsible for correct patient identification.
A. Check verbally.
B. Check ID band.

Admission & discharge policy

 Policy:
 The bed manager on duty has full delegation authority, by the hospital Executive
Director to place patients in ward/unit bed.
 Every ward is required to maintain a real time bed state of their
admission ,discharge and transfers.
 Patient will be allocated a bed in accordance with the admission priority list.
 The doctor must document, in doctors’ orders, when a patient is to be placed in
Isolation and Why.
 All staff involved in the movement of patients between wards should ensure that
effective communication and handover takes place between the respective clinical
teams.
 Once a bed has been vacated ,wards will be expected to receive another patient in
that bed ,within 30 minutes.
 For transfers out of Ibra Hospital, the doctor should call the receiving hospital to
confirm the acceptance of the case, after that the doctor should inform the bed
manager to arrange the bed .
 Communication with other hospital bed managers for external transfers only after
the doctor has communicated with the accepting doctor.
 Two beds from each ward, if possible, to be reserved during regular morning
duties,
 Co-ordinate with discharge planner, social worker, PRO and quality department
about over stays of admitted cases and expatriate cases.
 If all bed in ICU/CCU was occupied ,the first spill over patients from ICU /CCU
will be accepted by HD in either medical or surgical wards.
 No ward or unit is allowed to accept an admission without informing the bed
manager first or a doctors written order.
 The bed manager and discharge planner will attend the wards daily.
 The bed manager & discharge planner will meet with the PRO,social worker &
quality daily to discuss the bed availability and discharge issues.
 Procedure:
 The bed manager should know about how many patients, with their acuity level,
are in each department and how many vacant beds are available.
 On receiving a call from either A&E or OPD about an admission ,the bed
manager will take patient details including :- name ,hospital number, treatment
plan and specialty for admission.
 The bed manger will review bed census and contact the concerned ward/unit
about the proposed admission, they will then ring A&E or OPD back to confirm
the bed.
 If no bed is available at that time they will contact the doctors to review their
patients for fitness for discharge .
 For direct admissions from PHC ; the doctor in the Health Center or Polyclinic
has to contact the on call doctor , of the appropriate specialty, about the
proposed admission , ensuring name , past medical history, chief complaint with
signs and symptoms are obtained, the on call doctor will contact the bed manger
about the availability of abed, If abed is available the bed manger will contact the
ward /unit about the proposed admission, The on call doctor will contact the PHC
doctor about acceptance of the patient.
 Interdepartmental from referral- doctor should see these patient as soon as
possible so as not to delay treatment or discharge ,
 For interdepartmental transfers; the doctor will contact the bed manger to arrange
abed in the receiving department. If no beds available the patient will remain in
his /her bed and the primary team of doctor will review them there.
 Blocked beds-if there are no beds available and no patient is fit for discharge then
the bed manger will contact the administration who will then inform the PHC and
other neighboring hospitals with the information, so they can use other hospitals,
especially for critical patients, if admission is required.
 Long stay patients; the primary team of doctor has discharged the parent then the
discharge planner will contact their family, if no response then a letter will be sent
to Wali , supported by administration and the PRO.
 Expect patients to follow them since admission and inform PRO if any problems
and to make sure no payment problems.
 Patient escort from /to airport , the PRO & Ward in charge should be informed .
  The bed manger and discharge planner will follow the bed ridden with community
staff.

Crash cart-checking policy

 Policy
1. Crash trolleys should be standardized in Ibra Hospital departments and should
contain the adult, pediatric and infant supplies.
2. Crash trolley should be located in a place where it can be reached promptly and
easily.
3. The arrangement of the trolley should be based on the approved checklist.
4. Each drawer in the trolley should be labelled well with items contents.
6. Checking of the cart should be at the beginning of each Nursing Shift and should
be documented in the approved checklist .
7. Checking of expiry date of the items in the cart should be conducted on weekly
basis.
8. The pharmacist shall check the medications in the cart once every two months.
9. Any missing, damaged or expired item or medication should be reported to the
senior shift staff and refilling should be done immediately indenting from the
Medical Store.
10. After any resuscitation, the arrangement of the refilling should be done as soon as
possible.
11. The checking should include the top of the trolley till the last drawer for
completeness, cleanliness, arrangements and functioning .e.g.
 Functioning Defibrillator
 Availability of ECG Roll
 Functioning suction apparatus
 Full or more than half O2 Cylinder
 Availability of chest board
 Functioning Laryngoscope and blades
 Medication and IV fluids availability and completeness
 12. All the nurses mentioned in the scope of this policy should be trained. The
competency of the staff should be checked periodically.
13. The cart should be locked all the time when it is not in use.
14. The cart’s lock code number should be documented in the appropriate place in the
checklist.

Fall management policy

 Policy:
 All admitted patients would be assessed for potential to fall on the history using
the fall assessment in AL SHIFA 3 PLUS.
 If patient is not at high risk for fall, fall assessment should be repeated after five
days.
 If the patient is at higher risk of fall. He/she will be assessed for fall risk at the
beginning of every nurse's shift
 Procedure:
 Every patient admitted to Ibra hospital assessed for their risk to fall by the nursing
staff utilizing the criteria in AL Shife 3 Plus.
 The nurse will move the patient close to the nurses’ station for closer observation
if the patient at higher risk of fall.
 Following admission the Fall Risk Assessment Tool to be utilized to assign a fall
risk level and identify the most appropriate fall prevention protocol.

Procedures
 Performing an unoccupied and an occupied bed.
 Performing bathing.
 Performing mouth care for unconscious or debilitated client.
 Administering eternal feeding via nasogastric tube.
 Collecting a sterile urine specimen from an indwelling catheter.
 Vital signs assessment tool.
 Administration of oxygen via nasal cannula, facemask.
 Administration of fleet enema.
 Admitting clients and discharge.
 Transferring clients to different agency.
 Oral drug administration.
 Administration intramuscular injection.
 Administration intradermal injection.
 Administration subcutaneous injection.
 IV therapy
 Surgical wound dressing application.
 Skin suture removal.
 Tracheostomy/ endotracheal suctioning.
 Teaching the use of incentive spirometry.
 Using nebulizer therapy.
 Blood and blood product transfusion.
 Blood glucose monitoring.
 Per/postoperative technic exercises.
 Gathering health history from the clients.
 Physical assessment of a client.
 Administering medication(optic/otic/nasal/rectal)

Services Rendered in surgical and medical ward:

A. Services for staff
 Arranging duty roster if case any personal issue.
 Resting room and learning method in the system.
B. Services for patients:
 Health education
 Administer medication
 Psychological support
 Rehabilitative care services
 Infection control services
 Ear, Nose, & throat surgery services
 Laboratory services
Organizational structure of Ibra Hospital:
 Ibra hospital

Brown Red Green

 Administration
 Out patient’s  Pray Hall
 Central department  Medical records
Sterilizations  Renal dialysis unit  Pharmacy
Department Blue  Accident
 Medical Store &emergency
 BIO Medical  Male medical  Fracture clinic
Workshop Ward  Physiotherapy unit
 Cafeteria  Male surgical  Oncology unit
 Laundry  Female medical  Radiology
 Kitchen Ward department
 Female Surgical  C.T Scan suite
Ward  Laboratory and
 Obstetrics and Blood bank
Gynecology  Intensive care unit
Ward  Coronary care unit
 Paediatric Ward  Operating
Theaters
 Delivery Suite
 Special care baby
unit
 Burns unit
Management and leadership style used (role of nurse manager):
The nurse in charge of the female ward is responsible for about 36 nurses. She has the
power that she got from the position she has in the institution and authority which give
her the right to direct staff nurses in the female ward. The role of the nurse in charge of
the female ward is to ensure that patients receive safe and effective care. She is
responsible assign tasks to staff members. Each staff member knows to whom she is
responsible, who is responsible to her, and for what. The duty roster for the staff is
planned by the in-charge nurse taking into account personal requests. For example; on the
morning shift 6 staff nurses, and 2 medical orderly. On the afternoon shift 6 staff nurses,
and 1 medical orderly. On the night shift 6 staff nurses, and 1 medical orderly. After
working for two days night shift, followed by 2 days off, and 5 days afternoon, followed
by 2 days off. Also, she is responsible for stores to make sure that needed items are
available and cleanness of the unit to reduce the infectious rate, checking the narcotic
medication cabinet and expiry date, and checking the surgical store (surgical equipment).
As well as gives feedback, and motivates the staff nurses. In addition, she encourages
nursing staff to complete their study and participate in workshops.
Organizational Chart:
chart type:

Is a vertical chart that depicts the chief executive at the top with formal lines of authority
down the hierarchy. Beginning of the hospital director and under that development &
career guidance, environmental health & occupational safety, infection control & CSSD,
information and medical statistics, quality management & patient safety, public relation
& patient services, post & documents, follow up & coordinator, associate director of
medical & paramedical affairs, and associate director of administrative & financial
affairs. Then, under the associate director of medical & paramedical affairs two parts, the
first part contain pharmacy, physiotherapy, education & psychological counseling,
nursing, medical store, nutrition treatment, and respiratory medicine. The second part
contains OBS/GYN, anesthesia & ICU, radiology, lab, emergency medicine, surgery,
internal medicine, and pediatrics. Under the associate director of administrative &
financial affairs personal section, Information Technology Section, Finance Section,
Stores & Spare part.
Find the line of authority:
The organization chain in Ibra Hospital started with the Hospital director Dr. Khaled Al-
Sawafi and then the assistant director Dr. Fayez Al-Rashdi. Then the middle level of
management is Dr. Ahmed Al-Falahei who is the head of the nursing unit, then below
him is Zayana Al-Harthi who is the head unit of the female ward and she responsible for
Khadija who is In-charge unit and the second In-charge is Maya and then senior nurses,
junior nurses, and last one intern nurses.

Find interdepartmental co-ordination:

Collaboration exists between the female ward and other units like A&E, the operating
room, the laboratory, ICU, and radiology. When it comes to admitting and discharging
patients, they work together. Also, there is a paper in the female ward that contains the
numbers of all departments so that they can communicate with them more quickly to
provide services to patients faster, safely, and with high quality. The female ward in
charge will request more personnel from other departments if there is a staffing shortage
in the ward.

Identify the line of communication among staff:

In charge nurse communicates with other departments through call phones and messages.
This line of communication among them provides counsel on managerial problems. They
cooperate in solving work problems and achievements of organizational tasks.

Identify any possible conflict in the chart /conflict resolutions using

evidence:
Conflict is normal. It can happen to everyone and conflict can be described as a situation
of disagreement or misunderstanding by individuals or others. There are a lot of things
that lead to conflict in the healthcare environment. Conflicts that occur in the female
ward are between a staff nurse and a patient, the staff nurse and in charge nurse, or staff
nurses and doctors due to increasing stress on nurses, a shortage of medical staff, or
negligence of nurses and doctors in their duties. The strategies to resolve conflicts are:
1. Verbal counseling (used to inform nurses of unsatisfactory work performance or
unacceptable conduct in which the matter is discussed with nurses to find the proper
resolution.)
2. If occur a conflict between the staff nurses and in charge nurses resolve it by a
committee from the administration to discuss differences and conflicts and find solutions.
3.
Identify staff development activities/ CPD: