NMT 06104 Supervision in Nursing and Midwifery

THE UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND

CHILDREN
DIRECTORATE OF HUMAN RESOURCE DEVELOPMENT
FACILITATOR’S GUIDE FOR ORDINARY DIPLOMA

IN NURSING AND MIDWIFERY
NTA LEVEL 6
NMT 06104: Supervision in Nursing and Midwifery

DECEMBER, 2018
© Ministry of Health, Community Development, Gender, Elderly and Children, Department of Human Resources
Development Nursing Training Section 2018, Dodoma, Tanzania
NMT 06104: Supervision in Nursing and Midwifery ii

Table of Contents
Acronyms....................................................................................................................................................iv
Preamble.....................................................................................................................................................v
Acknowledgement......................................................................................................................................vi
1.0. Background...................................................................................................................................vii
2.0. Rationale.......................................................................................................................................vii
3.0. Goals and Objectives of the Training Manual..............................................................................viii
3.1. Overall Goal for Training Manual.............................................................................................viii
3.2. Objectives for Training Manual................................................................................................viii
4.0. Introduction...................................................................................................................................viii
4.1. Module Overview......................................................................................................................viii
4.2. Who is the Module For?.............................................................................................................ix
4.3. How is the Module Organized?..................................................................................................ix
4.4. How Should the Module be Used?............................................................................................ix
SESSION 01: CONCEPTS OF SUPERVISION IN THE CONTEXT OF NURSING AND MIDWIFERY
PRACTICE................................................................................................................................................10
SESSION 2: SUPPORTIVE SUPERVISION............................................................................................15
SESSION 3: ORIENTATION TO NEWLY EMPLOYED STAFF..............................................................28
SESSION 4: MENTORING, COACHING AND PRECEPTORSHIP........................................................33
SESSION 5: HEALTH POLICIES AND GUIDELINES FOR NURSING AND MIDWIFERY PRACTICE.38
SESSION 6: DUTY ROSTER, ANNUAL LEAVE, JOB ALLOCATION AND SCHEDULES....................44
SESSION 7: BUDGETING.......................................................................................................................52
SESSION 8: MANAGEMENT OF RESOURCES (HUMAN AND NON-HUMAN RESOURCES)............57
SESSION 9: QUALITY IMPROVEMENT.................................................................................................62
SESSION 10: BASIC PRINCIPLES OF QUALITY IMPROVEMENT IN HEALTH...................................69
SESSION 11: COORDINATION...............................................................................................................74
SESSION 12: MONITORING NURSING AND MIDWIFERY SERVICES................................................78
SESSION 13: MOTIVATION OF STAFF..................................................................................................84
SESSION 14: COUNSELLING ON STAFF PERFORMANCE.................................................................94
SESSION 15: CONFLICT RESOLUTION STRATEGIES......................................................................100
SESSION 16: DISCIPLINARY ACTIONS FOR STAFF.........................................................................106
SESSION 17: STAFF PERFORMANCE APPRAISAL...........................................................................111
NMT 06104: Supervision in Nursing and Midwifery iii

Acronyms
AGYW Adolescents Girl and Young Women
AIDS Acquired Immune Deficiency Syndrome
AIHA American International Health Alliance
ARV Antiretroviral
VMMC Voluntary Medical Male Circumcision
WHO World Health Organization
NMT 06104: Supervision in Nursing and Midwifery iv

Preamble
The Ministry of Health Community Development Gender Elderly and Children among other roles
ensures that Tanzanians receive quality health care and service. This can be achieved through
production of competent nurses and midwives amongst other health cadres. The training of competent
nurses and midwives can be achieved through various teaching and learning materials; one of them being
facilitator’s guides and student’s manual.
Dr. Loishook Saitori

Director for Human Resource Development
Ministry of Health, Community Development, Gender, Elderly and Children
NMT 06104: Supervision in Nursing and Midwifery v

Acknowledgement
Ministry of Health, Community Development, Gender, Elderly and Children through the Directorate of
Human Resource Development, Nursing training section has reviewed Facilitator’s guide for Nursing
and Midwifery training program. The review was informed by revised curriculum of the same. The
successfully completion of this facilitator’s guide has been made possible by the commitment of the
technical team through a series of writers’ workshops. Understanding the crucial role of the team, the
Ministry would like to express sincere appreciation to all those who involved in the completion of this task.
Special gratitude goes to coordinators of Nursing and Midwifery training, technical expert from NACTE and other
facilitators who tirelessly supported the development of this guide whose names are listed with appreciation:-
SN FULL NAME INSTITUON/ ORGANIZATION

1. Nassania Shango CDNT -MOHCDGEC-Dodoma
2. Professor Eliezer Tumbwene Lecturer -Aga Khan University
3. Ramadhani Samainda NACTE-Dodoma
4. Dr. Patrick Mwidunda Program Manager-Amref Health Africa
5. Lupyana Kahemela Program Officer-Amref Health Africa
6. Joseph Pilot Program Officer- Amref Health Africa
7. Mary Kipaya Principal- Kahama School of Nursing
8. Paul Magesa Ag. Principal –Newala School of Nursing
9. Dominic Daudi Tutor –Newala School of Nursing
10. Dr. Beatrice Mwilike Lecturer-MUHAS
11. Lilian Wilfred Tutor KCMC School of Nursing
12. Upendo Mamchony Tutor KCMC School of Nursing
13. Tito William Nurse Officer Muhimbili National Hospital
14. Sixtus Ruyumbu Nurse Officer- Mbeya Refferal
15. Dr Lenatus Kalolo Medical Specialist-Mbeya Refferal
16. Emmanuel Mwakapasa Principal Mbeya -OTM
17. Salma Karim Tutor- Mirembe School of Nursing
18. Athanas Paul Principal- Mirembe School of Nursing
19. Dr. Jiyenze Mwandu Kini Tutor -CEDHA
20. Joseph Mayunga Tutor- Kisare
21. Elizabeth Kijugu Principal-Kairuki School of Nursing
22. Charles Magwaza Principal Njombe School of Nursing
23. Meshack Makojijo Tutor Bugando School of Nursing
24. Stella Kiwale Tutor- PHN Morogoro
25. Evance Anderson Tutor Geita School of Nursing
26. Juliana Malingumu Tutor Mchukwi School of Nursing
27. Rehema Mtonga Tutor -
28. Masunga Iseselo Assistant Lecturer -MUHAS
29. Mbaruku Luga Driver-Mirembe School of Nursing
Lastly would like to thank the collaboration and financial support from Amref Health Africa who made
this task successfully completed.
Ndementria Arthur Vermand

Assistant Director Nursing Training Section, Ministry of Health, Community Development,
Gender, Elderly and Children
NMT 06104: Supervision in Nursing and Midwifery vi
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1.0. Background
In 2015 the Ministry of Health, Community Development, Gender, Elderly and Children through the
Directorate of Human Resource Development, Nursing training section started the process of reviewing
the nursing curricula NTA level 4-6. The process completed in the year 2017 and its implementation
started in the same year. The rationale for review was to comply with the National Council for Technical
award (NACTE) Qualification framework which offers a climbing ladder for higher skills opportunity.
Amongst other rationale was to meet the demand of the current health care service delivery. The
demand is also aligned with human resource for health strategic plan and human resource for health
production plan which aims at increasing number of qualified human resource for health.
The process of producing qualified human resource for health especially nurses and midwives requires
the plentiful investment of resources in teaching at the classroom and practical setting and the
achievement of clinical competence is acquired in step wise starting from classroom teaching to skills
laboratory teaching. In addition, WHO advocates for skilled and motivated health workers in producing
good health services and increase performance of health systems (WHO World Health Report, 2006).
Moreover, Primary Health Care Development Program (PHCDP) (2007-15) needs the nation to
strengthen and expand health services at all levels. This can only be achieved when the Nation has
adequate, appropriately trained and competent work force who can be deployed in the health facilities
to facilitate the provisions of quality health care services.
In line with the revised curricula, the MOHCDGEC in collaboration with developing partners and team of
technical staff developed quality standardized training materials to support the implementation of
curricula. These training materials address the foreseen discrepancies in the implementation of the
curricula by training institutions.
This facilitator’s guide has been developed through a series of writers’ workshop (WW) approach. The
goals of Writer’s Workshop were to develop high-quality, standardized teaching materials and to build
the capacity of tutors to develop these materials. The new training package for NTA Level 4-6 includes
a Facilitator Guide and Student Manual. There are 33 modules with approximately
520 content sessions
2.0. Rationale
The vision and mission of the National Health Policy in Tanzania focuses on establishing a health
system that is responsive to the needs of the people, and leads to improved health status for all.
Skilled and motivated health workers are crucially important for producing good health through
increasing the performance of health systems (WHO, 2006). With limited resources (human and non-
human resources), the MOHSW supported tutors by developing standardized training materials to
accompany the implementation of the developed CBET curricula. These training manuals address the
foreseen discrepancies in the implementation of the new curricula.
Therefore, this training manual for Certificate and Diploma program in Nursing (NTA Levels 4-6) aims at
providing a room for Nurses to continue achieving skills which will enable them to perform competently.
These manuals will establish conducive and sustainable training environment that will allow students
and graduates to perform efficiently at their relevant levels. Moreover, this will enable them to aspire for
attainment of higher knowledge, skills and attitudes in promoting excellence in nursing practice.
NMT 06104: Supervision in Nursing and Midwifery vii
vii
3.0. Goals and Objectives of the Training Manual
3.1. Overall Goal for Training Manual
The overall goal of these training manuals is to provide high quality, standardized and
Competence-based training materials for Diploma in nursing (NTA level 4 to 6) program.
3.2. Objectives for Training Manual

• To provide high quality, standardized and competence-based training materials.
• To provide a guide for tutors to deliver high quality training materials.
• To enable students to learn more effectively.
4.0. Introduction
4.1. Module Overview
This module content has been prepared as a guide for tutors of NTA Level 6 for training students. The
session contents are based on the sub-enabling outcomes of the curriculum of NTA Level 6 Ordinary
diploma in Nursing and Midwifery.
The module sub-enabling outcome as follows:

1.1.1 Describe concepts of supervision in the context of nursing and midwifery practice
1.1.2 Conduct supportive supervision according to guidelines
1.1.3 Conduct orientation to newly employed nurses and midwives by utilizing knowledge and skills of
supportive supervision
1.1.4 Mentor staff and students at work place by utilizing knowledge and skills of supportive supervision
1.1.5 Facilitate availability and accessibility of health policies and guidelines for nursing and midwifery
practice
1.2.1 Prepare duty roster, annual leave, job allocation and schedules according to guidelines and
protocols
1.2.2 Prepare a budget for the department or facility by using guidelines and protocols
1.2.3 Allocate/relocate resources (human and non-human, equipment and supplies) by using guidelines
and protocols
1.2.4 Utilize quality improvement standards in the provision of quality nursing care at work place
1.2.5 Coordinate departmental/unit nursing and midwifery activities according to standards
1.2.6 Monitor nursing and midwifery services according to guidelines and protocols
1.3.1 Motivate staff according to guidelines and interpersonal skills
1.3.2 Provide counselling on staff performance by using guidelines
1.3.3 Solve disputes or conflicts among staff and between staff and clients by using conflict resolution
strategies
1.3.4 Take disciplinary actions to staff according to disciplinary guidelines and regulations
1.3.5 Appraise staff performance according to standards
1.3.6 Build a working team according to interpersonal skills and guidelines
4.2. Who is the Module For?

This module is intended for use primarily by tutors of NTA Level 4 certificate and diploma in nursing
schools.
NMT 06104: Supervision in Nursing and Midwifery viii
viii
The module’ sessions give guidance on the time and activities of the session and provide information
on how to teach the session to students. The sessions include different activities which focus on
increasing students’ knowledge, skills and attitudes.
4.3. How is the Module Organized?

The module is divided into 18 sessions; each session is divided into sections. The following are the
sections of each session:
 Session Title: The name of the session.
 Learning Tasks – Statements which indicate what the student is expected to learn at the end of the
session.
 Session Content – All the session contents are divided into steps. Each step has a heading and an
estimated time to teach that step. Also, this section includes instructions for the tutor and activities
with their instructions to be done during teaching of the contents.
 Key Points – Each session has a step which concludes the session contents near the end of a
session. This step summarizes the main points and ideas from the session.
 Evaluation – The last section of the session consists of short questions based on the learning
objectives to check the understanding of students.
 Handouts are additional information which can be used in the classroom while teaching or later for
students’ further learning. Handouts are used to provide extra information related to the session
topic that cannot fit into the session time. Handouts can be used by the participants to study
material on their own and to reference after the session. Sometimes, a handout will have questions
or an exercise for the participants. The answers to the questions are in the Facilitator Guide
Handout, and not in the Student Manual Handout.
4.4. How Should the Module be Used?

Students are expected to use the module in the classroom and clinical settings and during self-study.
The contents of the modules are the basis for learning Supervision in Nursing and Midwifery. Students
are therefore advised to learn each session and the relevant handouts and worksheets during class
hours, clinical hours and self-study time. Tutors are there to provide guidance and to respond to all
difficulty encountered by students.
NMT 06104: Supervision in Nursing and Midwifery ix
ix
SESSION 01: CONCEPTS OF SUPERVISION IN THE CONTEXT OF
NURSING AND MIDWIFERY PRACTICE

Total Session Time: 120 Minutes
Prerequisites: None
Learning Tasks
At the end of this session a learner is expected to be able to:
Define supervision and supervisor
Explain the qualities of a supervisor
Differentiate between supervisor, leader and manager
Outline roles of a supervisor
Outline importance of supervision
Explain principles of supervision
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 LCD Projector and computer
 Note Book and Pen
Session Overview Box
Step Time (min) Activity/ Content

Method
1 05 Presentation Presentation of Session Title and Learning
tasks
2 05 Lecture/discussion Definition of supervision and supervisor
3 20 Lecture/discussion Qualities of a supervisor
4 20 Lecture discussion Differentiate between supervisor, leader and

presentation manager
5 30 Small group discussion Roles of a supervisor
6 10 Lecture discussion Importance of supervision
NMT 06104: Supervision in Nursing and Midwifery 10
10
7 20
Lecture discussion Principles of supervision
8 05
Presentation Key Points
9 05
Presentation Session Evaluation
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning tasks (05 minutes)
READ or ASK participants to read the learning task
ASK participants if they have any questions before continuing
STEP 2: Definition of Supervision and Supervisor (05 Minutes)

SESSION CONTENTS
 Supervision is an act of overseeing and managing employees in the workplace or the provision of
guidance or direction, oversight, evaluation, and follow-up by the licensed nurse for the
accomplishment of a delegated nursing task by assistive personnel. OR
 Is a method by which workers are helped to perform their work completely through monitoring and
measuring their performance continuously to ensure that the job is done correctly and to the
highest possible standards
 Supervisor is a person in the first-line management who monitors and regulates employees in
their performance of assigned or delegated tasks .
STEP 3: Qualities of a Supervisor (20 Minutes)

 The following are qualities of a supervisor;
 Emotional balance: The supervisor works in situations which involve authority, leadership,
meeting targets and deadlines, conflicts etc.
 Being proactive: The supervisors have some objectives to achieve. They cannot plan
everything in advance. Several times they have to respond to the needs of the situation which
has arisen suddenly.
 Creativity: It means that the supervisor must have the ability to come up with new responses
to situations.
 Mental ability: The supervisor must have the ability to grasp problems quickly, to think of
several things at the same time, and assess the whole situation quickly
 Learning habits: Effective supervisors are independent as learners. They take responsibility
for the rightness of what is learned, and are not dependent on others.
 Self-knowledge: Whatever the supervisor does is affected by their own view of their job and
role, objectives, strengths and weaknesses etc. So they must be aware of these attributes.
Hence the supervisor must develop skills of looking at himself critically.
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 Technical skill Technical skill is proficiency in a specific activity that involves methods,
processes, procedures or techniques. Individual performers expect their supervisor to be able
to help them with technical problems.
 Human skill Human skill is the ability to work with, understand, motivate, and communicate
with individuals and groups. Human skill also includes the ability to communicate with people,
to resolve conflict, and to discipline.
 Conceptual skill Conceptual skill is the ability to understand abstract or general ideas and
apply them to specific situations
 Diagnostic skill Diagnostic skill is the ability to analyze the nature of a problem with people,
ideas, things or events. A good diagnosis precedes a recommended solution to a problem (like
in medicine or automotive repair or management).
STEP 4: Differentiate Between Supervisor, Leader and Manager (20 Minutes)

The following are the difference between supervisor, leader and manager and their characteristics;
Supervisor is a person who is responsible for their direct report’s progress and productivity in the
organization.or is a person who supervises/help another person or an activity and always focused on
compliance, accuracy, day-to-day implementation.
Leader Is a person who leads or commands a group, organization, or country in order to achieve set objectives
always focus on goals, resources, direction.
Manager is a person who can organize people to work harmoniously together and make use of
resources to achieve laid down objectives, ffocused on priorities, planning, options and clarity.
Differences between supervisor, leader and manager

SUPERVISOR LEADER MANAGER
Supervisor Leader Manager

 Is overseeing the work of  Is guiding the  Is directing and
others through such organization and its controlling
activities as: people into the future organizational or
by doing things such company assets and
as: people through such
things as:
 Training and answering  Identifying trends and  Planning and budgeting

questions opportunities
 structuring and staffing
 Scheduling people and  Creating a shared jobs
work vision
 Monitoring performance
 Checking quality  Inspiring others to
commit to a new  Problem-solving
 Facilitating the removal direction
 Have an assigned
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of obstacles to  Creating an position within the
completion of work, such environment that formal organization
as broken equipment supports taking risks  Have a legitimate
and learning from source of power due to
mistakes delegated authority
 Carry out specific
 Have wider variety of function, duties and
roles responsibilities
 May or may not be part  Emphasize control,
of formal organization decision making,
 Focus on group decision analysis and
process, information results
gathering, feedback  Manipulate people,
and empowering others environment, money,
 Emphasize time, and other
interpersonal resources to achieve
relationship goals
 Have goals that may or  Have a greater formal
may not reflect those of responsibility and
the organization accountability than
 Direct willing follow leaders
 Direct willing and
 Do not have delegated
unwilling subordinates
authority, obtain power
through other means
like influence
STEP 5: Roles of a Supervisor (30 Minutes)

Activity: Small Group Discussion (10 minutes)
DIVIDE students into small manageable groups
ASK students to discuss in groups on roles of supervisor 5 minutes
AFTER small group discussion, ask students to provide their responses
CLARIFY and summarize by using the contents below
 The following are the roles of supervisor;

o Promotes and restores patients' health by developing day-to-day management and
long-term planning of the patient care area
o Directing and developing staff Initiating and guiding the process taking responsibilities
to move forward set goals
o Mobilizing and monitoring the use of resources
o Resolving conflicts
o Building sustainability, help others to develop commitment
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o Facilitates others to do work
o Change agent
o Critical thinker
o Advocate
o Teacher
o Diplomat
o Role model
o Providing physical and psychological support for patients, friends, and families
STEP 6: Importance of Supervision (10 Minutes)

 The importance of supervision are;
o Supervision helps staff to manage the personal and professional demands created by the
nature of their work. This is particularly important for those who work with people who have
complex and challenging needs.
o Clinical supervision provides an environment in which they can explore their own personal
and emotional reactions to their work.
o It can allow the member of staff to reflect on and challenge their own practice in a safe and
confidential environment. They can also receive feedback on their skills that is separate
from managerial considerations.
o It can be one part of their professional development, and also help to identify
developmental needs.
o It can contribute towards meeting requirements of professional bodies and regulatory
requirements for continuing professional development.
STEP 7: Principles of Supervision (20 Minutes)

 The following are the principles of supervision;
o Understand and recognize workers as individual (consider the educational background of the
subordinate), do not expect more from each workers than their capability ; help staff to
achieve the goal.
o Maintain a happy working atmosphere to the staffs (conducive working

environment),plan ahead the allocation of the work to the staffs.
 Example duty roster for a whole week, time table for the whole month,
Programme for the whole year etc
o Be familiar with workers but not unduly familiarity, socialize with respect so that to
make a difference between supervisor and subordinate. (fill the bottle maintain the
gap)
o Help each worker to assume as much responsible and consistence to the work,
delegate according to the capability and experience.
o Allow workers to control their own activities but keep on encouraging them to set their
own individual or team objectives provided it is within the organizational overall
objectives.
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o The job of supervise will to guide and help them to meet the goal.
o Supervisor should formulate his /her own decision about workers ability ( avoid
prejudices and being influenced by hear say)
o Concentrate on key result areas; identify the key result areas eg. Objectives of the
organization.
o Offer constructive criticism (by utilizing examples and demonstration rather than
negative criticism which lowers the morale of the workers and discourages the
initiatives.
o Avoid excessive close supervision (standing over them and breathing down their
necks), concentrate on the results and the key areas. Avoid over emphasize on minor
faults because excessive close supervision makes people work under pressure.
o Evaluate workers performance only after several similar observations both during
process and the finished results .Avoid permitting one incidence or mistakes to over
shadow all good works done by an individual.
o Give advice when sought (whenever is needed), be approachable, answer questions

graciously or friendly, consider no question is foolish or nonsense
o Be ready to comment good performance when worker deserves (be sincere and avoid
superficial remarks)
o Make reference materials available for workers
o Think of yourself as a leader, and understand other people, avoid threats and hard
driving, treat others as you would like to be treated, guide and lead not driving.
o Taking corrective action, refrain from taking corrective/disciplinary measures to the

publically, eg in front of the workers, patients or relatives. Decide on the action to be
taken and explain the reasons for it.
STEP 8: Key Points (5 minutes)

 Supervision is a method by which workers are helped to perform their work completely through
monitoring and measuring their performance continuously to ensure that the job is done correctly
and to the highest possible standards
 Supervision helps staff to manage the personal and professional demands created by the nature
of their work. This is particularly important for those who work with people who have complex and
challenging needs. Clinical supervision provides an environment in which they can explore their
own personal and emotional reactions to their work
Step 9: Session Evaluation (5 minutes)

 What are the roles of supervisor
15
 What are the principles of supervision
References
Diane L. H. (2006) Leadership and Nursing Care Management. (3rd Ed.) New Delhi: Elsevier Saunders
Koontz, H. & Weihrich H. (2005). Essentials of Management, an International perspective (6th Ed.) New
Delhi: MacGraw-Hill
Kozier & Erb’s (2014) Fundamentals of Nursing Concepts and Practice. (9th Ed.) Audreney Bernman
Shorlee Spyder
Marquis B.L. (2009), Leadership Roles and Management Functions in Nursing. (6th Ed.) Lippincott:
Philadelphia.
Ministry of Health and Social welfare, (2000).Quality Assurance Training Guidelines for Health Workers.
Dar es Salaam Tanzania: MoHSW
Sullivan, E.J.&Decker .P.J. (2009), Effective Leadership and Management in Nursing, (7th Ed.),
Pearson Prentice Hall, New Jersey.
World Health Organization. (1992).On Being In-charge, A Guide to Management in Primary Health
Care (2nd Ed.). WHO, Switzerland: Geneva.
SESSION 2: SUPPORTIVE SUPERVISION

Total Session Time: 120 minutes + 30 minutes for group assignment
Prerequisite: None
Learning tasks
Define supportive supervision
Outline importance of supportive supervision
Explain stages of supportive supervision
Identify tools for supportive supervision
Develop supportive supervision plan
Provide technical support
Resources Needed:
Describe on-job training process.
 Flip charts, marker
Write pens, supervision
supportive and maskingreport
tape
 Hand outs
16

Method
tasks
2 05 Brainstorming/Presentatio Definition of supportive supervision

n
3 05 Lecture discussion Importance of supportive supervision
4 10 Lecture discussion Stages of supportive supervision
5 10 Lecture/discussion Tools used in supportive supervision
6 40 Lecture/discussion Supportive supervision plan
7 10 Lecture/discussion Provide technical support
8 10 Lecture/discussion Conducting on-job training
9 15 Lecture/discussion Write supportive supervision report
10 05
11 05
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning tasks (05 minutes)

STEP 2: Definition of Supportive Supervision (05 Minutes)
Activity: Brainstorming (03 minutes)

ASK the students to brainstorm on definition of supportive supervision
ALLOW few students to respond and let others provide unmentioned responses
WRITE their responses on the flipchart/board
CLARIFY and summarize by using the information below
 Supportive supervision can be defined as:
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o A facilitative approach to supervision that promotes mentorship, joint problem-solving and
communication between supervisors and supervisees.
o Or is an exchange between practicing professionals to enable the development of
professional skills.
STEP 3: Importance of Supportive Supervision (05 Minutes)

 The following are the importance of supportive supervision:
Increases/improves health worker motivation
o Increases and sustains job satisfaction
o Improves skills on-the-job and service quality
o Promotes efficient use of resources, as staff are supported to prioritise activities and
allocate resources accordingly
o Prevents burnout
o Provides needed support for difficult cases
o Aids in personal fulfilment and career advancement
o Helps client receive appropriate support and better health outcomes
o Facilitates prompt response to problems
o Identifies opportunities for quality improvement
STEP 4: Stages of Supportive Supervision (10 minutes)
 The process of supportive supervision comprises of the following three stages:

o Preparatory stage( planning stage)
o Supervision stage ( actual supervision stage)
o Feedback stage ( giving feedback stage)
 During the preparatory stage, the supervisor is required to prepare as follows:
o Review past records or reports to identify deficiencies or problems and
recommendation.
o Agree on the time for supervision.
o Prepare supervision plan and time table
o Prepare and assemble tools for supervision, for example, the checklist.
o Inform everybody concerned about the supervision plan and timetable
 During the supervision stage, you should do the following:
o Greet and build good relationship with supervisee.
o Review previous feedback recommendations if any
o If clients or patients are present, greet them and be respectful.
o Do not embarrass the supervisee in front of clients or patients.
o Be supportive and helpful to the supervisee.
o Make sure not to disturb the work unnecessarily.
o Observe and listen carefully, avoid sticking to the checklist.
o Encourage the supervisee to share daily experiences.
o Giving feedback to supervise /supervised facility, When giving feedback, start with
positive findings.
o Combine feedback with on the job training
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o Immediate feedback:
The supervisor should point out areas which health workers have performed well,

then mention areas of weakness.
 Discuss together on how improvements can be made.
o Demonstrate correct ways of performing problem tasks and ask for return demonstration
o Late feedback
 Send a copy of supervision report to the supervised facility.

 The RHMT and the DHMT should have a file specific for supervision where all
supervision reports are kept.
 This will help easy retrieval of previous reports for studying before the next
supervision visit. At the same health facilities should have a similar file for all
supervision reports and record in MTUHA book two.
 Feedback can be positive or positive
o Positive feedback
 Positive feedback: implies that you are communicating to others what they
have done correctly.
 Most persons who are responsible for evaluating the performance of others
have little difficult with positive feedback
o Negative feedback Is equally important and often more difficulty
 Identifying unsatisfactory performance-that is, pointing out to an employee that

he or she is doing something wrong-constitutes the first step towards correcting
performance. It takes skill and experience to develop methods of providing
feedback that will help the employee to grow and learn.
o Giving Feedback Using Sandwich.
STEP 5: Tools Used in Supportive Supervision (10 Minutes)

 Supportive supervision data collection tools are data collection instruments designed to capture or
obtain relevant supervision data.
 The following are common data collection tools used in supportive supervision:
o Checklists and rating scales are used to generate data through observation method
o Compilation-sheets capture data when using document reviewing as method of data
collection during supervision
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o Questionnaires used when the method of data collection is administration of
questionnaire
o Interview guides used to capture through interviewing method
 The process of developing the supervision tools is similar to that used to prepare research data
collection tools; thus a learner is advised to read the session on data collection tools in the module
of fundamental of research
 Supportive supervision tools should be prepare to meet supervision objectives, which tend to be
similar to research objectives; Supervision tools need to be valid and reliable
 A sample of a supervision tools is shown supervision tool 2.1 at end of this session content
STEP 6: Supportive Supervision Plan (40 Minutes)

 To achieve better results, supervision should be planned and carried out according to a well-
elaborated schedule.
 For smoothing conducting of supportive supervision activities have to be planned, budgeted, and
be included in an organizational plan
 Once plan and budget are prepared, a supervision plan ( supervision matrix) has to be prepared
on quarterly basis
 The purposes of developing a supervision plan are to:
o Operationalize the annual plan of the organization in relation to supervision activities
o Communicate to staff and managers the range of supervision visits or activities to be
done
o Serve as tools for monitoring implementation of supervision activities
o Evaluate supportive supervision in an organization
 The supervision plan should include the following elements:
o Issues/place /activities
o Timeframe, which should indicate when the activities will be done or when a health
facility/unit will be supervised
o Responsible persons: indicate who will conduct the supervision
o Resources: resources needed to do the supervision activities
 Development of a supervision plan involves the following steps:
1. State the supervision activity or places to be supervised: e.g. conduct supervision to 5 nursing
units in health facilities/hospital;
2. State or indicate timeframe when the supervision activities will be conducted: e.g. first weeks of
November, 2019
3. Indicate persons who will conduct supervision activity: e.g. hospital matron and district nursing
officer and pharmacist
4. Indicate resources needed to conduct supervision: e.g. fuel, vehicle, finance, supervision tools
and notebook
 A basic format for preparing a supervision plan is indicated below
Table 2.1. A basic format for developing a supervision plan (matrix)

Activity/place Time frame Responsible person Resources needed
20
Small group work: group work (20 minutes)
 Divide students into groups of 3-6 members

 Using a sample table 2.1, ask learners to prepare a supervision plan for three months that will involve
supervise 40 primary health facilities and two hospitals
 Allow learners to do the work for 15 minutes

 Request learners to present their answers
 Provide feedback to learners
STEP 7: Provide Technical Support (10 Minutes)

 Providing of support is process of helping, guiding, empowering an individual to solve a problem or
improve performance
 Support given may be technical (directed to an aspect of health services) or managerial (directed to
management issues) in nature.
 Support may be in form of materials, knowledge or skills
 To provide support to an individual, unit, or organization, the following should be done:
o Assess what support is needed by an individual or organization by interviewing, observing
what is done, and reviewing documents
o Determine whether you can give the support and whether recipient are ready for the
support
o Provide the support needed: e.g. knowledge and skills support, or financial support, or
materials support
o Assess or evaluate the effects or impacts of support given to an individual, unit or
organization
o Re-plan again
STEP 8: Conducting On-Job Training (10 Minutes)

 On-job training is a form of training and learning that enables an individual to acquire
knowledge, attitude, skills and performance at work place
 It is also known as workplace learning, where a workplace is used as a learning site
 On-job training involves self-directed learning and is enhanced by coaching, mentoring, e-
learning and more
 Nurses and midwives can provide on-job training to their colleagues in order to improve their
knowledge, skills, and performance
 In order to provide on-job training, nurses and midwives need to go through the following steps:
21
1. Determine the training needs of colleagues and other workers: needs assessment helps in
identify learning gap – the gap between what is and what should be
2. Plan on-job training, which includes:
i. Set objectives( learning objectives/learning): what knowledge, attitudes and skills
should be acquired by the learner
ii. Determine the learning contents: determine what a learner should learn
iii. Determine the learning methods: e.g. coaching and mentoring, apprenticeship, and job
rotation within an organization
iv. Determine the assessment methods: determine the methods for evaluation
v. Determine on-job training resources: e.g. mentors and coach, site of learning, teaching
and learning resource such a books and handouts
3. Conduct on-job training using experienced coach and mentor and selected methods
4. Assess or evaluate on-job training to know if learner has acquired the knowledge, attitudes and
skills
STEP 9: Supportive Supervision Report (15 Minutes)
 Supervisors are required to prepare a supervision report soon after they have completed doing
supportive supervision
 A supportive report is describes and communicate process and findings of the supervision
 An effective supervision has the following elements:
o Preliminaries: title page, table contents, acknowledgement and abbreviation
o Summary: summarizes items b-g below.
o Introduction: state why the supervision was done, objectives of writing the SS report and
state the organization of the report and why writing report
o Purpose and specific objectives: state one broad purpose/aim and objectives of
conducting supportive supervision
o Methods of conducting supervision: type of supportive supervision, who conducted (by
title), health facilities/community covered, source of data, data collection methods and tools
o Findings and discussion : start with review of previous recommendations and the present
and discuss findings based on specific supervision objectives
o Finding and discussion should be presented by:
 Summarising the major findings for each supervision objective
 For gaps(weaknesses), state why they occurred
 State what was done by supervisors to address health service gaps
(problems) observed during supervision
 Specific observations could be reported in table ( see the sample of the
supervision report)
o Conclusions and specific recommendations
o Reference and appendices: e.g. supervision tools

 Supervision is an important function of a nurse professional
 Nurses and midwifery are expected to supervise nursing services and their subordinates
 Supervision has to be systematically using acceptable supervision tools
 After conducting supervision, supervisors are required to write supervision report and disseminate
report to stakeholders
22
STEP 11: Session Evaluation (05 minutes)
 Ask learners to answer the following questions:
 What is supportive supervision?
 What is the importance of supportive supervision?
R equest learners to do the assignment below
Group assignment (120 minutes)
 DIVIDE students into groups of 3-6 members

 ASK learners to do the following learning tasks Using a sample table 2.1,:
a) Conduct supervision Use the sample supervision tool to service areas indicated in the tool
b) Prepare a suppression report based on elements shown above and in line with the sample report
 ALLOW learners to do the work for 120 minutes
 REQUEST learners to present their report in class for discussion and feed
 PROVIDE feedback to learners
References
Delhi: MacGraw-Hill
Shorlee Spyder
Philadelphia.
MOHSW (2017).National supportive supervision guidelines for quality healthcare services. Dar es
Salaam, MOHSW
Handout 2.1: SUPPORTIVE SUPERVISION TOOL
23
NAME OF HEALTH FACILITY ______________________________
DATE___________________________________________________
Key: Y – Yes; P – Partial; N – Not at all; and X – Not Applicable
S/N Services VERIFICATION CRITERIA/ SPECIFIC STANDARD Y/P/N/X REMARKS
Health facility has skilled personnel to provide HIV/AIDS

services
Health facility has ART drugs (verify by checking ART ledger
and store)
HIV/AIDS
1 Health facility has OIs drugs (verify by checking ART ledger

and store)
Health facility has HIV/AIDS treatment guideline (verify by
checking presence of guideline at the site)
All clients are given medications according to their diagnosis
(verify through a sample of 5 case notes)
Health facility has skilled personnel responsible for providing
FP services (verify by observing provider while provide FP
FAMILY PLANNING`
services)
Health facility has adequate equipment for provision of FP
2 services (verify by observing the equipment)
Health facility observes infection prevention practices when
providing FP services (verify by observe hand washing and
proper disposal of syringe)
Health facility has a qualified staff for providing laboratory
MEDICAL LABORATORY
services
The Laboratory provide hematological investigation (verify by
checking lab register)
The Laboratory provide parasitology investigation (verify by
checking lab register)
Patient results are recorded in a registers (verify by checking
results register)
Health facility has receipt book for collecting funds.
Health facility has cash book which is properly filled.
Finance
Revenue collected by health facility is deposited in account

4
within two days.
Health facility uses collected funds in the last 6 months
Handout 2.2: SAMPLE OF SUPERVISION REPORT

EXECUTIVE SUMMARY
24
This supportive supervision was conducted at Themi Urban Health Centre in Arusha city council for the
purpose of gaining practical experience during supportive supervision training. The Aim conducting
supportive supervision was to assess provision of HIV/AIDS, Family Planning, Medical laboratory
services and financial management. The findings was HIV/AIDS services was provided by a qualified
personnel, ART medicines were available, some OIs drugs were available and patients were receiving
treatment as per their diagnosis. However, there were no enough clinicians to provide CTC services,
CTC services are provided on a single room.
At Family planning clinic there were qualified personnel, all family planning methods were available and
IPC policy were well observed. However, some client’s files were not properly filled and the principle of
first in first out was not observed.
Essential laboratory investigations are performed by qualified personnel and patients results are
recorded in the respective registers. However, IPC policy was not well observed and some essential
investigations were not performed e.g. FBP, Liver Function test, and renal function test.
Financial management was well managed, receipt books were available, cash books were properly
filled and collected funds were utilized within six months. But, the collected funds were not deposited
timely and there were no qualified personnel for financial management.
1. INTRODUCTION
The supportive supervision was done a part of the functions of CHMT members, as directed in national
health policy and national supportive supervision guideline. The aim of writing this report is to provide a
final supportive supervision feedback, after the immediate (oral) feedback report, to the service
providers at the Health Facility visited. The report will also assist the Management and Health Workers
to bridge the identified gaps and improve the health services.
This report covers broad objective, specific objectives, methods of conducting supportive supervision,
findings and discussion, conclusion and as well as specific recommendations for improving service
delivery.
2. SUPPORTIVE SUPERVISION OBJECTIVES
2.1. Broad Objective
To assess provision of HIV/AIDS, family planning, medical laboratory services and finance services at
Themi Urban Health Centre in Arusha City Council.
2.2. Specific Objectives
The specific supportive supervision objectives were as follows:

1) To assess provision of HIV/AIDS services
2) To assess provision of family planning services
3) To assess provision of medical laboratory services
4) To assess financial management
5) To support health workers through mentoring and coaching.
3. METHODS OF CONDUCTING SUPPORTIVE SUPERVISION
25
This was an integrated and planned supportive supervision. Source of data were facility health workers,
clients files, ledgers, cash books and receipt books. Data were collected by using 3 methods: document
reviewing, observation and interviewing. The tool used was a check list, which was adapted from the
2010 National Generic Checklist for supportive supervision.
4. FINDINGS AND DISCUSSION
4.1. HIV/AIDS services

Generally, HIV/AIDS services are provided as per national guideline and there is a skilled attendant for
provision of services. ART drugs are available, some OIs drugs were available and some important OIs
medicines were out of stock. Clients are given medication as per their diagnosis, however there were
no clinician to attend CTC clients, and there is only one room for providing CTC services.
4.2. Family planning services
Family planning services were provided by skilled personnel and all methods of family planning were
available and IPC observed. However, some documents were partially filled, first in first out principle
was not observed and some decontamination buckets missed covers.
4.3. Medical laboratory services
Generally, the health facility has skilled laboratory personnel and basic medical laboratory
investigations are performed such as B/S, MRDT, HB, Urinalysis, stool, HIV Screening, CD4 count and
sputum for AFB. Patient’s laboratory results were recorded in the respective register. However some
essential investigations were not performed e.g. FBP, liver function tests, and renal function tests. IPC
was not well observed.
4.4. Financial management
Financial management was well managed. Relevant receipt books are used and cash books were
properly filled and collected funds are used within six months. However, there were no qualified
personnel for financial management and collected funds were not deposited timely. Our
recommendations were health facility should request for qualified staff from City council and funds
collected should be deposited timely.
4.5. Other issues observed
There is a suggestion box but we were not sure of the use. Source of power is electricity and solar,
also they have a stand by generator. They have a placenta pit.
Mentoring and coaching was done in respective areas: FP clinic mentoring done on counseling for
informed choices of FP and proper filling of client files. Pharmacy mentoring and coaching was on
proper arrangement of medicine according to pharmacological actions and proper filling of ledger and
stock taking.
However, there were some areas which need improvement: the old building at the right side of the main
gate was very dirty, used as a store, store of old government documents, kitchen, bed room and toilet.
Toilets were not in good condition and there are in maintenance but no provisional toilets for client.
There is no incinerator, they are using pit hole. The Sewage system is questionable. The fence is not
compete; most of Buildings need repair; no ambulance; no waste bin around and there is a shortage of
staff.
26
Table 1. Specifc strengths, areas for improvement and specifc recommendatons
Area Areas for

S/N Strengths Specific recommendations
supervised improvement
Services at CTC are

Health facility in-charge should
provided by a trained No clinician at CTC
allocate clinician to work at CTC
nurse once per week.
The health facility has
ART medicine
HIV/AIDS service
Some OIs medicines

are out of stock e.g.
Pharmacy in charge should
The health facility has Nystatin oral
1 order missing OIs medicines
Some OIs medicine. suspension,
from City Pharmacist
clotrimazole
pessaries.
The health facility has
National Guidelines
Clients are given
medication according
to diagnosis
Some document
were partially FP service provider should
filled( e.g. one client complete fill the client register
file had no name)
st
The health facility has No observation of 1
Family Planning
skilled personnel for in 1st out principle

FP services for clients at FP
2 clinic.
FP service provider should
provide numbers to the clients
on arrival.
The health facility
provide all methods of
FP
Some buckets for FP service provider should
FP clinic observe IPC
decontamination make sure the new buckets with
policy
miss cover. covers are replaced.
IPC not well
Laboratory
Health facility has 3

Medical
observed (safety Laboratory staffs to adhere to

3 laboratory qualified
boxes were over full, IPC procedures.
staffs
used gloves were
27
S/N Area Areas for
Strengths Specific recommendations
supervised improvement
kept on the table,
Only one waste bin)
Health facility provide
some hematological Some important
and parasitology investigation were Health facility in charge should
investigation( e.g. Hb, not done (e.g. FBP, budget for purchasing
B/S, MRDT, Liver function test hematological and biochemistry
Urinalysis, stool, HIV and Renal function machines.
Screening, Sputum test
for AFB,CD4 count)
No qualified
The health facility has personnel Health facility in charge should
Financial management
relevant receipt responsible for request for qualified personnel

books. financial from city council management.
management
4 Health facility has
properly filled cash
book.
Health facility
collected funds is
used within 6 months
5. General recommendations
We recommend to the health facility in charge to allocate clinician to work at CTC and to find rooms for
conduction of CTC. Also, pharmacy in charge should order OIs medicines from City Pharmacist.
Service provider should fill in the documents properly and provision of numbers to the clients on arrival
at FP clinic. Replace with new decontamination buckets that contain covers.
The laboratory staffs should adhere to IPC policies and the Health facility in charge should budget for
purchasing haematological and biochemistry machines.
SESSION 3: ORIENTATION TO NEWLY EMPLOYED STAFF

Prerequisites: None
Learning Tasks
Define the term staff orientation
Outline the purpose of staff orientation

NMT 06104: Supervision
Explain in Nursing
steps of staff and Midwifery
orientation 28
Explain key areas for staff orientation 28
Orient new staff nurse

Resources Needed:

Method
tasks
2 05 Lecture discussion Definition of term orientation
3 10 Lecture discussion Purpose of orientation
4 25 Small group discussion Steps of staff orientation
5 15 Lecture discussion Key areas for orientation
6 25 Lecture discussion Orient new staff nurse
7 05
8 05
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Task (05 minutes)

29
STEP 2: Definition of Staff Orientation (05 Minutes)
 Staff orientation is the process introducing a new staff to a new situation or environment to
new staff.
o Main reasons for orientation are to enhance skills and knowledge in the new nurses, to
facilitate the integration of theory and practice and to ease the new graduates’
transition from school’s life to the clinical setting
STEP 3: Purpose of Orientation (10 Minutes)
 An effective orientation program is an ongoing process, allowing the employee time to
assimilate all the required information. It is a critical tool in making employees feels part of the
organization and increasing employee engagement and loyalty. The employee orientation
program will:
 The following are the purpose of staff orientation;

o Welcome the individual to the organization, workplace, and the position;
o Define and clarify work assignments, roles, and responsibilities;
o Highlight government's organizational structure, legislation, policies and procedures;
o Build positive connections between the employee, co-workers, and the organization;
o Consider the social and team-building aspects of employee development;
o Make workplace resources readily available to the newly-hired individual;
STEP 4: Steps of Staff Orientation (25 Minutes)

Activity: Small Group Discussion 6-8 (10 minutes)
DIVIDE students into small manageable groups  T
ASK students to discuss in groups on steps required for staff orientation h
AFTER small group discussion, ask students to provide their responses e
f
CLARIFY and summarize by using the contents below o
l
lowing are the steps of staff orientation;
1: On boarding
Have a smooth on boarding process where the institution is prepared to welcome the new employee on
the first day of work. This is the most difficult for institutions/companies with knowledge workers. Have
available their phone number, email account, and user ID's.
2: Acclimation
Help new employees become familiar with the work environment by developing aides to help them to
do their work. An online orientation can provide one location that can steer them to the answers.
3: Integration
Integration process contributes positively to employees wanting to stay with the company, it create
opportunities for new employees to meet other employees in the company.
New employees come into an organization with a fresh perspective. Encourage them to share any new
30
ideas or approaches to products and processes that would increase productivity or customer
satisfaction. Smart organizations take advantage of this source of innovation at their fingertips.
4: Relationship Management
Help employees build lasting relationships by having regular one-on-one conversations with
management. Go out to lunch together and get to know each other as people. This will keep them in
the company longer.
5: Expectations
Both employee and manager are coming into the relationship with expectations. It is important to share
these expectations with one another. Find out what the new employee expects.
STEP 5: Key Areas for Orientation (15 Minutes)
 In the orientation there some key areas for orientation as follows;
o Compliance with government rules and regulations, policies
o Organisation structure
o Information about the employer's mission, core values and culture
o Information about the employer's benefits and safety measures
o Information about critical employer policies
o Introduction to other employees and to the employer's facilities
o Thorough explanation about the new employee's job duties
o Documentation
STEP 6: Orient New Employed Nurse (25 minutes)
The following are the key things need to be followed when orienting new employee;
 Take a look at the job itself.
o As an employer, even before you hire, assess the job and what it entails. What hazards will
the worker be exposed to? Will certain situations present new risks? Are some tasks better
reserved for more experienced workers?
 Before the person starts a new position, provide effective health and safety orientation
and training. Content possibilities could include
o the company’s health and safety policy
o responsibilities of the employer, supervisor and worker
o Hazards in the workplace.
o Workers need to know how to protect themselves starting from day one, who to go to for
advice and what to do if things seem unsafe. And always remember workers have three
basic rights:
 To know about hazards,
 To participate in their organization’s health and safety efforts,
 To refuse dangerous work.
 Make sure all workers know that no one is to perform any task until they have been
trained to do so.
o Encourage workers to ask questions at any time, especially about safety.
o Demonstrate more than once.
31
o Training methods can also depend upon the age of the new worker. For young workers
(those under the age of 25), training should recognize their relative inexperience and
account for the differences in experiences, maturity and developmental level.
o For example, training could include interaction, instant reward and feedback, self-directed
learning, as well as teamwork.
o Adult worker training, on the other hand, should include more self-direction, as well as
encouragement to learn using their various experiences.
o All new workers, young and old, will benefit from more practical or classroom training for
new situations, procedures that are short and actively and clearly written, and by grouping
equipment or tasks that are associated with similar functions.
 Ensure the employer or supervisor is accessible
o During orientation and training. Stay close, watch the worker perform the task, and correct
any mistakes. The worker may feel pressured to get it right the first time, so you can help
by being patient, repeating instructions, and demonstrating procedures as often as
necessary.
o Workplaces are required to provide hands-on training on the correct use of equipment.
When demonstrating how to perform a task, always include
 safety features and control systems
 use of personal protective equipment (PPE)
 how to recognize hazards (including those outside own work area)
 the right to refuse hazardous work
 emergency procedures
 Ensure supervisors and managers monitor their workers.
o Take into consideration the amount of time allotted for each employee to absorb what they
are learning and how to conduct their work safely and correctly.
o A new employee can absorb only a certain amount of information in the first few days, so
provide a handout outlining the points covered in the orientation sessions.
o It can also serve as a checklist for the person conducting the orientation.
o A buddy system is also a helpful follow-up to the initial orientation.
o This allows for on-the-job reinforcement of the information presented to the new employee
and promotes the safety awareness of experienced workers who act as "buddies."
 Soon after the orientation sessions,
o Assess new workers on their understanding of the items discussed. Use this opportunity to
also evaluate the quality of training.
o Review and retrain where necessary.
o Be prepared to respond to procedural questions, such as “Can you show me that again?”
or “Why is this control necessary?”
o Health and safety education and job skills training can help to reduce the risk of injury
among inexperienced workers.
o Anyone supervising workers must have the knowledge, training or experience to organize
work and its performance.
o Be sure new workers are closely supervised, and adhere to recognized and safe work
procedures.
o Know the laws and regulations that apply to keeping workers safe on the job, and know
what is hazardous in your workplace.
Purpose of orientation
32
o Welcome the individual to the organization, workplace, and the position;
o Define and clarify work assignments, roles, and responsibilities;
o Highlight government's organizational structure, legislation, policies and procedures;
Build positive connections between the employee, co-workers, and the organization
STEP 8 Session Evaluation (05 minutes)

 What is orientation
 What are the steps for orientation
References
Delhi: MacGraw-Hill
Shorlee Spyder
Philadelphia.
SESSION 4: MENTORING, COACHING AND PRECEPTORSHIP

Total Session Time: 120 minutes
Prerequisites: None
Learning Tasks
Define a mentor, preceptor and a coach
Outline roles of a mentor
Outline the qualities of a mentor
Explain principles of mentorship

NMT 06104: Supervision in Nursing
Outline the and Midwifery
advantages of mentorship 33
Explain the process of mentoring 33
Guide staff and students at work place

Resources Needed:
 Flip charts, marker pens, and masking tape Black/white board and chalk/whiteboard markers

Method
tasks
2 05 Presentation Definition of mentor, preceptor and a coach
3 20 Small group discussion Roles of a mentor
4 10 Lecture discussion Qualities of mentor
5 20 Lecture discussion Principles of mentorship
6 20 Lecture discussion Advantages of mentorship

7 10 Lecture discussion Process of mentoring
8 20 Lecture discussion Guide staff and students at work place
9 05
10 05
SESSION CONTENTS
STEP 2: Definition of Mentor, Preceptor and a Coach (10 Minutes)

 Mentor: is an individual with expertise who can help develop the career of a mentee. The
mentor guides, trains, advises, and promotes the career development of the mentee.
34
o Mentee a person who is advised, trained, or counselled by a mentor.
 Preceptor: is the person who works as is an educator, facilitator, protector, and socialization
agent so as the one who received education will reach his goal or objectives.
 Coach: is the person who helping someone expands and applies skills, knowledge and
abilities by teaching motivating, listening encouraging and setting goals
STEP 3: Roles of a Mentor (20 Minutes)

ASK students to discuss in groups on role of mentor
 The following are the roles of a mentor;

o Teacher: This involves modeling behavior, providing information, etc., to understand
better what the mentee is seeking from the mentoring relationship.
o Sponsor: This involves helping the mentee to open doors, referring the mentee to others,
promoting the mentee's talents.
o Cheerleader: This involves inspiring the mentee to achieve what they can, challenging the
mentee in their assumptions and encouraging them in their development.
o Counselor: This involves listening, probing to discover the key issues affecting the
mentee's success, clarifying, and advising.
o Friend: This involves accepting the mentee for who they are and engaging in a more
personal relationship that supports the mentee in their personal and professional growth.
STEP 4: Qualities of Mentor (10 Minutes)
 The following are the qualities of mentor;
o Expertise and experience.
o Enthusiastic.
o Desire and energy to help others.
o Good Interpersonal skills.
o Honest and supportive in their work.
o Ability to work well with a diverse group of people
STEP 5: Principles of Mentorship (20 Minutes)

 Emphasizing the relationship between the more experienced person (the mentor) and the less
experienced person (the mentee):
o The mentor is more of a facilitator – creating a safe, open environment in which the mentee
can both learn and try things for them. Building trust and rapport with the mentee is a major
part of the role of the mentor.
 Giving the mentee a significant role in directing the process:
35
o Thoughts and perceptions are the basis of all behaviour, and learning new behaviour
requires engaging the mentee and altering his or her thoughts. To accomplish this, the
mentor engages the mentee through a process of questioning that guides the mentee to
discover solutions him or herself.
 Emphasizing the personal development of the mentee:
o This includes improving self-awareness and self-knowledge, developing individual skills
and talents, building capacities to coach, and fulfilling mentees’ aspirations.
 Formalizing the process:
o A formal process of support for mentees augments the informal mentoring that takes place
during practices and competitions. The formal process includes a preplanning meeting,
observation, and reflective conversations.
STEP 6: Process of Mentoring (20 Minutes)
 The following are the process of mentoring ;
o State the goals of the task or session
o Summarize the task or session
o Clarify the roles of those involved in the task or session
o List the actions of those involved in the task or session
o Itemize the challenges and opportunities associated with performing the task or session
o Identify what successful completion of the task
o Observation: The mentor observes the mentee and gathers information on how well the
mentee’s plan worked. The mentor shares this information with the mentee during the reflective
conversation.
o Reflective conversation: in this part of the process, the mentor summarizes and gives feedback
on the information gathered, and the mentee responds to the mentor’s summary and feedback.
STEP 7: Advantages of Mentorship (10 Minutes)

 A learning culture is created where knowledge is continually shared in a collaborative nature.
 Mentoring helps employees reach their full potential; thus promoting their personal and professional
development in a supportive way.
 Mentorship enhances leadership and coaching skills in current and future managers.
 Mentorship engages and motivates your top-talent employees.
 Employers of mentored employees gain from greater productivity in the workplace.
 Employees turn to mentors for advice; thus making fewer mistakes; thus cutting loss to employers.
 Employees in mentoring relationships tend to have greater job satisfaction and feel a high level of
engagement in their roles.
 Greater job satisfaction leads to a more positive work environment.
36
 A positive work environment creates less employee turnover and workers feel a greater sense of
loyalty to their company.
STEP 8: Guide Staff and Students at Work Place (20 Minutes)

 Guiding students and staff should take place over a number of weeks, even months. During
this time, employees need to assimilate a great deal of information.
 The Manager responsible for the induction programme can help this programme by:
o Not overloading
 Too intensive an information-giving session is likely to be ineffective.

o Deciding on priorities
What must be said on the new employee’s first day?

 What can wait for the second week?
 What will have the most significance in the second month?
o Explaining the purpose of knowing each new piece of information
Information is more likely to be digested if the new employee is told the relevance of it
to their job or the University.
o Using a variety of techniques
 People have a variety of learning styles. Some people may learn easily from written
material. Others may prefer to be given the information orally and also the opportunity
to discuss and ask questions.
o Involving other people
 This may include a number of colleagues from the Faculty/Directorate, a trade union
representative or someone from another Directorate such as Human Resources,
Finance and Legal Services, Academic and Student Affairs or Corporate Affairs.
 Roles of mentor are;
o To be a teaching model which involves modelling behaviours
o Should act as a sponsor by helping the mentee to open doors, referring the mentee to
others, promoting the mentee's talents.
o Should function as a Counsellor by listening, probing to discover the key issues affect the
mentee's success, clarifying, and advising.
 What is a mentor
 What are principles of mentorship
References
Diane L. H. (2006) Leadership and Nursing Care Management. (3rd Ed.) New Delhi: Elsevier
Saunders
37
Koontz, H. & Weihrich H. (2005). Essentials of Management, an International perspective (6th Ed.)
New Delhi: MacGraw-Hill
Kozier & Erb’s (2014) Fundamentals of Nursing Concepts and Practice. (9th Ed.) Audreney
Bernman Shorlee Spyder
Philadelphia.
Ministry of Health and Social welfare, (2000).Quality Assurance Training Guidelines for Health
Workers. Dar es Salaam Tanzania: MoHSW
Care (2nd Ed.). WHO, Switzerland: Geneva
SESSION 5: HEALTH POLICIES AND GUIDELINES FOR NURSING AND

MIDWIFERY PRACTICE
Prerequisites: None
Learning Tasks
Define policy and guideline
Explain the types of policy
Outline the importance of health policy and guidelines
Explain strategies
NMT 06104: Supervision ofand
in Nursing health policy
Midwifery 38
Identify health policies and guidelines related to nursing and midwifery practice 38
Resources Needed:

Method
1 05 Presentation
Presentation of Session Title and Learning Tasks
2 20 Brainstorming Concepts of Policy and Guidelines
Presentation
3 30 Presentation Types of Policy
4 10 Brainstorming Importance of Health policy and Guidelines

Presentation
5 45 Brainstorming Health Policies and Guidelines Related to Nursing
Presentation and Midwifery practice
6 05
7 05
SESSION CONTENTS
STEP 2: Concepts of Policy and Guidelines (20 minutes)

ASK students to define the policy and guideline
ALLOW
NMT 06104: time for them
Supervision to respond
in Nursing and Midwifery 39
WRITE their answers on a flip chart/board.
39
CLARIFY and provide summary using the content below.
Policy
 The term policy is defined differently by experts; the following some of the definitions:
o Policy refers to decision taken by those with responsibility for a particular policy area
o Policy denotes a set of statements of broad intent by the organization
 Public policies refers to policies made by the state or the government, by those in the public
sector
 Health policy refers to “courses of action (and inaction) that affect the set of institutions,
organisations, services and funding arrangements of the health care system (both public and
private (Buse, Mays & Walt, 2005)
 Healthy public policies (health related policies) are all public policies that take account of health
or promote health of individual or population.
 Guideline is a document containing “recommendations [instructions, directives, or statements] for
practice or health policy” (WHO, 2014).
 Policy or guideline recommendations are what an individual “can or should do in specific
situations to achieve the best health outcomes possible, individually or collectively” (WHO, 2014).
 Policy or guideline process is the way in which policies are initiated, developed, negotiated,
communicated, implemented and evaluated.
 Policy stakeholders (actors) are individuals or institutions have interests (stake) and who need to
be involved in policy or guideline process.
 Policy content is the substance of a particular policy which details its constituent parts
 Policy makers are people who make policy in an organization or sector
STEP 3: Types of Policies (30 Minutes)

ASK students to identify how policy exist in workplace
ALLOW time for them to respond
 Policies are expressed or exist in workplaces in various forms:

o Constitution
o Policies
o Acts or laws
o Regulations
40
o Guidelines
o Authoritative/formal statements
o Professional practices
o Plan or a more generalized statement of approach of doing or approaching an
issue or problem
 Policies and guidelines can be categorised in various way such:
o Specific health policies and guidelines: they address specific issue, problem or
services in the health sector and examples include the following:
 National policy on HIV/AIDS POLICY
 HIV and AIDS act
 National Multi-sectoral Strategic Framework
 National guidelines for Management of HIV/AIDS
 National Policy Guidelines for Collaborative TB/HIV Activities
o General health policies and guidelines: these cut-across the health sector and
examples include
 The public health act
 The National health insurance fund act
 Health sector scheme of services
 Health Planning guideline
 Treatment guidelines
 Supportive supervision guideline
 Infection prevention and control guidelines
o Public policies: these are policies that have impact in all public sectors and examples
include the following:
 The Development Vision 2025
 Employment policies: policy, act, and regulations
 National educational policy
 Procurement policies
 Financial act and regulations
 National strategic plan
 National strategy for growth and reduction of poverty (NSGRP II MKUKUTA
II)
o International policies: these are policies that affect more than one country and
example include:
 Sustainable Development Declaration for SDGs: cover major sectors,
including health sector
 Millennium Declaration for MGDs: covers important sectors, including health
sector
 Abuja Declaration for health financing: covers only health sector
Step 4. Importance of Health Policy and Guidelines (10 Minutes)
 Health policies and guidelines are regarded as means or approaches that help society to
organize its efforts to restore, protect, and improve individual or population health.
 Health polices and guidelines fulfil the following purposes:
o They specify health objectives and priorities
o They identify means/strategies and resources required to achieve objectives
o They rationalize or facilitate decision-making
41
o They define and clarify what can and cannot be done by who
Step 5: Health Policies and Guidelines Related to Nursing and Midwifery Practice
(45 Minutes)
Activity: Buzzing (05 minutes)
ASK students to identify list two health policies and guidelines that guide or influence nursing and
midwifery practice in Tanzania
 Nursing and midwifery practices is guided and influenced by many policies and guidelines in
Tanzania; e.g. of such health policies and guidelines are:
o The national health policy: the national health policy recognizes the importance of nursing and
midwifery services in Tanzania and promotes improvement of nursing services in Tanzania.
o Health sector scheme of services: the scheme of services recognizes nursing and midwifery
cadres as of the core cadres in the health sector; set educational qualification, salary scales,
and experience for nurses and midwives to guide employment of nurses and midwives;
prescribe duties and tasks of nurses and midwives
o Public employment policy: the policy set the minimum educational qualification for public
servants, including nurses
o Procurement act and its regulations: the act and regulation prescribe how nursing and
midwifery, among other, supplies can be procured in Tanzania.
o Nursing and midwifery procedures manual: the manual describes various procedures and how
a nurses and midwives can perform them effectively and efficiently.
o Nursing and Midwifery Act, Regulations and standards; set by Tanzania Nurses and Midwives
Council (TNMC), and formulate regulations for regulating nursing and midwifery profession and
professionals in Tanzania.
o Infections preventions and control guideline: the guideline describes what nurses and other
health professionals can do to prevent infections in health settings
o Supportive supervision guideline: the guideline specify how nurses and midwives and nursing
and midwifery services can supervised
Step 6: Key Points (05 minutes)
 There key concepts that a leaner need to master to understand health policies and guidelines
 Policies, health policies and guidelines exist in various forms in the workplaces
 Health policies and guidelines play various roles in the health sector
 Nursing and midwifery practice is guided and influenced by many health policies and guidelines
42
 What is the health policy and public policy?
 What are the importance of health policies and guidelines?
References
Saunders
Philadelphia.
SESSION 6: DUTY ROSTER, ANNUAL LEAVE, JOB ALLOCATION AND

SCHEDULES
Total Session Time: 120 minutes + 120 Group assignment
Prerequisites: None
Learning Tasks
Define duty roster, annual leave, job allocation and schedules
Explain the purpose of duty roster, job allocation, leave roster and schedules
Identify factors to consider in planning duty roster, job allocation, leave roster and
schedules
Outline steps of preparing duty roster job allocation, leave roster and schedules
Outline components of duty roster, job allocation, leave roster and schedules
Resources Needed:
43
 Handout 6.1 Job description for enrolled nurse
 Handout 6.2 Duty Roster

Method
1 05 Presentation Presentation of session title and learning
objectives
2 15 Brainstorming Definition of duty roster, annual leave, job
Presentation allocation and schedules
3 20 Presentation Purpose of duty roster, leave roster, job allocation

and schedules
4 20 Presentation Factors to consider when assigning duties
5 30 Small group Components of duty roster and job allocation

discussion
Presentation
6 15 Presentation Steps of preparing duty roster and job allocation
7 05 Presentation Assignment
8 05
9 05
SESSION CONTENTS
STEP 2: Definition of Terms (15 minutes)

ASK students to brainstorm on definition of duty roster, annual leave, job allocation and schedules
44
 Duty roster
o A roster is a schedule of staff members (e.g. nurses, health care assistants, ward
managers) with the task they are scheduled to work during a specific period (e.g. 1 week).
 Job allocation
o Job description is written account of organizational relationship, responsibilities, specific
duties, and working condition of a particular job.
 Annual leave
o Annual leave is paid time off work granted by employers to employees to be used for
whatever the employee wishes.
 Schedule
o Is a plan for carrying out a process or procedure, giving lists of intended events and times.
STEP 3: Purpose of duty roster, annual leave, job allocation and schedules (20
minutes)
 Purpose of a duty roster
o A good roster plan (or employee shift schedule) ensures that each shift has
enough employees to keep things running smoothly and efficiently.
 Purpose of annual leave

o The primary purpose of paid annual leave is to allow and encourage every
employee to renew his physical and mental capabilities and to remain a fully
productive employee.
o Employees are encouraged to request leave during each year in order to achieve
this purpose.
 Purpose of job allocation is to define exactly to the holders of different posts, their fellow
workers and their supervisors
o What the holders of the post are expected to do
o What standards are expected to reach
o To whom they are responsible
o Whose work they supervise
STEP 4: Factors to Consider when Assigning Duties (20 minutes)
Factors to Consider when Assigning Duties
 Tradition and training
o These define how similar jobs have been done previously, or are done elsewhere
o For example midwives are expected to perform certain duties according to the way
they are trained and the way other midwives practices
 The interpretation of the person who holds the job
 Experience; often needs people to change their way of work or to adapt to new
circumstances for example
o A midwife in a village has to work in a different way from a midwife in a large
hospital
o Rural health work and community are developing and changing, supervisors and
workers should keep job descriptions under review so that they remain useful
45
o One way to do this is to get health workers themselves to define their duties
o A supervisor will find it very useful to ask health workers to list their duties and then
discuss these duties
 Other means of helping to distribute tasks among the health team are
o Job description
o Duty roster
o Job allocation
o Other policies reflecting your working area
 Consideration when Planning Duty Roster
o Qualified nurses must be present in the ward for each shift
o Balance of senior and junior staff
o Balance of trained and untrained staff
o Continuity from one day to the next
o Sharing of weekends off
o Preferences of days off
o Special request
 Consideration when Preparing Job Allocation
o Staff level (number) as compared to patients
o Ratio of qualified nurses
o Ward design e.g. small rooms etc
o Patient turn over
o Mode of patient care in the ward
STEP 5: Components of Duty Roster and Job Allocation (20 Minutes)
Factors to consider when writing job allocation/duty roster
 The duty rosters must be legible and white corrected must not be used.
 All duty rosters must include the number of staff on that shift at the bottom of the roster sheet
i.e. 4 / 2 / 3.
 Each member of staff has their full name recorded on the roster.
 The off duty reflects the acceptable staffing levels.
 The nurse in charge of the shift is clearly identified on the off duty.
o Changes to the off duty must be dated and initialled by sister/charge nurse or her/his
deputy.
 All types of leave are clearly identified.
o As a guide 21% =
 Annual Leave 15%
 Maternity Leave 1%
 Sickness 3%
 Study Leave 2%
 There is a recognised system in place for the authorisation of annual leave and study leave, to
ensure equity
 Sickness/absence will be recorded on the off duty in red.
Components of a Job Description

 Job description should be written under specific headings to make sure that all necessary
information is given.
46
 The following are components of job description
o Job title
 Standard title for the person doing the work, e.g., nurse tutor, nurse midwife
etc.
o Date
 Date should be included, people changes in terms of position and status, so
their roles should be reviewed and if necessary revised at least each year
o Job summary
 Brief summary of the main responsibilities of the job
o Duties
 It is the central and most important part of the job description
 A duty is identifiable and recognizable part of the job holder work
o Relations
 They are simple statements about
 Title of the person to whom the job holder is accountable for his work, for a
particular job can be responsible to only supervisor, but one person hold more
than one job
 Title of the person whose work is supervised by the job holder, e.g., senior
nurse can supervise junior nurses
o Qualification
 It describes the level of training and level of experience required for the job
holders
o Training and development
 It has to show the programme for further training and development of person
holding the job, in service training and opportunity to attend professional
meetings
o Review and appraisal
 A statement describing the process for review and appraisal of the
performance of job holder e.g. the appraisal may take a form of confidential
report /open appraisal report by a supervisor (a simple statement that work is
satisfactory or a recommendation for change of duty)
STEP 6: Steps of Preparing Duty Roster and Job Allocation (20 Minutes)

ASK students to discuss in groups on the steps of preparing duty roster and job
allocation
Steps in duty roster preparation

 Rosters must ensure that there is sufficient and appropriately skilled staff planned to work, in
order to provide appropriate patient care and to meet anticipated service demands.
 Rostering processes should ensure staffs are allocated fairly, while still providing appropriate
flexibility to facilitate meeting unit staffing needs.
47
 Rosters must make appropriate provision for adequate staff supervision, training and clinical
handover.
 The organisation must have appropriate governance structures in place to oversee roster
planning, creation, approval, monitoring and reporting.
 The steps in duty roster preparation include:
1. List names of staff in order of seniority (indicate cadres)
2. Date, time, month and year
3. Identify staff with special request /need
4. Note days off, noting the busier days, leave
5. Add the shifts, balancing senior and junior nurses
6. Total the number of staff on duty for each shift
Steps in Job description preparation
 The first fundamental element of the job description is the job title.
 The job description should contain a list of the duties and responsibilities associated with the
role, along with the amount of time expected to be dedicated to each task.
 List the skills and competencies separately.
o Skills are activities the candidate can perform based on what they have learned in the
past, or from qualifications they have obtained.
o Competencies are the traits or attributes you expect the candidate to display in the
role.
 It is important to include reporting lines and working relationships in your job description.
 Work out a salary range to include in the job description that is competitive with similar
positions in other organisations and allows for variations in education and experience.

 Duty roster: is the central and most important part of a job description
 A duty is identifiable and recognizable part of the job holder work
 Job descriptions are one means of helping to distribute tasks among the health team
 What is duty roster?
 What are the components of job description?
References
Marquis, B.L. & Carol J. H. (2003). Leadership roles and Management Functions in Nursing Theory
and Application.(4th ed.). London: Lippincott Williams &Wilkins
MOHSW. (2006). Hospital management Team Training Module Level I, II & III. Dar es Salaam
Tanzania: Ministry of Health and Social Welfare.
MoHSW, (2000). Quality Assurance Training Guidelines for Health Workers. Dar es Salaam Tanzania:
Ministry of Health and Social welfare
48

 ASK learners to do the following learning tasks
Prepare duty roster for medical department of December 2019, with 20 staff, 15 EN, RN 5, and
MA 5 with the consideration that one EN she is a nursing mother and one RN on annual leave.
 REQUEST learners to present their report in class for discussion
Handout 6.1 Job description for enrolled nurse
Provide health care to the community, hospital and any clinical setting where health care could
be offered
 Supervise and coordinate health care activities at the working area
 Collect and prepare date for daily working
 Provide domicile care
 Counselling
 Provide preventive services including family planning
 Provide reproductive and child health care
 Conduct health education on health related issues
 Supervise and monitor working tools at working area
 To perform any other activities as it may deem necessary according to his/her knowledge and
experience
Handout 6.2 Duty Roster
49
SESSION 7: BUDGETING
Total Session Time: 60 minutes+60 assignment
Prerequisites: None
Learning Tasks
Define budget
Outline types of budget
Explain the purpose of budgeting

Explain steps in budgetary process
50
Explain methods of budgeting
Resources Needed:
Method
objectives
2 05 Brainstorming Definition of budget
Presentation
3 10 Presentation Types of budget
4 05 Presentation Purpose of budgeting
5 15 Buzzing Steps in budgetary process

Presentation
6 10 Presentation Methods of budgeting
7 05 Presentation Assignment
7 05
8 05
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Task(05 minutes)
STEP 2: Definition of Budget (05 minutes)

ASK the students to brainstorm on definition of budget
51
Budget
 A budget is a financial plan that includes estimated expenses as well as income for a period of
time.
o Accuracy dictates the worth of a budget; the more accurate the budget blueprint, the better
the institution can plan the most efficient use of its resources.
STEP 3: Types of Budget (10 Minutes)

Three major types of budgets that the unit manager may be directly involved in with fiscal planning are
personnel, operating, and capital budgets.
 The Personnel Budget
o The largest of the budget expenditures
o A manager must monitor the personnel budget closely to prevent understaffing or
overstaffing.
o As patient days or volume decreases, managers must decrease personnel costs in relation
to the decrease in volume
o In case of pay per hour, the formulary used is:
 The Operating Budget

o Reflects expenses that change in response to the volume of services
o Include daily expenses like cost of electricity, repairs and maintenance,
o medical/surgical supplies
o Consider cost effectiveness of reusable versus disposable supplies, rental versus
o facility owned equipment
 Capital Budget
o Include purchase of buildings or major equipment i.e. long life equipment (5-7 years)
o Composed of long-term planning and short term budgeting components
o Outline future replacement and organizational expansion
STEP 4: Purpose of Budgeting (5 Minutes)

 The following are the purpose of budgeting;
o Forecast of income and expenditure
o Aids planning, this gives a direction to an organization. A budget takes the organisational
plan and quantifies this into something tangible to aim for.
o Assists to measure performance against the targets set in the budget.
o Facilitate on decision making
o Helps to control organizational finance
o Helps to achieve organizational goal
 Budget helps an organization devote resources to those things that are

most important
52
STEP 5: Steps in Budgetary Process (15 Minutes)
TELL the students to pair up and discuss on the steps in budgetary process
ALLOW few students to respond and let other pairs provide unmentioned
responses
The nursing process provides a model for the steps in budget planning:
 Assess
o Determine what needs to be covered in the budget.
 Diagnosis.
o The diagnosis would be the goal or what needs to be accomplished, which is to create a
cost-effective budget which maximizes the use of available resources.
 Develop a plan.
o The budget plan may be developed in many ways.
o A budgeting cycle that is set for 12 months is called a fiscal-year budget.
o This fiscal year, which may or may not coincide with the calendar year, is then usually
broken down into quarters or subdivided into monthly or semiannual periods. Most budgets
are developed for a 1-year period, but a perpetual budget may be done on a continual
basis each month so that 12 months of future budget data are always available
 Implementation.
o In this step, ongoing monitoring and analysis occur to avoid inadequate or excess funds at
the end of the fiscal year.
o In most healthcare institutions, monthly statements outline each department’s projected
budget and deviations from that budget.
 Evaluation.
o The budget must be reviewed periodically and modified as needed throughout the fiscal
year.
o Each unit manager is accountable for budget deviations in his or her unit.
o Most units can expect some change from the anticipated budget, but large deviations must
be examined for possible causes and remedial action taken if necessary.
STEP 6: Methods of Budgeting (10 Minutes)
 Incremental Budgeting
o Incremental or the flat-percentage increase method is the simplest method for budgeting.
o By multiplying current-year expenses by a certain figure, usually the inflation rate or
consume price index, the budget for the coming year may be projected.
o Although this method is simple and quick and requires little budgeting expertise on the part
of the manager, it is generally inefficient fiscally because there is no motivation to contain
costs and no need to prioritize programs and services.
53
 Zero-Based Budgeting
o In comparison, managers who use zero-based budgeting must rejustify their program or
needs every budgeting cycle.
o This method does not automatically assume that because a program has been funded in
the past, it should continue to be funded. Thus, this budgeting process is labor intensive for
nurse–managers.
 Flexible Budgeting
o Flexible budgets are budgets that flex up and down over the course of the year depending
on volume.
o A flexible budget automatically calculates what the expenses should be, given the volume
that is occurring.
o This works well in many healthcare organizations as a result of changing census and
manpower needs that are difficult to predict, despite historical forecasting tools.
 Performance Budgeting
o Emphasizes outcomes and results instead of activities or outputs.
o Thus, the manager would budget as needed to achieve specific outcomes and would
evaluate budgetary success accordingly.
STEP 7: Assignment (05 minutes)

 A budget is a financial plan that includes estimated expenses as well as income for a period of
time.
 Three major types of budgets that the unit manager may be directly involved in with fiscal
planning are personnel, operating, and capital budgets.
 The nursing process provides a model for the steps in budget planning which includes
assessment, diagnosis, develop a plan, implementation and evaluation
 What is budgeting?
 What are the methods of budgeting?

 ASK learners to do the following learning tasks
 Prepare budget for Surgical department
 REQUEST learners to present their report in class for discussion
References
54
Delhi: MacGraw-Hill
Shorlee Spyder
Philadelphia.
SESSION 8: MANAGEMENT OF REOSRCES

Prerequisites: None
Learning Tasks
Define resources, human and non-human resources
Explain categories of human and non-human resources
Explain the importance of human and non-human resources
Allocate staff according to demand and job description
Describe the receiving and issuing of supplies and equipment
55
Resources Needed:

Method
objectives
2 05 Brainstorming Definition of human and non-human resources
Presentation
3 10 Presentation Categories of human and non-human resources
4 05 Presentation Importance of human and non-human resources
5 15 Presentation Staff allocation according to demand and job

description
6 10 Presentation Receiving and issuing of supplies and equipment
7 05
8 05
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Objectives (5 minutes)
READ or ASK participants to read the learning objectives
STEP 2: Definition of Human and Non-human Resources (5 minutes)

ASK the students to brainstorm on definition of human and non-human resources
56
Human resources
 Human resources are the people who make up the workforce of an organization sector,
or economy.
 Human resources is used to describe both the people who work for organization and the
department responsible for managing resources related to employees.
Non-human resources
 Non-human resources would be any resource that is not a person.
STEP 3: Categories of Human and Non-human Resources (10 minutes)
Categories of human resources
 Human Resource deals with personnel who deliver services to the client/ patient/students i.e.
o Health professional and non health professional
o Level of qualification
Categories of non-human resources

 Money/Finance
o Invisible money or budgetary allocation
 This is the money that is not seen or handled.
 It is a “paper credit” (Cheque) given as an allowance, allocation, or warrant of
funds.
 Is issued by using cheque or vendor form
o Visible money or cash
 This is money that is seen and handled.
 It is advanced to the health worker to spend for work of the health services/
institutional services.
 It is not safe to have large amount of money at a health centre/ institution as it
may be stolen for this reason visible is usually small in amount and is called
“petty cash”.
 It is issued and recorded in a cash book
 Materials
o Non-consumable material (equipment) - which lasts for several years, needing care
and maintenances e.g., weighing scales, microscope, bed pans, kidney dishes,
vehicles etc.
o Consumable material (supplies) - which are used within a short time e.g., cotton wool,
stationary, disposable syringes etc.
 Space
o Is an amount of an area or place that is empty or that is available for use
o Good management of space helps the workers to provide care smoothly and for the
convenience of the patient and others who use it
 Time
57
o Time is an important resource, once wasted is not renewable.
o For that matter, time need to be planned so as to facilitate efficient and effective use of
other resources in delivering services to client/ patient etc.
STEP 4: Importance of Human and Non-human Resources (5 minutes)

 providing services,
 strategic planning
 Improve organization image.
 Improve quality and utilization of non-human resources such as money, equipment and
supplies promote service provision of the organization when they are properly used by human
resources.
 Manage health services
 Support provision and management of health services
STEP 5: Staff Allocation According to Demand and Job Description (15 Minutes)
As a manager you need to consider the following things so that you can successfully allocate work to
your team:
 Allocating Based On Skill
o This is one of the main things that you should take into consideration although, as you
will find out below, it is not the only thing that you should base your decision on.
o Some staff are better skilled at certain tasks than others.
o When it comes to allocating work for a certain activity then skill is definitely one of the
main things you need to consider.
 Availability and Priority
o Besides simply looking at the skill set of your team you also need to consider the
availability of your staff and when the work needs to be completed.
o There isn’t much point assigning an important piece of work to someone that is away
on holiday for two weeks even if they are the best person for the job.
o Similarly, someone might be great at what they do but it takes a long time to complete
their tasks so if the work is high priority and has to be finished quickly perhaps another
team member is better suited.
 Enhancing Personal Development
o Finally, what about the less experienced members of your team? How can you
enhance their development?
STEP 6: Receiving and Issuing of Supplies and Equipment (10 Minutes)

The following are the procedures in managing equipment and supplies
 Ordering involves
o Perform need assessment
o Listing requirements based on the past use and the estimates of the present needs
58
o Writing the requirements in the requisition form
o Forwarding the requisition to the store/district/ region/ MSD or pharmacy shops
 Receiving involves
o Collecting equipment and supplies ordered
o Filling ledger/inventory books/forms
 Storing involves
o Recording the receipt of new equipment supplies and their issue note
o Keeping your equipment/ supplies in the ledger balanced
 Issuing
o This is the process of giving out and balancing the remaining stock using signed issue
voucher
o When issuing; observe FIFO /FEFO (First in first out or first expired first out)
 Controlling and maintaining equipment and supplies
o Equipment and supplies must be controlled to avoid wastage and kept in good working
condition
o This should be done by:
 Keeping the equipment clean
 Doing frequent inspection
 Reporting defect immediately and action to be taken by concerned authority (put in
action plan immediately)
 Returning equipment to their correct places after use
 Keeping an up-dated inventory, an inventory form in each room should be
displayed at the back of the door or on the wall of each room
 Human resource deals with personnel who deliver services.
 Human resources is used to describe both the people who work for organization and the
department responsible for managing resources related to employees.
 Procedures in managing equipment and supplies includes ordering, receiving, storing, issuing,
and controlling and maintaining equipment and supplies

 What is the meaning of human resources/
 What is non-human resources?
 What are the importance of human and non-human resources?
References
Delhi: MacGraw-Hill
Shorlee Spyder
59
Philadelphia.
SESSION 9: QUALITY IMPROVEMENT

Prerequisites: None
Learning Tasks
Define quality, quality control, quality assurance and quality improvement
Resources Needed:
Explain indicators of quality improvement
Explain the basic steps in quality control
 LCD Projector
Describe and computer
control standards
Describe the basic concepts of quality improvement
Explain concept of 5S (Sort, Set, Shine, Standardize, Sustain)
Describe the steps for
Method 5S implementation
tasks
2 10 Brainstorming/presentation Definition of quality, quality control, quality

assurance and quality improvement
3 10 Lecture discussion Indicators of quality improvement
4 15 Lecture discussion Basic steps in quality control
5 20 Lecture discussion Control standards
60
6 20 Lecture discussion Basic concepts of quality improvement
7 30 Lecture discussion Concept of 5S (Sort, Set, Shine,

Standardize, Sustain)
8 05
9 05
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning task (05 Minutes)

READ or ASK learners to read the learning tasks
ASK learners if they have any questions before continuing

STEP 2: Definition of Quality, Quality Control, Quality Assurance and Quality
Improvement (10 Minutes)

ASK the students to brainstorm on definition of quality, quality control, quality assurance and
quality improvement
Quality
 The standard of something as measured against other things of a similar kind; the degree of
excellence of something. Or is the totality of features and characteristics of a product or service that
CLARIFY and summarize
bears its ability by using
to satisfy stated the information
or implied needs. below
Quality control
 Refers to activities that are used to evaluate, monitor, or regulate services rendered to
consumers/ l is concerned with the operational activities and techniques that are used to fulfill
the requirements of quality.
Quality assurance
 Is any systematic process of determining whether a product or service meets specified

requirements
 Quality assurance is a process based approach whose prime objective is to prevent defects in
deliverables in the planning process itself to avoid the rework, which costs a lot.
Quality improvement
61
 Is a management philosophy to improve the organizational structure and the level of
performance of key processes in the organization to achieve high quality outcomes
 Quality Improvement is a formal approach to the analysis of performance and systematic
efforts to improve it. QI involves both prospective and retrospective reviews
 Quality improvement (QI) consists of systematic and continuous actions that lead to
measurable improvement in health care services and the health status of targeted patient
groups
STEP 3: Indicators of Quality Improvement (10 Minutes)

 Indicator is a variable that measure changes directly or indirectly to attain targets or
objectives
o Primary indicators - Are those which tend to be objective statistical indicators associated
with tangible physical measures e.g. births, deaths ,morbidity
o Secondary indicators - Are those which tend to be associated with or causally related to
the primary indicators
 Examples of secondary Indicators of Health Status
 Demographic -Indicator ;crude birth rate, Crude death rate
 Social - Percent literacy
 Socioeconomic - GNP per capita
 Political - Capitalism vs. socialism
 Nutritional - Per capita calorie/protein consumption
 Culture and Tradition - Percent of women circumcised
 Health Care Delivery - Facility to population ratio, etc
STEP 4: Basic Steps in Quality Control (15 Minutes)
1. Establish control criteria
2. Identify the information relevant to the criteria
3. Determine ways to collect the information
4. Collect and analyze the information
5. Compare collected information with the established criteria
6. Make a judgment about quality
7. Provide information and, if necessary, take corrective action regarding findings
8. Reevaluation
STEP 5: Control Standards (20 Minutes)

 A standard is a predetermined level of excellence that serves as a guide for practice.
 Standards have distinguishing characteristics; they are predetermined, established by an
authority, and communicated to and accepted by the people affected by them.
 Because standards are used as measurement tools, they must be objective, measurable, and
achievable.
 Each organization and profession must set standards and objectives to guide individual
practitioners in performing safe and effective care
STEP 6: Quality Improvement Process (15 Minutes)

The following are the steps for quality improvement ;
 Establish a culture of quality in your practice.
62
o Organization processes, and procedures should support and be integrated with your QI
efforts. The culture of a practice, attitudes, behaviors, and actions reflect how passionately
the practice team embraces quality.
o The QI culture looks different for every practice, but may include establishing dedicated QI
teams, holding regular QI meetings, or creating policies around your QI goals.
 Determine and prioritize potential areas for improvement.
o Examine your patient population (e.g., to identify barriers to care, frequently diagnosed
chronic conditions, or groups of high-risk patients) and your practice operations (e.g., to
identify management issues such as low morale, long patient wait times, or poor
communication).
 Collect and analyze data.
o Data collection and analysis lie at the heart of quality improvement. Data will help you
understand how well your systems work, identify potential areas for improvement, set
measurable goals, and monitor the effectiveness of change.
o It’s important to collect baseline data before you begin a QI project, commit to regular data
collection, carefully analyze your results throughout the project, and make decisions based
on your analysis.
 Communicate your results.
o Quality improvement efforts should be transparent to your staff, physicians, and patients.
Include the entire practice team and patients when planning and implementing QI projects,
and communicate project needs, priorities, actions, and results to everyone (patients
included).
o When a project is successful, celebrate and acknowledge that success.
 Commit to ongoing evaluation.
o Quality improvement is an ongoing process. A high-functioning practice will strive to
continually improve performance, revisit the effectiveness of interventions, and regularly
solicit patient and staff feedback.
 Share quality improvement successes and lesson learnt .

o Share lessons learned with others to support wide-scale, rapid improvement that benefits
all patients and the health care industry as a whole
STEP 7: Concept of 5S (Sort, Set, Shine, Standardize, Sustain) (30 Minutes)

 5S is a philosophy and a way of organizing and managing the workspace and work flow with
the intent to improve efficiency by eliminating waste, improving flow and reducing process
unreasonableness.
 5S activities are to create good working environment
 It help to have a basis of strong management of workplace
 5S Approach
o 5S: Sort-Set-Shine-Standardize-Sustain
 S1: Sort
o Focuses on eliminating unnecessary items from the workplace
o Categorize equipment, furniture, tool in your working place into the following 3
categories
 Necessary
 Unnecessary
 May not necessary
63
 S1: Sorting activities
o Equipment, material, tools, files, furniture etc. can be categorized based on the frequency
of use
o Examples of “Sorting”
 Place “Red tag” for categorization of items to identify unnecessary items
 Move unnecessary items( broken tools, obsolete jigs and fixtures, scrap and excess
raw material etc.) to central stored area
 Free up valuable floor space (Space utilization)
 Finding abnormality of equipment and tools (Out of order, missing parts etc.)
 S2: Set
o “Set” is based on finding efficient and effective storage of necessary items
o Apply “Can see, Can take out, and Can return” philosophy
o This will save time and energy to look for something
 S2: Setting activities
o Use 5S tools for proper Organization of items such as Labeling, Color coding, Numbering,
Zoning etc.
o Example of “Setting” activities
 Labeling , numbering, zoning for clear identification of storage areas to keep necessary
items
 Set necessary items matching with workflow to minimize unnecessary movement and
transportation time
 S3: Shine
o Cleaning up one’s workplace daily so that there is no dust on floors, machines or
equipment.
o It will create ownership and build pride in the workers
 S3: Shining activities
o Clean floor, windows and walls
o Clean and Maintain office automation machines, medical equipment and tools, office
furniture Develop and follow regular cleaning and Maintenance schedule
 Example of “Shining” activities
 Daily sweeping and mopping of floor, bathroom, corridor etc
 Regular cleaning and maintenance of equipment and tools
 Periodical check for changes in equipment and the service area such as: leaks,
vibration, misalignment, breakage etc.
 IPC activities such as hand hygiene, waste segregation are also part of shine
S4: Standardize
o Maintain an environment where S1 to S3 are implemented in the same manner
throughout the organization
o Give opportunities to employees to take active part in the development of these
standards.
 S4: Standardizing activities
64
o Standardization is useful for;
 Easy implementation of S1 to S3 activities
o Equalization process output
o Everyone’s participation
Example of “Standardize” activities
 Work instructions, Standard Operating Procedures (SOPs)
 Checklist development and regular usage for SOPs
 Mechanism and format development for ordering supplies, reporting etc
 Color coding for waste segregation
 Standardized common symbols
 S5 : Sustain
o Maintain S1-S4 through discipline, commitment and empowerment
o It focuses on defining a new mindset and a standard in workplace
 Example of “Sustain” activities
o Regular progress reporting
o Refresher training
o Periodical evaluation of 5S activities with proper advices for continuation and further
improvements
o Appreciation, recognition and awarding on good 5S activities
o Reminder using 5S corner, new letters, good practice sheet etc .

 Control standards for the quality for the quality control
o A standard is a predetermined level of excellence that serves as a guide for practice.
o Standards have distinguishing characteristics; they are predetermined, established by
an authority, and communicated to and accepted by the people affected by them.
o Because standards are used as measurement tools, they must be objective,
measurable, and achievable.
 5S activities are to create good working environment
o It help to have a basis of strong management of workplace
o 5S Approach
 5S: Sort-Set-Shine-Standardize-Sustain

What is quality improvement?
What are the indicators for the quality improvement?
References
Delhi: MacGraw-Hill
65
Shorlee Spyder
Philadelphia.
SESSION 10: DEVELOPMENT AND USE OF QUALITY

IMPROVEMENT TOOLS
Total Session Time: 120
Prerequisites: None
Learning Tasks
Define quality improvement tools
Develop quality improvement tools
Use quality improvement tools to improve quality of health services
Resources Needed:
66

Method
1 05 Presentation
Presentation of Session Title and Learning tasks
2 05 Lecture discussion Definition of quality improvement tools
3 60 Lecture discussion/group Development of quality improvement tools

work
4 40 Lecture-discussion Using quality improvement tools to collect data to

improve care
5 05
6 05
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (05 minutes)

STEP 2: Definition of Quality Improvement Tools (10 minutes)

 Quality improvement tools refer to instruments that are used to collect or generate data for the
purpose of improving health services.
o There are four types of tools commonly used to collect data for improving quality of health
services:
 Questionnaires: used when administering a questionnaire method is chosen to collect
data
 Interview guides/interviews schedules: used when the method of data collection is
Interviewing and use to capture opinion and behaviours
 Checklists/rating scales: these are relevant for observation method and are used to
capture data related to practice, procedure, behaviours and skills
67
 Compilation-sheets/data extraction forms: Used to collect data through documents
reviewing; they capture data from written source such as medical records,
administrative data and other documents
STEP 3: Development of Quality Improvement Tools (50 minutes)

 The process of developing quality improvement is similar to the process of developing research
data collection tools; the process has the following steps:
1) Review or formulate quality indicators and standards of care: E.g. % of under-five children
who received correct treatment; % of clients satisfied with nursing care.
2) Identify the variables that are related to each indicator : satisfaction with nursing care
3) Identify data required for each variable: e.g. satisfaction with nursing care given
4) Determine sources of data for each variable: who or what will provide data for each
variable: e.g. Clients
5) Determine data collection method: e.g. administration of questionnaire
6) Formulate specific and understandable data collection questions or statements for each
variable and other background data; data collection questions (or statement) are questions
that are used by researchers to obtain data from data sources. Example of data collection
question: To what extent are you satisfied with nursing care you have received? 5) Very
satisfied; 4) satisfied; 3) not sure; 2) dis-satisfied; 1) very dis-satisfied.
7) Compile the formulated data collections questions or statements to form one or more than
one data collection tools: e.g. questionnaire and interview guide
8) Edit the quality improvement tools
9) Request other professionals to review the edited version of the quality improvement tool
 Data collection questions or item statements should have the following feature:
o They are relevant to indicators of quality
o They are specific to variable
o They are generally short
o Understandable to majority of people, especially research participants and data collect
o They have one idea: not double barreled
 A table 11.1 can be used as a format to systematize the process of developing data collection tool
 For demonstration purpose, the first raw has been filled.
Table 11.1: Format for the process of developing data collection tools
Indicator Variable Data required Source of Data collection Data collection question
data method
% of clients satisfaction satisfaction clients administration of To what extent are you
satisfied with with nursing with nursing questionnaire satisfied with nursing
nursing care care given care given care you have received?
5) Very satisfied; 4)
satisfied; 3) not sure; 2)
dis-satisfied; 1) very dis-
satisfied.
68
Small Group Work: Group Work (30 minutes)
 DIVIDE students into groups of 3-6

 ASK learners to develop data collection tool (questionnaire) using twenty minutes for the
following indicators Using Table 11.1:
a) % of clients who have received all prescribed medication in public health facilities in council X
b) % of clients who are satisfied with clinician’s consultation the time
c) % of clients who have received all basic laboratory investigations ordered by clinicians and
nurses

 REQUEST learners to present their answers
 PROVIDE feedback to learners on quality of quality improvement tools
Step 4: Using Quality Improvement Tools to Collect Data for Improving Care (40
Minutes)
 Once quality improvement tools are developed, they should be used to collect data for improving
quality of health care
 Tools should be used that are appropriate to data collection indicators and data collection methods
 Collected data on quality of health services should be analysed and quality improvement report
prepared to communicate findings of quality of services
 Quality improvement report should have the following sections:
o Introduction: stating why quality of services was conducted and objectives of assessment
of health services quality
o Methods: state methods employed to assess quality of health services
o Results and discussion: present findings/results of the assessment and discussion of
findings
o Conclusions and recommendations: conclusions and recommendations should be stated in
this section
o Reference: include all literature cited in the quality improvement report
o Attachments: include additional information and tools in this section
Step 5: Key points (05 minutes)
69
 Quality improvement tools are important instrument for assessment and for improving quality of
care
 Nurses and midwives should be able prepare the quality improvement tools and use them to
assess quality of health services
 It is important that quality improvement report should be share and use to improve quality of care

 Ask learner to answer the following questions:
1) What is a quality improvement tool?
2) What are steps used for quality improvement tools that can be used to assess quality of
health services?
References
Dommitter B, Kernstock E, and Nowak P., (2013). Quality Management: Bundesinstitut fur Qualitat im
Gesundeheitswesen, BIQG
Ministry of Health (2004). Tanzania quality improvement framework: delivering quality health services.
Dar es Salaam: Ministry of Health
Ministry of Health and Social Welfare (2009).Health service quality improvement manual for district
hospital, health centre and dispensary. Dar es Salaam: Ministry of Health and Social Welfare
Ministry of Health and Social Welfare (May 2009). Implementation guideline for 5S-CQI-TQM
Ovretveit, J. (1992). Health service quality: Introduction To Quality Methods For Health Services,
Oxford: Blackwell Science
Parsley, K and Corrigan, P. (1999). Quality Improvement in Healthcare. 2nd edition. heltenham: Stanley
Thornes (Publishers) Ltd.
WHO (2004). Quality improvement in primary health care: a practical guide. Geneva: WHO
WHO (2006). Quality of care: a process for making strategic choices in health systems. Geneva: WHO
SESSION 11: COORDINATION OF NURSING SERVICES

Prerequisites: None
Learning Tasks
Define coordination
Explain importance of coordination

Explain principles of coordination
70
Prepare monthly/quarterly and annual report
Resources Needed:

Method
objectives
2 05 Brainstorming Definition of coordination
Presentation
3 20 Presentation Importance of coordination
4 20 Presentation Principles of coordination
5 05
6 05
SESSION CONTENTS
STEP 2: Definition of Coordination (05 minutes)

ASK the students to brainstorm on definition of coordination
WRITE
NMT their
06104: responsesinon
Supervision the flipchart/board
Nursing and Midwifery 71
71
Coordination
 Coordination is the process of linking the activities of various departments of the organization.
o It is the process of integrating the objectives and activities of the separate units
(departments or functional areas) of an organization in order to achieve organizational
goals efficiently.
STEP 3: Importance of Coordination (20 minutes)

DIVIDE students intois small
 Coordination manageable
an ingredient of allgroups
the managerial functions in an organization.
ASK students to discuss in groups on
 Whether it is integrating the variousthe importance of coordination
plans through mutual discussion, or organizing various
AFTERactivities
small group discussion, ask students to provide
of different departments, coordination plays theira responses
vital role.
 Coordination is a deliberate and conscious effort to obtain desired goal and it is important in the
following aspects:
o Efficiency and effectiveness
 Coordination helps to improve the efficiency of operations by avoiding overlapping
efforts and duplication of work.
 Quality of coordination determines the effectiveness of organized efforts.
o Unity of direction
 Coordination helps to ensure unity of action in the face of disruptive forces.
 It helps unity of action and helps to avoid conflicts between line and staff elements
o Human relation
 Coordination helps to improve team spirit and morale of employees.
 In a well-coordinated organization, organizational goals and personal goals of
people are reconciled
o Essence of management
 Coordination is all inclusive concepts and the end result of management process.
 Coordination helps in the accomplishment of organizational goals.
STEP 4: Principles of Coordination (20 minutes)

Four principles of effective coordination include the following:
 Early Start:
o Plans should be based on participation.
72
o So coordination must start during planning and policy making stage.
o Will result in making the best plan and implementing them with success.
 Direct Contact:
o Managers must have direct contacts with the people concerned.
o Improves interpersonal relationship.
o Helps to avoid misunderstandings and disputes.
o Helps managers to coordinate all activities effectively and efficiently.
 Continuity:
o The process must start from the beginning till the end.
o It must be done continuously during planning, organizing, directing and controlling.
 Reciprocal Relations:
o The decisions and actions of all departments are interrelated.
o These actions may affect another person and department.
o Managers must find out the effects that can create.
o If it is followed properly, coordination will be successful.
Additional principles of coordination includes:
 Effective Communication:
o Good communication must be present within organization and its stakeholders. It helps
to avoid misunderstanding.
 Mutual Respect:
o Without mutual respect coordination may not survive. The managers must respect the
feelings and emotions of employees and they also respect to their bosses.
 Clarity of objectives:
o Every employee must know and have clear understanding of the organizational
objectives. Clear objectives can be achieved easily and quickly.
 Scalar Chain:
o This line of authority joins everyone from top to bottom. Every member must know who
is his superiors and subordinates. It helps good communication. If needs, gang
plank/bridge/direct contact could be done.

 Coordination is an ingredient of all the managerial functions in an organization.
 Whether it is integrating the various plans through mutual discussion, or organizing various
activities of different departments, coordination plays a vital role.
 Coordination integrates the efforts of individuals and departments to make them work as a
group. The group works to maximize group goals as well as organizational goals.
73
 What is coordination?
 Explain the importance of coordination
References
MOHSW. (2006). Hospital management Team Training Module Level I, II & III. Dar es Salaam
Tanzania: Ministry of Health and Social Welfare.
SESSION 12: MONITORING

Prerequisite: None
Learning tasks
At the end of this session a learner is expected to be able:
Define monitoring
Explain the purpose of Monitoring
Describe the process of Monitoring
Outline methods and tools for monitoring nursing activities
Develop a monitoring plan
Observe staff performance
Review nursing care Records
Check status of supplies and equipment
Identify gaps in service Delivery

Resources Needed:
74

Method
1 05 Lecture/discussion
Presentation of session title and learning tasks
2 10 Brainstorming
Definition of monitoring
3 20 Lecture/discussion Methods and tools for monitoring nursing activities
4 15 Lecture/discussion Developing Monitoring plan
5 10 Lecture/ discussion Observing staff performance
6 10 Lecture /discussion Reviewing Nursing care records
7 15 Brainstorming Status of supplies and equipment
8 25 Presentation Gaps in service delivery
9 05
10 05
SESSION CONTENTS
STEP 2: Definition of Monitoring (05 Minutes)
ASK students to brainstorm answers to the Definition of monitoring
PROVIDE possible answers if necessary:
75
Monitoring.
 Monitoring is the ongoing process of collecting and using standardized information to assess
progress towards objectives, resource usage and achievement of outcomes and impacts. It
usually involves assessment against agreed performance indicators and targets.
STEP 3: Methods and Tools for Monitoring Nursing Activities (20 Minutes)
 Methods for monitoring nursing activities
o Direct observation
 This can be done through management rounds often called management by walking.
 When the manager makes round can identify potential problems, can make on-spot
suggestion and corrections as needed, and develop staff through couching and role
modelling, build trust with staff, physician and patient. Reinforces the mission and vision of
Organization.
o Peer review procedure
 This is used to monitor adherence to standards of care
o Formal employee standards performance appraisals
 Held in regular intervals to inform employees about whether they are performing at
expected level
 Pay raises and promotion are based on these formal evaluations
 Tools for monitoring nursing activities
o Checklists.
o Activity plans
o schedules
o Indicator of general activity (progress)
o log frame work of activity
STEP 4: Developing Monitoring Plan (15 Minutes)

 As a guide, the Monitoring work plan explains the goals and objectives of the overall plan as
well as the evaluation questions, methodologies, implementation plan, matrix of expected
results, proposed timeline, and monitoring instruments for gathering data.
 To develop the monitoring plan one needs to focus on:
o What do we want to know?
o Different kinds of information are the different stakeholders interested in?
o How will we get information?
o Who should be involved?
 Note: Student should develop action
STEP 5: Observing Staff Performance (10 Minutes)

 Nurse managers are responsible for observing nurses performance
 Observation data are used to assess compliance of health worker practice to established
guidelines.
 Direct observation may be followed by special studies in order to improve data credibility.
76
 Observations of provider–client interaction require observers with advanced training in a
health-related field.
 Effective nurse managers purposively spend much of their day out of their offices with their
staff observing what is happening in clinical
 Nurse Managers monitor the activities of their units of departments; this may include the
number of client’s seen, average length of the day.
 Nurse Managers will also observe absentee rates and unproductive time.
STEP 6: Reviewing Nursing Care Records (15 Minutes)

 Nursing care record includes:
o Nursing care plan with assessment planning, implementation and evaluation of care
o Comprehensive patient care forms
o Dependent and interdependent nursing interventions, patient problems, patient comments
and responses to interventions and tests, progress toward goals, and communication with
other members of the health team.
o Care that was omitted because of the patient’s condition or refusal of treatment.
o Performance of day to day activities
o Various reports available e.g. MHUTA reports
o Various register used in the health facility
 Nurses manager must ensure that the:
o Nursing care record is accurate, complete and timely documented and reported.
o Nursing care records are kept in place where they can be accessible
o Reviewing of nursing care records is done for quality assurance by randomly selecting
records to see if certain standards of care have been met and documented.
 Deficiencies
o If deficiencies are detected nursing care plan and other documents can be designed to
improve outcomes in care of patients
STEP 7: Status of Supplies and Equipment (15 Minutes)

 The person in charge of the health facility should keep a master copy of all items and update
this list each time an item is received and issued.
 Each patient service section should keep its own working copy and update their own list.
 The person in charge of each service should keep an updated list of all the equipment and
supplies they receive and include items damaged, broken or sent for repair.
 An inventory should be carried out at regular intervals (at least once a year) to check the
condition and location of supplies and equipment in use and in stock.
 Checking the inventory of stock is an important part of stock control and helps to identify
purchasing requirements.
 Inventory: List of items that are kept in a certain place, each section of health centre, or
institution keeps an inventory of its non-expandable equipment
Scenario
On 18th May, 2011, hospital X purchased 10 trolleys with code number 0010, 7 delivery beds with
code number 0011 and 6 delivery kits coded 0012. On 2nd June, 2011, 6 trolleys, 4 delivery beds
and 4 delivery kits were issued to the wards. All other materials are still in store and in good
condition
ASK students to read the scenario and fill in inventory form for 5 minutes
Refer Students to Handout 11:1: Sample of Inventory Form 77
CLARIFY
STEP 8: Gaps In Service Delivery (25 Minutes)
Gaps in service deliveries refer to disparities in health care access, health care needs and medical
services. In the daily services nurses are required to observe and study the differences between standards
and the delivery of those standards. The differences could be used to explain satisfaction and to
document areas in need of improvement. Perspective, gaps in a quality service delivery include:
 Service quality
 Management understanding
 Service design
 Service delivery
 Communication
o Service Quality Gap.
 Indicates the difference between the service expected by customers and the service they
actually receive. For example, customers may expect to wait only 20 minutes to see their
doctor but, in fact, have to wait more than thirty minutes.
o Management Understanding Gap.
 Represents the difference between the quality level expected by customers and the perception
of those expectations by management. Lack of communication between contact personnel
directly dealing with the customer and management may be due to so many levels in an
organization or hierarchical structure. Due to these reasons service organizations fail to
understand the customer needs and requirements and how they evaluate the service, which
may result in low quality service
o Service Design Gap.
 This is the gap between management's perception of customer expectations and the
development of this perception into delivery standards..
o Service delivery gap
 Represents the gap between the established delivery standards and actual service delivered.
o Communication Gap.
 This is the gap between what is communicated to consumers and what is actually delivered.
For example services at Reproductive and Child Health Clinic may indicate that it takes only 30
minutes but in reality, it takes more than thirty minutes.
o Implementing Gap Analysis
 Gap analysis involves internal and external analysis.
 Externally, Health facility must communicate with customers.
 Internally, it must determine service delivery and service design.
78
o The steps involved in the implementation of gap analysis are:
 Identification of customer expectations

 Identification of customer experiences
 Identification of management perceptions
 Evaluation of service standards

 Evaluation of customer communications
The identification of customer expectations and experiences might begin with focus-group interviews
o The importance of Service Quality Gap Analysis

 The main reason gap analysis is important to firms is the fact that gaps between customer
expectations and customer experiences lead to customer dissatisfaction.
 Measuring gaps is the first step in enhancing customer satisfaction.
 Determine where Health Facility services exceed or fall below customer expectations.
 Customer satisfaction leads to good reputation of the organization or health facility.
 Understanding customer perceptions is important to a care delivery and nurses
performance.
 Gap analysis is used as a tool to narrow the gap between perceptions and reality, thus
enhancing customer satisfaction
STEP 9: Keys Points (05 Minutes)

 Monitoring means finding out what is going on; it is concerned with observation of activities or
services ensuring their implementation
 Methods for monitoring nursing activities include direct observation, peer review and
performance appraisal
 Tools used in monitoring include checklist ,activity plans schedules Indicator of general activity
(progress) log frame work of activity
STEP 10: Session Evaluation (05 Minutes)

 What is monitoring?
 What will you focus when developing monitoring action plan?
References
Handbook on Monitoring and Evaluation of Human Resources for Health: With Special Applications for
Low- and Middle-income Countries
Marquis, B.L. & Carol J. H. (2003). Leadership roles and Management Functions in
Nursing Theory and Application.(4th ed.). London: Lippincott Williams &Wilkins
79
Handout 11:1-Inventory control card
SESSION 13: MOTIVATION OF STAFF

Pre-requisites: None
Learning Tasks
Define motivation
Resources Needed
 Describe
Flip charts, motivation Theories
marker pens, and masking tape
 Black/white board and chalk/whiteboard makers
 Explain types
Computer of motivation
and LCD
 Overhead projector
Outline motivating factors at work place
Outline strategies to create motivating climate
Method
Give feedback to staff
1 05 Presentation Presentation of Session Title and Learning Tasks
Reward staff performance
2 05 Presentation Definition of motivation
3 30 Presentation Motivation theories

Brainstorming
4 10 Presentation Types of motivation
5 20 Presentation Motivation factors at work place
6 20 Presentation Strategies to create motivation climate
7 20 Presentation/Group Feedback to staff

Discussion
8 10 Presentation Reward staff performance
9 05 Presentation Keywords
80
10 05 Presentation Evaluation
SESSION CONTENTS

READ or ASK students to read learning tasks and clarify.
ASK students if they have any question before proceeding.
STEP 2: Definition of Motivation (05 Minutes)
ASK students to brainstorm answers to the definitions of motivation

ALLOW time for them to respond.
PROVIDE possible answers,
 Motivation is the force which can be within or outside the individual that influences or directs
behavior.
STEP 3: Motivation Theories (30 Minutes)
 Abraham Maslow’s theory of motivation

o Maslow (1970) believed that people are motivated to satisfy certain needs, ranging from basic
survival to complex psychological needs, and that people seek a higher need only when the
lower needs have been predominantly met.
o In the workplace, Maslow’s work contributed to the recognition that people are motivated by
many needs other than economic security
Refer figure 12:1 Abraham Maslow’s hierarchy of needs is depicted
 Skinner motivation theory (reinforcement theory)
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o B. F. Skinner was another theorist in this era who contributed to the understanding of
motivation, dissatisfaction and productivity.
o Skinner’s (1953) research on operant conditioning and behavior modification demonstrated
that people could be conditioned to behave in a certain way based on a consistent reward
or punishment system.
o Behavior that is rewarded will be repeated, and behavior that is punished or goes
unrewarded is extinguished.
 Herzberg motivation theory
o Frederick Herzberg (1977) believed that employees can be motivated by the work itself and
that there is an internal or personal need to meet organizational goals.
o He believed that separating personal motivators from job dissatisfiers was possible. This
distinction between hygiene or maintenance factors and motivator factors was called the
Motivation–Hygiene theory or two Factor theories.
Table 12:1 lists motivator and hygiene factors identified by Herzberg.
HTT Table 12:1 Herzberg motivation and hygiene factors

Motivators factors Hygiene factors
Achievement Salary
Recognition Supervision
Work Job security

Responsibility Positive working conditions
Advancements Personal life
Possibility for growth Interpersonal relationships and peers
Company policy
Status
Factors Herzberg’s Motivators and Hygiene Factors Herzberg’s M
o Herzberg maintained that motivators or job satisfiers are present in work itself; they give
people the desire to work and to do that work well. Hygiene or maintenance factors keep
employees from being dissatisfied or demotivated but do not act as real motivators.
o It is important to remember that the opposite of dissatisfaction may not be satisfaction.
o When hygiene factors are met, there is a lack of dissatisfaction, not an existence of
satisfaction. Likewise, the absence of motivators does not necessarily cause
dissatisfaction.
o For example, salary is a hygiene factor. Although it does not motivate in itself, when used
with other motivators such as recognition or advancement, it can be a powerful motivator.
However, salary is deficient, employee dissatisfaction can result.
 McGregor motivation theory
o Douglas McGregor was born in 1906 in Detroit. After high school he attended Oberlin
College and later graduated from Wayne University in He earned his PhD degree from
Harvard University in Experimental Psychology where he had received an A grade in every
single course.
o Douglas McGregor (1960) examined the importance of manager’s assumption about
workers on the intrinsic motivation of the workers. The assumption which McGregor
developed was labeled as theory x and theory y. McGregor believed people should not
classified artificially as always having theory x and theory y assumption about other
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instead most people fall on some point on the continuum: see table 12:2 Theory X and
Theory Y
Table 12:2 Theory X and Theory Y
Theory x Theory y
Avoid work if possible Like and enjoy work
Dislike work Are sel directed
Must be directed Are seek responsibility
Have little ambition Are imaginative and creative
Avoid responsibilities Have underutilized intellectual capacity
Need threat to be motivated Need only general supervision
Need close supervision Are encouraged to participate in problem solving

Are motivated by motivation and punishment
 Taylor (1911), motivation theory
o Instrumentality’ is the belief that if we do one thing it will lead to another. In its crudest
form, instrumentality theory states that people only work for money. Taylor (1911), who
wrote: ‘It is impossible, through any long period of time, to get workmen to work much
harder than the average men around them unless they are assured a large and
permanent increase in their pay.’
 McClelland’s achievement–affiliation–power needs motivation theory
o An alternative way of classifying needs was developed by McClelland (1961), who based it
mainly on studies of managers. He identified three needs as being most important:
 The need for achievement, defined as the need for competitive success
measured against a personal standard of excellence.
 The need for affiliation, defined as the need for warm, friendly, compassionate
relationships with others.
 The need for power, defined as the need to control or influence others
STEP 4: Types of Motivation (10 Minutes)

The two types of are motivation Intrinsic motivation and extrinsic motivation
 Intrinsic motivation
o Intrinsic motivation can arise from the self-generated factors that influence people’s
behaviour.
o It is not created by external incentives.
o Deci and Ryan (1985) suggested that intrinsic motivation is based on the needs to be
competent and self-determining (that is, to have a choice )
 Extrinsic motivation
o Extrinsic motivation occurs when things are done to or for people to motivate them.
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o These include rewards, such as incentives, increased pay, praise, or promotion; and
punishments, such as disciplinary action, withholding pay, or criticism.
o Extrinsic motivators can have an immediate and powerful effect, but will not necessarily
last long
STEP 5: Motivation Factors at Work Place (20 minutes)

 Individual factors
o To know what can motivate the employees a leader must know their aims, objectives
and values
o Human needs are both numerous and complex and often is difficult to detect them
o A leader has to closely observe the individual action and behavior at work and
interpreter the same in in terms of the underlying motivation
 Organizational components
o Organizational structure
o Organizational culture
o Technological systems
o Physical facilities
o Whatever constitutes the internal environment of an organization
 External or exogenous variables
o Nurses life outside the health Institution is important part affecting motivation or
willingness to work in the health facility
o Life at work and outside work are interdependent of each other
o A strong motivational role is played by culture, customs and norms, images and
attributes conferred by the society on particular jobs.
STEP 6: Strategies To Create Motivation Climate (20 Minutes)
DIVIDE student into small manageable groups

ASK students to discuss in group on strategies to create motivation climate
ASK students to provide their responses after discussion
CLARIFY and summarize by using the content below
 Have a clear expectation for workers, and communicate these expectation effectively
 Be fair and consistent when dealing all employee
 Be a firm decision maker using an appropriate decision –making style
 Develop the concept of team work. Develop group goal and project that will build team spirit
 Integrate the staff’s need and wants with organization’s interest and purpose
 Know the uniqueness of each employee. Let each know that you his/her uniqueness.
 Remove traditional block between the employee and the work to be done
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 Provide experiences that challenge or stretch the employee and allow opportunity for growth.
 Whenever possible give subordinates recognition and credit
 Be certain that the employee understand the reason behind decision and action
 Reward desirable behavior and be consistent on how you handle undesirable behavior
 Create trustful and helping relationship with employee
 Let employee exercise as much control as possible over their work environment
 Be a role model for employee
STEP 7: Giving Feedback to Staff (20 Minutes)

 Motivating employees is about more than charisma and vision.
 To help employees perform their best, a great leader will provide feedback — the right kind, at the
right time. Feedback is an essential tool for any manager
 Employee feedback is the core of personal and professional growth.
 Feedback can help an employee get better at what they do, and surprisingly employees crave
feedback
 There is a proper way of providing feedback consistently that will produce fruitful results.
 We have identified eight ways you can offer employee feedback –it’s painless, immediate and will
get you the outcome you need
o Focus on issue not person
 Focus on employees’ behaviors (what they do) rather than on their personality
traits (what they’re like).
 Put your message in writing as well as delivering it verbally.
 In an instant, employees can see their progress — or lack thereof
o Make your feedback specific

 Specific feedback more effectively corrects or reinforces certain behaviors,
enabling the brain to focus on something concrete
o Right Balance Between Positive & Negative Comments
 Most people have probably worked with a manager who puts negative feedback
front and centre
o Connect your feedback with company goals
 Goals help the brain focus.
 Make your employee feel that her contributions are valued and create a positive
emotion with the feedback
o Make it one-on-one
 Even praise for some people is better delivered in a private meeting, rather than
being pointed out in a public arena: some people simply don’t like being the center
of attention.
o Feedback is a two-way flow
 Ask for feedback from your employees on your own performance and on company
policies.
o Reply and follow-up the conversation
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 One of the biggest mistakes that leaders make when they receive written feedback
from employees, is they don’t reply
STEP 8: Rewarding Staff Performance (10 Minutes)
 There are a variety of ways to reward people for the quality of the work they do in the
workplace. For example, rewards can be in the form of money, benefits, time off from work,
acknowledgement for work well done, affiliation with other workers or a sense of
accomplishment from finishing a major task
o Guiding Principles of Effective Reward Systems
 Rewards should support behaviors directly aligned with accomplishing strategic
goals
 Rewards should be tied to passion and purpose, not to pressure and fear
 Workers should be able to clearly associate the reward to their accomplishments
 Rewards should occur shortly after the behaviors they are intended to reinforce
o Guidelines to Rewarding Employees
Reward employees by letting them hear positive comments from customers about

how the employees’ activities benefited the customer
 Occasionally have a Board member come to an employee meeting to thank them
Understand what motivates each of your employees
 In each monthly staff meeting, take a few minutes to open the meeting by
mentioning major accomplishments of various employees
 Present gift certificates to employees who have made major accomplishments.
 Probably the most fulfilling for employees is to be able to do useful work
o Rewarding staff
 Positive reinforcement must be specific or relevant to a particular performance
 The manager should praise an employee for a specific task accomplished goal or
met. This appraise should not be general. For example saying your nursing care is
good
 Positive reinforcement must occur as close to the event as possible
 Reward –feedback system must be achievable.
 All performance must be attainable and both large and small achievement should
be recognized or rewarded in some how
 Reward should unpredictable and intermittent. If the reward are given routinely
they tend to lose their value

 Motivation is the force within the individual that influences or directs behavior.
 Motivation theories include Abraham Maslows,,Alderfers, Herzberg two factor or hygiene
or maintenance theory, McClelland’s three needs theory, Taylor (1911), motivation theory,
McGregor motivation theory, Skinner motivation theory (reinforcement theory)
 The two types of are motivation Intrinsic motivation and extrinsic motivation
 Have a clear expectation for workers, and communicate these expectation effectively
 To help employees perform their best, a great leader will provide feedback
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STEP 10: Evaluation (5 minutes)
 What is Motivation?
 What are the two types of motivation?
References
Bass, B. M. and R. M. Stogdill (1990). Bass & Stogdill's handbook of leadership: Theory,
research, and managerial applications, Simon and Schuster.
Marquis, B. L. and C. J. Huston (2009). Leadership roles and management functions in
nursing: Theory and application, Lippincott Williams & Wilkins.
Marquis, B. L., et al. (1992). "Leadership roles and management functions in nursing: Theory
and application." Journal for Nurses in Professional Development 8(6): 284-287.
Haldar,K.U,(2011)Leadership and building team,Chamana entrepesi,Delh INdiaPP174-188
Hand out: Key concepts in motivation

 Because human beings have constant needs and wants, they are always motivated to some
extent. However, human beings are motivated differently. Managers cannot intrinsically
motivate people, because motivation comes from within the person.
 The humanistic manager can, however, create an environment in which the development of
human potential can be maximized.
 Maslow stated that people are motivated to satisfy certain needs, ranging from basic survival to
complex psychological needs, and that people seek a higher need only when the lower needs
have been predominantly met.
 Skinner’s research on operant conditioning and behavior modification demonstrates that people
can be conditioned to behave in a certain way based on a consistent reward or punishment
system.
 Herzberg maintained that motivators or job satisfies, are present in the work itself and
encourage people to want to work and to do that work well.
 Hygiene or maintenance factors keep the worker from being dissatisfied or demotivated but do
not act as true motivators for the worker.
 Vroom’s expectancy model says that people’s expectations about their environment or a
certain event will influence their behavior.
 McClelland’s studies state that all people are motivated by three basic needs: achievement,
affiliation, and power.
 Gellerman states that most managers in organizations over manage, making the
responsibilities too narrow and failing to give employees any decision-making power or to
stretch them often enough.
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 McGregor points out the importance of a manager’s assumptions about workers on the intrinsic
motivation of the worker.
 There appears to be a perceived threshold beyond which increasing reward incentives results
in no additional meaning or weight in terms of productivity. Positive reinforcement is one of the
most powerful motivators the manager can use and is frequently overlooked or underused.
 The supervisor or manager’s personal motivation is an important factor affecting staff’s
commitment to duties and morale.
 The success of a motivational strategy is measured by the increased productivity and benefit to
the organization and by the growth in the person, which motivates him or her to accomplish
again.
 Managers must show their own positive attitude to demonstrate to employees that there is
SESSION 14: COUNSELLING ON STAFF PERFORMANCE

Prerequisites: None
Learning Tasks

Define performance, counselling
Explain steps of staff performance counselling
Outline principles of staff performance counselling
Outline importance of staff performance counselling

Resources Needed:
Counsel staff on performance
88

Method
1 05 Presentation
Introduction, Learning Objectives
2 05 Lecture discussion Define performance, counselling
3 30 Small group discussion Steps of staff performance counselling

presentation
4 20 Lecture discussion Principles of staff performance
counselling
5 15 Lecture discussion Importance of staff performance
counselling
6 35 Presentation ,demonstration Counsel staff on performance
7 05
8 05
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Objectives (5 minutes)
STEP 2: Definition of Performance and Counselling (5 Minutes)

 Performance is the accomplishment of a given task measured against present known standards of
accuracy, completeness, cost, and speed.
OR
 Is considered to be the fulfilment of an obligation, in a manner that releases the performer from all
liabilities under the contract
 Counselling is a process whereby an individual has to discuss issues that are causing concern in
a supportive, respectful and confidential environment for the purpose of solving them.
o People can attend counselling as individuals, couples, as a family or group of related
individuals.
 Performance counseling is the process of improving employees performance and productivity by
providing employee with feedback regarding areas where he is doing well and areas that may
require improvement
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STEP 3: Steps of Staff Performance Counselling (30 Minutes)

ASK students to discuss in groups on six steps of staff performance counseling
 The following are six steps for staff performance counseling

1. Establish performance standards
2. Communicate performance expectation to employee
3. Measure actual performance
4. Compare actual performance with standards
5. Discuss the appraisal with the employee
6. Initiate corrective actions.
 Establish Performance Standards:
o The appraisal process begins with the establishment of performance standards. The managers
must determine what outputs, accomplishments and skills will be evaluated. These standards
should have evolved out of job analysis and job descriptions.
o These performance standards should also be clear and objective to be understood and
measured. Standards should not be expressed in an articulated or vague manner such as “a
good job” as these unclear phrases tells nothing.
 Communicate Performance Expectations to Employees:
o Once the performance standards are established, this need to be communicated to the
respective employees so that they come to know what is expected of them.
o The feedback from the employees on the standards communicated to them must be obtained.
If required, the standards may be modified or revised in the light of feedback obtained from the
employees. It is important to note that communication is a two-way street.
 Measure Actual Performance:
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o This is the third step involved in the appraisal process. In this stage, the actual performance of
the employee is measured on the basis of information available from various sources such as
personal observation, statistical reports, oral reports, and written reports.
 Compare Actual Performance with Standards:
o In this stage, the actual performance is compared with the predetermined standards. Such a
comparison may reveal the deviation between standard performance and actual performance
and will enable the evaluator to proceed to the fifth step in the process, i.e., the discussion of
the appraisal with the concerned employees.
 Discuss the Appraisal with the Employee:
o The fifth step in the appraisal process is to communicate to and discuss with the employees the
results of the appraisal. This is, in fact, one of the most challenging tasks the manager’s face to
present an accurate appraisal to the employees and then make them accept the appraisal in a
constructive manner.
o A discussion on appraisal enables employees to know their strengths and weaknesses. This
has, in turn, impact on their future performance. Yes, the impact may be positive or negative
depending upon how the appraisal is presented and discussed with the employees.
 Initiate Corrective Action:
o The final step in the appraisal process is the initiation of corrective action when it is necessary.
The areas needing improvement are identified and then, the measures to correct or improve
the performance are identified and initiated.
o This type of action involves time to analyze deviations. Hence, managers often opt for the
immediate action, or Training, coaching, counselling, etc. is the common examples of
corrective actions that managers initiate to improve the employee performance.
STEP 4: Principles of Staff Performance Counselling (20 Minutes)

 The following are the principles of performance counseling
o Prepare for the meeting.
 Review documentation: employee’s position description, performance plan, works
instructions, etc.
 Arrange for the meeting. Arrange for privacy and be prepared to give your undivided
attention.
 Outline key discussion points in advance and practice.
o Establish a neutral/positive tone in voice and body language and stay focused
 Use nonjudgmental, descriptive language.
 Control personal emotions
 Express confidence in the employee.
 Stay focused on the purpose of the meeting.
o Address the deficiencies.
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 Be specific.
 Provide examples.
 Share any documentation of problem
 Explain why it’s a problem; its impact on work of unit and others.
 Explain expectations; communicate what changes are expected.
o Turn meeting into a problem solving session.
 Make employee an active participant in the process.
 Express confidence that employee can make necessary changes.
 Allow employee time to respond.
 Consider employee's point of view.
 Encourage employee to provide solutions.
 Discuss how things can be done differently.
 Ask employee how you can help.
 Ask employee if there is anything else that would help
 Get agreement on necessary improvements
 End on a positive note expressing confidence in the employee by highlighting employee's
strengths.
 Confirm counseling sessions in writing and be sure to include any action steps discussed.
 Review written confirmation and give employee a copy.
 Schedule follow-up meeting(s) and keep to the schedule
STEP 5: Importance of Staff Performance Counselling (15 Minutes)
 Performance Counseling is a very important activity that helps employees to know themselves
better.
o Chalk down the career path
o Retaining Valuable Employees
o Effective Communication
o Growth for Employees
o Ensure transparent environment
o Put problems on the table for open evaluation and draft resolutions
o Clearly define expectations
o Ensure employee follow ethical standards, rules, common culture etc
o Decrease costs related to turnover, absenteeism
o Improvement in employee performance
o Increase in productivity
o Manage behavioral problems brought about by organizational change
o Helps in superior decision making
o Assist in understanding the situation more objectively
o Facilitates to look at the situations with a new perspective
o Motivates to search for alternate solutions to problems
.
STEP 6: Counsel Staff on Performance (35 Minutes)
 The following are steps to follow on counseling process staff performance;
92
1. Identify the Need
2. Prepare for Counseling
3. Conduct the Session
4. Follow-up
1: Identify the need
o Observe the situation, events or issues
o Compare the current situation with the desired one
o Focused and two way communication
o Interactive session
2: Prepare for Counselling
o Select a suitable place and notify the time
o Notify the concern members well in advance
o Organize Information
o Outline the session components
o Plan your counseling strategy
o Establish the right atmosphere
3: Conduct the Session
o Opening the session
o Discussing the issue
o Developing the plan of action
o Recording and closing the session
4: Follow up
o Support subordinates to implement their plan of action
o Review plan of action to determine if the desired results were achieved
o Amend the plan of action if required
o Measures after session include follow up counseling and informing the high-up.
STEP 7: Key Points (05 Minutes)

 Steps involved in process of performance counselling:
o Identify the Need
o Prepare for Counseling
o Conduct the Session
o Follow-up
STEP 8: Evaluation (05 Minutes)

 What is performance and counseling?
 What are the principles of performance counseling?
References:
93
Saunders
Kozier & Erb’s (2014) Fundamentals of Nursing Concepts and Practice. (9th Ed.) Audreney
Bernman Shorlee Spyder
Philadelphia.
Pearson Prentice Hall, New Jerse
SESSION 15: CONFLICT RESOLUTION STRATEGIES

Prerequisites: None
Learning Tasks
Define conflict and disputes
Outline the categories of conflicts
State the sources of conflicts
Explain conflict process
Describe strategies for conflict resolution
Resolve disputes or conflicts at work place

Resources Needed:

Method
94
1 05 Presentation
2 05 Lecture discussion Definition of conflict and disputes
3 15 Lecture discussion Categories of conflicts
4 15 Lecture discussion Sources of conflicts
5 20 Lecture discussion Conflict process
6 30 Small group, discussion Strategies for conflict resolution
7 20 Lecture discussion Resolve disputes or conflicts at work

place
8 05
9 05
SESSION CONTENTS
STEP 2: Definition of Conflict and Disputes (05 Minutes)

 Conflict: is an internal or external disagreement that results from differences in ideas, values, or
feelings between two or more people
 Disputes: is an argument or disagreement between people or groups example employees and
employer
STEP 3: Categories of Conflicts (15 Minutes)

 Interpersonal conflict
o This happens between two or more people with differing values, goals, and beliefs
o The person experiencing this conflict may experience opposition in upward, downward,
horizontal, or diagonal communication
 Intrapersonal conflict
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o Occurs within the individual
o It involves an internal struggle to clarify contradictory values or wants
o For the manager the conflict may result from the multiple areas of responsibility associated with
the management roles
o Manager’s responsibilities to the organization, subordinates, consumers, clients/ patients, the
profession, and themselves may sometimes conflict, and the conflict may be internalized
 Inter-group conflict
o This occurs between two or more groups of people, department, institutions or organization
STEP 4: Sources of Conflicts (15 Minutes)

 Incompatible differences.
 This may be due to:
o Culture-Culture differences for example, can be related to differing concept of work, change,
and openness
o Work may be seen as means to an end or as satisfying in itself
o Values
o Beliefs
o Language
o Education
o Experience
o Skills
o Professional values and norms
o Behaviour patterns
o Status
o Pay differences etc
STEP 5: Conflict Process (20 Minutes)

ASK students to discuss on conflict process for 5 minutes
ALLOW 2 to 3 groups to present and let other groups to provide additional points
WRITE their response on the chalk/white board or flip chart
CLARIFY and summarize their responses using the content below
 Process of conflict;
o Latent conflict stage
 At this stage conditions are mature to conflict, although none has occurred and may never
occur
 Most conflict could be prevented at this stage if managers examine the institution more
closely for previous conditions. These condition for example change the budget and
results into conflict if have not well thought out so that intervention can be made before
occurrence of conflict
o Perceived conflict
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 If the conflict progresses it may develop into the second stage, it is intellectualized and
often involves issues and laws
 It is recognized logically and impersonally by the individuals who are quailing
 Sometimes conflict can be resolved at this stage before it is internalize or felt
o Felt conflict
 It occurs when the conflict is emotionalized. Felt emotion include bitterness, fear, mistrust
and anger
 It also referred to as affective conflict and it is possible to perceive conflict and not feel it
i.e. no emotion is attached to the conflict the individual views it only as a problem to be
solved
 A person also can feel the conflict but not perceived the problems i.e. he/she is unable to
identify the cause of the felt conflict
o Manifest
 It is the fourthly stage also called overt conflict
 Action is taken at this stage
 The action may be to withdraw complete, debate or seek conflict resolution
 If conflict reaches this stage it is difficult to bring about conflict resolution without the use of
other resources
 People may learn to deal with manifest conflict early in their lives
 Traditionally men are socialized to use competition, dominance and aggression to solve
conflict as they are growing up while women to be socialized either to avoid or use at
attempts pacify conflict
o Conflict aftermath
 This aftermath may be more significant than the original conflict if the conflict has not been
handled constructively
 There is always conflict aftermath, positive or negatives. If conflict is managed well,
individuals involved in the conflict will feel that their position was given a fair hearing
 If the conflict is managed poorly the conflict issues frequently remain and may return later
to cause more conflict
STEP 6: Strategies for Conflict Resolution (30 Minutes)

The common conflict resolution strategies are;
 Compromising
 Competing
 Cooperating /accommodating
 Smoothing
 Avoiding
 Collaborating
 Compromising
o Each part gives up something it wants
o Antagonistic cooperation may result in a lose-lose situation because either or both parties
perceive that they have given up more than the other and may, therefore feel defeated
o To avoid lose-lose situation, both parties must be willing to give up something of equal value
 Competing
o Win-lose conflict resolution strategies
97
o Is used when one party pursues what it wants at the expense of the others.
o Usually only one party wins
o The competing party seeks to win regardless of the cost to others
o Win-lose conflict resolution strategies leave the loser angry, frustrated and wanting to get even
in the future
o Managers may use competing when quick or unpopular decision needs to be made
o It also may be used when one party has more information or knowledge about a situation than
others
 Cooperating/ accommodating
o One party sacrifices his/her beliefs and wants to allow the other party to win
o The actual problem is usually not solved in this win-lose situation
 Smoothing
o Occurs when one party in a conflict attempts to compliment the other party or to focus on
agreements rather than differences
o One person ‘smoothes’ others involved in the conflict in an effort to reduce the emotional
component of the conflict
 Avoiding
o The parties involved are aware of a conflict but choose not to acknowledge it or attempt to
resolve it
o May be indicated in trivial disagreements, when the cost of dealing with the conflict exceeds the
benefits of solving it, when the problem should be solved by people other than yourself, when
one party is more powerful than the other, or when the problem will solve itself.
o The greatest problem in using avoidance is that, the conflict remains, often re-emerge at a later
time in an even more exaggerated fashion
 Collaborating
o All parties set aside their original goals and work together to establish a supra-ordinate or
priority common goal
o All parties accept mutual responsibility for reaching the supra-ordinate goal
o Although it is very difficult for people truly to set aside original goals, collaboration can not
occur if this does not happen.
o True collaboration requires mutual respect, open and honest communication, and equitable,
shared decision making powers
STEP 7: Resolve Disputes or Conflicts at Work Place (20 Minutes)

 There are many benefits to establishing and maintaining an appropriate amount of conflict in
the workplace, including increased harmony and productivity;
o A pleasant working environment, reductions in stress and anxiety; and decreased
victimized behaviour.
o Manager should create a stable work environment that minimizes the antecedent
conditions for conflict has more time and energy to focus on meeting organizational and
human resource needs.
98
o When conflict does occur in the unit, managers must be able to discern constructive from
destructive conflict. Conflict that is constructive will result in creativity, innovation, and
growth for the unit.
o When conflict is deemed to be destructive, managers must deal appropriately with that
conflict or risk and result that may be even more destructive than the original conflict.
o Consistently using conflict resolution strategies with win–lose or lose–lose outcomes will
create disharmony within the unit.
o Leaders who use optimal conflict resolution strategies with a win–win outcome promote
increased employee satisfaction and organizational productivity.
o Negotiation also requires both management functions and leadership skills. Well-prepared
managers know with whom they will be negotiating and prepare their negotiation
accordingly.

 The common conflict resolution strategies are;
o Compromising
o Competing
o Cooperating /accommodating
o Smoothing
o Avoiding
o Collaborating
 What is conflict?
 What are the sources of conflict?
References
Delhi: MacGraw-Hill
Shorlee Spyder
Philadelphia.
SESSION 16: DISCIPLINARY ACTIONS FOR STAFF

99
Prerequisites: None
Learning Tasks
Define discipline and disciplinary action
Explain reasons for disciplinary action
Explain types of disciplinary proceedings
Identify guidelines and regulations for disciplinary action
Disciplinary committees and process
Resources Needed

Method
1 05 Presentation
2 05 Lecture- Define discipline and disciplinary actions
discussion/barnstorming
3 20 Lecture-discussion Reasons for disciplinary actions
4 10 Lecture-discussion Types of disciplinary proceedings
5 35 Lecture-discussion/buzzing Guidelines and regulations for disciplinary

action
6 35 Lecture-discussion Disciplinary committees and process
7 05
8 05
SESSION CONTENTS
100
STEP 2: Definition of Discipline and Disciplinary Action (05 Minutes)

ASK students to define discipline and disciplinary action
ALLOW few students to provide their responses
 Discipline is the practice of training people to obey rules or a code of behaviour, using
punishment to correct disobedience.
 Disciplinary action is a conduct/process which dealing with regulating behaviour that does not
allowed in a certain institution or are not expected to communicate in an organization.
STEP 3: Reasons for Disciplinary Action (20 Minutes)
The following are reasons for taking disciplinary actions:

 To effectively deal with marginal or below standard performance or conduct guide managers
towards fair and equitable outcomes
 To address performance problems at the time they occur
 To provide employees with a real opportunity to improve
 To ensure flexibility given the particular circumstances of each case
 To enable managers and employees to review and agree expectations for performance and
development to provide guidance on how to improve
STEP 4: Types of Disciplinary Proceedings (10 Minutes)

 Disciplinary proceedings can be categorised into two broad types:
o Formal proceedings: conducted when committed disciplinary offences (see public service
regulation first schedule part A) may warrant dismissal, reduction in rank or reduction in salary
o Summary proceedings: conducted when committed disciplinary offences (see public service
regulation first schedule part B) may not warrant dismissal, reduction in rank or reduction in
salary, only warrant written warning, reprimand and stoppage of increment .
STEP 5: Guidelines and Regulations for Disciplinary Action (35 Minutes)

ASK students to list three guidelines for disciplinary action for 3 minutes
101
 The employee should have forewarning or foreknowledge of the possible or probable
disciplinary consequences of his/her conduct
 A progressive discipline approach should be utilized
 The rule or order should be reasonably related to the orderly, efficient and safe operation of the
department or city.
 Before administering discipline, an effort should be made to discover whether the employee
did in fact violate or disobey the disciplining authority's rule, standard or order.
 The investigation of the situation should be conducted in a fair and objective manner
 The rule, order and penalty should be applied without discrimination to all employees in
comparable situations.
 The degree of discipline proposed should be reasonably related to the seriousness of the
employee's proven offense, the record of the employee's service with the City, and penalties
imposed previously in the department and the City in comparable circumstances.
STEP 6: Disciplinary Committees and Process (35 Minutes)

 Disciplinary Committee can be established to deal with various disciplinary issues in health setting.
 Common disciplinary issues relate to professional misconduct, under-performance, engagement in
corruptions, and violation of professional ethics.
 Disciplinary committee can be established when nurses and midwives misconduct, grossly under-
perform; engage in corruptions and unethical behaviour, violet professional ethics.
 According to public service act and its regulation, disciplinary committees are established by
disciplinary authorities (employers) are:
o Permanent secretaries,
o Regional administrative secretaries,
o District executive directors,
o Directors/heads of executive agencies and independent organization
 The objectives of disciplinary committee is to investigate, advise, and report all disciplinary offences
to employment and disciplinary authorities any disciplinary issues or offences such misconduct,
grossly under-performance; engagement in corruptions and unethical behaviour, and violation of
professional ethics.
 When it is necessary to institute formal disciplinary proceedings against employee, disciplinary
authorities shall make preliminary investigation before instituting disciplinary proceedings.
 The procedures or steps for conducting formal proceedings ( leading dismissal, reduction in rank
or reduction in salary) for disciplinary offence by disciplinary authority can be summarises as
follows:
o Conducting preliminary investigation
o Preparing charges in prescribe manner
o Serving employee with charges (accompanied by notice) stating nature of the offence and
inviting him or her to state in writing in time specified in the notice
o Giving accused employee time to respond to charges in written form
102
o Appointing two or three members to hold inquiry into the charges
o Conducting inquiry on charges
o Submitting the inquiry report to the disciplinary authority
 Based on findings and recommendations of disciplinary committees, employment and disciplinary
authorities can take any of the following specific disciplinary actions:
o Take no disciplinary action against employee
o Give an employee an oral warning
o Give an employee a written warning
o Take other actions/measures/punishment against employee such as reduction of salary of
an employee, terminating employment contract, firing/dismissal, and reduction in rank
 The responsibilities of employees in any disciplinary procedure/process may include the following:
o To report disciplinary offence committed
o To provide evidence/testimony for the committed disciplinary offence
o To participate, when appointed, in the process of conducting disciplinary inquiry on committed
disciplinary offence
Step 7: Key Points (05 Minutes)
 Discipline and disciplinary actions are important issues for promoting provision better health
services delivery
 There are guidelines and procedures to be followed in taking disciplinary actions against a
staff
 Appropriate disciplinary actions should be taken against staff for each disciplinary offences
 Staff in health sector have specific responsibilities that need to be discharged properly to
prevent disciplinary offences in organizations
Step 8: Session Evaluation (05 Minutes)
 Ask learners to answer the following questions

 What id disciplinary action?
 What are disciplinary authorities in Tanzania?
References
Armstrong, M. (2014). A Handbook of Human Resource Management (thirteen ed). London: Koga
Page.
Cole, G.A. (2002). Personnel and Human Resource Management (5th Ed). London: Bookpower
Godwin, N., Gruen, R., Iles V. (2006). Managing Health Services. Maidenhead: Open University Press.
Government of Tanzania (2002). Public Service Management Act. Dar es Salaam: Government Printer.
Government of Tanzania (2003). Public Service Management Regulations. Dar es Salaam:
Government Printer.
Government of Tanzania (2004). Employment and Labour Relation Act. Dar es Salaam: Government
Printer.
103
SESSION 17: STAFF PERFORMANCE APPRAISAL
Prerequisites: None
Learning Tasks
Define appraise, staff appraisal and evaluation
Explain different methods used to evaluate staff performance
Outline factors influencing effective performance appraisal
Explain the strategies to ensure accurate and fairness in performance appraisal

NMT 06104: Supervision in Nursing
Conduct staff and Midwifery
appraisal session 104
Give feedback on work performance 104
Conduct follow up on identified performance deficiencies

Document the appraisal processing
Resources Needed:
Step Time Activity/ Content

(min) Method
1 05 Presentation introduction, Learning Objectives
2 05 Lecture/discussion Define appraise, staff appraisal and evaluation
3 20 Lecture/discussion different methods used to evaluate staff performance
4 10 Lecture/discussion factors influencing effective performance appraisal
5 25 Lecture/discussion strategies to ensure accurate and fairness in

performance appraisal
6 20 Small group/discussion Staff appraisal session
7 10 Lecture/ discussion feedback on work performance
8 10 Lecture/ discussion follow up on identified performance deficiencies
9 05 Lecture/ discussion Documenting the appraisal process
10 05 Presentation Key Points

11 05 Presentation Session Evaluation
SESSION CONTENTS
READ or ASK participants to read the learning Task
STEP 2: Define Appraise, Staff Appraisal and Evaluation (05 Minutes)
105
ASK students to brainstorm answers to the definitions of appraise, staff appraisal and evaluation
ALLOW time for them to respond.
PROVIDE possible answers
 Performance appraisal is referred as activity done by employer or supervisor by review

performance of staff performance by observing if agreed standards and objectives were met.
 or employee appraisal is a method by which the job performance of an employee is evaluated
based on the set objectives in relation with its performance.
STEP 3: Different Methods Used to Evaluate Staff Performance (20 Minutes)

 Trait Rating Scales
o A trait rating scale is a method of rating a person against a set standard, which may be the
job description, desired behaviors, or personal traits.
o The trait rating scale has been one of the most widely used of the many available appraisal
methods.
 Job Dimension Scales
o Job dimension scales require that a rating scale be constructed for each job classification.
o The rating factors are taken from the context of the written job description. Although job
dimension focus on job requirements rather than on ambiguous terms such as “quantity of
work.”
 Behaviorally Anchored Rating Scales

o BARS, sometimes called behavioral expectation scales, overcome some of the
weaknesses inherent in other rating systems. As in the job dimension method, the BARS
technique
STEP 4: Factors Influencing Effective Performance Appraisal (10 Minutes)

 The following are the factors influencing effective performance appraisal;
o Appraisal should be based on a standard.
o Employee should have input into development of the standard.
o Employee must know the standard in advance.
o Employee must know the sources of data gathered for the appraisal.
o Appraiser should be someone who has observed the employee’s work.
o Appraiser should be someone who the employee trusts and respects .
STEP 5: Strategies to Ensure Accurate and Fairness in Performance Appraisal (25

Minutes)
106
ASK students to discuss on Strategies to ensure accurate and fairness in performance appraisal
 The appraiser should develop an awareness of his or her own biases and prejudices.
o This helps to guard against subjective attitudes and values influencing the appraisal.
 Consultation should be sought frequently.
o Another manager should be consulted when a question about personal bias exists and in
many other situations. For example, it is very important that new managers solicit
assistance and consultation when they complete their first performance appraisals.
o Even experienced managers may need to consult with others when an employee is having
great difficult of fulfilling the duties of the job.
o Consultation must also be used when employees work several shifts so that information
can be obtained from all of the shift supervisors.
 Data should be gathered appropriately.
o Many different sources should be consulted about employee performance, and the data
gathered needs to reflect the entire time
 Accurate record-keeping is another critical part of ensuring accuracy and fairness in

the performance appraisal.
o Information about subordinate performance (both positive and negative) should be
recorded and not trusted to memory.
o The recording of both positive and negative performance behavior throughout the
performance period is often called critical incident recording (11 Performance Appraisal
Methods, 2009).
o The manager should make a habit of keeping notes about observations, others’ comments,
and his or her periodic review of charts and nursing care plans.
o Taking regular notes on employee performance is a way to avoid the recency effect, which
favors appraisal of recent performance over less recent performance during the evaluation
period.
 Collected assessments should contain positive examples of growth and
achievement and areas where development is needed.
o Nothing delights employees more than discovering that their immediate supervisor is aware
of their growth and accomplishments and cancite specific c instances in which good clinical
judgment was used. Too frequently, collected data concentrate on negative aspects of
performance.
 Some effort must be made to include the employee’s own appraisal of his or her
work.
o Self-appraisal may be performed in several appropriate ways.
107
o Employees can be instructed to come to the appraisal interview with some informal
thoughts about their performance, or they can work with their managers in completing
a joint assessment.
 The appraiser needs to guard against three common pitfalls of assessment: the halo
effect, the horns effect, and central tendency.
o The halo effect
-Occurs when the appraiser lets one or two positive aspects of the assessment or
behavior of the employee unduly influence all other aspects of the employee’s
performance.
o The horns effect
Occurs when the appraiser allows some negative aspects of the employee’s
performance to influence the assessment to such an extent that other levels of job
performance are not accurately recorded
o The Matthew Effect
 The Matthew effect is said to occur when employees receive the same appraisal
results, year after year.
 Those who performed well early in their employment are likely to do well.
 Those who struggled will continue to struggle.
STEP 6: Staff Appraisal Session (20 Minutes)

 The following are the staff appraisal sessions;
o Before the Interview

o Make sure that the conditions mentioned previously have been met (e.g., the employee
knows the standard by which his or her work will be evaluated), and he or she has a
copy of the appraisal form.
o Select an appropriate time for the appraisal conference. Do not choose a time when
the employee has just had a traumatic personal event or is too busy at work to take the
time needed for a meaningful conference.
o Give the employee 2 to 3 days of advance notice of the scheduled appraisal
conference so that he or she can be prepared mentally and emotionally for the
interview.
o Be prepared mentally and emotionally for the conference yourself. If something should
happen to interfere with your readiness for the interview, it should be canceled and
rescheduled.
o Schedule uninterrupted interview time. Hold the interview in a private, quiet, and
comfortable place.
o Forward your telephone calls to another line, and ask another manager to answer any
pages that you may have during the performance appraisal.
o Plan a seating arrangement that reflects collegiality rather than power.
o Having the person seated across a large desk from the appraiser denotes a power–
status position; placing the chairs side by side denotes collegiality .
 During the Interview

o Greet the employee warmly, showing that the manager and the organization have a
sincere interest in his or her growth.
108
o Begin the conference on a pleasant, informal note.
o Ask the employee to comment on his or her progress since the last performance
appraisal.
o Avoid surprises in the appraisal conference.
o The effective leader coaches and communicates informally with staff on a continual
basis, so there should be little new information at an appraisal conference.
o Use coaching techniques throughout the conference
o When dealing with an employee who has several problems—either new or
longstanding—do not overwhelm him or her at the conference.
o If there are too many problems to be addressed, select the major ones.
o Conduct the conference in a nondirective and participatory manner.
o Input from the employee should be solicited throughout the interview; however, the
manager must recognize that employees from some cultures may be hesitant to
provide this type of input. In this situation, the manager must continually reassure the
employee that such input is not only acceptable but is also desired.
o Listen carefully to what the employee has to say.
o Focus on the employee’s performance and not on his or her personal characteristics.
o Avoid unclear generalities, either positive or negative, such as “your skills need a little
work” or “your performance is fine.
o When delivering performance feedback, be straightforward and state concerns directly
so as not to retard communication or cloud the message.
o Never threaten, intimidate, or use status in any manner.
o Let the employee know that the organization and the manager are aware of his or her
uniqueness, special interests, and valuable contributions to the unit.
o Remember that all employees make some special contribution to the workplace.
o Make every effort to ensure that there are no interruptions during the conference.
o Use terms and language that are clearly understood and carry the same meaning for
both parties.
o Avoid words that have a negative connotation.
o Do not talk down to employees or use language that is inappropriate for their level of
education.
o Mutually set goals for further growth or improvement in the employee’s performance.
o Decide how goals will be accomplished and evaluated and what support is needed.
o Plan on being available for employees to return retrospectively to discuss the
appraisal
o review further
o There is frequently a need for the employee to return for elaboration if the conference
did not go well or if the employee was given unexpected new information.
o This is especially true for the new employee
 After the Interview

o Both the manager and employee need to sign the appraisal form to document that the
conference was held and that the employee received the appraisal information.
o End the interview on a pleasant note.
Refer students to display of an example of such a form is shown in 16:1
109
STEP 7: Give Feedback on Work Performance (10 Minutes)
 Purpose of providing feedback
o People feel better when they receive constructive feedback from their performance
o From their leadership perspective, feedback equal information, information that is valuable,
often critical to the individual.
o Failing to give or receive feedback reduces immediate risk of being exposed to criticism but
increase the risk of later failure.
o Feedback clarifies performance expectations, reinforces constructive behaviour, corrects
negative behaviour, provides recognition (Recognition for work well done is a powerful and
inexpensive, increases self-awareness) and promotes growth and change.
o Frequently feedback challenges caregivers
 Performance Improvement Plan(PIP)
o Determine if the problem is a performance (mastering skills/tasks/job responsibility) or a
behaviour (disrupting the workplace) problem. If there is more than one, list them
separately.
o For each identified problem explain what must change and identify the standards upon
which the identified performance or behaviour will be measured.
o Identify specific and measureable steps to improve performance.
o Define expectations in detail and be sure the staff member understands.
o Make sure expectations are reasonable and attainable in the allotted time period.
o When meeting with your staff member, engage them in a discussion on how they can
improve.
o Identify how long the plan for improvement will last and establish periodic review dates.
o Identify a reasonable timetable for accomplishing the needed change in
performance/behaviour for each area identified in the plan for improvement.
o Supervisors should maintain active contact with the staff member through regularly
scheduled meetings other than the formal PIP review meetings.
o Describe what resources are available to assist the staff member.
o Describe the consequences if performance is not improved.
STEP 8: Follow Up on Identified Performance Deficiencies (10 Minutes)

 Implementing the plan of action may require long term intervention by the supervisor, such as
motivating, coaching, or counseling the employee.
o Motivating
 The nursing manager/leader is in the best position to motivate employees to achieve their
goals because managers set the tone for an environment that encourages productivity and
success.
 A motivating environment is one in which the nurse leader/manager:
Establishes a career development program
Helps employees to meet their career goals
Communicates the organization’s goals and priorities
Involves the staff in the development of department and organizational mission and
goals
Encourages teamwork
Rewards teamwork, innovation, and creativity
110
o Coaching
 In assisting employees to reach their goals and develop professionally.
 Coaching might be likened to on-the-job training or teaching
 Short-term coaching is generally spontaneous, brief, and open.
 Long-term coaching can be used to correct performance deficiencies
 Coaching also might involve providing opportunities for the employee to attend workshops
or conferences or serve on committees.
o Counseling
 Counseling is one of the most productive functions to improve employee performance
 Counseling generally occurs in a private session where the focus is on helping the
employee solve a problem
 Other problems that require counseling might include disputes or conflicts with other
employees.
o Disciplining
 The purpose of disciplining is to improve job performance
STEP 9: Documenting the Appraisal Processing (05 Minutes)

 Document the goals for further development that have been agreed on by both parties.
 The documentation should include target dates for accomplishment, support needed, and
when goals are to be reviewed.
 This documentation is often part of the appraisal form.
 If the interview reveals specific long-term coaching needs, the manager should develop a
method of follow-up to ensure that such coaching takes place .

 Performance appraisal also referred to as performance review, performance evaluation,
development discussion, or employee appraisal is a method by which the job performance
of an employee is documented and evaluated
 Different methods used to evaluate staff performance include trait rating scale, Job
dimension scales and Behaviorally Anchored Rating Scales
 Staff appraisal session are before , during and after interview
 What is performance appraisal?

 What are different methods used to evaluate staff performance?
References
Haldar,K.U(2011)Leadership and team building, Delhi , Oxford University press

Jones, P.A.R (2007) Nursing Leadership and Management: Theories Processes and Practice.F.A
Davis and company
111
Hand out 16:1: Performance appraisal Documentation form
Performance appraisal .
Name: _______________________________________________________________________
Unit: _________________________________________________________________________
Prepared by: __________________________________________________________________
Reason: _____________________________________________________________________
(Merit, terminal, end of probation, general reviews)
Date of appraisal conference:_____________________________________________________
Comments by employee:
Employee’s signature: _________________________________

(Signature of employee denotes that the appraisal has been read. It does not signify acceptance or
agreement. Space is provided for any comments the employee wishes to make.)
Comments by appraiser.
112
(These comments are to be written at the time of the appraisal conference and in the presence of the
employee.)
_______________________ __________________________
Employee’s signature (Date) Evaluator’s signature (Date)
113
SESSION 18: TEAM AND TEAMWORK

Prerequisites: None
Learning Tasks
Define a team and teamwork
Explain the importance of teamwork in health care
State the qualities of an effective team
State features/characteristics of effective and in-effective team
Describe the team development process
Conduct a staff meeting
Develop a plan for teamwork

Resources Needed:
 Assign
Flip charts, responsibilities
marker to eachtape
pens, and masking member of the team

Method
1 05 Presentation
2 05 Lecture/discussion Define a team and teamwork
3 15 Lecture/discussion Explain the importance of teamwork in

health care
4 10 Lecture/discussion State the qualities of an effective team
5 15 Lecture/discussion State features/characteristics of effective

and in-effective team
6 20 Small group/discussion Describe the team development process
114
7 20 Lecture/ discussion Conduct a staff meeting
8 10 Lecture/ discussion Develop a plan for teamwork
9 10 Lecture/ discussion Assign responsibilities to each member of

the team
10 05
11 05
SESSION CONTENTS
STEP 2: Define a Team and Teamwork (05 Minutes)

 A team is a small number of people with complementary skills who are committed to a
common purpose, performance goals, and hold themselves accountability.
o For example, on health care teams, the purpose is to meet patient care needs.
 Teamwork is a group of people working together for a common goal in providing quality
services to clients and better health to people in their communities
.
STEP 3: Importance of Teamwork in Health Care (15 Minutes)
The main importance of team work is;
o Promotes smooth talk and leaner structures, with less hierarchy
o Fosters flexibility and responsiveness, especially the ability to respond to change
o Collective decision making is possible
o Knowledge and experience of different persons are available and shared
o Responsibilities can be shared
o Tasks can be divided among members and hence less time can be used
o Members provided each other with support (moral, materials and emotional) to accomplish
results
o Sharing of resources is enhanced
o Critique of each other’s behaviour is for the purpose of improving team spirit and performance
o Promotes the sense of achievement,
o Various ideas/ opinions can be contributed
STEP 4: Qualities of an Effective Team (10 Minutes)

 Clear goals
 Clear roles and responsibilities
115
 Mutual trust
 Reliable plan
 Ability to adapt quickly
 Individualized coaching
 Suitable leadership
 Commitment
 Continuous learning
 Appropriate culture
 Specified task
 Distinct roles
 Adequate resources
 Relevant members
STEP 5: Features/Characteristics of Effective and In-Effective Team (15 Minutes)

ASK students to discuss on characteristics of effective team
 A well-functioning health team should have the following characteristics

o It should have clear goals and objectives which everyone in the group understands and is
committed to work with.
o The team should work together to achieve the planned goal
o Each member should understand their roles and responsibilities and how they relate to the
work to the others
o The decision making procedure should be clearly defined, e.g. how will decision be carried
at. Is it by consensus or majority vote?
o Each team member should understand the work and duties of the others to be able to give
assistance during a heavy work session or replace another on his/her absence. This mean
staff should be flexible
o The team should have a leader who will assume a leadership role of organizing staff
rosters, meeting, and on the job training to make sure the common goals are attained on
time
116
o The team leader should ask for assistance if in difficulties from other team members or
supervisors
o A good team should have a good relationship within the group and other related
beneficiaries, members should be open and understanding
o An effective team has clear rules and norms and mechanisms for conflict resolution
o Team should disseminate information among team members and other beneficiaries
through meetings circulars, reports and feedback
o An effective team is accountable for their responsibilities and resources assigned and
conduct its work in a transparent manner
o Delegation of authority and responsibilities motivates and develops team members and
encourages initiative
 Characteristics of Ineffective team work
o Does not have goal
o Does not have objectives
o Does not have leaders
o Does not have clear rules and norms
o Does not have good relationship
STEP 6: Team Development Process/ Stages (20 Minutes)
This process of learning to work together effectively is known as team development. Research has
shown that teams go through definitive stages during development. Bruce Tuckman, an educational
psychologist, identified a five-stage development process that most teams follow to become high
performing. He called the stages: forming, storming, norming, performing, and adjourning. Team
progress through the stages is shown in the following diagram.
Most high-performing teams go through five stages/ process of team development.
Forming stage
117
The forming stage involves a period of orientation and getting acquainted. Uncertainty is high during
this stage, and people are looking for leadership and authority. A member who asserts authority or is
knowledgeable may be looked to take control. Team members are asking such questions as “What
does the team offer me?” “What is expected of me?” “Will I fit in?” Most interactions are social as
members get to know each other.
Storming stage
The storming stage is the most difficult and critical stage to pass through. It is a period marked by
conflict and competition as individual personalities emerge. Team performance may actually decrease
in this stage because energy is put into unproductive activities. Members may disagree on team goals,
and subgroups and cliques may form around strong personalities or areas of agreement. To get
through this stage, members must work to overcome obstacles, to accept individual differences, and to
work through conflicting ideas on team tasks and goals. Teams can get bogged down in this stage.
Failure to address conflicts may result in long-term problems.
Norming stage
If teams get through the storming stage, conflict is resolved and some degree of unity emerges. In the
norming stage, consensus develops around who the leader or leaders are, and individual member’s
roles. Interpersonal differences begin to be resolved, and a sense of cohesion and unity emerges.
Team performance increases during this stage as members learn to cooperate and begin to focus on
team goals. However, the harmony is precarious, and if disagreements re-emerge the team can slide
back into storming.
Performing stage
In the performing stage, consensus and cooperation have been well-established and the team is
mature, organized, and well-functioning. There is a clear and stable structure, and members are
committed to the team’s mission. Problems and conflicts still emerge, but they are dealt with
constructively. (We will discuss the role of conflict and conflict resolution in the next section). The team
is focused on problem solving and meeting team goals.
Adjourning stage
In the adjourning stage, most of the team’s goals have been accomplished. The emphasis is on
wrapping up final tasks and documenting the effort and results. As the work load is diminished,
individual members may be reassigned to other teams, and the team disbands. There may be regret as
the team ends, so a ceremonial acknowledgement of the work and success of the team can be helpful.
If the team is a standing committee with ongoing responsibility, members may be replaced by new
people and the team can go back to a forming or storming stage and repeat the development process.
STEP 7: Conduct a Staff Meeting (20 Minutes)

 Conduct staff meeting
o Welcome employees to the meeting.
118
o Share the agenda and the time you are allotting for the meeting.
o Ensure you stick with the agenda as close as possible.
o If there is an employee participation component, be sure to be supportive and encouraging.
o Have someone take minutes or notes of the meeting, and of any decisions made so that
they can be followed-up on.
o Leave enough time for questions and answers at the end of the meeting
STEP 8: Develop a Plan for Teamwork (10 Minutes)

 Work plan templates are usually made for projects to make them more organized and efficient.
 They should display all the activities and tasks which are involved in a project, who is assigned
to each activity and task and when the tasks are supposed to be completed.
o Start-up Plan
o Estimates
o Staffing
o Resource Acquisition
o Project Staff Training
o Work Plan
o Work Breakdown Structure
o Schedule Allocation
o Resource Allocation
o Budget Allocation
o Project Tracking Plan
o Requirements Management
o Schedule Control
o Budget Control
o Quality Control
o Reporting
o Project evaluation
STEP 9: Assign Responsibilities to Each Member of the Team (10 Minutes)

Provide leadership by-:
 Showing the way through supervision and guidance
 Accepting responsibility
 Recognizing the ability of each team member by cultivating the spirit of team work through
making them, have each other cooperation and having the common goal.
 Organize and direct all the activities of a team by using their capability.
Supervising by:-
 Observing what is happening
 Identifying problems
 Evaluating and teaching the team members
 Maintaining goal communication and goal human relations
119
Team members.
 Each team member to work cooperatively with the leader
 Everybody should give the best care s/he is capable of giving.
 Participate fully and constructively at meeting reports etc. and feel free
 Respect the contribution of each team member to the welfare of the patient.
For the team leader all their activities are grouped into four parts.
1. Plan and direct all patient care by showing:-
 What must be
 How to do it
 Who should do it
 Where and when to do it
2. Observe constantly using all senses
3. Teaching
 Good nursing care
 Right attitudes
 Good human relations
 Teach all team members, direct and indirect instruction
4. Evaluate fairly and objectively on job performance.

 The main importance of team work are;
o Promotes smooth talk and leaner structures, with less hierarchy
o Fosters flexibility and responsiveness, especially the ability to respond to change
o Collective decision making is possible
o Knowledge and experience of different persons are available and shared
o Responsibilities can be shared

 What is the team work?
 What are the qualities of team work?
ASK students if they have any comments or need clarification on any points.
References
Harold Koontz, Heinz Weihrich (2004) Essentials of Management (6 th ed.)
Koontz H. Weihrich H. (2005) Essentials of Management, An International perspective (6 th ed.),
McGraw-Hill New Delhi
Marquis B. L, Huston C. J (2000) Leadership roles and management function in nursing (3 rd ed.),
Lippincott – Philadelphia
Marquis, L Bessie and Huston, Carol (2006). Leadership Roles And Management Functions In Nursing;
(5th ed.), Lippincott Williams, New York
McMahon R M and PIOT M (1985) On Being In-charge. A guide for Middle level management in
Primary Health Care. WHO Geneva
120
121
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THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND

DIRECTORATE OF HUMAN RESOURCE DEVELOPMENT

FACILITATOR’S GUIDE FOR ORDINARY DIPLOMA

NMT 06104: Supervision in Nursing and Midwifery

NMT 06104: Supervision in Nursing and Midwifery ii

NMT 06104: Supervision in Nursing and Midwifery iii

NMT 06104: Supervision in Nursing and Midwifery iv

Dr. Loishook Saitori

NMT 06104: Supervision in Nursing and Midwifery v

SN FULL NAME INSTITUON/ ORGANIZATION

Ndementria Arthur Vermand

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3.2. Objectives for Training Manual

The module sub-enabling outcome as follows:

4.2. Who is the Module For?

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4.3. How is the Module Organized?

4.4. How Should the Module be Used?

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NURSING AND MIDWIFERY PRACTICE

Session Overview Box

Step Time (min) Activity/ Content

3 20 Lecture/discussion Qualities of a supervisor

4 20 Lecture discussion Differentiate between supervisor, leader and

6 10 Lecture discussion Importance of supervision

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STEP 2: Definition of Supervision and Supervisor (05 Minutes)

STEP 3: Qualities of a Supervisor (20 Minutes)

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STEP 4: Differentiate Between Supervisor, Leader and Manager (20 Minutes)

Differences between supervisor, leader and manager

Supervisor Leader Manager

 Training and answering  Identifying trends and  Planning and budgeting

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STEP 5: Roles of a Supervisor (30 Minutes)

 The following are the roles of supervisor;

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STEP 6: Importance of Supervision (10 Minutes)

STEP 7: Principles of Supervision (20 Minutes)

o Maintain a happy working atmosphere to the staffs (conducive working

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o Give advice when sought (whenever is needed), be approachable, answer questions

o Make reference materials available for workers

o Taking corrective action, refrain from taking corrective/disciplinary measures to the

STEP 8: Key Points (5 minutes)

Step 9: Session Evaluation (5 minutes)

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SESSION 2: SUPPORTIVE SUPERVISION

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Step Time (min) Activity/ Content

2 05 Brainstorming/Presentatio Definition of supportive supervision

3 05 Lecture discussion Importance of supportive supervision

4 10 Lecture discussion Stages of supportive supervision

5 10 Lecture/discussion Tools used in supportive supervision

6 40 Lecture/discussion Supportive supervision plan

7 10 Lecture/discussion Provide technical support

8 10 Lecture/discussion Conducting on-job training