SEMINAR

ON

CO-ORDINATION, SYSTEM APPROACH, COMMUNITY

AUDIT AND SANCTION
1. Co-ordination is the orderly arrangement of group efforts to provide unity of an action in
pursuit of common purpose

2. System: a set of objects or elements in interaction to achieve a specific goal

3. Theory: a formulation of the apparent relationships among several principles that relate to a
topic of interest.

4. Model :an abstraction or representation of something more complex.

5. Audit: A final statement of account or a review or a evaluation of health care procedures and
Documentation

6. Concurrent: a part of utilization management programme in which in patient or home

healthcare is reviewed as it is provided.

7. Retrospective: it is made for relation ship between one phenomenon and condition and

another that occurred in the past.

8.community audit is the assessment of the quality of care delivered to the community with the

help of records.

9. Sanction: threatened penalty for disobeying a law or rules

10. sanctions: measures taken by a state to try to force another to do something.

11. Role : the set of behaviors’ expected of an individual in a given situation

 CO-ORDINATION

INTRODUCTION

In every organization and harmonization of the various departmental-activities are indispensable

to achieve the desired objectives. The ensure harmonious and smooth functioning of an enterprise, the
activities in all areas, departments, decisions of an enterprise are required to be pulled tighter. At the
same time, it is necessary to avoid the splintering efforts that may destroy the unit of action through their
cross-purpose working or inter-departmental conflicts. All this requires effective co-ordination. Co-
ordination is the integration, synchronization, or orderly pattern of individual and group efforts to achieve
the organizational objectives.co-ordination affects the people, groups, organizational units, and all
activities with in every enterprise. Lack of co-ordination causes tremendous waste of time, effort, and
money.

DEFINITIONS

Co-ordination is defined in different ways as follows.

It is the adjustment of the parts of each others and of the movement and operation of party in time. So
that each can make into maximum contribution to the product of the whole.(TERRY)

Co-ordination is the integrating process in an orderly pattern of group efforts in an organization toward
the accomplishment of a common objective.

Co-ordination is the orderly arrangement of group efforts to provide unity of an action in pursuit of
common purpose.

Co-ordination is the orderly synchronization of efforts to provide the proper amount, timing and
directing of execution resulting in harmonious and unified actions to a stated objective.(NEW
MAN,1953)
CHARACTERSTICS

Group effort

Organization is not a haphazard collection of people, material, machnines, equipment and other
financial and physical resources. The financial, human and technical resources are properly organized
and co-ordinate.co-ordination transcends and permeates all managerial functions. It is the orderly
synchronization of efforts of the sub-ordinates to provide the proper amount and quality of execution, so
that their unified efforts lead to the stated objectives of a group of people to achieve organizational
objectives.

Unity of action

Co-ordination applies to the group effort,not individual effort, co-ordination stress the unity of
effort and unity of action. It is an ongoing process where managers develop and integrated, orderly and
synchronization pattern of group effort among his sub-ordinates and try to attain unity of effort in the
pursuit of some common objective.

Common purpose

Effective co-ordination is good management. Co-ordination is not a one-shot deal. It is a never

ending process of ensuring the achievement of organizational goals effectively. When the individual and
group as well as organization are interrelated the in congruency between personal goals and
organizational objectives gets resolved automatically.co-ordination involves a reciprocal relationship i.e.
willingness to take and give among the people and activities concerned. Each tries to serve his own goals,
perceptions, attitudes, beliefs, values ect. Each tries to serve his own goals and ends. Conflicts between
individual goals and organizational objectives are inevitable in every firm, such conflicts and in
congruencies demand co-ordination of efforts to achieve common goals.

IMPORTANT FEATURES OF CO-ORDINATION

Co-ordination is a integrity process.

If subdivision of work is in escapable, co-ordinationbecomes mandatory.
Undue confusion is a symptom of poor co-ordination.
Co-ordination is a process. It is a process of achieving integration among different organizational
units.
Unity of effort is the heart of co-ordination problem. By unity of effort means that the managers
arrange the nature and timing of activities so that individual efforts blend into a harmonious
stream of productive action.
The idea that co-ordination is a fixed entity that either exists or does not exist is totally
unrealistic.co-ordination is present in all organizations but in varying degrees.
The chief objective of co-ordination is a common purpose.
Co-ordination cannot be achieved automatically. It must be won by intelligent,
vigorous,persistent and organized effort.

PRINCIPLES OF CO-ORDINATION

Co-ordination is a process where by an executive develops an orderly pattern of group effort

among his subordinates and secures unity of action in the pursuit of common objectives. Co-ordination is
the continuous and dynamic process and emphasizes unity of efforts of achieve the desired objectives.
Co-ordination the managerial responsibility.

1.Principle of direct contact: co-ordination can be achieves by direct contact among the responsible
people concerned. Co-ordination can be easily obtained by direct interpersonal relationships and direct
personal communications. Such personal contacts bring about agreement on methods, actions and
ultimate achievement of objectives. Direct contacts also help with away the controversies and
misunderstanding among organizational participants. It is based on the principle that co-ordination is
better achieved through understanding,not by force or order.

2. Principle of early stages: co-ordination should start from the very beginning of planning process. At
the time of policy formulation and objective setting. Co-ordination problem is 90% solved. it is because
participative goal setting enables agreement and commitment to orgazational goals and there is no
question of conflict and in congruency, if not initiated in the early stages of planning process and policy
formulation, becomes difficult to exercise in the later stages of the execution of plans.

3.Reciprocal relationships: as the third principle: all factors in a situation are reciprocally related.in
other words all the parts influence and are influenced by other parts. For example when A works with B
and he is turn works withC and D,each of the four finds himself influenced by others influenced by the
people in the total situation.

4.Principles of self co-ordination: in this when a particular department affects other function or
department or function in turn affected, may not have direct control over the other department that is
influencing the said department. However, if other departments are modified in such a fashion that this
affects a particular department favorably then self co-ordination is achieved. this principle is rarely
practiced in day-to-day life.

IMPORTANCE OF CO-ORDINATION

Co-ordination is crucial factor in the survival of any enterprise. The need for co-ordination arises
from the diversity of tasks to be undertaken and of persons to carry them out. It emerges as soon as the
operation to be multiple or complex, by reason of the fact that more than one person is concerned with
it.co-ordination is essential as:

It resolves conflicts between line and staff inter-department,intraa-departmental conflicts and

restores harmony in operations.
It results in the accomplishment of organizational goals
It helps to increase the effectiveness of management

CO-ORDINATION HELPS TO INCREASE THE EFFECTIVENESS OF MANAGEMENT IN

THE FOLLOWING WAYS

Co-ordination pulls all the function and activities together. In the absence of co-ordination the
energies, resources, skills, and intelligence of people, materials and financial resources cannot
follow a specific direction. it is quiet likely that the resources and people will be misused and
misutilized.
Co-ordination brings unity of action and direction. it resolves effectively the dangerous conflicts
between individual and organizational goals. The managerial function of co-ordination strives for
unity of action in a setting characterized by baffling diversity of
goals,perceptions,attitudes,personality,skills,intelligence,ect without the desired degree of unity
organization will not be in a position to attain the specified objectives.
Activities are dividing and sub-divide in organizations. such differentiation requires effective
integration of activities. The integration is brought about by co-ordination in terms of fusion
among differentiated work units and authority centers.
Modern organizations are considered as open system these open systems are characterized by
information flows, resource flows, and the flow of activities.co-ordination ensures the smooth
flow of resources into productive units and brings required quality output.

TECHNIQUES TO ACHIEVE CO-ORDINATION

1. co-ordination by rules or procedures

In the work that need to be accomplished is highly predictable and hence can be planned in
advance, a manager can specify a head of time what actions his subordinating the routine rescuing
activities, rules and procedures are helpful which specify in detail a head of time, what courses of action
the subordinates should take if some situation should a rise.

2. Co-ordination by targets or goals

Most of the managers assign specific goals/ targets to their subordinates facilitate co-ordination.

3. Co-ordination through hierarchy

 Rules, regulations and procedures as well as the goals apart, managers also use the chain of
command to achieve co-ordination. When situations arise the specified rules or targets do not cover that,
subordinates are trained to bring the problem to their concerned manager. Co-ordination through the
hierarchy works well as long as the number of problems that must be brought to the boss is not great.

4. co-ordinationthrough departmentalization

Departmentalization also serves as a technique to bring about effective co-ordination. some

forms of departmentalization also facilitate co-ordination better than do others. a matrix approach means
each project has the continuous and undivided attention of its own project manager and the project team.
Therefore in the case of matrix organization co-ordination is automatically ensured.

5. Using a staff assistant for co-ordination

To make his job of coordinatinating easier, a manager may hire an assistant. When subordinate
brings a problem to him, the assistant can comic the information on the problem, research the problem,
provide alternative solutions available. This increases, undoubtedly, the manager’s ability to handle the
problems and coordinate the work of his subordinates.

6. Using a liaison for coordination

In some big organizations where the volume of contacts between two departments grows, many
managers appoint a special liaison person to facilitate coordination.

7. Using committee for coordination

Another sound technique of coordination is to from committee for understanding various

functions and problems. Committees are increasingly useful for coordinating, planning and executing
programs and controlling the various activities. Committees also establish face-to-face contacts and
personal relationships and promote voluntary cooperation.further, to coordinate the overlapping and
conflicting functions committees need to be established.

8. Using independent integrators for coordination

In some special circumstances, independent integrator may be recruited by organizations. An

independent integrator‘s job is to coordinate the activities of several interdependent departments. They
are not attached to the departments they coordinate. The independent integrators will be either individuals
or departments. Using independent integrators for achieving coordination has to be useful in high-
technology companies.

9. Conferences
 Conferences at regular intervals also ensure better coordination. Conferences provide adequate
platform for discussion of various problems being encountered by different departments.

10. The techniques of communication

To promote coordination, communication system must be perfect. It must be well designed.

Communication is an artery through which the decisions flow top to bottom and reports flow from
bottom to top. With out proper communication coordination is almost impossible.

11. Miscellaneous

Other coordinating techniques include :grouping the similar activities, reorganization of departments to
ensure coordination, cross functioning of the departments, project management organization hierarchy,
planning techniques, creation of certain staff positions, periodical staff meetings ect.

TYPES OF CO-ORDINATION

Coordination can be classified into two broad categories, one on the basis of its shape in the organization
and other on the basis of its scope and coverage. On the former basis, it can be classified into vertical and
horizontal coordination and on, the latter basis, into internal and external coordination.

1. Vertical and horizontal coordination

The term vertical coordination is used when coordination is to be achieved between various links
or different levels of the organization vertical coordination is needed to ensure that all the levels in the
organization act in harmony and in accordance with organizational policies and programmers. It is the
function of the top executives to bring about this co-ordination. Vertical coordination is secured through
delegation of authority and with the help of directing and controlling.

The term “horizontal coordination” is used when coordination has to be achieved between
departments on the same level in the management hierarchy. Thus, when coordination is brought
between production department, sales department, personnel department etc it is said to be horizontal
coordination.

2.Internal and external coordination

Coordination may be internal or external to be organization. Coordination is internal when it is achieved

between different departments, sections, and units of an enterprise. It is both vertical and horizontal.

The various factors with whom it has interaction include government, customs, supplies and
competitors. An enterprise has to keep proper coordination with these. Such type of coordination is
known as external co-ordination and it is essential for the survival of the enterprise. External coordination
also involves interaction with other business, economic and research institutions to have the benefits of
latest information and technological advances.

DIFFICULTIES OF CO-ORDINATION

Lack of coordination and understanding between and among individuals, groups, and
departments.
lack of good interpersonal relations
failure in accomplishing objectives according to time and work schedule
Lack of direction and consequently aimless individual efforts.
Functioning of departments in the organization as watertight compartments.
Lack of initiative and loyalty towards the organization.

SYSTEM APPROACH
INTODUCTION
It was first proposed under the name of “General system theory” by the biologist Ludwig Von
Bertalanffy. Von noted that all systems studied by physicists are closed. They do not interact with the
outside world. When a physicist makes a model of the solar system, of an atom, or a pendulum, he or she
assumes that all masses, particles, forces that affect the system are included in the model. It is as if the
rest of the universe does not exist. This makes it possible to calculate future states with perfect accuracy,
since all necessary information is known.
However, as a biologist von knew that such an assumption is simply impossible for most
practical phenomena. Separate a living organism from its surroundings and it will die shortly because of
lack of oxygen, water and food. Organisms are open systems they cannot survive without continuously
exchanging matter and energy with their environment.
DEFINITION
A system approach is especially necessary for planning and control functions of management.
CHARACTERISTICS OF A SYSTEM
 A system is a set of objects or elements that interact to achieve a specific goal.
 It explains relationship between objects or elements.
 It is not just an orderly arrangement of parts but an ongoing process
 It is capable of maintaining some degree of organization.
FUNCTION OF SYSTEM
 the function of a system is to convert information, energy or materials into a planned outcome or
product for use within the system, outside the system
 It facilitates understandings of a complex phenomenon by encouraging information and
clarifying relationships between different aspects of the phenomenon.
TYPES OF SYSTEM
In order to design, use and modify systems effectively, a nurse leader must be able to capitalize
on characteristics of different types of system
1.Natural and man-made system
It is one that grows out of natural processes, remains stable over long periods of time and
operates within well-defined limits.
Man made system is one that is artificially contrived by a human to accomplish a desired end.
2.Static and dynamic system
Static system is one that constitutes a steady state,in which neither system elements nor the
total system changes in relation to its environment.
Dynamic system is one that continuously alters and is altered by its environment.
3.deterministic and probabilistic system
a deterministic system is one in which the parts interact in a predictable way,once the state of
the system is known. If the system controller changes one input element in a deterministic
system, it is possible to accurately predict output of the changed system.
a probabilistic system is one in which the outcome of system performance is somewhat
uncertain, so it is impossible to make a precise prediction about performance of system
components or total system output.
4.open and closed system
A closed system is characterized by fixed, automatic relationships among system components
and no give and take with the environment.
An open system interacts with the environment.
5. Centralized and decentralized system
A centralized system is one in which a single subsystem plays so dominant a role that it
minimizes the importance of other subsystems.
A decentralized system is one in which all subsystems are of equal importance.
6. External and internal system
An external system is a socio technical system consisting of behavior that are determined by
formal organizational structure and function.
An internal social system consists of behaviours that develop from interaction between formal
job requirements and individual needs.
7. Purpose and purposeful system
A purposive system is a multigoal have a common property. Although a purposive system can
pursue different goals at different times, the system operators are not free to select the goal to be
pursued. Instead, system goals are selected by the system initiator.
a purposeful system is one that can produce the same outcomes in different ways in the same
internal or external state and can produce different outcomes in the same internal and external
state.
PRINCIPALS OF A SYSTEM APPROACH
1. A system approach to problem solving requires investigating the whole situation, rather than
considering one or two more obvious or troublesome problem aspects.
 2. Each system behaves in a characteristic manner because of the unique relationships among its
parts. So long as system components remain the same and the systems environment is not
radically changed, system behavior is predictable.
3. Each system is a self-contained entity, it is also part of another system of wider and higher
order.
4. The central objective of any system can be identified by the system operator’s willingness to
sacrifice other goals to ensure its realization.
5. every system , whether living or mechanical, is an information system, in that data of some
type are needed to select input, shape process , govern feedback, determine control, and evaluate.
6. Although a boundary divides a system from its environment, system and its environment are
highly interrelated.
7. It requires that a situation be viewed as a whole, a highly complex system may have to be
broken into subsystem so that each can be analyzed and understood separately before being
reassembled into a comprehensive whole.
8. A system consists of a set of objects and of greater importance to the functioning of the system
than the objects.
9. System is a dynamic network of interconnecting elements, a change in only one of those
elements must produce a change in all the others.
10.when subsystem are arranged in series, as when output of one system becomes input for
another, process alterations in any subsystem necessitate complementary alterations in related
subsystem.
11. All systems tend toward equilibrium, a balance of various forces operating within and on the
system.
12.the boundary of the a system can be redrawn at will by a systems analyst, either to include
certain environmental elements not previously considered as part of the system or to exclude
certain previously included components.
13. A system must be strongly goal directed, governed by feedback, and capable of adapting to
changing external circumstances.
ADVANTAGES OF SYSTEM APPROACH
 Highlights input-output relationships
 Clarifies process steps and channels
 Identifies optimum control points
 Facilitates broad-scale, multidirectional change.
DISADVANTAGES OF SYSTEM APPROACH
 Centralizes decision making.
 Obscures differences, disagreements
 Depersonalizes human interactions.
SYSTEM MODELS IN NURSING
System theory can be used to describe and explain the behaviours of individuals, groups and
communities. Conceptual models based on system theory, known as systems models are useful in
nursing.These models focus on the organization,interaction,interdependency, and integration of parts and
elements. Systems models are based on general system theory as described by von,(1952), who wrote
that “ every organism represents a system, by which terms we mean a complex of elements in mutual
interaction. concepts frequently discussed in relation to general systems theory , are wholeness,
organization, openness, boundary, entropy, negentropy and equifinality.
Wholeness refers to that condition in which a collection of parts responds as an integrated single
part. The arrangement of the elements and their relationship to each other represents their organization.
The openness of a system refers to the extent to which it exchanges energy with the environment and it
turn affects the environment output. in an open system a continuous give and take occurs with the
environment. all living systems are open, the use of the term closed system actually indicates expression,
since at present it is impossible to demonstrate totally closed system.
Boundary refers to a line or border that defines what elements constitute the system. Each of the
system requires a specific form of energy to continue functioning.
Negentropy is the energy the end that is “free” can be used for work, and tends towards order.
Because living systems are open systems, they make use of negentropy rather than entropy.
Equifinality it means the end state of the open system is dependent of the beginning state.
Feedback is the process whereby the output of the system is redirected as the input to the same system.
All open or living systems have input, output, and feedback.
Communities can be understood from a systems perspective in the following way. According to
systems theory, the community is an open system that exchanges materials such as energy, goods and
services, values and ideas with the environment inside and outside the community. The community as a
system has boundaries the moist obvious being geographical lines. The imaginary boundary is one that
encompasses all the subsystems in the community and identifies what is inside and outside the
community. Entropy can be compared to the land fill garbage dumps which disintegrate and results of
which may not be converted to something useful. Negentropy can be compared to the resources, health,
wealth and altruistic values of the people. Equifinality indicates the community’s attempt to attain or
maintain balance and beauty. Communication is the means within the community that subsystems relate
to each other and to the entire community.
The community is a social system made up interrelated and interdependent subsystems. The
subsystems are economics, education, religion, health care, politics, welfare, law enforcement, energy
and recreation. When any one of the subsystems that immediately affects the whole community is the
economic system. If a major employer in the community lays off workers, the entire community,
including is economic, social, educational and health care institutions will be affected.
System thinking popularized in the 1960s remains relevant in today’s world. four nurse theorists,
Johnson(1980),Roy(1984),King(1981),and Neuman (1989), formulated conceptual models of nursing
based on systems theory. All through all these models are applicable to health and nursing. Neuman
systems model is particularly suited to community health nursing.

APPLICATION OF NEUMAN SYSTEMS MODEL TO EDUCATION

 The neumansystems model the community is seen as systems of interfacing subsystems.
Stressors that affect any subsystem and create in stability for the community must be assessed so that
appropriate interventions can be designed to reduce these stressors, and promote health. This process is
interactive and collaborative between the nurses and community.
Three types of prevention can be used.
 Primary prevention is appropriate to identify community risk factors and to plan mutually for
health education programs with the community leaders.
 Secondary prevention interventions are initiated when one or more normal defenses of the
community have invaded, resulting in the development of specific health problems. at this point,
the community health nurse would assist the community is identifying the stressors and would
begin treatment to correct the problem as well as initiate interventions to strengthen the lines of
resistance to prevent further dysfunction with in the community.
 Tertiary prevention intervention strategy is most appropriate with in a community that has
become chronically dysfunctional overtime. For example major disaster such as a flood or an
influenza epidemic can create health problems for the community and leave it severely
compromised. The community losing a major source of employment or having a high incidence
of heart disease are other examples. Over time health problems develop because of these
stressors and lead to poor nutrition, postponement of medical care, depression and ultimately to a
chronically ill community. Through to readapt and reeducated to prevent further instability.

The core or basic structure of the community can be classified as physiological, psychological,
socio-cultural, developmental and spiritual variables, . for instance, physiological community variables
are the structure (eg physiological boundaries, rural or urban) and functions( local government, police
and fire protection) of the community. Each of the five variables is interdependent with the other
variables, flexible boundaries exist between them. The purpose of categorization under variables is to
provide a comprehensive frame work for assessment there by eliminating the possibility of overlooking
any community area.
Systems theory indicates, a change in one subsystem will affect the entire system. Stressors can
be defined as intra community (originating from with in one or more subsystems or the whole), inter
community (originating from adjacent areas) or extra community (imposed from structures outside the
community).community health nurses create linkages between subgroups within the community and
intercommunity and extra community resources to assist the community in maintaining health.

To identify community stressors and to assess the degree of community reaction to the stressors.
The selection of appropriate intervention follows stressor identification and depends on the aim of the
intervention. For example primary prevention might include giving immunizations, providing health
education seminars. Early case findings followed by appropriate referrals, counseling about high risk
behaviours and the use of medications illustrates secondary interventions. Tertiary intervention.common
to all three models of intervention is client advocacy, coordinating, health resources, and providing
information to maintain or regain system stability.
 The community as client model, as adopted from Neuman by Anderson et.al (1986),provided the
conceptual basis for community analysis in a project that involved faculty and student collaboration to
identify and meet the health needs of one plants industrial workforce.

Three course objectives were addressed

1. Assess a community from a theory based perspective.

2. Develop a theory based community health care plan

3. Address a community health problem using nursing theory

Nurses who work with transcultural populations to identify stressors unique to that cultural
community can also use the Neuman’s systems model. Bed dome (1989)and Anderson et.al.(1995) state
that interact with the basic core of the community its people, their values, beliefs, culture, and religion.
Physiological,psychological,sociocultural,developmental, and spiritual variables identified by the
Neuman systems model affect the basic core and subsystems.

APPLICATION OF NEUMAN SYSTEMS MODEL TO PRACTICE

A primary goal of the new system is to provide consumers with easier access to long term care
services in their homes and communities. The newman systems model which include agency response
teams, relief and short-stay beds in long term care facilities (line of resistance) help defend the core
against external and internal stressors. The services providers (normal line of defence) address the steady
state of service delivery to the care. These include nurses, physiotherapists, occupational therapists,
volunteers and transportation and meal service personnel, service providers help maintain the core in the
community to prevent or delay institutionalization.

The administrative level can utilize all three models of prevention primary, secondary, tertiary to
reduce stressors. The primary prevention model is used by the administration to communicate health care
changes by managing the day-to-day concerns that may affect with stressors. Tertiary prevention focuses
on long range planning by coordinating system goals and ensuring availability of short-stay beds in long-
term facilities.
Utilizing the neuman systems model is creative and cost effective. the neuman system model
facilities a system that is planned in partnership with communities and providers a way to measure
outcomes.

ROYS ADAPTATION THEORY

The goal of nursing service management is to ensure the most effective delivery of services to
client by adapting organizational systems and their resources. Successful achievement of this goal will be
evidenced by the survival and change of an organization. The nurse administrator plays a key role in
organizations through facilitating adaptive changes in response to environmental influences. to be an
effective nurse administrator, a theoretical basis to guide and direct practice is needed. It is imperative to
select a model using a frame work for assessing the adequacy, completeness, and appropriateness for use
in the directing, explaining and predicting the practice of nursing services. nursing and health care
organizations in deed are complex and in a constant state of change. the following describes an overview
of roys model and its implication for practice. Included are value and judgment statements based on my
evaluation of the model. the model will be critiqued based on guide for critical reflection of theory as
discussed by chin and Kramer(1991)the model will be discussed from a broad perspective and more
specifically as it parallels nursing administration.

Roys model is complex because it contains several major concepts,subconcepts and a number of
relational statements. the model contains the following six concepts-nursing , person, heal-illness,
environment, adaption and nursing activities. It also includes the sub concepts of regulator, cognator and
the four –effectors modes as stated previously there are numerous relational statements.
Roys model is broad-based complex and includes several sub concepts. Increasing the complexity
increases empiric accessibility. Broad concepts stem from theory in psychology, sociology, physiology
and nursing therefore providing opportunities for empirical study. The empiric indicators are based in
reality and are with in the realm of nursing and most broadly defined and all assumptions are not
operationally defined.

Roy’s model is important to nursing and will facilitate practice through a consistent to resolve or
distinguish the nursing plan of care from the medical plan of care.
Roy’s model is broad in scope, clear, complex and accessible. Its emphasis on systems theory and
humanistic values is congruent with a number of management perspectives. As a nurse executive, it
provides a frame work for managing nursing services and directing patient care.providing effective,
quality care in a containment era is a compelling goal for the nurse administrator. The use of a theoretical
perspective can serve as a catalyst to advance knowledge development for administrative nursing
practice.

ROYS ADAPTATION MODEL AS A THEORETICAL APPROACH FOR NURSING

ADMINISTRATION

Categorize the problem adaptive mode

self concept adaptive mode
role function adaptive mode
interdependence adaptive

KINGS THEORY

Kings frame work describes three interacting systems personal, interpersonal, and social. Each
individual as a unique and distinct functioning system represents personal systems. when the individual
enters into interaction with another the interpersonal system is created. Interpersonal systems are
represented in kings frame work as a group of at least two individuals in instruction. the social system is
the third system in which both groups and individuals stand as elements in interaction with in the
immediate environment.

The concept central to the theory are interaction, perception communication, transaction,
role,stress, growth and development, time and space.

 Interaction-human interaction assists the nurse in gathering information. Observation physical

presence and verification are key elements of interaction.
 Perception-it is the manner in which each individual conceives reality.
 Communication-this is the informational process for transmitting messages. Verbal and non
verbal symbols are involved in the communication process.
 Transaction-individuals communicating for the purpose of goal setting, to achieve goals
compose the process of transaction. Roles, values, exceptions and perceptions of each person
contribute to the success of the transaction.
 Role- the set of behaviors’ expected of an individual in a given situation.
 Stress- it is a state produced by interactions between the environment and the individual.
The propositions of this theory are based on assumptions about humans as open systems in
interaction with their environment.therefore; the theory is applicable to any human interaction.
Nurses who understand and practice king’s theory will be to apply the theory in every human
interaction

COMMUNITY AUDIT

INTRODUCTION

Audit is an independent appraisal activity within an organization for the review of accounting,
financial and other operations as a basis of services to the management. Audit seeks to investigate all
practices related to accounting of materials, labour or any activity that involves a cost. Audit refers to the
monitoring the budget reports are needed to monitor expenditure and keeps the budget process focused
on long range objectives.

A community audit is not an empty exercise. Its purpose is to provide useful information to key
local stakeholders, including firms and workers as well as policymakers, workforce and economic
development practitioners, and educators. In other words, community audits are strategic research, not
academic research. Those who regularly conduct community audits never talk about just presenting data;
instead they insist on the need to tell a compelling story. Community audits provide stakeholders in a
local area the information they need to develop a shared view of the critical economic and social
challenges that confront them and a forum within which they can find solutions. Community audits focus
not only on the needs of a community, but also on its assets.

DEFINITION
 An audit is a systematic and official examination of a record, process or account to evaluate
performance.

Auditing in health care organization provide managers with a means of applying control process to
determine the quality of service rendered.

community audit is the assessment of the quality of care delivered to the community with the help of
records.

TYPES OF AUDIT

the audits most frequently used in quality control include out come , process and structure audit

1.OUTCOME AUDITS

outcomes are the end results of care, the changes in the patients health status and can be attributed to the
delivery of health care services.outcome audits determines what of specific nursing invention for clients.
thes audits assume rately and demonstrate the quality of care that was provided.

2.PROCESS AUDIT

process audit are used to measure the process of care or how the care was carried out.it is task oriented
and focus on whrther or not practice standards atre being fulfilled. this audit assumes that a relationship
exists between the quality of the nurse and quality of care provided.

3.STRUCTURE ADUIT

it monitors the structure or setting in which patients care occurs, such as the finances,nursing service,
medical records and environment.this audit assumes that a relationship exists between quality care and
appropriate structure.

PURPOSE OF COMMUNITY AUDIT

 evaluating the services rendered to the community.

 achievements desired and feasible quality of care.

 stimulant to better records.

 focuses on care provided and not on care provider.

 contributes to research

PRINCIPLES OF AUDIT

 create a constancy of purpose for the improvement of the products and service
 adopt a philosophy of continual improvements

 institute job training and retraining

 develop the leadership in the organization

 drive out fear by encouraging employees to participate actively in the process.

 focus on quality and not just quantity

 promote teamwork rather than individual accomplishment

METHODS OF COMMUNITY AUDIT

Two types of audit are used in nursing peer review

1. CONCURRENT AUDIT

It is a method for evaluating quality of ongoing care through appraisal of the nursing process.
Concurrent audit currently is used by medical care to evaluate care being received by public health or
home health clients.

ADVANTAGES

 Identification of problems at the time care is given

 Provision of a mechanism for identifying and meeting client needs during care.
 Implementation of measures to fulfill professional responsibilities.
 Provision of mechanism for communicating on behalf the client.
2. RETROSPECTIVE AUDIT

The retrospective audit evaluates quality of care through appraisal of the nursing process after the clients
discharge from the health care system

ADVANTAGES

 Comparison of actual practice to standards of care

 analysis of actual practice findings
 more accurate data for planning corrective action

AUDIT PROCESS

 Topic for study selected

 explicit criteria selected for quality care
 records reviewed
  Peer review of all cases not meeting criteria.
 recommendations for correcting deficiencies

 follow-up of problems

ROLES OF AUDIT


Encourages followers to be actively involved in the quality control process.

clearly communicates standards of care to subordinates

Encourages the setting of high standard to maximize quality instead of setting minimum safety
standards.
 Implements quality control proactively instead reactively
 Uses control as a method of determining why goals where not met
 Is positively active in communicating quality control findings
 Act as a role model for followers in accepting responsibility and accountability for nursing
actions.
COMMUNITY SANCTION

Community sanctions may have a time limit or be indefinite. Community sanctions are a social
construction.

COMMON TYPES OF COMMUNITY SANCTIONS

The following is a list of the most common types of restrictions. Unique restrictions that have been
imposed in unusual situations are not listed.

1.Account restriction

The user is limited to editing with a single account.

2.Civility restriction
The user may be blocked if they make any edits which are judged by an administrator to be
uncivil, personal attacks, or assumptions of bad faith.
3.Probation (supervised editing)
Generally, editors on probation may be banned from pages they edit disruptively, either for a set
period of time or indefinitely, by action of an uninvolved administrator. (Although the wording of
probation remedies sometimes varies, so be sure to check the specific case.) Probation is used as an
alternative to an outright topic ban in cases where the editor shows some promise of learning better
behavior.
4.Revert limitation
The user is limited to one revert per page per week (excepting obvious vandalism), and is
required to discuss any content reversions on the page's talk page. They may be blocked if they exceed
this limit or fail to discuss a content reversion.
5.Topic ban
 The user is prohibited from editing any page related to a particular topic, and may be blocked if
they do so.

IMPOSING COMMUNITY SANCTIONS

Community sanctions, like community bans, are proposed and discussed on the Administrators'
noticeboard. Sanctions may be proposed by any editor, and they take effect if there is a consensus.
Discussions typically last a minimum of 48 hours, and are closed by an uninvolved administrator who has
not participated in the discussion. For the purpose of placing community sanctions, the community has
rejected the idea of "votes for banning." Therefore, the standard for determining consensus is "no
uninvolved administrator objects". When there is significant disagreement amongst administrators over
how to handle a matter, a request for arbitration is often the result.

APPEALING COMMUNITY SANCTIONS

Community sanctions may be appealed to the Administrators' noticeboard, or to the Arbitration

Committee. The Arbitration Committee may accept or decline the request. If they accept, they may
reduce or change the sanctions, or may even enlarge upon them.

CONCLUSION

.Coordination is one of the functions of the management. It is the process of integrating the objectives
and activities of separate work in order to realize the organizational goal effectively. It is a continuous
process for achieving units of purpose in the organization .each of the managerial functions is the purpose
of management.systems theory helps the nurse manager to organize herself and coordinate her activities
for an effective and smooth running of the organization.

JOURNAL ABSTRACT

1. In May 2005, the Community Audit Demonstration Program,volume-6.issues-5

The Community Audit Demonstration Program to encourage workforce strategic planning and research
with grant awards to 34 State and local workforce investment boards (WIB's) and related organizations.
Integral to this effort were partnerships among local stakeholders of WIBs, community colleges,
economic development agencies, employers, trade associations, and others in a collective effort to: (1)
obtain information on local and regional economic and labor market trends, (2) undertake workforce
development demand-driven planning, and (3) disseminate information to the public on current and
future job and career opportunities, skill requirements, and related matters.

2. International Organizations Law Review, Uruena, Rene1Michael Jacobson,May 4, 2007

Volume 4, pp. 321-342(22)Senior Treasury and State Department officials testifying before Congress
were criticized for failing to employ sufficiently tough economic sanctions against Iran. This failure was
partly attributed to Washington's fear of upsetting foreign allies. Ironically enough, the Bush
administration could use such congressional pressure as leverage in its efforts to forge effective
international cooperation on Iran.

BIBLIOGRAPHY

1.Stoner A.P.James and Freeman R.Edward, Management 5th edition, NewDelhi, pg no-322-325.

2.Stanhope Lancaster, foundations of community health nursing, Mosby

publications,philadelphia pg no- 135-138.

3. Chabra T.N. principles and practice of management, 5th edition 1995.pg no-31-40

4. Awasthi and maheswari” public administration” New Delhi, pgno-248-252.

5.web site

 http://google.com
 hhp:// pubmed.in