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‫الدورة التحضيرية للخريجين الجدد‬

‫الجتياز االمتحانات العامة للتمريض وامتحانات دول الخليج‬

‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات العامة للتمريض وامتحانات دول الخليج ‪ – 2025‬عبدالرحمن ديباجة – ‪0786207997 - 0782470430‬‬
 DEFINITION OF MANAGEMENT :
art of getting things done through people ” .

both art and a science ” .

work that involves the guidance or direction of a group of people toward

organizational goals or objective’s.

interpersonal and technical aspects, through which the objectives of an

organization being managed .
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" Management:
Management in nursing is the process of planning, organizing, directing, and
coordinating resources—human, financial, and material—to achieve safe, effective,
and quality patient care outcomes. Nurse managers focus on efficiency, delegation,
team coordination, and policy enforcement.

Yoder-Wise, P. S. (2019). Leading and Managing in Nursing (7th ed.). Elsevier.

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RESPONSIBILITIES OF NURSE MANAGERS:
1. Staffing and scheduling
2. Policy implementation
3. Budgeting
4. Quality and safety monitoring
5. Delegation and supervision

Reference: Yoder-Wise, P. S. (2019). Leading and Managing in Nursing.

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LEADERSHIP (DEFINITION)
Leadership is the ability to influence, inspire, and guide individuals or teams to achieve
shared goals, often by creating vision, motivating others, and fostering collaboration.

Nurse Leaders Focus On:

1. Role modeling
2. Communication
3. Change advocacy
4. Team empowerment
5. Conflict resolution
Reference: Huber, D. (2022). Leadership and Nursing Care Management.

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 Leadership Styles
Style Description Example in Nursing
Inspires and motivates the team toward
Transformational Leading quality improvement project
shared vision
Focuses on structure, rewards, and task Ensuring staff comply with infection control
Transactional
completion policies
Makes decisions independently, good in
Autocratic Leading a code blue
emergencies
Holding staff meetings for shared decision-
Democratic Encourages staff participation in decisions
making
Minimal direction; delegates full Appropriate with expert, experienced nursing
Laissez-Faire
responsibility to team teams

📚 Reference: Marquis, B. L., & Huston, C. J. (2021). Leadership Roles and Management Functions in Nursing. 7
KEY CONCEPTS OF LEADERSHIP STYLES
No one-size-fits-all:
 Effective leaders adapt their style based on the situation, the team's experience, and the clinical context
(e.g., emergency vs. routine care).

Style affects outcomes:

 The way a nurse leader leads impacts communication, morale, productivity, and patient safety.

Leadership is different from management:

 Management focuses on systems and tasks; leadership focuses on vision, motivation, and influence.

Flexibility is essential:
 Good leaders may use a combination of styles depending on circumstances (called situational leadership).

Leadership style influences delegation:

 For example, autocratic leaders may tightly control delegation, while democratic leaders encourage team
input.

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 Comparison Table:
Aspect Management Leadership
Primary Focus Organizing and controlling resources Inspiring and influencing others
Innovation, change, achieving a shared
Goal Efficiency, achieving set objectives
vision
Orientation Short-term, operational Long-term, strategic
Style Transactional (task-oriented) Transformational (people-oriented)
Decision-Making Based on data, facts, and existing policies Based on vision, values, and inspiration
Approach to
Implementing within existing structures Driving and facilitating change
Change
Internal motivation (e.g., passion,
Motivation External rewards (e.g., salary, benefits)
purpose)
Outcome Stability and process efficiency Growth, innovation, and empowerment
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APPLICATION IN NURSING:
Managers in Nursing are often responsible for coordinating day-to-day operations,
ensuring compliance with policies, and managing resources. They focus on ensuring
that patient care is safe, efficient, and delivered in a timely manner.
Nurse Leaders are those who inspire their teams to provide the best patient care,
engage in professional development, and advocate for change to improve patient
outcomes and care systems. They may not always hold formal managerial roles but
are influential in guiding the nursing team.

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The charge nurse is leading a team during a mass casualty incident in the emergency department. Which
leadership style is most appropriate in this situation?

A. Democratic
B. Autocratic
C. Laissez-Faire
D. Transformational
✅ Correct Answer: B. Autocratic
Rationale: In emergencies, the autocratic (directive) style is most effective because it allows for quick decision-
making without waiting for group input. This promotes patient safety and reduces confusion.
📚 Reference: Yoder-Wise, P. S. (2019). Leading and Managing in Nursing.

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A nurse manager involves staff in decision-making, encourages shared governance, and values their
input on unit protocols. Which leadership style is being demonstrated?

A. Laissez-Faire
B. Democratic
C. Autocratic
D. Transactional
✅ Correct Answer: B. Democratic
Rationale: Democratic leaders promote participation, collaboration, and open communication, which enhances
job satisfaction and teamwork.
📚 Reference: Marquis, B. L., & Huston, C. J. (2021). Leadership Roles and Management Functions in Nursing.

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Which leadership style is most likely to be effective in promoting innovation and
inspiring nurses during a quality improvement project?
A. Transformational
B. Autocratic
C. Transactional
D. Laissez-Faire
✅ Correct Answer: A. Transformational
Rationale: Transformational leaders motivate staff through a shared vision, foster
innovation, and support personal and professional growth—ideal for driving change
and quality improvement.
📚 Reference: Huber, D. (2022). Leadership and Nursing Care Management.
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A new nurse on the unit feels unsupported and unclear about job expectations. The
nurse manager has adopted a hands-off approach. What leadership style is being
used?
A. Democratic
B. Transformational
C. Laissez-Faire
D. Transactional
✅ Correct Answer: C. Laissez-Faire
Rationale: Laissez-Faire leadership is characterized by little guidance or involvement
from the leader. While it may work with experienced teams, it can cause confusion
and low morale in new or less experienced staff.
📚 Reference: Silvestri, L. A. (2023). Saunders NCLEX-RN Review.

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DEBAJAH QUESTION TIP:
Choose autocratic style for emergencies.
Choose democratic for collaboration.
Choose transformational for leadership in change

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COMMUNICATION, CONFLICT MANAGEMENT,
TEAMWORK & COLLABORATION

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1. Communication in Nursing
Effective communication is essential for patient safety, coordination of care,
and teamwork.

Key Elements:
•SBAR: Situation – Background – Assessment – Recommendation
•Assertive Communication: Respectful, clear, and direct
•Therapeutic Communication: Focuses on the patient's needs, active listening,
empathy
•Nonverbal Communication: Body language, eye contact, tone matter
•Closed-loop Communication: Confirms message received (critical in
emergencies) CPR

📚 EXAM Tip: Use therapeutic communication in mental health and patient-centered

care questions. 17
 ⚖️ 2. Conflict Management
Conflict is natural in healthcare settings. Effective management promotes patient safety and team cohesion
🎯 Conflict Resolution Styles:

Style Description Use When…

Win-win, works together to find best Ideal approach, especially for
Collaborating
solution patient care
Compromising Each party gives something up Quick, fair solutions needed
Accommodating One party gives in Maintaining harmony temporarily
Useful if issue is minor or timing is
Avoiding Withdraws from the conflict
bad
Emergencies or policy
Competing Assertive, goal-focused
enforcement
.

📚 Reference: Huber, D. (2022). Leadership and Nursing Care Management

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3. TEAMWORK & COLLABORATION
Safe and effective care depends on interprofessional collaboration.

🔑 Key Concepts:
•Shared Decision-Making: Nurses collaborate with patients and other professionals
•Respect Roles: Know the scope of practice for RNs, LPNs, and UAPs
•Delegation: RN retains accountability but may assign appropriate tasks
•Open Communication: Reduces errors, improves outcomes
•Team STEPPS Tools: Used to enhance team performance and patient safety

📚 EXAM Tip: Choose responses that promote teamwork, respect, and safe
delegation. 19
TEAMSTEPPS TEAM STRATEGIES AND TOOLS TO ENHANCE
PERFORMANCE AND PATIENT SAFETY (TEAMSTEPPS)
an evidence-based teamwork system designed
to improve the quality, safety and efficiency of
healthcare. TeamSTEPPS consists of a
collection of instructions, materials and tools
to help drive a successful teamwork initiative
from the initial planning to implementation
through to sustainment. The system is designed
to improve patient safety using a three-phase
approach

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The nurse notices conflict between a new graduate nurse and a senior nurse.
What is the best initial action?
A. Report them to the manager
B. Ask the new nurse to avoid the senior nurse
C. Facilitate a private conversation between both nurses
D. Ignore the situation unless it worsens
✅ Answer: C. Facilitate a private conversation between both nurses
Rationale: Encouraging open communication and early resolution aligns with the
collaborating conflict style.

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PROBLEM SOLVING & DECISION MAKING
Steps in Problem Solving and Decision Making
Assessment: Gather relevant data about the situation, including patient history,
symptoms, and diagnostic results.
Diagnosis: Identify potential issues or problems based on the assessment data. This is
typically in the form of a nursing diagnosis.
Planning: Develop a plan of care with measurable and achievable goals. Prioritize
the patient’s needs using frameworks like Maslow's Hierarchy of Needs.
Implementation: Carry out the plan while considering patient safety, nursing
standards, and individual needs.
Evaluation: Assess the effectiveness of the interventions and whether the desired
outcomes were met.
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2. CRITICAL THINKING
Critical thinking is the foundation for problem-solving and decision-making.
Critical thinking involves:
•Analyzing: Examining data, symptoms, and responses critically.
•Synthesizing: Combining various data points to form a cohesive understanding of the
problem.
•Evaluating: Judging the reliability and validity of information.
•Reasoning: Using logical and ethical reasoning to make decisions.

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3. TYPES OF DECISION MAKING
Autocratic Decision Making: The nurse makes decisions independently, usually in an
emergency or when time is critical.
Democratic Decision Making: Decisions are made collaboratively, with input from
patients, families, and other team members.
Laissez-Faire Decision Making: The nurse provides the minimum guidance and allows
others to make decisions, which is often used in situations where the team is highly
skilled and independent.
Shared Decision Making: Nurses, patients, and families are all involved in decision
making, particularly in complex cases where multiple perspectives are valuable.

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4. PROBLEM-SOLVING MODELS
Nursing Process: The standardized approach used in clinical decision-making
(Assessment, Diagnosis, Planning, Implementation, and Evaluation).
Clinical Judgment Model: Involves gathering data, identifying patterns, and making
decisions based on clinical evidence.
DECIDE Model:
 D: Define the problem.
 E: Explore alternatives.
 C: Consider the consequences.
 I: Identify the best action.
 D: Decide and take action.
 E: Evaluate the outcome.

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5. PATIENT SAFETY AND ETHICAL
CONSIDERATIONS
When making decisions, consider patient safety and ethical principles such as:

Autonomy: Respecting the patient’s right to make their own decisions.

Beneficence: Acting in the best interest of the patient.
Non-maleficence: Doing no harm.
Justice: Treating all patients fairly.

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EXAMPLES OF PATIENT SAFETY AND
ETHICAL CONSIDERATIONS:
1. Autonomy: A patient with a chronic illness decides to discontinue chemotherapy. The nurse
supports this decision, ensuring the patient understands the risks, and respects their choice, even
though the family disagrees.
2. Beneficence: A nurse ensures a patient receives pain medication after surgery to promote comfort
and well-being, adhering to the principle of doing good for the patient.
3. Non-maleficence: A nurse notices a medication error where the wrong dosage was administered.
The nurse quickly notifies the doctor and takes steps to prevent harm to the patient.
4. Justice: During a busy shift, a nurse prioritizes a patient with chest pain over one with a sprained
ankle, following triage protocols to ensure the most critical patient is treated first.
5. Confidentiality: A nurse refuses to share a patient’s medical information with a family member
who is not authorized, protecting the patient's privacy as required by law.

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6. Informed Consent (Patient’s Right to Understand and Agree to Treatment)
The patient makes an informed decision, reducing the risk of regret or dissatisfaction
later, and ensuring that their rights are respected.

7. Duty to Report (Protecting Vulnerable Patients)

Reporting the suspected abuse leads to an investigation that can protect the child
from further harm and provide the necessary support and interventions.

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‫يوجد ملف ملحق فيه المزيد من االمثلة‬

‫‪30‬‬
HEALTHCARE INFORMATICS & EVIDENCE-BASED
PRACTICE

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1. HEALTHCARE INFORMATICS
Definition: Healthcare informatics is the use of technology, data, and information systems to improve
the quality and efficiency of healthcare delivery. It involves the collection, analysis, and use of data to
support clinical decision-making, patient care, and healthcare management.
Key Components:
Electronic Health Records (EHR): Digital versions of patients' paper charts, allowing healthcare
providers to access and share patient data in real-time.
Clinical Decision Support Systems (CDSS): Computer-based tools that help healthcare providers make
clinical decisions based on patient data and evidence-based guidelines.
Telemedicine: The use of technology to provide remote clinical care to patients, especially beneficial
for those in rural or underserved areas.
Data Analytics: Analyzing large datasets to uncover trends, improve clinical outcomes, and enhance
healthcare delivery.
Interoperability: Ensuring that different healthcare systems can communicate and exchange information
seamlessly for better patient care coordination.
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1. HEALTHCARE INFORMATICS
Importance in Nursing:
Improves patient care: Healthcare informatics facilitates quick access to patient data,
improving decision-making and treatment planning.
Enhances communication: EHRs allow nurses to share patient information with the healthcare
team in real-time, reducing errors and improving coordination.
Supports evidence-based practice: Informatics systems can provide access to the latest
research and clinical guidelines, ensuring that nurses apply evidence-based practices in
patient care.

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2. EVIDENCE-BASED PRACTICE (EBP)
Definition: Evidence-Based Practice (EBP) is the integration of the best available research evidence,
clinical expertise, and patient preferences to guide clinical decision-making and improve patient
outcomes. It is a problem-solving approach to clinical decision-making that involves critical thinking
and the use of scientific evidence.
Key Steps in the EBP Process:
Ask a clinical question: Develop a focused, answerable question using the PICO(T) format (Population, Intervention,
Comparison, Outcome, Time).
Search for the best evidence: Use databases such as PubMed, Cochrane, and CINAHL to find relevant research and
studies.
Critically appraise the evidence: Assess the quality, validity, and applicability of the research to the clinical situation.
Implement the evidence: Apply the findings to practice in a way that fits the patient's needs and context.
Evaluate the outcomes: Assess the impact of the intervention on patient outcomes and make adjustments if necessary.

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2. EVIDENCE-BASED PRACTICE (EBP)
Importance in Nursing:
Improves patient outcomes: By using the best available evidence, nurses can provide
more effective care, leading to better patient outcomes.
Promotes best practices: EBP ensures that nurses use scientifically proven methods
and interventions rather than relying on outdated practices.
Involves patient preferences: EBP incorporates the patient's values and preferences,
ensuring care is personalized and respectful of individual choices.

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EXAMPLE IN CONTEXT:
A question on exam may ask you to prioritize actions for a nurse based on the use of
technology and evidence-based practice. For instance:
Scenario: A nurse receives a report on a new clinical guideline for wound care
management. The nurse is asked to implement this guideline in the care of a patient
with a diabetic foot ulcer.
Correct Action: The nurse would use healthcare informatics to access the guideline,
review relevant patient data, and apply the evidence-based practices to improve
patient outcomes.

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‫يوجد امثلة اكثر في الملف المرفق‬

‫‪37‬‬
Management Process –
Achieving Organizational Objectives
Step Definition Example in Nursing Practice
Developing a plan to reduce hospital-
Setting goals and deciding how to achieve
1. Planning acquired infections (HAIs) over the next 6
them.
months.
Assigning ICU nurses to shifts and
Allocating resources and coordinating tasks
2. Organizing responsibilities based on skills and
and responsibilities.
patient acuity.
Hiring qualified nurses for the
3. Staffing Recruiting, hiring, training, and retaining staff. emergency department and enrolling
them in BLS training.
Encouraging staff to comply with
Guiding, motivating, and leading the team to
4. Directing infection control protocols through team
meet goals.
meetings and education.
Reviewing monthly hand hygiene
Monitoring performance and making
5. Controlling compliance reports and taking steps 38
to
necessary corrections.
STAFFING & SCHEDULING

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1. STAFFING
Definition: Staffing refers to the process of hiring and assigning appropriate numbers and types
of healthcare workers, particularly nurses, to ensure patient care needs are met.
Key Factors Influencing Staffing:
•Patient acuity: The severity of a patient’s condition determines the number of nurses required.
•Nurse-to-patient ratio: A regulated or ideal ratio between nurses and patients that ensures
quality care.
•Staff experience and qualifications: More experienced nurses or specialists may be needed
for complex cases.
•Workload balance: Ensuring nurses are not overburdened or underutilized, contributing to job
satisfaction and quality care.
•Hospital policies: Staffing decisions are often influenced by healthcare standards and
regulations set by the hospital or governmental agencies.
I

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1. STAFFING
importance in Nursing:
•Ensures patient safety: Adequate staffing is critical to ensuring nurses have enough
time to monitor and provide quality care to all patients.
•Prevents burnout: Proper staffing helps prevent nurse fatigue, burnout, and stress,
which can negatively affect patient care.
•Improves job satisfaction: Proper staffing and workload management contribute to
better job satisfaction and retention among nurses.

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2. SCHEDULING
Definition: Scheduling involves creating and managing work schedules for nurses, ensuring that
shifts are covered appropriately while also meeting labor laws and staff preferences.
Key Factors Influencing Scheduling:
Shift length: Common shifts include 8-hour, 10-hour, or 12-hour shifts. Scheduling must
ensure adequate rest periods between shifts.
Shift types: Nurses may be scheduled for day, evening, or night shifts depending on
patient care needs.
Flexibility: Allowing staff to request time off or work flexible hours can improve morale
and prevent burnout.
Overtime management: Ensuring that overtime is used appropriately without
overworking staff.
Holiday and weekend coverage: Ensuring that there is enough staff available during
weekends and holidays, when patient needs may still be high.

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2. SCHEDULING
Importance in Nursing:
Promotes work-life balance: Effective scheduling helps nurses balance work with
personal time, reducing stress and improving job satisfaction.
Ensures continuous care: Proper scheduling ensures that there is always a qualified
nurse available, especially during high-demand periods such as night shifts or
holidays.
Compliance with regulations: Ensuring that the schedule complies with labor laws
(e.g., rest periods, maximum work hours) and hospital policies.

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LEGAL AND REGULATORY CONSIDERATIONS
IN STAFFING & SCHEDULING:
1. Nurse-to-Patient Ratio Laws: Some regions have laws that regulate the number of patients
a nurse can care for at one time. These laws aim to improve patient safety by ensuring that
nurses are not overloaded.
2. Overtime Regulations: Labor laws may limit the number of hours a nurse can work in a day
or week to prevent exhaustion and ensure quality care.
3. Rest Periods: Laws typically require rest periods between shifts to allow nurses to recover
and maintain alertness.
4. Holiday Pay: In some settings, nurses working on holidays are entitled to extra
compensation (e.g., holiday pay), which must be taken into account when creating schedules.

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EXAMPLES OF STAFFING AND
SCHEDULING SCENARIOS IN NURSING:
Staffing:
 Scenario 1: A nurse manager assesses the ward's patient acuity and assigns more nurses to a unit with critically ill patients. This
ensures that each patient receives the necessary level of care and reduces the risk of patient harm.
 Scenario 2: A hospital has a high census of patients needing surgery. The nurse manager hires temporary nurses to meet the
increased demand while ensuring quality care is not compromised.
 Scenario 3: A unit is experiencing high turnover. The nurse manager implements retention strategies, including improved staffing
ratios and mentorship programs, to reduce burnout and improve morale.

Scheduling:
Scenario 1: The nurse manager ensures that night shift nurses are scheduled adequately and have the right support staff (such as
an experienced charge nurse) to handle emergencies.
Scenario 2: A nurse manager uses a rotating schedule system where nurses take turns working weekends and holidays to maintain
fairness and ensure sufficient staffing for patient care.
Scenario 3: A nurse requests a flexible schedule due to personal reasons. The manager accommodates this request while ensuring
that the unit is adequately staffed to meet patient care needs. 45
NURSING CARE DELIVERY MODELS

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NURSING CARE DELIVERY MODELS
1. Team Nursing
2. Primary Nursing
3. Functional Nursing
4. Case Management

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KEY POINTS FOR NURSING CARE
DELIVERY MODELS:
Team Nursing involves collaboration among various levels of nursing staff.
Primary Nursing gives the RN direct responsibility for a patient's care from admission to
discharge.
Functional Nursing focuses on task-oriented care, with specific staff responsible for specific
duties.
Case Management involves a nurse overseeing the entire care process for patients with complex
needs.
Patient-Centered Care prioritizes the patient’s preferences and needs when designing care plans.
Integrated Care Delivery ensures all healthcare professionals collaborate to deliver holistic care
for the patient.
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1. TEAM NURSING
Definition: In Team Nursing, care is delivered by a team of nursing personnel, with a Registered Nurse (RN) acting as
the leader. The team typically includes RNs, Licensed Practical Nurses (LPNs), and nursing assistants who work
together to provide care to a group of patients.
Key Features:
The RN leads the team, coordinates care, and assigns specific tasks to team members based on their roles.
Team members collaborate to provide holistic care, including assessments, interventions, and documentation.
Tasks are delegated based on skill levels and expertise.
Advantages:
Promotes collaboration and communication among staff members.
Allows for a more efficient distribution of workload.
Ensures that different levels of expertise are utilized in patient care.
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Team Nursing Example:
A nurse manager organizes a team consisting of two RNs, an LPN, and two nursing
assistants to care for a group of 10 patients on a medical-surgical floor. The RN is
responsible for patient assessments and creating care plans, while the LPN and
nursing assistants assist with routine tasks such as vitals, hygiene, and monitoring for
changes in patient conditions.

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2. PRIMARY NURSING
Definition: Primary Nursing assigns one RN to be responsible for the overall care of a specific patient or
group of patients throughout their hospital stay. The primary nurse is responsible for planning, coordinating,
and implementing all aspects of patient care.
Key Features:
1. The primary nurse is responsible for patient assessments, care planning, and providing continuity of care.
2. The RN works directly with the patient and their family to develop a care plan and ensure that patient
needs are met.
3. The model encourages strong nurse-patient relationships, promoting trust and better communication.
Advantages:
Provides continuity of care as the same nurse is responsible for the patient’s care throughout their stay.
Increases patient satisfaction due to personalized care.
Promotes nurse autonomy and accountability.
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Primary Nursing Example:
A nurse in a pediatric unit is assigned to a child with a chronic illness. The primary
nurse manages the child’s care plan, including medication administration, monitoring
progress, and providing education to the family. The nurse is the patient’s main point
of contact and ensures the family is well-informed throughout the child’s
hospitalization.

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3. FUNCTIONAL NURSING
Definition: Functional Nursing focuses on task-oriented care, with each nurse or nursing assistant assigned
specific functions or tasks to perform for patients. Care is broken down into specific duties, and the nurse may
not be responsible for the overall care of the patient but for performing particular tasks.
Key Features:
1. Nurses or nursing assistants are assigned specific tasks such as administering medications, providing
hygiene care, or monitoring vital signs.
2. The emphasis is on task completion rather than on developing a comprehensive care plan.
3. The model is typically used in fast-paced environments or in situations where resources are limited.
Advantages:
Efficient task delegation, particularly in large hospitals or emergency situations.
Maximizes the use of available resources, as each staff member performs specific tasks based on their skills.

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Functional Nursing Example:
In a busy emergency room, one nurse is responsible for administering medications,
another is responsible for taking vital signs, and a nursing assistant handles patient
hygiene. Each staff member focuses on their designated task, allowing the team to
provide rapid care to many patients.

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4. CASE MANAGEMENT
Definition: Case Management focuses on coordinating and overseeing the care of patients with complex medical needs or
chronic conditions. A case manager is responsible for ensuring that patients receive appropriate care across different settings,
from admission to discharge.

Key Features:
1. A case manager, often a Registered Nurse, works with the patient, family, and healthcare team to ensure comprehensive
care.
2. Emphasis is placed on optimizing outcomes through appropriate resource utilization and care coordination.
3. The case manager monitors patient progress and ensures follow-up care after discharge.
Advantages:
Provides personalized, continuous care for patients with complex needs.
Reduces unnecessary hospitalizations and readmissions by ensuring proper discharge planning and follow-up care.
Promotes interdisciplinary collaboration to address all aspects of patient health
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Case Management Example:
•A case manager in a hospital works with a patient who has multiple chronic conditions (e.g.,
diabetes, heart failure). The case manager coordinates care between specialists, ensures
medication adherence, and arranges for home health care services upon discharge to prevent
readmission.

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5. PATIENT-CENTERED CARE
Definition: Patient-Centered Care focuses on providing care that is respectful of, and responsive to,
individual patient preferences, needs, and values. In this model, patients are considered active
participants in their care.
Key Features:
Care plans are developed with the patient's input, considering their preferences and values.
Emphasis on building a partnership between the patient, family, and healthcare team.
Focuses on holistic care, addressing not just physical but also emotional, spiritual, and social aspects
of health.
Advantages:
Improves patient satisfaction and engagement in their care.
Enhances communication between the patient and healthcare providers.
Encourages the patient’s involvement in decision-making, leading to better health outcomes.

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Example:
A nurse in a maternity unit works closely with an expectant mother to develop a birth
plan that aligns with her values and preferences. The nurse provides education on
pain management options, encourages open communication, and ensures that the
patient’s wishes are respected throughout the labor process

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6. INTEGRATED CARE DELIVERY
(INTERDISCIPLINARY TEAM CARE)
Definition: Integrated care delivery involves a team of healthcare professionals from various disciplines
working together to provide coordinated care to patients. This model is used for patients with complex, long-
term, or chronic conditions that require multiple specialists.
Key Features:
•An interdisciplinary team includes nurses, doctors, therapists, social workers, and other specialists who
collaborate to develop a comprehensive care plan.
•The team works together to address all aspects of the patient's condition, including medical, psychological, and
social factors.
•Care is typically coordinated through case management or a lead provider.
Advantages:
•Comprehensive care that addresses all patient needs.
•Promotes collaboration and communication between various healthcare providers.
•Ensures a more holistic approach to patient care.

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Integrated Care Delivery Example:
•A nurse working in a rehabilitation center is part of an interdisciplinary team that
includes physical therapists, occupational therapists, speech therapists, and physicians.
The team works together to help a patient recover from a stroke, developing a
treatment plan that includes physical rehabilitation, speech therapy, and
psychological support.

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ETHICS
1. Ethical Principles in Nursing
2. Ethical Decision-Making
3. Informed Consent

‫تم شرحها في الساليدات السابقة‬

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4. PATIENT RIGHTS AND ADVOCACY
Nurses have an ethical responsibility to advocate for patients, ensuring that their
rights are respected and upheld, especially in situations where patients may be
vulnerable or unable to advocate for themselves.

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 key Patient Rights:
Patient Right Description Example
A nurse ensures that a patient’s medical
The patient’s personal health information must
Right to Privacy records are securely stored and not shared
be kept confidential.
without consent.
A patient refuses chemotherapy despite
A patient can refuse treatment or procedures,
Right to Refuse Treatment the nurse explaining the possible
even if it may result in harm.
consequences of not receiving it.
A nurse provides a patient with information
The patient must be given adequate information
Right to Be Informed about the side effects of a medication
to make informed decisions.
before administering it.
A nurse advocates for timely administration
The patient has the right to receive safe,
Right to Receive Appropriate Care of pain relief medication to a patient
appropriate, and timely care.
suffering from severe pain.
A nurse involves a patient in the creation of
The patient has the right to be involved in their their care plan, asking for their
Right to Participate in Care
care decisions. preferences and goals in their treatment
process.
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5. ETHICAL ISSUES IN END-OF-LIFE CARE
End-of-life care can raise many ethical dilemmas, especially around issues of euthanasia, assisted
suicide, and do-not-resuscitate (DNR) orders.
Key Concepts:
Euthanasia and Assisted Suicide: In some regions, these are legal, but nurses must respect the
laws, patient autonomy, and ethical considerations when discussing or being involved in such
practices. ‫غير موجود في االسالم‬
Do Not Resuscitate (DNR): A legal order that prevents medical staff from performing CPR if a
patient’s heart stops. Nurses must ensure that the patient and family fully understand this decision.
Palliative Care: Nurses should advocate for palliative care to ensure that the patient is as
comfortable as possible during the dying process.
Example:
A nurse advocates for a patient in hospice care to receive palliative treatment to alleviate pain,
while respecting the patient's wishes for no aggressive interventions.

64
CHANGE

65
1. UNDERSTANDING CHANGE MANAGEMENT
IN NURSING
Change management refers to the structured approach to transitioning individuals,
teams, and organizations from a current state to a desired future state. In nursing, this
often involves implementing new policies, procedures, technologies, or practices that
affect patient care, safety, or efficiency.

66
Key Concepts in Change
Management:
Concept Description Example
Lewin’s Change Model (Unfreeze → Change
Frameworks or models that describe how change is
Change Theory → Refreeze), Kotter’s 8-Step Change Model,
implemented in organizations.
Rogers' Diffusion of Innovations Theory.
Nurses may resist using a new electronic health
The natural reaction of individuals or groups to resist or
Resistance to Change record (EHR) system due to unfamiliarity or
oppose change.
fear of increased workload.
Involving nurses, physicians, and patients in
The process of including key individuals or groups
Stakeholder Involvement discussions when introducing new clinical
affected by the change.
guidelines for care.
Regular meetings or updates to inform staff
Communication during Ensuring clear, consistent, and transparent
about upcoming changes in procedures, such
Change communication about the change.
as a new patient safety protocol.
A nurse manager leading a team to adopt a
The role of leadership in guiding and supporting the
Leadership in Change new patient care delivery model by providing
change process.
support, resources, and feedback.

67
2. KEY CHANGE MODELS FOR NURSES
Lewin’s Change Model:
Unfreeze: Prepare the organization for change by creating awareness and addressing any resistance.
Change: Implement the new practice, technology, or procedure.
Refreeze: Solidify the change by reinforcing the new practices and integrating them into daily routines.

Example:
Unfreeze: A hospital introduces a new electronic health record system, and training sessions are held to
prepare staff.
Change: Nurses begin using the new system during patient care, with support available as they adjust.
Refreeze: The system becomes part of daily practice, with regular follow-ups to ensure continued use.

68
69
 3. RESISTANCE TO CHANGE IN NURSING
Nurses may resist change for various reasons, such as fear of the unknown, perceived
workload increases, or lack of understanding of the change’s benefits. Effective
change management addresses these concerns.
Common Causes of Resistance:
Cause Description Example
A nurse resists a new medication administration system, fearing
Fear of the Unknown Nurses fear the new change may disrupt their routine or lead to failure.
errors or difficulties in learning the system.
Staff members resist the implementation of a new
Perceived Increased Workload Nurses may feel that the change will add to their already heavy workload. documentation system, believing it will require more time than
their current system.
A nurse expresses resistance to a new patient safety protocol,
Lack of Understanding Nurses may not understand why the change is necessary or how it will benefit them. feeling it is unnecessary because they haven't seen a direct
impact on patient outcomes.
Nurses struggle with adopting a new infusion pump because of
Lack of Training or Support Insufficient education or resources may hinder the implementation of change.
inadequate training and technical support.

A nurse resists using a new patient assessment tool because they

Fear of Incompetence Nurses may fear being judged or criticized if they are not successful with the change.
fear they won’t be able to use it correctly and will be criticized.

70
 4. Effective Communication during
Change
Effective communication is essential to ensure that all stakeholders are informed and aligned throughout the change process.
Communication Strategies:

Strategy Description Example

A nurse manager explains the new
Use simple, clear language that everyone can
Clear Messaging medication administration policy using
understand.
simple terms in a staff meeting.
Send weekly email updates on the status of
Provide regular, timely updates to keep everyone
Consistent Updates the new charting system implementation
informed.
and address any concerns raised by staff.
Nurses are asked to submit feedback on
Encourage feedback from staff about the change
Two-Way Communication the new patient care protocols in a survey
process.
or during team meetings.
Announce changes via staff meetings,
Use different communication methods (meetings, followed by emails, and post visual
Multiple Channels
emails, posters, etc.) to reach all stakeholders. reminders in the break room about the new
71
procedures.
DELEGATION

72
1. DEFINITION OF DELEGATION
Delegation is the process by which a nurse assigns tasks to other members of the
healthcare team, while retaining accountability for the patient’s care. Nurses
delegate tasks based on the scope of practice of the person to whom the task is
being assigned, the complexity of the task, and the patient’s needs.
Key Principles of Delegation:
Nurses delegate responsibility but retain accountability for the outcomes of the
delegated task.
Delegation involves transferring the responsibility to perform a task, but the nurse
remains responsible for overseeing and evaluating the outcome.
Nurses must ensure that the person to whom a task is delegated is competent and
qualified to perform the task.

73
2. THE 5 RIGHTS OF DELEGATION
The 5 Rights of Delegation provide a framework to help nurses make safe and effective
delegation decisions. The 5 Rights ensure that tasks are assigned appropriately and that
patient safety is maintained.
Right Description Example
A nurse can delegate routine vital signs
Right Task Ensure the task is appropriate to delegate. measurement to a nursing assistant, but cannot
delegate assessment or diagnosis.
A nurse can delegate a bathing task if the
Ensure the environment and patient’s condition patient is stable and doesn’t require special care,
Right Circumstance
are appropriate for delegation. but cannot delegate tasks in emergency
situations.
A nurse can delegate medication administration
Ensure the person to whom the task is delegated to a licensed practical nurse (LPN), but cannot
Right Person
has the appropriate skill level and training. delegate it to an unlicensed assistive personnel
(UAP).
A nurse delegates the task of taking vital signs,
Provide clear instructions regarding the task and
Right Direction/Communication providing specific guidelines for when to report
the expected outcome.
abnormal readings.
Ensure that the task is being completed as A nurse follows up with the UAP to ensure the
Right Supervision/Evaluation expected and provide feedback or direction if 74
vital signs were taken correctly and assess the
3. TASKS THAT CAN BE DELEGATED
Certain tasks can be safely delegated to UAP, LPNs, or other healthcare team
members, depending on the complexity of the task and the scope of practice. Here’s
a breakdown of common tasks that can be delegated:

75
TASKS THAT CAN BE DELEGATED TO
UNLICENSED ASSISTIVE PERSONNEL (UAP):
Activities of daily living (ADLs): bathing, dressing, feeding, grooming.
Basic patient care: turning and positioning, ambulation assistance.
Measurement of vital signs (if stable patients).
Collecting urine specimens or other routine specimens.
Transporting patients within the facility.

76
TASKS THAT CAN BE DELEGATED TO
LICENSED PRACTICAL NURSES (LPNS):
Administering medications (excluding IV medications, except in some cases where allowed
by state law).
Wound care (for stable, uncomplicated wounds).
Monitoring stable patients: Assessing and reporting patient status, but not providing an
initial assessment.
Tracheostomy care (in certain situations).
Catheter care and changing sterile dressings.

77
TASKS THAT CAN NOT BE DELEGATED:
•Initial assessment.
•Nursing diagnosis.
•Care planning.
•Initial Patient education.
•Critical decision-making and clinical judgment.

78
‫امثلة اضافية في الملف المرفق‬

‫‪79‬‬
QUALITY

80
1. QUALITY IMPROVEMENT (QI)
Quality Improvement (QI) in healthcare refers to systematic efforts to improve care
delivery, patient outcomes, and operational efficiency. The process involves assessing
current practices, identifying areas for improvement, and implementing changes to
enhance patient care.
Continuous Quality Improvement (CQI)
CQI is an ongoing effort to improve services, processes, or outcomes by identifying
problems, analyzing causes, and implementing improvements. Nurses actively
participate in CQI by providing feedback on practices, processes, and patient care.
Example: A nurse noticing a recurring issue of medication errors might report the
issue, collaborate with other healthcare team members, and contribute to creating a
safer medication administration system.
81
PATIENT-CENTERED CARE

Patient-centered care focuses on ensuring that care is respectful of, and responsive to,
individual patient preferences, needs, and values. In a quality context, this means
actively involving patients in their care decisions and striving to provide care that
aligns with their preferences.
Example: A nurse provides tailored education to a patient with diabetes, allowing
them to make informed decisions about diet, medications, and lifestyle changes

82
STANDARDIZATION OF CARE
Standardizing care involves creating protocols and guidelines based on evidence-
based practices to reduce variability in care delivery. This ensures that all patients
receive consistent, high-quality care regardless of the healthcare provider.
Example: A nurse follows a standardized protocol for assessing patients' pain and
adjusting pain medication accordingly.

83
POLICY & PROCEDURE
Policy = What & Why (What needs to be done and why it matters)
Procedure = How (Exactly how to do it)

Term Definition Purpose Example

A broad guideline or rule that

"All patient care areas
outlines the organization’s
Sets direction and must follow infection
Policy philosophy, values, and
expectations. prevention and control
expectations for a particular issue
standards at all times."
or activity.

"To perform hand

A step-by-step set of instructions on hygiene: 1. Wet hands
Guides consistent and
Procedure how to carry out a specific task or with water, 2. Apply
safe action.
process in alignment with the policy. soap, 3. Rub for 20
seconds…"
84
 QUALITY FRAMEWORKS AND MODELS
A. The PDSA Cycle (Plan-Do-Study-Act)
PDSA cycle is a common framework for continuous quality improvement, encouraging repeated testing and
The

refinement of practices to achieve improvement over time.

Step Description Example

A nurse identifies that patient falls are a frequent
Identify an issue and plan an
Plan issue and plans to implement hourly rounding to
intervention.
prevent them.
The nurse tests hourly rounding with one group of
Implement the intervention on a small
Do patients to evaluate the effectiveness of the
scale.
intervention.
Analyze the results and identify what After the test phase, the nurse examines data on
Study
worked and what didn’t. patient falls to assess if rounding reduced falls.

If the intervention was successful, The nurse expands hourly rounding to other units
Act implement it on a larger scale; if not, based on successful results or revises the intervention
modify and test again. if the results were not as expected. 85
QUALITY FRAMEWORKS AND MODELS
Six Sigma
Six Sigma is a methodology aimed at reducing errors and variability in healthcare
processes. It uses a data-driven approach to identify and eliminate causes of defects
in patient care.
Example: A hospital implements a Six Sigma project to improve the accuracy of
patient medication orders by reducing prescription errors.

86
NURSE’S ROLE IN QUALITY IMPROVEMENT

A. Reporting and Documentation

Nurses must report adverse events, near misses, and any issues that could affect patient care
quality. Accurate documentation is essential for tracking quality outcomes and ensuring
transparency.
Example: A nurse reports a medication error that was caught before harm occurred, which
contributes to a larger quality improvement project aimed at reducing errors in the medication
administration process.
B. Involvement in Committee Work
Nurses may participate in committees such as the infection control committee or the patient safety
committee, which work to develop guidelines and strategies to improve care delivery.
C. Participation in Staff Education
Educating fellow staff members on best practices, protocols, and procedures helps maintain a high
standard of care. Nurses contribute to creating a learning environment that fosters quality
improvement.
87
TYPES OF INCIDENT REPORTS
Type Definition Examples
- A patient falls but has no injury.
An unplanned event that may affect
- IV infiltration requiring site change.
Incident patient care or safety. May or may
- Patient receives a double dose of medication but
not cause harm.
remains stable.
- Nurse catches wrong medication before
administration.
An error that was caught before it - Surgeon notices wrong surgical site just before
Near Miss
reached the patient or caused harm. incision.
- Blood unit label mismatch identified before
transfusion.

- Surgery on wrong patient.

A serious unexpected event causing - Maternal death during childbirth.
Sentinel Event death, permanent harm, or requiring - Suicide of a patient in a healthcare setting.
life-saving intervention. - Retained surgical instrument after operation.
- Infant abduction or discharge to wrong family.
88
 Type Reached Patient? Harm Caused? Requires Report? Requires RCA?
Possibly (not
Incident Yes ✅ Yes ❌ Not always
always)
Near Miss No ❌ No ✅ Yes ❌ No
✅ Serious harm
Sentinel Event Yes ✅ Yes ✅ Yes
or death

89
LEVELS OF MANAGEMENT:
Level Description Common Titles Example in Nursing
Developing hospital-
Strategic planning and
Chief Nursing Officer wide patient safety
Top-Level Management overall organizational
(CNO), CEO, Directors policies or budgeting
direction.
plans.
Implements goals from
Managing the daily
Middle-Level top management and Nurse Manager,
operations of the ICU or
Management supervises lower-level Department Head
medical-surgical unit.
managers.
Directly supervises Assigning nurses to
First-Level frontline staff and Charge Nurse, Team patients and ensuring
Management focuses on day-to-day Leader, Unit Supervisor care plans are followed
activities. during the shift.

90
 ORGANIZATIONAL STRUCTURE
Organizational structure refers to the formal system that outlines how activities, such as task allocation,
coordination, and supervision, are directed toward achieving the goals of an organization.
It defines:
1. Who reports to whom (chain of command) communication chanal
2. Roles and responsibilities
3. Lines of communication and authority
In Nursing Context:
In a hospital or healthcare facility, the organizational structure helps: Example (Clinical Setting):
A staff nurse knows to report to the
1. Establish clear reporting lines (e.g., nurse → charge nurse → nurse manager)
charge nurse, who reports to the unit
2. Promote efficient decision-making manager
3. Improve communication and teamwork —ensuring a structured flow of
4. Ensure accountability and patient safety information and authority.

91
CHAIN OF COMMAND

Chain of command is the formal line of authority pathway within an organization

Example of a Nursing Chain of Command:
1. Staff Nurse
2. Charge Nurse
3. Nurse Manager (Unit Manager)
4. Director of Nursing
5. Chief Nursing Officer (CNO)
6. Hospital Administrator / CEO
➡ Following this structure helps ensure effective communication, accountability, and
patient safety.

92
COMMUNICATION PROCESS
Step Definition Example in Nursing
A nurse giving discharge instructions to a
1. Sender The person who initiates the message.
patient.
The information, idea, or instruction being "You need to take your antibiotics twice a
2. Message
communicated. day after meals."
The process of converting the message into words, Nurse uses simple language and visual
3. Encoding
gestures, or symbols. aids to explain medication instructions.
The medium through which the message is sent Verbal explanation, written handout, or
4. Channel
(verbal, nonverbal, written, etc.) nonverbal cues like eye contact.
The person who receives and interprets the The patient listening to and reading the
5. Receiver
message. discharge instructions.
The process by which the receiver interprets the Patient understands what the nurse said
6. Decoding
sender’s message. and asks questions for clarification.
The receiver’s response that confirms whether the The patient repeats the instructions back
7. Feedback
message was understood. to the nurse (teach-back method). 93
94
 COMMUNICATION CHANNELS
Channel Direction of Communication Description Example in Nursing
A nurse manager sends
Instructions, policies, feedback, and
From managers to instructions to staff about a
1. Downward goals are communicated from
subordinates new policy on infection
managers to staff.
control.
A nurse reports to the unit
Information, feedback, concerns, or
From subordinates to manager about staffing
2. Upward reports are communicated from staff to
managers shortages or concerns about
higher management.
patient care.
End shift report
Communication occurs among staff at
Between peers or Nurses working in different
3. Lateral the same level. It helps in coordination
colleagues units collaborate on patient
and sharing information.
care plans or discuss a case.
A nurse manager
Across different levels and Communication that goes across communicates directly with
4. Diagonal departments (cross- different departments and levels of the pharmacy department to
functional) hierarchy. ensure accurate medication
95
orders.
96
 Staff Appraisal Program
Component Description Example in Nursing
A nurse manager works with a nurse to set goals for
Setting clear, measurable goals and performance
1. Objective Setting improving patient satisfaction and reducing
expectations for the staff.
medication errors.
Regular feedback provided to a nurse regarding
2. Continuous Ongoing assessment of staff performance over
adherence to infection control protocols and patient
Monitoring time, not just during formal evaluations.
care practices.
A nurse reflects on their ability to manage patient
Nurses evaluate their own performance, identifying
3. Self-Assessment care and communicates any challenges or growth
strengths and areas for improvement.
areas with their manager.

A nurse receives feedback from fellow staff on how

Feedback from colleagues regarding performance,
4. Peer Review well they collaborate during patient handovers and
teamwork, and communication skills.
interdisciplinary rounds.

The nurse manager evaluates the nurse’s Nurse manager assesses a nurse's ability to meet
5. Manager Evaluation performance based on established criteria and patient care standards, communication with
outcomes. 97
patients, and teamwork.
Negligence vs. Malpractice
‫اإلهمال و األخطاء الطبية‬
Aspect Negligence Malpractice
A failure of a professional (such as a nurse) to
Failure to take proper care or provide
Definition provide care according to accepted standards,
reasonable care, leading to harm.
resulting in harm.
Breach of the general standard of care Breach of the professional standard of care
Standard of Care
expected in a given situation. expected of a nurse or healthcare provider.
Intentional or unintentional failure to meet the
Can be unintentional and does not
Legal Implication professional standards of care expected in the
necessarily involve professional duty.
nursing profession.
A nurse forgetting to administer a A nurse administering the wrong medication or
Example in Nursing medication on time, leading to mild incorrect dosage, causing serious harm to the
complications. patient.
Less severe consequences compared to Serious consequences, such as harm to patients,
Outcome
malpractice. loss of licensure, or legal action.

98
Key Differences to Remember:
• Negligence is often unintentional and involves careless actions or
failure to follow procedures, usually leading to minor harm.
• Malpractice involves intentional or unintentional failure to meet
professional standards, which causes serious harm or severe
consequences.

99
Example Scenarios:
• Negligence:
• A nurse fails to check the patient’s identification bracelet before
administering medication, leading to a medication error. While the nurse's
action is careless, it was unintentional and may cause mild harm.
• Malpractice:
• A nurse administers the wrong medication to a patient based on poor
judgment or a failure to follow the proper clinical guidelines, leading to
severe patient harm.

100
101
102
• Ms. Caputo learns that some leaders are transactional leaders. Which
of the following does not characterize a transactional leader?

• A. Focuses on management tasks.

• B. Is a caretaker.
• C. Uses trade-offs to meet goals.
• D Inspires others with vision.

103
• Her former manager demonstrated passion for serving her staff
rather than being served. She takes time to listen, prefers to be a
teacher first before being a leader, which is characteristic of:

• A. Transformational leader
• B. Transactional leader
• C Servant leader
• D. Charismatic leader

104
• One leadership theory states that “leaders are born and not made,”
which refers to which of the following theories?

• A. Trait
• B. Charismatic
• C Great Man
• D. Situational

105
• She came across a theory which states that the leadership style is
effective depends on the situation. Which of the following styles best
fits a situation when the followers are self-directed, experts, and are
matured A. Democraticindividuals?

• A. Democratic
• B. Authoritarian
• C Laissez-faire
• D. Bureaucratic

106
• Which of the following is true about functional nursing?

• A Concentrates on tasks and activities.

• B. Emphasizes the use of group collaboration.
• C. One-to-one nurse-patient ratio.
• D. Provides continuous, coordinated, and comprehensive nursing
services.

107
• He raised the issue of giving priority to patient needs. Which of the
following offers the best way for setting priority?

• A Assessing nursing needs and problems.

• B. Giving instructions on how nursing care needs are to be met.
• C. Controlling and evaluating the delivery of nursing care.
• D. Assigning a safe nurse: patient ratio.

108
• Stephanie is a new Staff Educator of a private tertiary hospital. She
conducts orientation among new staff nurses in her department.
Joseph, one of the new staff nurses, wants to understand the channel
of communication, a span of control, and lines of communication.
Which of the following will provide this information?

• A Organizational structure
• B. Policy
• C. Job description
• D. Manual of procedures

109