These are the process for the developing nursing standards of practice Standard 1: Assessment: The registered nurse collects comprehensive data about patientâ€™s health. Standard 2: Diagnoses: The registered nurses analyze the assessment data to determine the diagnoses or the issues. Standard 3: Outcome identification: The registered nurse identifies the expected outcomes for the patientâ€™s plan of care. Standard 4: Planning: The registered nurse develops the plan that authorizes strategies and a way to obtain the outcomes. Standard 5: Implementation: The registered nurse implements the identified plan. Standard 5A: Coordination of care: The registered nurse coordinates care delivery. Standard 5C: Consultation: The registered nurse provide consultation to control the identified plan and effect change. Standard 5D: Prescriptive authority and power: The registered nurse uses rigid authority, procedures, treatments, and therapy in accordance with state an federal laws and regulations. Standard 6: Evaluation: The registered nurse evaluates progress towards fulfillment of outcomes. Different entities that might be involved in developing the standard practice. American Nurses Association members are the first link in developing sources (American Nurses Association, 2014). The Department of Health Scope of Practice might be involved in the development of standards (â€œScope of Practice,â€ 2014). State boards of nursing develop standards ofÂ care at the state level and enforce those standards. The American Nurse Credentialing Center (ANCC) work on the national level. Professional specialty nursing organizations, Educational institution, state boards of nursing and other government agencies develop standards of care. The American nurses Association and the Joint Commission on Accreditation of Healthcare Organization (JACHO) recognized standards of care. Federal and state laws, rules and regulation and other professional agencies/organizations help define standards of practice. The ANA and Joint Commission on Accreditation of Healthcare Organization (JCAHO) established nationally recognized standards of care. References American Nurses Association: Professional Standards (2014). Retrieved from http://nursingworld.ord/nursingstandards Scope of practice decision tree (2011). Retrieved from http://www.doh.wa.gov
The Process Of Leading And Directing Construction Essay According to Websters Dictionary, management defines as the process of leading and directing all or part of an organization, often a business one through the deployment and manipulation of resources (human, financial, material, intellectual or intangible). Other function of management is the action of measuring a quantity on a regular basis and adjusting an initial plan and the actions taken to reach ones intended goal. This applies even in situations where planning does not take place. Situational management may precede and subsume purposive management. Therefore the maintenance management will characterise the process of leading and directing the maintenance organization. British Standard Glossary of terms (3811:1993) defined maintenance as: the combination of all technical and administrative actions, including supervision actions, intended to retain an item in, or restore it to, a state in which it can perform a required function , maintenance is a set of organised activities that are carried out in order to keep an item in its best operational condition with minimum cost acquired . According to British Standard 8210 defined maintenance as the combination of all technical and administrative action intended to retain an item in, or restore it to, state in which it can perform its required function. Another British standard ( BS 8831 : 1964 ) maintenance as the combination of any action will be make to retain the items or restore it to make sure it in acceptable standard , maintenance management typically required both capital and operating expenditure. The maintenance management needs to work hard to make sure the maintenance standard is achieved. According to (Noble, 1984; Lee, 1987).there is no absolute maintenance definition for maintenance, the definition is very subjective, the standard is depends on person, or organization as a client request. The standard of maintenance is base on the objectives of the company or organization that the maintenance company will take care. Every building have their function and the maintenance works need to achieve to make sure the building is function as the client wanted, for example, for the building that function as a business purposed, the maintenance standard is high, such as maintenance for hotel building. According to books (building pathology principles and practice by David S. Watt), building and their services inevitably become obsolete as a result of factor relating to the use of the building (functional, economic, locational, social, statutory or physical) and changes in the needs of building user. BS 3811: 1984 define maintenance as A combination of any action carried out to retain an item in, or restore it to an acceptable condition. From this definition two key components can be identified: Action that will take is not only to the physical execution of maintenance, but it also concerned with its initiation, financing and organization. The notion of an acceptable condition, which implies and understanding or requirement for the effective usage of the building and its parts which in turn compel broader consideration of building performance. The committee on building maintenance recommended the adoption of the following definition work undertaken in order to keep, restore or improve every facilities, i.e. every part of the building, its services and surround to a currently acceptable standard that and to sustain the utilities and value of the facilities. According to Paul Wordsworth ( Lee s Building Maintenance Management, 4th edition ) The Charted Institute of Building offer the following definition work undertaken in order to keep ,restore or improve every facilities i.e. every part of building services and surround to an agreed standard by the balanced between need and available resource. 2.2 MAINTENANCE OBJECTIVE Maintenance may be undertaken either in anticipitation of failure (preventive maintenance) or carried out to restore the building to an acceptable standard after failure (corrective maintenance). According to several of reference the successful maintenance program should achieve these goals. Help buildings function as they were intended and operate at peak efficiency, including minimizing energy consumption. (Harvey H. Kaiser, The Facilities Managers Reference (Kingston, MA: R. S. Means Companying., 1989), 81; and American Public Works Association (APWA), Public Works Management Practices (Chicago: APWA, August 1991), 65.). Building maintenance must achieve to make sure the building can functioning as it proposed to be. For example, the design for commercial building must be function to attract people to come; proper maintenance to keep the building in good condition must be program. Prevent failures of building system that would interrupt occupant activities and the delivery of public services. (R. S. Means Company, Inc., Cost Planning Estimating for Facilities Maintenance (Kingston,MA: R. S. Means Company, Inc., 1996), 264.) Building that operate trouble-free allow public employee to do their jobs and serve the public. Because building maintenance includes regular inspection and replacement of equipment crucial to operating a building, maintenance staff reduces the problem that might otherwise lead to a breakdown in operation. Sustain a safe and healthful environment by keeping building and their component in good repairs and structurally sound.( APWA, Public Works Management Practices, 63; and International Code Council, Inc., International Property Maintenance Code 1998 (Country Club Hills, IL: International Code Council, Inc.,1997), 9-10.). Building maintenance must protect every building component in good condition, to create safe and healthful environment to the building occupant. Any serious defect to the building must be take an action because event a small defect it can slowly effect the building structure, and sometimes it also can effect to the occupant health. Provide maintenance in ways that are cost- effective. (Federal Facilities Council, Standing Committee on Operations and Maintenance, Budgeting for Facilities Maintenance and Repair Activities (Washington D.C.: National Academy Press, 1996), 29. Cost-effective denotes both economic efficiency and desirable results.) A main goal of maintenance is to minimize cost without reduce the quality services and building performance. To achieve cost effective a proper building maintenance cost planning must be developed to make the maintenance cost that will be spent for the building is relevant. To protect building owner invest for the building. (Dr. Ahmad Bin Ramly, 2002, Prinsip dan Praktis Pengurusan Bangunan) Building owner has been investing a lot of money for the building; every investment must give an income. The increasing operation and maintenance cost of building will cause the owner investment will unrelavant and also not economical for a long term. The impact will be more conspicuous when the building has a lot of problem defect and need a lot of repairing works. 2.3 BUILDING MAINTENANCE CLASSIFICATION. In generally, building maintenance can be categories into 2 categories, planned and unplanned maintenance. Planned maintenance is maintenance organized and carried out with forethought, control and the used of record to a predetermined planned. Maintenance works must be program properly, to make sure there no failure will occurred, any defects or problem must be recorded to make the observation works will be easier. Unplanned maintenance is ad hoc maintenance carried out to no predetermined plan. According to the Audit Commission considered a better maintenance to be as follows. Strategic repair and maintenance. This represent work required for a long term preservation of an asset, and includes planned maintenance of the building fabric (decoration and routine replacement), maintenance of engineering services and maintenance repair items such as re-roofing. There are normally item which can be plan of because, for some extent there can be foreseen and budgeted for. Tactical repair and maintenance. These items are related with day to day works of minor nature in response to immediate need. The audit commission point out that tactical maintenance is not necessarily the same as responsive maintenance as some immediate respond item are clearly of strategic nature for example a flat of roof failure. According to BS 3811 and for practical purposed about maintenance classifications are Preventive maintenance this maintenance carried out at pre determined interval, or corresponding to prescribe criteria, and intended to reduce probability of failure or the performance degradation of an item. Corrective maintenance maintenance carried out after failure is occurred, an intended to restore an item to a state in which it can perform it required function. Emergency maintenance maintenance which it is necessary to put in hand immediately to avoid serious consequences. Condition based maintenance preventive maintenance as a result of knowledge of the condition of an item from routine or continuous monitoring. Schedule maintenance preventive maintenance to carried out to a pre-determined interval of time, number of operation mileage etc. Another maintenance classification was made by Noble (1984) that classified maintenance as five different types: a. Routine or cyclic maintenance, it is task carried out at more or less regular intervals without prior inspection, such as cutting grass, lamp changing, cleaning of drains and gutters. b. Planned maintenance; can be determined as selected services, plant and equipment. It is a regular inspection and servicing (lubrication and adjustment) with repairs and replacements made or programmed only when found to be necessary. c. Planned inspection, for selected elements of structure, fabric and finishes. It is a regular inspection but with maintenance work carried out or only when found to be necessary. d. Breakdown or emergency maintenance, an action taken to remedy failure. e. Minimum maintenance, often applied to premises awaiting disposal. No action except to meet mandatory requirements, e.g. for health or safety, to conform to the terms of a lease, or to keep the property wind and waterproof. MAINTENANCE STANDARD In maintenance management there is no specific statement that defines the maintenance standard for building. In generally, maintenance standard is base on the client requirement and the contractor will know the standard base on the owner requirement. According to Dr Ahmad Bin Ramly, maintenance standard is basically same in any building or equivalent with the type of building, however in practically small size building will be easier to maintain and easier in maintenance management. Many of it repairing works can be done as planning. For the building that larger and more complex, with sophisticated design it will need a lot of special service. To fulfill the maintenance need, the building owner needs to provide one maintenance department to take care of the building facility and services. If the owner want to take consultant to maintain their building, they must specify ,what maintenance jobs will be carried out ,then ,all the workers must be supervise properly, to make sure the maintenance work is followed as planned. Besides that, all the maintenance workers must a qualified person to carry out the works, there must be no person can do the maintenance job, except the qualified person or maintenance expert. Milne, 1985, the main idea about maintenance standard is basically the request or maintenance work order from the owner to contractor, which area or defect that should be repair or replace, and this order should be clear as a standard for the contractor to perform the job. The work order should include the sufficient detail in order to enable the workman to take with him the correct quantity and type of material when making the maintenance work. In fact some of 40% of the maintenance standard was directed in site. (Lee, 1987) have mention, in building maintenance management describe building maintenance standard can be divide into two categories. Lower level The need of maintenance due to increasing probability of failure involving not only enhanced repairs costs but also consequential losses where the normal user of the building is interfered with. Upper level Set by a cost of achieving it. Lee also said about building individual element, he divide the maintenance standard into three condition : Physical condition of the elements. Has two related terms, the condition of element that related to the magnitude of defect that calls for remedial action and second is the performance or environment systems. Times criteria. When the repair or replacement will be make. At this method, the maintenance need frequent inspection and its need a little bit knowledge about decoration. The balance between frequently inspection, risk, and consequences of failure is the important part that should be achieve. Financial criteria. This criterion can be taken from the variable sum based on the costs of some primary activity or replacement value, or taken from fixed sum based on historic costs or an analysis of anticipated benefits. In certain time, maintenance works sometimes have a difficulty during do an operation some product that gives unsatisfaction to the owner. However, this problem can be solving if the proper maintenance works can be program, beside give a relevant budget. It can be done smoothly with one good maintenance program. MAINTENANCE NEEDS According to Dr. Ahmad bin Ramly state that in Principe, the important building maintenance can be seen in four main aspects: Investment value. Building design Building function. heritage stuff 2.5.1 Retaining investment value. There is no person that have been invest for one thing want to lost, they always hope what they have been spent the money will be get a benefit from it. It also same with building owner, they have spent a lot of money for the building; so, they wanted their investment will be worth, and they will get the benefits. There are two type of income that usually investor hopes from their investment. Short term income. It means the owner hope to get profit from their new building. They hope their new building can be sold fastly, especially when the owner used loan to buy the land, then they must sale the building quickly, so they can cut the loan interest quickly. If the sale is slow, the loan interest will be rise, and when the interest is more than profit, the owner will be lost. Long term investment. Long term investment usually consists of calculation about rental rate that will be get and sale price. If the investor find the land market is in the good condition and increase, or any sign that the land market will be a rise, usually the owner will save their property for a longer term, so that, one day, they can sale the land or building with the higher price, or they used tenant as a source to pay the loan. Building Design. With proper building maintenance, the building will be look more interesting and less defects will occur. There have some reason that can cause the building will look not interesting and a lot of defect occurs: Dirt because of user careless. Natural environment effects. Such as, weather, season and air pollution. Insect attack. Fungus and plant attract. A decay that usually attack at some part of building that has dampness. Natural disaster or any unpredictable accident. Building function. All building that build have a reason to build, there have their function. So, proper building maintenance program will help to retain the building function as planned. There have some reason, why the building need maintenance to retain their function : To remain their actual design function and their construction objectives especially for preservation and conservation proposed. To maintain and fulfill building occupant needs or the owner. To remain or followed the statutory requirement or other local authority requirement. To remain building space with other services that have been provide for the buildings. To make sure all the facilities that provide or other services always functioning and can be used all the time Heritage Stuff The awareness and interest of the public and country to heritage item is increase. Now a day, the heritage stuffs not only just a collection to the people that interest with history, but now, it can be main things to make money. The heritage stuff such as old building, fortress, and houses not only have high value from their design, but for some local community it was a main thing to them, to make money. Those structures can attract tourist from out or in the country to come. 2.5.5 The satisfaction of building needs. According to Paul Wordsworth (Lee building maintenance management ,4th edition), said that, in order to put the problem into perspective it is necessary to view maintenance in the context of the overall building process. The building needs community is met by interrelated construction activities of maintaining, modernizing and replacing existing stock of building and by erection of additional new building.( figure 2.0) The recent express view is that the level of expenditure on maintenance is too high. However in order to know the reasonable of expenditure is reasonable or not it is necessary to consider 3 factors: Whether the amount spent is excessive in relation to the work done. The amount that provide for maintenance works need to use carefully, to make sure the works is reasonable with the budget. Whether the work which is done is necessary and unavoidable. There are many reported cases of early maintenance which could have been avoided with better design and the suitable of the material. Whether it would be advantageous to carry out more works. Clearly construction resourced are limited and the goal should be to achieve the optimum allocation of manpower, material and capital between the maintenance and improvement of existing building and the construction of new building. 2.6 MAINTENANCE PLANNING The maintenance planning is one of the important element in develop the good maintenance works, according to Barrie Charter and Peter Swallow, (1996, The Maintenance Management) state that, the basic principle of the planning should be firmly understood before considering maintenance planning specifically. The planning should be transparent to make sure the workers are understood what is the maintenance planning and their goal to achieve. The maintenance planning should be planned before the construction building , this will make sure to take account the effect of the building design to the maintenance aspect. According to Dr. Ahmad Bin Ramli (2002, Pengurusan Penyelenggaraan Bangunan), the maintenance planning should be done in five stages: The building in still in design stage. The proper maintenance planning should be plan at this stage need to be rigid and nonstop, especially for those building that need to do renovation in the future, the maintenance aspects need to take account to make sure the building long lasting. In the construction stage, the maintenance manager need to know the progress to make sure the construction works is followed as in planned. Before handover to the owner. the planning should be prepare before the building is handover to the new owner, the maintenance manager must know the condition of the building , and the new owner need, from the information, maintenance manager can program the maintenance works for the client need. The change of use to the building. The maintenance manager should have a planned if the building will change to the new function, they must know the relevant of the new function that will be use to the building. The maintenance manager should give advice or inform to the new owner about the impact of the building function to the maintenance. The change of maintenance budget. The change of maintenance budget is not impossible if the client faces the economic problem, the maintenance manager need to plan what should do to use the new budget to the maintenance. Thats mean if the client decides to cut the maintenance budget, the manager should cut down the unimportant works, and only focus on the serious maintenance works. Change of manpower. There have a possibilities that the manpower will decrease, this is because with some reason, such as because of high demand that the workers cannot accept the situation, and resign. The because of the economic problem by the owner, maybe a lot of worker will be reject to cut the operation fees. The maintenance manger should reprogram all the planning, and find the other alternative to face the problem. 2.7 PROBLEM IN MAINTENANCE MANAGEMENT. Maintenance management is very important for the building, a good maintenance management will make the building life span is more, and also can reduce maintenance cost for the building. Any small defects at the building must be identify and must be solve it as soon as possible, because the small defects is like a cancer that slowly will become big defects in the future. Big defect means, big problem, and big problem need big cost to solve. However, why there still have some of the building that have maintenance department, but the defects still occurs? Until sometimes the defects have cause injuries to the people who used the building. There are some general ideas about the problem in maintenance management: The building design. The building design is one of the factors that cause problem in maintenance management. Sometimes, the building designer does not consider about building maintenance during design the building, the design just take serious about building appearance compare to building maintenance. Some maintenance access must have to provide to make maintenance works can be done quickly and safe, beside that to make sure all part of building can be reach, so that any problem to the building can be Identify and solve quickly. Maintenance budget. Budget for maintenance is very important things, with the relevant budget, the maintenance management can manage all the maintenance cost properly. Most of the owner didnt want to spend a lot of budget for maintenance, because for them, the money is more important to use it in their business. For government building, limited budget to maintain will cause the maintenance management could not do their job properly. Because, the maintenance equipment, such as any specials equipment is very expensive, but it is very important tools, to make sure the building test or survey is accurate. Poor maintenance program. Poor maintenance program means the maintenance manager failed do their job to manage the building properly. Good maintenance management can provide the good maintenance program such as, provide maintenance information management, routine maintenance schedule, proper maintenance planning, and manage maintenance budget. Lack of professional skills. Maintenance management is a work that needs a skill to manage it. Less professional workers to manage building maintenance is very important to make maintenance management process can do smoothly. Professional person in maintenance need to know all about maintenance, such as , programming maintenance work, get to know , the suitable material to use for building and also know how to do and analysis test. Some country needs to import the professional worker from oversea to do this works. It is very sad, when government need to spend a lot of money to pay foreign workers. It will be better if the works can be managed by local people. Unqualified workers Maintenance works need a qualified person to do the work; this is because maintenance work is dangerous which the workers need to handle dangerous equipment such as electrical system. At this stage, maintenance management is responsible to take a qualified person, besides have high skill or experience to do maintenance works. The maintenance workers need have a high knowledge about the works that they will do,they need to know how to reduce the risk and work safety during do the maintenance works.
Write something about yourself. No need to be fancy, just an overview.