Sub: Nursing Management & Administration

identifying the problems of speciality unit & development of a plan of action by using problem
solving approach

Submitted to, Submitted by,

Madam Mani Nandy Mitra Shreya Putatunda
Senior Lecturer MSc Nursing Part-II
CON, NBMCH CON, NBMCH
INTRODUCTION
Problem solving is a mental process and is part of the larger problem process that includes
problem finding and problem shaping. Considered the most complex of all intellectual
functions, problem solving has been defined as higher-order cognitive process that requires
the modulation and control of more routine or fundamental skills. Problem solving occurs
when an organism or an artificial intelligence system needs to move from a given state to a
desired goal state.

DEFINITION
A problem being defined as the difference existing between a situation or condition
prevailing and the desired situation.
Problem solving is defined as decision making for solving a problem. A problem being
defined as the difference existing between a situation or condition prevailing and the
desired situation.

PRINCIPLES OF PROBLEM SOLVING

Problem solving like other managerial activities is facilitated by proper organization. In
organizing subordinates, problem-solving efforts, a manager should observe the following
principles:
 To resolve problems affecting organizational efficiency, the manager should separate
large problems from small ones, use policy to solve the smaller problems, and conserve
managerial time for solving major problems.
 The manager should delegate smaller problems to subordinates and teach them to solve
these by applying existing agency rules.
 In resolving operational problems, the manager should consult internal and external
experts, so that solutions will be based on current knowledge.
 Problem solutions are most effective when the manager approaches problems in relaxed
fashion and refuses to solve problems under stress.
 It is impossible to anticipate all eventualities or to expect 100 percent accuracy in
diagnosing and resolving problems. Therefore, it is unwise to agonize over selecting a
solution.

PROBLEM SOLVING PROCESS

The steps of the problem-solving process are the same as the steps of the nursing process and
the decision-making process: assess and analyze, plan, implement and evaluate.
Problem solving consists of the following steps:
1. Identification and specification of the problem.
2. Collection of data in relation to the problem.
3. Analysis of available data and inference.
4. Identifying probable solutions and selection of the best solution.
 5. Implementation of solution with feedback.
6. Modification of solution, if necessary, on the basis of feedback data.

APPROACHES TO PROBLEM SOLVING

There are five main approaches to problem solving
1. Routine
2. Scientific
3. Decisional
4. Creative
5. Quantitative
These approaches are strategies for problem solving and any one approach may be suitable
for the given situation.
1. Routine approach: This approach deals with problem solving on traditional methods.
a. What has always been in the past, when such situation occurred? If we do it now the
same way we may succeed.
b. There is Standard Operating Procedures (SOP) in many departments of the hospital.
These SOPs tell that what should be in a particular situation. How is it done? Who
does it? When will it be done? Step by step approach to deal with the problems.
c. Another way of problem solving based on the traditional methods is, to have regards
for the superior officer’s opinion and orders. Whatever they direct, instruct or order,
presume that they are correct and follow it 100%. Such methods are of great value in
medical care setting, like where the treatment of the patient is concerned.
2. Scientific approach: The first step in this approach is to identify the problem. Second
step is preliminary observation regarding the proposed scheme. Then we have to derive
solutions to the problems. With the use of current knowledge and with controlled
 experiments investigate the proposition. The data so collected are classified and analyzed.
On the basis of analysis, a tentative solution is drawn. The solution so derived is
implemented in that situation. After implementation it is evaluated for its relevance.
3. Decisional approach: This is one of the most popular and also common approaches to
deal with the problems. First of all, we have to state as to what is the desired result. After
making definition of the problem, various possible alternatives are sorted out then each
alternative is evaluated from the point of view of its suitability and relevance. The best
alternative is selected and implemented in the given situation. For any given situation
several decisions can be made.
4. Creative approach: First step is to define the problem and decisions makers study the
information, people and facilities involved and concentrate on interactions and outputs
from the inputs. Creativity and innovations of idea is given due consideration. This
method uses the ability to develop new ideas and to implement them. The core theme is to
create and apply new idea. It represents a new way of achieving the desired result without
being prejudice.
5. Quantitative approach: Problem solving is done by construction of mathematical
models. First define the problem and construct a mathematical model and derive a
solution from the model. Evaluate the model as well as the solution drawn from the model
and implement the solution to solve the problem. The computer is of great help, when the
mathematics is complex and the calculations are of large volume.

IDENTIFICATION OF THE PROBLEM OF SPECIALITY UNIT

During our clinical experience at PICU (Pediatric Intensive Care Unit) in North Bengal
Medical College and Hospital, Darjeeling we have found that the used syringes and needles
are disposed in one container along with other materials instead three separate bucket such as
ampoules, plastic paper and also the amount of hypochlorite solution is less and strength is
not known. The used syringes and needles are not properly disposed.

STEPS OF PROBLEM SOLVING

Step I: Problem identified: disposal of syringes and needles

Assess the Facts of the Situation

S – Subjective Data
 Nurses report that during busy shifts, syringes with needles are sometimes left on
procedure trays or thrown into red bags.
 Housekeeping staff complain about accidental pricks while clearing waste in PICU.

O – Objective Data
 Observed intact syringes with needles in red plastic bags and general waste bins.
 Puncture-proof (white) sharps containers not placed at all bedsides.
 Some sharps containers found overfilled, without lids secured.
Improper disposal of used needles and syringes.

Collection of data in relation to the problem.

What? Used needles and syringes are not properly disposed

Where? In PICU in North Bengal Medical College & Hospital

From whom data is collected? Nurses (sister in charge, staff nurses, student nurses), doctor
and group D staff.

Data is collected regarding used syringes and needle

How extensive is the problem?

 Needle prick injury for care giver and group D.

 Waste management protocol is not maintained.

 Chance of recycling of syringes and needles.

 Needles and syringes carry blood which is a good source of nosocomial infection if not
disinfected properly.

It is interpreted that

i. There may be lack of knowledge of the concerned staff regarding waste disposal
ii. Lack of Supply of the container for dispose of sharp instrument.
iii. They have the knowledge but does not possesses any attitude of doing
the work accurately. Needs motivation for doing work.

Step 2: Next step is Formulation of goals for resolution of the stressful situation:

The goal is selected as to reduce the malpractice regarding disposal of syringes and needles
among the staff of PICU of North Bengal Medical College and Hospital within two
weeks.

1. Ensure 100% safe disposal of needles and syringes in white puncture-proof

containers in PICU within 2 weeks.
2. Prevent needle-stick injuries among PICU staff.
3. Maintain continuous BMW compliance in PICU.

Step 3: The alternatives for dealing with the situation are as follows :

i. Lack of knowledge can be dealt with some in-service training programme

or by verbal discussion for transferring knowledge.
 ii. Puncture proof container must be supplied in the department. There may be
sufficient supply of bleaching powder so that the solution can be changed every
day at a particular time.
iii. Proper counseling should be done.
iv. Supervisory rounds and compliance checklist by sister-in-charge.

Step 4: Determination of the risk and benefits of each alternative.

Risk: Needs time and planning for training the staff. It needs planning for man,
material, money and time. The higher level authority needs to look after the fact.

Benefit: The staff will be enriched with the knowledge of proper disposal of waste, which
will be reflected in their practice.

 Prevention of Needlestick Injuries and blood-borne infection transmission.

 Safer environment for staff, patients, and attendants.
 Regulatory compliance with BMW Rules.

Step 5: Selection of an alternative

 More supply of receptacles and gloves from the hospital store.

 Staff development Programme regarding waste management.
 Training of group D regarding handling of syringes and needles after disinfection
and about the disposal of these items
 Supply of reusable puncture proof container if disposable containers are not available.
 Supply of bowl and strainer so that the needles can be put into the strainer which is
deep in the bowl containing hypochlorite 1% bleaching solution.
 Supply of big bowl or bucket for receiving syringes for disinfection by 1%
solution.
 Supply of one big bucket for other materials such as plastic, ampoules etc.
 Motivate all health care professionals to dispose syringe and needles at their proper
place.

Counselling the staff is selected as the alternative method.

Step 6: Implementation the alternative method selected.

 Requested the sister in charge to give two separate container one for needle and
one for syringe, one strainer and one hard plastic box for carrying the needles.
 Teaching regarding waste management is given to the Staffs and Group D.
Sister in charge has provided the things needed. She has given strict instructions to the staff
for changing of hypochloride solution every day and new poster for disposal of waste
materials are hanged on the wall. Arranges meeting and discussion for problem solving with
the staffs. Sister in-charge also provided strainer. The staff nurses and students are
motivated to dispose the syringe and needles properly. Group D are motivated to wear gloves
and how to handle the syringes and needles after use.

Step 7: Evaluation of the outcome of the alternative implemented.

Next day it is observed that sister-in-charge has supplied the puncture proof container
container with bleaching solution in it. Staff are practicing the dispose of syringe and
needle properly; needle and syringes are disposed separately.

 On follow-up, PICU staff were observed disposing of used syringes and needles
properly.
 Fewer incidents of sharps in red plastic bags.
 No new reports of needle-stick injuries in the following week.

Step 8: If the first choice is ineffective, it needs to shift to the second option

Now they dispose syringes and needle in the blue plastic bag. Follow up and regular
supervision by the higher authority is needed for proper practice.
 Organize a formal hands-on training session by the Infection Control Nurse.
 Institute daily supervisory checks and surprise audits.
 Escalate repeated non-compliance to the hospital Biomedical Waste Management
Committee.

Conclusion:

Problem-solving is a complex skill. It involves critical thinking, decision-making,

creativity, and information processing. Effective problem-solvers use a systematic
approach that allows them to break down difficult problems into smaller, more
manageable parts.

In PICU, where multiple invasive procedures are performed daily, improper disposal of
needles and syringes poses a serious threat to healthcare workers and patients. By applying
a structured problem-solving approach—from assessment to evaluation—safe disposal
practices can be ensured, thus protecting staff, patients, and complying with biomedical
waste management rules.