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PROFESSIONAL ADJUSTMENT, NURSING LEADERSHIP, NURSING MANAGEMENT,

NURSING RESEARCH

Presented to the faculty

Of the College of Nursing

Panpacific University North Philippines

Urdaneta City, Pangasinan

In Partial fulfillment

Of the Requirement for the Degree

Bachelor of Science in Nursing

Camero, Jhon Lester

Delfin, Jhon Paul

Naces, Normalyn

Nacion, Camilo

Ochinang, Regielyn

Ordanza, Mark Joseph

Ordinario, Alexander

Urbano, jerrylyn

OCTOBER 2013

MARK JOSEPH VIRAN ORDANZA,BSN

What is Profession

A profession is a vocation founded upon specialized educational training, the purpose of

which is to supply objective counsel and service to others, for a direct and definite

compensation, wholly apart from expectation of other business gain.

A calling, vocation or undertaking in which its member should have acquired specific and

distinct value, knowledge training or by experience.

Characteristic of a profession as Applied nursing Practice

1. Accountability

Is answerability, blameworthiness, liability, and the expectation of account-giving.

2. Competence

This refers to the possession of required skills, knowledge and capacity in

providing safe care to patients.These skill acquired through theoretical related

learning in school and hospital exposures.

EX. Nurse Mark Joseph who just passesd the nurse licensure examination should not

immediately perform venipunture procedure without proper training.

3. Ethical

Being equipped with morality of human conduct, value and standard. It is the

wrongfulness of human action

4. Service Oriented

The main goal of profession nursing practice is to deliver optimum level of health

for all, both sick and well.

5. Caring Profession

Nursing requires diligent effort in caring for any client , both sick and well. Nurses

supposed to have a truly caring attitude for all her client regardless of their

economic or social status.

What is Professional Nursing?

Is the performance, for fee or a salary of professional service

A profession within the health care sector focused on the care of individuals, families,

and communities so they may attain, maintain, or recover optimal health and quality of

life.


http://en.wikipedia.org/wiki/Quality_of_life_(healthcare)

http://en.wikipedia.org/wiki/Quality_of_life_(healthcare)

http://en.wikipedia.org/wiki/Health_care

http://en.wikipedia.org/wiki/Legal_liability

http://en.wikipedia.org/wiki/Blameworthiness

http://en.wikipedia.org/wiki/Training

http://en.wikipedia.org/wiki/Educational

http://en.wikipedia.org/wiki/Vocation

Has been defined as an occupation that requires extensive education or a

calling that requires special knowledge, skills and preparation.

Scope of Nursing Practice

Is a terminology used by national and state/provincial licensing boards for various

professions that defines the procedures, actions, and processes that are

permitted for the licensed individual. The scope of practice is limited to that which

the law allows for specific education and experience, and specific demonstrated

competency. Each jurisdiction has laws, licensing bodies, and regulations that

describe requirements for education and training, and define scope of practice.

Scope of practice can be easily identified by three categories.

1. Education and training — Has the person been educated academically or on-the-job

and have documentation proving education to do the item in question?

2. Governing body — Does your state, district, province or federal government that

oversees the skill or profession allow (or not explicitly disallow) the item in question?

3. Institution — Institution allow a person or their profession to do the item in question.

Step on How to become a Professional nurse in the Philippines

1. Get a high school diploma or pass the General Education Development (GED)

test. While in high school, pay attention to your performance, skill, and interest in science

courses like biology, physiology, and chemistry. How you perform in these types of

courses early on will help you determine whether a carrier in medicine is right for you.

2. Obtain a bachelor's degree in nursing (BSN). Programs typically take four years to

complete, and vary in cost depending on which institution you choose. Bachelor's

programs usually include more training in social sciences than other nursing programs.

You may take courses in sociology, communications, leadership, and critical thinking

3. Complete an associate's degree in nursing (ASN). These programs usually take two

to three years to complete. Many students transition to BSN programs after having

completed an ASN.

4. Get a diploma from an accredited nursing program. Though most RNs complete a

BSN or an ASN, you can also be eligible for licensure by completing a vocational nursing

program. These programs vary in length, depending on which institution you choose.


5. Know the skills involved. Beyond having a breadth of knowledge in medicine, a nurse

must also exhibit the following qualities: strong communication skills, a caring attitude,

interest in working with people, openness to diversity, and ability to perform under stress.

(Section 12, 9173 or the “ Philippine Nursing Law of 200”( which took October 21, 2002)

Examination and Registration

Section 12.

Licensure Examination. - All applicants for license to practice nursing shall be required to pass

a written examination, which shall be given by the Board in such places and dates as may be

designated by the Commission: Provided, That it shall be in accordance with Republic Act No.

8981, otherwise known as the "PRC Modernization Act of 2000."

Required Rating by an Examinee in Order to Pass the Nurse Licensure Examination

Section 15. Article IV, R.A 9173

Ratings. In order to pass the examination, an examinee must obtain a general average of at

least seventy-five percent (785%) with a rating of not below sixty percent (60%) in any subject. An

examinee who obtains an average rating of seventy-five percent (75%) or higher but gets a rating

below sixty percent (60%) in any subject must take the examination again but only in the subject

or subjects where he/she is rated below sixty percent (60%). In order to pass the succeeding

examination, an examinee must obtain a rating of at least seventy-five percent (75%) in the

subject or subjects repeated.

Requirement of an Oath

Section 16

Oath. All successful candidates in the examination shall be required to take an oath of

profession before the Board or any government official authorized to administer oaths prior to

entering upon the nursing practice.

Section 17 Issuance of Certificate of Registration/Professional License and Professional

Identification Card.

A certificate of registration/professional license as a nurse shall be issued to an applicant who

passes the examination upon payment of the prescribed fees.


Every certificate of registration/professional license shall show the full name of the registrant, the

serial number, the signature.

What is registration by Reciprocity for nurses?

Section 20

Registration by Reciprocity.

A certificate of registration/professional license may be issued without examination to nurses

registered under the laws of a foreign state or country: Provided, That the requirements for

registration or licensing of nurses in said country are substantially the same as those prescribed

under this Act Provided, further, That the laws of such state or country grant the same privileges

to registered nurses of the Philippines on the same basis as the subjects or citizens of such

foreign state or country.

Who can Practice under a special or Temporary Permit

Section 21. Practice Through Special/Temporary Permit. A special/temporary permit may be

issued by the Board to the following persons subject to the approval of the Commission and upon

payment of the prescribed fees:

Licensed nurses from foreign countries/states whose service are either for a fee or free if

they are internationally well-known specialists or outstanding experts in any branch or

specialty of nursing;

Licensed nurses from foreign countries/states on medical mission whose services shall

be free in a particular hospital, center or clinic; and

Licensed nurses from foreign countries/states employed by schools/colleges of nursing

as exchange professors in a branch or specialty of nursing.

Section 22.Non-registration and Non-issuance of Certificates of Registration/Professional

License or Special/Temporary Permit.

No person convicted by final judgment of any criminal offense involving moral turpitude or any

person guilty of immoral or dishonorable conduct or any person declared by the court to be of


unsound mind shall be registered and be issued a certificate of registration/professional license or

a special/temporary permit.

What are the Ground for Non- Registry and Non Issuance of Certificate of Registration/

Profession License or Special/ Temporary Permit?

1. Those convicted of a crime involving moral turpitude

2. Those who are guilty of immoral or dishonorable conduct

3. Any person declared by the court to be of unsound mind

What are the Ground for revocation or Suspension of the Certificate of

Registration/Professional license/Cancellation or Special/ Temporary permit?

Section 23

Revocation and suspension of Certificate of Registration/Professional License and

Cancellation of Special/Temporary Permit.

The Board shall have the power to revoke or suspend the certificate of registration/professional

license or cancel the special/temporary permit of a nurse upon any of the following grounds:

(a) For any of the causes mentioned in the preceding section;

(b) For unprofessional and unethical conduct;

(c) For gross incompetence or serious ignorance;

(d) For malpractice or negligence in the practice of nursing;

(e) For the use of fraud, deceit, or false statements in obtaining a certificate of

registration/professional license or a temporary/special permit;

(f) For violation of this Act, the rules and regulations, Code of Ethics for nurses and

technical standards for nursing practice, policies of the Board and the Commission, or the

conditions and limitations for the issuance of the temporarily/special permit; or

(g) For practicing his/her profession during his/her suspension from such practice;


Provided, however, That the suspension of the certificate of registration/professional license shall

be for a period not to exceed four (4) years.

Section 26

Requirement for Inactive Nurses Returning to Practice.

Nurses who have not actively practiced the profession for five (5) consecutive years are required

to undergo one (1) month of didactic training and three (3) months of practicum. The Board shall

accredit hospitals to conduct the said training program.

Law Mandate Regarding the Comprehensive Nursing Specialty Program

Section 31.

Comprehensive Nursing Specialty Program

Within ninety (90) days from the effectivity of this Act, the Board in coordination with the

accredited professional organization recognized specialty organizations and the Department of

Health is hereby mandated to formulate and develop a comprehensive nursing specialty program

that would upgrade the level of skill and competence of specialty nurse clinicians in the country,

such as but not limited to the areas of critical care, oncology, renal and such other areas as may

be determined by the Board.

Section 33 Funding for the Comprehensive Nursing Specialty Program.

The annual financial requirement needed to train at least ten percent (10%) of the nursing staff of

the participating government hospital shall be chargeable against the income of the Philippine

Charity Sweepstakes Office and the Philippine Amusement and Gaming Corporation, which shall

equally share in the costs and shall be released to the Department of Health subject to

accounting and auditing procedures: Provided, That the department of Health shall set the criteria

for the availment of this program.

Composition of the Board of Nursing

ARTICLE III

Organization of the Board of Nursing

Section 3


Creation and Composition of the Board. There shall be created a Professional Regulatory

Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six

(6) members. They shall be appointed by the president of the Republic of the Philippines from

among two (2) recommendees, per vacancy, of the Professional Regulation Commission,

hereinafter referred to as the Commission, chosen and ranked from a list of three (3) nominees,

per vacancy, of the accredited professional organization of nurses in the Philippines who possess

the qualifications prescribed in Section 4 of this Act.

“Under the R.A. 7164 or the previous 1991 Nursing Law, The Composition of the Board of

Nursing Consist of a Chairman and Four(4) members only”

Section 4

Qualifications of the Chairperson and Members of the Board. - The Chairperson and

Members of the Board shall, at the time of their appointment, possess the following

qualifications:

(a) Be a natural born citizen and resident of the Philippines;

(b) Be a member of good standing of the accredited professional organization of nurses

(c) Be a registered nurse and holder of a master's degree in nursing, education or other

allied medical profession conferred by a college or university duly recognized by the

Government: Provided, That the majority of the members of the Board shall be holders of

a master's degree in nursing: Provided, further, That the Chairperson shall be a holder of

a master's degree in nursing;

(d) Have at least ten (10) years of continuous practice of the profession prior to

appointment: Provided, however, That the last five (5) years of which shall be in the

Philippines; and

(e) Not have been convicted of any offense involving moral turpitude; Provided, That the

membership to the Board shall represent the three (3) areas of nursing, namely: nursing

education, nursing service and community health nursing.

Section 5

Requirements Upon Qualification as Member of the Board of Nursing. Any person

appointed as Chairperson or Member of the Board shall immediately resign from any


teaching position in any school, college, university or institution offering Bachelor of

Science in Nursing and/or review program for the local nursing board examinations or in

any office or employment in the government or any subdivision, agency or instrumentality

thereof, including government-owned or controlled corporations or their subsidiaries as

well as these employed in the private sector. He/she shall not have any pecuniary

interest in or administrative supervision over any institution offering Bachelor of Science

in Nursing including review classes.

Section 6

Term of Office The Chairperson and Members of the Board shall hold office for a term

of three (3) years and until their successors shall have been appointed and

qualified: Provided, That the Chairperson and members of the Board may be re-

appointed for another term.

Section 11

Removal or Suspension of Board Members. The president may remove or suspend any

member of the Board after having been given the opportunity to defend himself/herself in a proper

administrative investigation, on the following grounds;

(a) Continued neglect of duty or incompetence;

(b) Commission or toleration of irregularities in the licensure examination; and

(c) Unprofessional immoral or dishonorable conduct.

Section 29

Qualification of Nursing Service Administrators. A person occupying supervisory or

managerial positions requiring knowledge of nursing must:

(a) Be a registered nurse in the Philippines;

(b) Have at least two (2) years experience in general nursing service administration;

(c) Possess a degree of Bachelors of Science in Nursing, with at least nine (9) units in

management and administration courses at the graduate level; and

(d) Be a member of good standing of the accredited professional organization of nurses.


Provided, That a person occupying the position of chief nurse or director of nursing service shall,

in addition to the foregoing qualifications, possess:

(1) At least five (5) years of experience in a supervisory or managerial position in nursing;

and

(2) A master's degree major in nursing

Provided, further, That for primary hospitals, the maximum academic qualifications and

experiences for a chief nurse shall be as specified in subsections (a), (b), and (c) of this

section: Provided, furthermore, That for chief nurses in the public health nursing shall be given

priority.

Provided, even further, That for chief nurses in military hospitals, priority shall be given to those

who have finished a master's degree in nursing and the completion of the General Staff Course

(GSC): Provided, finally, That those occupying such positions before the effectivity of this Act

shall be given a period of five (5) years within which to qualify.

Section 9

Powers and Duties of the Board

The Board shall supervise and regulate the practice of the nursing profession and shall have the

following powers, duties and functions:

(a) Conduct the licensure examination for nurses;

(b) Issue, suspend or revoke certificates of registration for the practice of nursing;

(c) Monitor and enforce quality standards of nursing practice in the Philippines and

exercise the powers necessary to ensure the maintenance of efficient, ethical and

technical, moral and professional standards in the practice of nursing taking into account

the health needs of the nation.

(d) Ensure quality nursing education by examining the prescribed facilities of universities

or colleges of nursing or departments of nursing education and those seeking permission

to open nursing courses to ensure that standards of nursing education are properly

complied with and maintained at all times.


The authority to open and close colleges of nursing and/or nursing education programs

shall be vested on the Commission on Higher Education upon the written

recommendation of the Board;

(e) Conduct hearings and investigations to resolve complaints against nurse practitioners

for unethical and unprofessional conduct and violations of this Act, or its rules and

regulations and in connection therewith, issue subpoena ad testificandum and subpoena

duces tecum to secure the appearance of respondents and witnesses and the production

of documents and punish with contempt persons obstructing, impeding and/or otherwise

interfeming with the conduct of such proceedings, upon application with the court;

(f) Promulgate a Code of Ethics in coordination and consultation with the accredited

professional organization of nurses within one (1) year from the effectivity of this Act;

(g) Recognize nursing specialty organizations in coordination with the accredited

professional organization; and

(h) Prescribe, adopt issue and promulgate guidelines, regulations, measures and

decisions as may be necessary for the improvements of the nursing practice,

advancement of the profession and for the proper and full enforcement of this Act subject

to the review and approval by the Commission.

Accredited Nursing Organization in the Philippines

Philippine Nurses Association (PNA)

Founded on September 2, 1922 as Filipino Nurses Association (FNA) in a meeting of 150

nurses presided by then Anastacia Giron (Mrs. Tupas), the FNA was incorporated in 1924.

The International Council of Nurses accepted the FNA as one of the member organizations

during the congress held in Montreal, Canada on July 8–13, 1929. The FNA became

the Philippine Nurses Association.

MISSION:

1. Zealously provide strategic directions and programs that enhance the competencies of nurses

to be globally competitive.

2. Passionately sustain the quality work life and collegial interactions with and among nurses.


http://en.wikipedia.org/wiki/International_Council_of_Nurses

3. Continuously strengthen the internal capacity and capabilities for quality care and services of

the nurses.

4. Enthusiastically explore possibilities of collaboration towards unification of nurses.

VISION:

The caring and fortifying light giver committed to providing opportunities for the professional

growth and development of world class Filipino nurses, Filipinos and people of the world.

Ethics

Is a branch of applied ethics that concerns itself with activities in the field

of nursing. Nursing ethics shares many principles with medical ethics, such

as beneficence, non-maleficence and respect for autonomy.

(“THE PATIENT BILL OF RIGHTS”)

1. Right to Appropriate Medical Care and Humane Treatment

2. Right to inform consent

3. Right to Privacy and Confidentiality

4. Right to information

5. Right to choose Health care provider and facility

6. Right to self determination

7. Right to religious belief

8. Right to Medical Record

9. Right to Grievances

10. Right to Refuse in Medical Research

Bio- Ethical Principles Affecting Nursing?

1. Autonomy Right to make ones decision

2. Beneficence Duty to good

3. Non- Maleficence Duty to avoid evil

4. Double Effect Choose the Lesser evil

5. Veracity Telling the truth

6. Totality Sacrificed other part of the body

7. Confidentiality keeping patient Privacy.

8. Fidelity Loyalty


http://en.wikipedia.org/wiki/Autonomy

http://en.wikipedia.org/wiki/Primum_non_nocere

http://en.wikipedia.org/wiki/Beneficence_(ethics)

http://en.wikipedia.org/wiki/Medical_ethics

http://en.wikipedia.org/wiki/Nursing

http://en.wikipedia.org/wiki/Applied_ethics

Professional /Legal Responsibilities of Nurses

Contract

Is an agreement having a lawful object entered into voluntarily by two or

more parties, each of whom intends to create one or more legal obligations

between them. The elements of a contract are "offer" and"acceptance" by

"competent persons" having legal capacity who exchange "consideration" to

create "mutuality of obligation

An agreement between two or more parties, especially one that is written and

enforceable by law.

Documentation and Charting Nurse

Charting or documentation is the process of preparing a complete record of a patient’s

care.

Include:

Nursing admission history (nsg history & physical assessment)

Flow sheets (record of repeated measurements; V/S)

Graphics/neuro checks/diabetic records


http://en.wikipedia.org/wiki/Party_(law)

Criteria for Effective Documentation & Reporting

1) Factual – descriptive, objective, factual information

2) Accurate – precise measurements, avoid statements such as “drank adequate amount”

instead should have “intake 1000ml over 8 hrs”

3) Correct spelling/grammar – use accepted abbreviations & appropriate medical

terminology

4) Confidentiality – legally & ethically bound to maintain confidentiality

5) Organization – follow the nursing process to be organized. Narrative entries should be in

logical order. DAR is an excellent example of an organized, concise method of charting

Guidelines for Charting: Legal Protection

Do not erase or whiteout an entry. Put a line through it, provide a reason, & sign your

initials

Never recopy or throw out the original

Never leave a blank space. Prevents others from tampering with your entry

Write neat & legibly – print if necessary

What are the Purpose of Charting or Documentation

1. Systematically communication patient’s condition and care.

2. Future reference and statistical purposes.

3. Demonstrate the decision making of nurses.


4. Basis of any investigation or professional liabilities.

5. Legal evidence.

WHAT IS INCIDENT REPORT?

Incident report or accident report is a form that is filled out in order to record details of

an unusual event that occurs at the facility, such as an injury to a patient. The purpose of

the incident report is to document the exact details of the occurrence while they are fresh

in the minds of those who witnessed the event. This information may be useful in the

future when dealing with liability issues stemming from the incident.

Documentation stating a report of a sudden unusual risk or occurrence.

Terms that a Nurse should know in Relationship with the Execution of last will and

testament

Will

The mental faculty by which one deliberately chooses or decides upon a course of action

Holographic Will.

The absence of any ritual value, may account for the fact that holographic wills are not

recognized in the majority of the states, and for some decisions, in states recognizing

them, requiring the most precise compliance with specified formalities.

Testator

Person making a will.

To make a valid will one must be of sound mind though s/he need not possess superior

or even average mentality. One is of sound mind for testamentary purposes only when

s/he can understand and carry out in his or her mind in a general way:

(1) The nature and extent of his property

(2) The persons who are the natural objects of his bounty, and

(3) The disposition which he is making of his property.

Noncupative Will


http://en.wikipedia.org/wiki/Document

http://en.wikipedia.org/wiki/Patient

The oral will is generally only effective to pass personal property, and the statutes in

many states impose a maximum limit, ranging from $200 to several thousand dollars, on

the amount of property that can be transferred.

The nuncupative device is usually useable only in situations of extreme emergency such

as an automobile accident followed by death within a few hours.

Living Wills"

Is the oldest type of health care advance directive.

1. The instruction directive (so-called living will) in which persons specify the type of care they

do or do not want should they become incompetent; and

2. The proxy directive (so-called durable power of attorney) in which persons designate

surrogates to make decisions should they ever be unable to do so.

Durable Power of Attorney

A Durable Power of Attorney for Health Care is a signed, witnessed (or notarized)

document in which the signer designates an agent to make health care decisions if the

signer is temporarily or permanently unable to make such decisions.

Durable powers of attorney under which the agent's authority continues even when his or

her principal has become incompetent. This is an agency relationship. There is also a

durable power of attorney for health care.

Self-Proved Will

By the self-proved will procedure, the witnesses' (and testator's) sworn testimony is

taken at the time of execution, thereby relieving the witnesses of the obligation to appear

at the probate proceeding, unless called to testify on some issue in dispute by one of the

parties.

It has been held that a self-proved will may not be contested in regard to signature

requirements and makes conclusive the presumption of proper execution that arises from

the presence of an attestation clause.


ADVANCE DIRECTIVE

Is a document by which a person makes provision for health care decisions in the event

that, in the future, he/she becomes unable to make those decisions?

Decedent

An individual who has died. The term literally means "one who is dying," but it is

commonly used in the law to denote one who has died, particularly someone who has

recently passed away.

A decedent's estate is the real and Personal Property that an individual owns upon his

or her death.

Succession

Mode of acquisition by virtue of which, properties right and obligation, to the extent of the

value of the inheritance of a person are transmitted to another throught his death.

Legal Doctrines Applied in Nursing Practice

Malpractice

Do things beyond your scope of practice”

Also denotes stepping beyond one’s authority with serious consequences.

Negligence

The commission of an act that a prudent person would not have done or the omission of

a duty that a prudent person would have fulfilled, resulting in Injury or harm to another

person. In particular, in a malpractice suit.

A professional person is negligent if harm to a client results from such an act or such

failure to act, but it must be proved that other prudent members of the same profession

would ordinarily have acted differently under the same circumstances.

Specific Examples of Negligence:

1. Failure to report observations to attending physicians.

2. Failure to exercise the degree of diligence which the circumstances of the particular case

demands.

3. Mistaken identity.


http://legal-dictionary.thefreedictionary.com/Personal+Property

4. Wrong medicine, wrong concentration, wrong route, wrong dose.

5. Defects in equipments that may result in injuring the patients.

6. Errors due to family assistance.

7. Administration of medicine without a doctor prescription.

The Doctrine of Res Ipsa Loquitor

“The thing speaks for itself.”

It means that the nature of the wrongful act or injury is suggestive of negligence

Three conditions are required to establish a defendant’s negligence without proving

specific conduct:

That the injury was of such nature that it would not normally occur unless there was a

negligent act on the part of someone.

That the injury was caused by an agency within the control of the defendant

That the plaintiff himself did not engage in any manner that would tend to bring about the

injury.

Doctrine of Force Majeure

It means an irresistible force, one that is unforeseen or inevitable.

“you cannot stop it from happening”

circumstances such as floods, fire, earthquakes and accidents fall under this doctrine

Doctrine of Respondeat Superior

“Let the master answer for the acts of the subordinate”

The liability is expanded to include the master as well as the employee and not a shift

of liability from the subordinate to the master

This doctrine applies only to those actions performed by the employee within the

scope of his employment

Incompetence

Is the lack of ability, legal qualifications or fitness to discharge the required duty.

Although a nurse is registered, if in the performance of her duty she manifests

incompetency, there is ground for revocation or suspension of her certificates of

registration.

Liability of Nurses for the Work of Nursing Aides

Nursing aides perform selected nursing activities under the direct supervision of

nurses.


Nurses should not delegate their functions to nursing aides since the Philippine

Nursing Act specifies the scope of nursing practice of professional nurses.

If a nurse delegates, he is responsible.

Liability for the Work of Nursing Students

Under the Philippine Nursing Act of 2002, nursing students do not perform

professional nursing duties.

They are to be supervised by their Clinical Instructors.

Consent

Is defined as a “free and rational act that presupposes knowledge of the thing which

consent is being given by a person who is legally capable to give consent.”

It is the NURSE who actually secures the consent of the patient upon admission.

Informed Consent

“It is established principle of law that every human being of adult years and sound

mind has the right to determine what shall be done with his on body”

Elements of Informed Consent

1. Diagnosis and explanation of the condition

2. A fair explanation of the procedures to be done and used and the consequences

3. A description of alternative treatment or procedures

4. A description of benefits to be expected

5. Material rights if any

6. The prognosis, if the recommended care, procedure, is refused.

Proof of Consent

A written consent should be signed to show that the procedure is the one consented

to and that the person understands the nature of procedure

A signed special consent is necessary before any medical or surgical treatment is don

such as x-rays.

Who Must Consent

Normally the patient himself is the one who gives the consent,


If he is incompetent (minors or mentally ill) or physically unable, consent must be

taken from another who is authorized to give it in his behalf.

Consent of Minors

Parents,or someone standing in their behalf

If emancipated minor consent is signed by them.

Consent of Mentally Ill

They cannot legally give consent. Parents or guardians.

Emergency Situation

When an emergency situation exists, no consent is necessary because inaction at

such time may cause greater injury.

Refusal to Consent

Patients other than those who are incompetent to give consent can refuse consent.

If refuses to sign, this should be noted in his chart

Consent for Sterilization

Is the termination of the ability to produce offspring.

The husband and wife must consent to the procedure if the operation is primarily to

accomplish sterilization.

If its medically necessary or an incidental result, the patient alone is sufficient.

Medical Records

As a record of illness and treatment, it saves duplication in future cases and aids in

prompt treatment

It serves as a legal protection for the hospital, doctor, and nurse by reflecting the

disease.

“If it was not charted, it was not observed or done.”

Nurses have the responsibility of keeping the patient’s right to confidentiality.

Permission has to be taken from the Medical Records Division of the Hospital.

Intentional Wrongs

nurse may be held liable for intentional wrongs.


Crimes Affecting the Nursing Profession

Torts

Is a legal wrong, committed against a person or property, independent of a contract

which renders the person who commits it liable for damages in a civil action.

The person who has been wronged seeks compensation for injury or wrong he has

suffered

Fraud

A false representation of a matter of fact whether by words or by conduct, by false or

misleading allegations.

Is commonly understood as dishonesty calculated for advantage.

Examples of Torts are:

1. Assault and Battery

Assault is the imminent threat of harmful or offensive bodily contact; “banta”

Battery is an intentional, unconsented touching of another person.

2. False Imprisonment or Illegal Detention

Unjustifiable detention of a person without legal warrant within the

boundaries fixed by the defendant by an act or violation of duty intended to

result in such confinement

Defamation

Types:

Slander is oral defamation of a person by speaking unprivileged or false

words by which his reputation is damaged.

Libel is defamation by written words, cartoons or such representations that

cause a person to be avoided, ridiculed or held in contempt or tend to injure

him in his work.

Felony

Refers to all Crimes punishable under Reversed penal code. ( Murder, Rape,

Homecide.)

Criminal offence

Is an act harmful not only to some individual, but also to the community or the state

(A public wrong). Such acts are forbidden and punishable by law.


http://en.wikipedia.org/wiki/Law

http://en.wikipedia.org/wiki/Wrong

Misdemeanor

Is any "Lesser" criminal act in some common law legal systems. Misdemeanors are

generally punished less severely than felonies, but theoretically more so than

administrative infractions (also known as Minor, petty or summary offences) And

regulatory offences. Many misdemeanors are punished with monetary fines.

Offenses lower than felonies and generally those punishable by fine,

penalty, Forfeiture, or imprisonment other than in a penitentiary. Under federal law, and

most state laws, any offense other than a felony is classified as a misdemeanor.

Classification of Felonies

1) Dolo (deceit)- Act is committed with deliberate intent.

2) Culpa (fault)- Act is committed with negligence, reckless, imprudence, lack of skill or

foresight.

Stage of Execution of a Felony

1. CONSUMMATED

All elements necessary for its execution and accomplishment are present.

2. FRUSTRATED

The offender has performed all the acts of execution to produce the felony as a

consequence but the crime does not result due to some cause independent of the will of

the offender.

3. ATTEMPTED

The offender begins the commission of the felony by direct overt acts but does not

perform all the acts of execution which should produce the felony as a consequence

by reason of some cause or accident other than his own spontaneous desistance.

Grave of Offense Committed

1) Grave- An excavation for the interment of a corpse


http://legal-dictionary.thefreedictionary.com/Forfeiture

http://en.wikipedia.org/wiki/Regulatory_offence

http://en.wikipedia.org/wiki/Summary_offence

http://en.wikipedia.org/wiki/Infraction

http://en.wikipedia.org/wiki/Felony

http://en.wikipedia.org/wiki/Punishment

http://en.wikipedia.org/wiki/Crime

2) Grave Coercion- Any person is prevented by another from doing something not

prohibited by law, or compelled to do something against his

or her will.

3) Grave Yard- A place where worn-out or obsolete equipment or objects are

kept

Degree of Participation of the Perpetrator

Principal

Is any actor who is primarily responsible for a criminal offense

First, highest, or foremost in importance, rank, worth, or degree

The Mastermind of Group

Accomplice

Is a person who actively participates in the commission of a crime, even though they

take no part in the actual criminal offense

Referred to as an abettor

Is an individual who participates in the commission of a crime knowingly, willingly, and

with common interest.

Accessory

Is a person who assists in the commission of a crime, but who does not actually

participate in the commission of the crime as a joint principal.

Usually participates after the crime was already committed.

Different Circumstances Affecting Criminal Liabilities

A. Justifying Circumstances

These are the defenses in which the accused is deemed to have acted in accordance

with the law and therefore the act is lawful. Since the act is lawful, it follows that there is

no criminal, no criminal liability and no civil liability,

Self-defense.


http://en.wikipedia.org/wiki/Crime

http://en.wikipedia.org/wiki/Abettor

http://en.wikipedia.org/wiki/Criminal_offense

B. Exempting Circumstances

These are defenses where the accused committed a crime but is not criminally liable.

There is a crime, and there is civil liability but no criminal.

Ex. Imbecile or insane person, mentally ill.

1. The basis is the lack of any of the elements which makes the act/omission voluntary,

i.e. freedom, intelligence, intent or due care.

2. These defenses pertain to the actor and not the act. They are personal to the accused

in whom they are present and the effects do not extend to the other participants. Thus if a

principal is acquitted, the other principals, accessories and accomplices are still liable.

3. They apply to both intentional and culpable felonies and they may be available in

violations of special laws.

D. Mitigating Circumstances

Those which when present results either to the penalty being reduced by at least one

degree of the penalty shall be imposed in its minimum period.

Ex. Older person age 70 years old because they cannot defend herself to the court

F. Aggravating Circumstances

Those which when present will result either to a change in the nature of the offense as to

make it more serious and result to the imposition of a higher penalty the penalty being

imposed in its maximum period.

Ex. Increase the penalty.

G. Alternative Circumstances

Those which may either be appreciated as mitigating or aggravating.

Ex. A. Intoxication

B. Relationship and Education.

Crime Affecting Nursing Profession

1) Abortion

Termination of Pregnancy before the fetus is viable. Usually occur during the first

12-24 weeks or 3-6 month of pregnancy.


Is the termination of pregnancy by the removal or expulsion from the uterus of

a fetus or embryo prior to viability.

2) Infanticide

Is the intentional killing of infants or killing within 24 hours of a child's birth, is

most commonly done by the mother whereas infanticide of a child more than one

day old is slightly more likely to be committed by the father.

3) Parricide

The act of murdering one's father (patricide), mother (matricide) or other close

relative, but usually not children (infanticide).

A person (such as the ruler of one's country) who stands in a relationship

resembling that of a father a person who commits such an act.

4) Murder

Is the unlawful killing, with malice aforethought, of another human, and generally

this premeditated state of mind distinguishes murder from other forms of

unlawful homicide (such as manslaughter).

The elements of common law murder are:

1. Unlawful

2. killing

3. of a human

4. by another human

5. With malice aforethought.

5) Homicide

Is the killing of a person in a ordinary manner of execution

6) Suicide

Is the act of intentionally causing one's own death. Suicide is often committed out

of despair, the cause of which is frequently attributed to a mental disorder such

as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse.

7) Robbery

Taking or attempting to take anything of value from a person by force or threat of

force or violence.


http://en.wikipedia.org/wiki/Substance_abuse

http://en.wikipedia.org/wiki/Alcoholism

http://en.wikipedia.org/wiki/Schizophrenia

http://en.wikipedia.org/wiki/Bipolar_disorder

http://en.wikipedia.org/wiki/Major_depressive_disorder

http://en.wikipedia.org/wiki/Mental_disorder

http://en.wikipedia.org/wiki/Despair_(emotion)

http://en.wikipedia.org/wiki/Manslaughter

http://en.wikipedia.org/wiki/Homicide

http://en.wikipedia.org/wiki/Malice_aforethought

http://en.wikipedia.org/wiki/Infanticide

http://en.wikipedia.org/wiki/Matricide

http://en.wikipedia.org/wiki/Patricide

http://en.wikipedia.org/wiki/Fetal_viability

http://en.wikipedia.org/wiki/Embryo

http://en.wikipedia.org/wiki/Fetus

http://en.wikipedia.org/wiki/Uterus

http://en.wikipedia.org/wiki/Pregnancy_(mammals)

8) Theft

Is the taking of another person's property without that person's permission

or consent with the intent to deprive the rightful owner of it.

9) Defamation

Also called calumny, vilification, or traducement is the communication of a

false statement that harms the reputation.

10) Fraud

A false representation of a matter of fact whether by words or by conduct, by

false or misleading allegations.


http://en.wikipedia.org/wiki/Consent

http://en.wikipedia.org/wiki/Property

LEADERSHIP

Is the process of persuasion and by example which an individual influences a group to

take actions that is in accordance with their common goal.

Can be demonstrated in formal or informal roles.

ELEMENTS OF LEADERSHIP

1. Leader – person who influences his/her members.

2. Followers – members, who are duty-bound to follow leader’s orders and give respect to

him.

3. Group – includes both the leader and members.

4. Process – the means, style, formula, policies used by both the leader and his followers

for the achievement of a common goal.

5. Goal – the purpose, objective or reason of the group.

THEORIES IN LEADERSHIP

Great-Man theory – it explains that leaders are born and not developed because some people

are born to be great leaders and not as subordinates. They were born with the capacity to

persuade, influence and motivate others. To be leader under this theory, experience or skill that

you may developed through the years is not an utmost consideration, if you were already born as

one. Great leaders are simply born with the necessary internal characteristics such as charisma,

confidence, intelligence, and social skills that make them natural-born leaders.

Trait Theory – it states that a person can be a good leader if he has the basic characteristics of a

leader. He must have the personality, intelligence and abilities of an effective leader. Acquisition

or development of said traits are important in becoming a good leader. Trait theories often identify

particular personality or behavioral characteristics shared by leaders. For example, traits like

extraversion, self-confidence, and courage are all traits that could potentially be linked to great

leaders.

Charismatic Theory – a good leader is one who has “charisma”, charm, inspirational quality,

devotion or referent power. Only some people has this power to make others feel better with their

so called “charisma”.

Situational Theory – it is a theory that states that a person can be a good leader in one situation

but only a follower in another situation. “Case-to-Case” basis of leadership. Leadership is a

relationship between the leader, his followers and the situation arising. There is no exact


leadership style, but as the situation so demands. Situational theories propose that leaders

choose the best course of action based upon situational variables. Different styles of leadership

may be more appropriate for certain types of decision-making.

Vroom-yetton Expectancy theory – the leader determines the amount of participation possible

in her group. The leader assists in choosing what leadership style depending on the acceptance

of said decision by the group.

Contingency theory – a nurse can be a leader if she can immediately resolve a sudden crisis,

emergency or critical situation. Introduces leadership utilizing three important dimensions; such

as leader-member relations, task structure and position-power. Contingency theories of

leadership focus on particular variables related to the environment that might determine which

particular style of leadership is best suited for the situation. According to this theory, no

leadership style is best in all situations. Success depends upon a number of variables, including

the leadership style, qualities of the followers and aspects of the situation.

Transformational Leadership Theory – give emphasis on the members’ values and

commitment to service. It depends on group empowerment to achieve a goal.

Transactional Leadership Theory – give emphasis to written or documented policies, rules and

regulations in influencing a group.

Fielder’s Theory – leadership based on the leader’s personality upon the particular needs of a

situation (fielder, 1967).

Path-Goal Theory – effective leadership style provides a path for members in attaining their

common goal.Behavioral Theory - Behavioral theories of leadership are based upon the belief

that great leaders are made, not born. Consider it the flip-side of the Great Man theories.

Participative Theory - Participative leadership theories suggest that the ideal leadership style is

one that takes the input of others into account. These leaders encourage participation and

contributions from group members and help group members feel more relevant and committed to

the decision-making process. In participative theories, however, the leader retains the right to

allow the input of others.

Management Theory – Management theories, also known as transactional theories, focus on

the role of supervision, organization and group performance. These theories base leadership on a

system of rewards and punishments.


http://psychology.about.com/od/leadership/f/transactional-leadership.htm

Relationship Theory - Relationship theories, also known as transformational theories, focus

upon the connections formed between leaders and followers. Transformational leaders motivate

and inspire people by helping group members see the importance and higher good of the task.

These leaders are focused on the performance of group members, but also want each person to

fulfill his or her potential. Leaders with this style often have high ethical and moral standards.

DIFFERENT STYLES OF LEADERSHIP

Authoritarian/Autocratic/Dictatorial/”Hard”Leader

One leadership style dimension has to do with control and one's perception of how much control

one should give to people. For example, the laissez faire style implies low control, the autocratic

style is high in control while the participative one lies somewhere in between. Kurt Lewin called

these control styles: authoritative, participative (democratic) or delegative (Laissez Faire).

The Coaching Style Of Leadership

A great coach is definitely a leader who also possess a unique gifts ability to teach and train.

Cross-Cultural Leadership

Not all individuals can adapt to the leadership styles expected in a different culture whether that

culture is organizational or national. In fact, there is some evidence that American and asian

leadership styles are very different, primarily due to cultural factors.

Emergent Leadership

Contrary to the belief of many, groups don't automatically accept a new "boss" as

leader. Emergent leadership is what you must do when one taking over a new group.

The Exchange Style

Sometimes known as leader-member exchange, the style involves the exchange of favors

between two individuals. An exchange can be hierarchical between the boss and subordinate or

occur between two individuals of equal status. For this leadership style to work, you need to know

how to develop, maintain and repair relationships.

Situational Leadership

leaders must adjust their leadership style to the situation as well as to the people being led.

Strategic Leadership


This is practiced by the military services such as the US Army, and many large corporations. It

stresses the competitive nature of running an organization and being able to out fox and out wit

the competition.

Team Leadership

A few years ago, a large corporation decided that supervisors were no longer needed and those

in charge were suddenly made "team leaders." Today, companies have gotten smarter about how

to exert effective team leadership but it still takes leadership to transition a group into a team.

Facilitative Leadership

This is a special style that anyone who runs a meeting can employ. Rather than being directive,

one using the facilitative leadership style uses a number of indirect communication patterns to

help the group reach consensus.

Servant Leadership Style

Some leaders have put the needs of their followers first.

The Transformational Leadership Style

The transformational style requires a number of different skills and is closely associated with two

other leadership styles: charismatic and visionary leadership.

POWER EXERCISED BY A LEADER

a. Legitimate power – vested upon a leader in relation with his position or rank. Sanctioned

by the institution itself.

b. Expert power – the power to control a group utilizing one’s extra ordinary or exceptional

knowledge or skill which is not ordinarily observed with other staff.

c. Referent power – based on special character and personality that empower him to

acquire the admiration and respect of members to achieve their respective goals and

functions.

d. Connection power – ability to influence others due to linkage to influential people. Being

a leader is based on “whom you know and not on one’s capacity or skills”.

e. Reward power – positive power of a leader to compensate or remunerate the

achievements of his staff.

f. Coercive power – fear, ability to punish, threat or duress is used to gain control.


SKILLS/QUALITIES OF A LEADER

1. AUTHORITY – is the legitimate right of a leader to exact obligations from his

subordinates. The ability of a leader to delegate tasks to his subordinate for its

compliance and discipline them for its non-compliance.

Accountability vs. Responsibility

- Responsibility is the personal or professional obligation and dependability to perform a

specific task.

- Accountability is the legal liability arising from any omission or improper performance of

any task or responsibility.

2. BEHAVIOR – behavior affects leadership. It is required that a leader must possess a

behavior which is group-centered.

Some positive behaviors of a leader includes the following:

- Vision

- Integrity

- Patience

- Passion

- Direction and purpose

- Ability to motivate

- Ability to motivate

- Ability to listen

- Trustworthy

- Critical thinker

- Intelligence

- Self confidence

- Flexibility

-

3. COMMUNICATION – is the transfer of information with understanding from one person to

another.


Phases of therapeutic Relationships:

a. Pre-interaction – occurs prior to any initial contact with a client. All relevant and

necessary information related to a certain client are collected and reviewed prior to any

initial meeting. Data could either be primary or secondary depending on its source.

b. Orientation – the stage where the caregiver and the client establishes rapport and trust.

They get to know each other better.

c. Interaction/working – one listens, understands and gives necessary feedback to client

as a means to show empathy and respect.

d. Termination – the client resolves his problems and conflicts resulting to an actual

fulfillment of one’s goals.

ELEMENTS OF COMMUNICATION PROCESS

a. Sender/encoder – the one who initiates the communication process in order to

transfer data or information to others.

b. Message – is the information or data to be transmitted by the sender to the receiver.

c. Encoding – the means used to convey the message to the receiver. Could be thru

verbal or non verbal means.

d. Actual transmission of message

e. Receiving – acceptance by the receiver of the message coming from the sender.

f. Decoding – refers to the receiver’s interpretation, perception, or actual

understanding of the message received. Affected by the situation, environment and

relationship between the sender and the receiver.

g. Feedback – the response or behavior of the receiver to any message received.

Response could either verbal or non verbal.

TYPES OF COMMUNICATION BEHAVIOR

Aggressive type

They talk loud, has inappropriate and confronting behavior. Usually hostile, egoistic and

sarcastic while communicating with others.


Passive type

They are usually shy, quiet, uninvolved, apologetic, regressive and easily manipulated by

others.

Assertive type

The most ideal behavior to communicate. It is balance between aggressive and passive

behavior. They have;

F – facial expression are appropriate

E – eye contact is proper

W – well-modulated voice

R – respect others while communicating

I – ideal in all situations

G – gestures are appropriate

H – honest statements

T – truthful remarks

S – spontaneous response

EFFECTIVE COMMUNICATION TECHNIQUES:

- Offering oneself

- Focusing on the client

- Clarifying

- Summarizing

- Using silence

- Open-ended questions

- Conveying acceptance

- Supporting

- Providing information

- Reflecting


BARRIERS TO EFFECTIVE COMMUNICATION

a. Psychological barriers – if a persons is under panic attack, state of phobias, extereme

anxiety, stress, grief, loss, intense fear or other emotional disturbances.

b. Environmental barriers – this may include noise, space and distance.

c. Disinterested listeners

d. Semantic barriers – a single message conveyed is subjected to two or more

interpretations by the receiver.

e. Physical barriers – defects in speaking, seeing, listening or cognitively impaired

individuals.

DIFFERENT CHANNELS OF COMMUNICATION

A. Downward communication – communication originates from people occupying top level

positions then transmitted down to their subordinates.

B. Upward communication – communication originates from the operational level and

proceeds up to the top level position.

C. Lateral communication – communication occurs between a sender and receiver having

equal position in the hierarchy. It is used to collaborate tasks, information and care plan.\

D. Diagonal communication – communication flows from people of different hierarchical

level but without any direct supervisor. (Sullivan and Decker, 2001).

4. DECISION MAKING – the process of providing resolution of conflicts or problems by

careful analyses of all possible information, data or alternative solution.

STAGES IN THE DECISION – MAKING PROCESS

a. Identify the problem with the group

b. Determine the people who would be directly or indirectly be affected by the problem

c. Gather all related data or information

d. Gather all possible remedies or options

e. Select the best

f. Implement the chosen solution

g. Develop a criteria for evaluation

h. Evaluate according to criteria established/controlling of outcome risk.

5. ETHICAL – to be an ethical nurse, he/she must have good manner and right conduct.

6. SOLVING CONFLICT

Conflict – clash of ideas resulting to possible crisis. Conflict must be resolve by the

leader because it hinders achievement of the goal.


Types of Conflict:

a. Intrapersonal – occurs within the person

b. Interpersonal – occurs between two individuals

c. Organization/interdepartmental – occurs between two or more groups,

departments, units.

DIFFERENT METHODS OF RESOLVING A CONFLICT

1. AVOIDANCE – the leader is passive as regards solving conflict.

2. BARGAINING/COMPROMISING – gives up something to gain something.

“although conflict occurs in an organization, it affects good relationship among

members of the group”

3. COMPETING – one who has an advantage takes opportunity to exploit others

party weakness by means of threat, coercion or fear.

4. SMOOTHING/ACCOMODATING – a party appease the other by using

conscientious efforts or kindness.

5. NEGOTIATION – the most advisable solution in resolving conflict.

Stages of Team Building

1. Forming

o The forming stage is when the group is created. Everyone is new to each other and feeling one

another out. At this stage, the leader is relied on heavily to maintain order and keep the group on

task. The team members may be hesitant to voice their input. They may also test the resolve of

their leader to see what they can and cannot get away with. Relationships start forming at this

stage.

Storming

o At this stage, each team member has a general idea of how the other team members operate.

Differences are brought into the open, and cliques may form at opposite ends around these

issues. Group members will also quarrel amongst themselves to set a pecking order or a

hierarchy of members; sometimes, a member will challenge the leader in an attempt to attain her

position within the team. The team will gain confidence with the help of the leader. The leadership

style in this stage should be similar to coaching.

Norming

o In the norming stage, ground rules are established. Group members have brought their concerns

out into the open and their differences have been resolved, often through some form of


compromise. The leader takes a less influential role and lets the group to work together as a unit.

The overall identity of the group takes shape, and each player finds her role within the unit.

Motivation naturally increases at this stage as results come more easily.

Performing

o The group finally begins to perform at its optimal level. People know each other’s roles and learn

how to pick up the slack when one team member lags behind. At this stage, the team has a

sense of purpose and direction. The leader delegates responsibilities with the knowledge that she

is giving the correct person the correct job. A sense of team is evident, and members look out for

one another. Decisions are made on the go, often not by the leader.

Adjourning

o This stage comes when the task has been completed and the team is disbanded. Questions

about where the next step will lead may reduce motivation and increase tension. Often group

members will feel a sense of disappointment when the team is adjourned. Sometimes this stage

is followed by another project; when this happens, re-forming occurs and the process starts over.


MANAGEMENT

The organization and coordination of the activities of a business in order to achieve defined objectives.

Management is often included as a factor of production along with‚ machines, materials, and money. According to the management guru Peter Drucker (1909-2005), the basic task of management includes both marketing and innovation. Practice of modern management originates from the 16th century study of low-efficiency and failures of certain enterprises, conducted by the English statesman Sir Thomas More (1478-1535). Management consists of the interlocking functions of creating corporate policy and organizing, planning, controlling, and directing an organization's resources in order to achieve the objectives of that policy.

The directors and managers who have the power and responsibility to make decisions and oversee an enterprise.

The size of management can range from one person in a small organization to hundreds or thousands of managers in multinational companies. In large organizations, the board of directors defines the policy which is then carried out by the chief executive officer, or CEO. Some people agree that in order to evaluate a company's current and future worth, the most important factors are the quality and experience of the managers.

Views on the definition and scope of management include:

Management defined as the organization and coordination of the activities of an enterprise in accordance with certain policies and in achievement of clearly defined objectives.

Fredmund Malik defines as Management is the transformation of resources into utility. Management included as one of the factors of production - along with machines,

materials and money Peter Drucker (1909–2005) sees the basic task of a management as twofold: marketing

and innovation. Nevertheless, innovation is also linked to marketing (product innovation is a central strategic marketing issue). Peter Drucker identifies marketing as a key essence for business success, but management and marketing are generally understood as two different branches of business administration knowledge.

Directors and managers should have the authority and responsibility to make decisions to direct an enterprise when given the authority.

As a discipline, management comprises the interlocking functions of formulating corporate policy and organizing, planning, controlling, and directing a firm's resources to achieve a policy's objectives

The size of management can range from one person in a small firm to hundreds or thousands of managers in multinational companies.

In large firms, the board of directors formulates the policy that the chief executive officer implements.

Theoretical scope

Management involves the manipulation of the human capital of an enterprise to contribute to the success of the enterprise. This implies effective communication: an enterprise environment (as opposed to a physical or mechanical mechanism), implies human motivation and implies some sort of successful progress or system outcome. As such, management is not the manipulation of a mechanism (machine or automated program), not the herding of animals, and can occur in either a legal as well as illegal enterprise or environment. Based on this, management must have humans, communication, and a positive enterprise endeavor. Plans, measurements, motivational psychological tools, goals, and economic measures (profit, etc.) may or may not be necessary components for there to be management. At first, one views management functionally, such as measuring quantity, adjusting plans, meeting goals. This applies even in situations where


planning does not take place. From this perspective, Henri Fayol (1841–1925) considers management to consist of six functions:

1. forecasting2. planning3. organizing4. commanding5. coordinating6. controlling

Fayol was one of the most influential contributors to modern concepts of management. In other way of knowledge: Mary Parker Follett (1868–1933), defined management as "the art of getting things done through people". She described management as philosophy.

Some people, however, find this definition useful but far too narrow. The phrase "management is what managers do" occurs widely, suggesting the difficulty of defining management, the shifting nature of definitions and the connection of managerial practices with the existence of a managerial cadre or class.

One habit of thought regards management as equivalent to "business administration" and thus excludes management in places outside commerce, as for example in charities and in the public sector. More broadly, however, every organization must manage its work, people, processes, technology, etc. to maximize effectiveness. Nonetheless, many people refer to university departments that teach management as "business schools". Some institutions (such as the Harvard Business School) use that name while others (such as the Yale School of Management) employ the more inclusive term "management".

English speakers may also use the term "management" or "the management" as a collective word describing the managers of an organization, for example of a corporation. Historically this use of the term often contrasted with the term "Labor" - referring to those being managed.

Nature of managerial work

In for-profit work, management has as its primary function the satisfaction of a range of stakeholders. This typically involves making a profit (for the shareholders), creating valued products at a reasonable cost (for customers), and providing rewarding employment opportunities for employees. In nonprofit management, add the importance of keeping the faith of donors. In most models of management and governance, shareholders vote for the board of directors, and the board then hires senior management. Some organizations have experimented with other methods (such as employee-voting models) of selecting or reviewing managers, but this is rare.

In the public sector of countries constituted as representative democracies, voters elect politicians to public office. Such politicians hire many managers and administrators, and in some countries like the United States political appointees lose their jobs on the election of a new president/governor/mayor.

Historical development

Difficulties arise in tracing the history of management. Some see it (by definition) as a late modern (in the sense of late modernity) conceptualization. On those terms it cannot have a pre-modern history, only harbingers (such as stewards). Others, however, detect management-like-thought back to Sumerian traders and to the builders of the pyramids of ancient Egypt. Slave-owners through the centuries faced the problems of exploiting/motivating a dependent but sometimes unenthusiastic or recalcitrant workforce, but many pre-industrial enterprises, given


their small scale, did not feel compelled to face the issues of management systematically. However, innovations such as the spread of Hindu-Arabic numerals (5th to 15th centuries) and the codification of double-entry book-keeping (1494) provided tools for management assessment, planning and control.

Given the scale of most commercial operations and the lack of mechanized record-keeping and recording before the industrial revolution, it made sense for most owners of enterprises in those times to carry out management functions by and for themselves. But with growing size and complexity of organizations, the split between owners (individuals, industrial dynasties or groups of shareholders) and day-to-day managers (independent specialists in planning and control) gradually became more common.

Early writing

While management (according to some definitions) has existed for millennia, several writers have created a background of works that assisted in modern management theories. Some ancient military texts have been cited for lessons that civilian managers can gather. For example, Chinese general Sun Tzu in the 6th century BC, The Art of War, recommends being aware of and acting on strengths and weaknesses of both a manager's organization and a foe's.

Various ancient and medieval civilizations have produced "mirrors for princes" books, which aim to advise new monarchs on how to govern. Examples include the Indian Arthashastra by Chanakya (written around 300BC), and The Prince by Italian author Niccolò Machiavelli (c. 1515).

Further information: Mirrors for princes

Written in 1776 by Adam Smith, a Scottish moral philosopher, The Wealth of Nations discussed efficient organization of work through division of labor. Smith described how changes in processes could boost productivity in the manufacture of pins. While individuals could produce 200 pins per day, Smith analyzed the steps involved in manufacture and, with 10 specialists, enabled production of 48,000 pins per day.

19th century

Classical economists such as Adam Smith (1723–1790) and John Stuart Mill (1806–1873) provided a theoretical background to resource-allocation, production, and pricing issues. About the same time, innovators like Eli Whitney (1765–1825), James Watt (1736–1819), and Matthew Boulton (1728–1809) developed elements of technical production such as standardization, quality-control procedures, cost-accounting, interchangeability of parts, and work-planning.

20th century

By about 1900 one finds managers trying to place their theories on what they regarded as a thoroughly scientific basis (see scientism for perceived limitations of this belief). Examples include Henry R. Towne's Science of management in the 1890s, Frederick Winslow Taylor's The Principles of Scientific Management (1911), Frank and Lillian Gilbreth's Applied motion study (1917), and Henry L. Gantt's charts (1910s). J. Duncan wrote the first college management textbook in 1911. In 1912 Yoichi Ueno introduced Taylorism to Japan and became first management consultant of the "Japanese-management style". His son Ichiro Ueno pioneered Japanese quality assurance.

The first comprehensive theories of management appeared around 1920. The Harvard Business School offered the first Master of Business Administration degree (MBA) in 1921. People like


Henri Fayol (1841–1925) and Alexander Church described the various branches of management and their inter-relationships. In the early 20th century, people like Ordway Tead (1891–1973), Walter Scott and J. Mooney applied the principles of psychology to management, while other writers, such as Elton Mayo (1880–1949), Mary Parker Follett (1868–1933), Chester Barnard (1886–1961), Max Weber (1864–1920), Rensis Likert (1903–1981), and Chris Argyris ( 1923) approached the phenomenon of management from a sociological perspective.

Peter Drucker (1909–2005) wrote one of the earliest books on applied management: Concept of the Corporation (published in 1946). It resulted from Alfred Sloan (chairman of General Motors until 1956) commissioning a study of the organization. Drucker went on to write 39 books, many in the same vein.

H. Dodge, Ronald Fisher (1890–1962), and Thornton C. Fry introduced statistical techniques into management-studies. In the 1940s, Patrick Blackett worked in the development of the applied mathematics science of operations research, initially for military operations. Operations research, sometimes known as "management science" (but distinct from Taylor's scientific management), attempts to take a scientific approach to solving decision problems, and can be directly applied to multiple management problems, particularly in the areas of logistics and operations.

Towards the end of the 20th century, business management came to consist of six separate branches, namely:

human resource management operations management or production management strategic management marketing management financial management information technology management responsible for management information systems

21st century

In the 21st century observers find it increasingly difficult to subdivide management into functional categories in this way. More and more processes simultaneously involve several categories. Instead, one tends to think in terms of the various processes, tasks, and objects subject to management.

Topics

Basic Functions:

Management operates through various functions, often classified as planning, organizing, staffing, leading/directing, and controlling/monitoring and motivation.

Planning: Deciding what needs to happen in the future (today, next week, next month, next year, over the next five years, etc.) and generating plans for action.

Organizing: (Implementation) pattern of relationships among workers, making optimum use of the resources required to enable the successful carrying out of plans.

Staffing: Job analysis, recruitment and hiring for appropriate jobs. Leading/directing: Determining what must be done in a situation and getting people to do

it. Controlling/monitoring: Checking progress against plans. Motivation: Motivation is also a kind of basic function of management, because without

motivation, employees cannot work effectively. If motivation does not take place in an


organization, then employees may not contribute to the other functions (which are usually set by top-level management).

Communicating: is giving, receiving, or exchange information. Creating: ability to produce original Idea, thought through the use of imagination

Basic roles

Interpersonal: roles that involve coordination and interaction with employees Informational: roles that involve handling, sharing, and analyzing information Decisional: roles that require decision-making

Management skills

Political: used to build a power base and establish connections Conceptual: used to analyze complex situations. Interpersonal: used to communicate, motivate, mentor and delegate Diagnostic: ability to visualize most appropriate response to a situation Technical: Expertise in one's particular functional area.

Formation of the business policy

The mission of the business is the most obvious purpose—which may be, for example, to make soap.

The vision of the business reflects its aspirations and specifies its intended direction or future destination.

The objectives of the business refer to the ends or activity that is the goal of a certain task.

The business's policy is a guide that stipulates rules, regulations and objectives, and may be used in the managers' decision-making. It must be flexible and easily interpreted and understood by all employees.

The business's strategy refers to the coordinated plan of action it takes and resources it uses to realize its vision and long-term objectives. It is a guideline to managers, stipulating how they ought to allocate and use the factors of production to the business's advantage. Initially, it could help the managers decide on what type of business they want to form.

Implementation of policies and strategies

All policies and strategies must be discussed with all managerial personnel and staff. Managers must understand where and how they can implement their policies and

strategies. A plan of action must be devised for each department. Policies and strategies must be reviewed regularly. Contingency plans must be devised in case the environment changes. Top-level managers should carry out regular progress assessments. The business requires team spirit and a good environment. The missions, objectives, strengths and weaknesses of each department must be

analyzed to determine their roles in achieving the business's mission. The forecasting method develops a reliable picture of the business's future environment. A planning unit must be created to ensure that all plans are consistent and that policies

and strategies are aimed at achieving the same mission and objectives.


All policies must be discussed with all managerial personnel and staff that are required in the execution of any departmental policy.

Organizational change is strategically achieved through the implementation of the eight-step plan of action established by John P. Kotter: Increase urgency, get the vision right, communicate the buy-in, empower action, create short-term wins, don't let up, and make change stick.

Policies and strategies in the planning process

They give mid and lower-level managers a good idea of the future plans for each department in an organization.

A framework is created whereby plans and decisions are made. Mid and lower-level management may add their own plans to the business's strategies.

Levels of management

Most organizations have three management levels: first-level, middle-level, and top-level managers. These managers are classified in a hierarchy of authority, and perform different tasks. In many organizations, the number of managers in every level resembles a pyramid. Each level is explained below in specifications of their different responsibilities and likely job titles.

Top-level managers The top consists of the board of directors (including non-executive directors and executive directors), president, vice-president, CEOs and other members of the C-level executives. They are responsible for controlling and overseeing the entire organization. They set a tone at the top and develop strategic plans, company policies, and make decisions on the direction of the business. In addition, top-level managers play a significant role in the mobilization of outside resources and are accountable to the shareholders and general public.

Middle-level managers consist of general managers, branch managers and department managers. They are accountable to the top management for their department's function. They devote more time to organizational and directional functions. Their roles can be emphasized as executing organizational plans in conformance with the company's policies and the objectives of the top management, they define and discuss information and policies from top management to lower management, and most importantly they inspire and provide guidance to lower level managers towards better performance. Their functions include:

Design and implement effective group and inter-group work and information systems. Define and monitor group-level performance indicators. Diagnose and resolve problems within and among work groups. Design and implement reward systems that support cooperative behavior.

First-level managers Consist of supervisors, section leads, foremen, etc. They focus on controlling and directing. They usually have the responsibility of assigning employees tasks, guiding and supervising employees on day-to-day activities, ensuring quality and quantity production, making recommendations, suggestions, and up channeling employee problems, etc. First-level managers are role models for employees that provide:

Basic supervision Motivation Career planning


Performance feedback

What do we mean by Management Theories?

Management theories are the set of general rules that guide the managers to manage an

organization. Theories are an explanation to assist employees to effectively relate to the

business goals and implement effective means to achieve the same.

General Management Theories:

There are four general management theories.

1. Frederick Taylor – Theory of Scientific Management.

2. Henri Fayol- Administrative Management Theory.

3. Max Weber - Bureaucratic Theory of Management.

4. Elton Mayo – Behavioral Theory of Management (Hawthorne Effect).

1. Frederick Taylor’s Theory of Scientific Management:

Taylor’s theory of scientific management aimed at, improving economic efficiency, especially labor productivity. Taylor had a simple view about, what motivated people at work, - money. He felt that, workers should get a, fair day's pay for a fair day's work, and that pay, should be linked to the amount produced. Therefore he introduced the, DIFFERENTIAL PIECE RATE SYSTEM, of paying wages to the workers.

Taylor's Differential Piece Rate Plan:

If Efficiency is greater than the defined Standard then workers should be paid 120 % of Normal Piece Rate.

If Efficiency is less than standard then workers should be paid 80% of Normal Piece Rate.

Principles of Scientific Management.

Four Principles of Scientific Management are:

1. Time and motion study: - Study the way jobs are performed and find new ways to do them.

2. Teach, train and develop the workman with improved methods of doing work. Codify the new methods into rules.

3. Interest of employer & employees should be fully harmonized so as to secure mutually understanding relations between them.

4. Establish fair levels of performance and pay a premium for higher performance.

2. Henri Fayol’s Administrative Management Theory:

Henri Fayol known as the Father of Management laid down the 14 principles of Management.-


1. Division of Work.

2. Equity.

3. Discipline.

4. Initiative.

5. Authority and Responsibility.

6. Esprit De Corps.

7. Subordination of Individual Interest to General Interest.

8. Stability of Tenure.

9. Remuneration.

10. Unity of Direction.

11. Centralization.

12. Scalar Chain.

14. Unity of Command.

3. Max Weber’s Bureaucratic Theory of Management:

Weber made a distinction between authority and power. Weber believed that power educes obedience through force or the threat of force which induces individuals to adhere to regulations. According to Max Weber, there are three types of power in an organization:-

1. Traditional Power2.Charismatic Power3.Bureaucratic Power or Legal Power.

Features of Bureaucracy:

1. Division of Labor.

2. Formal Hierarchical Structure.

3. Selection based on Technical Expertise.

4. Management by Rules.

5. Written Documents.

6. Only Legal Power is Important.

7. Formal and Impersonal relations.

4. Elton Mayo’s Behavioral Theory of Management:


Elton Mayo's experiments showed an increase in worker productivity was produced by the psychological stimulus of being singled out, involved, and made to feel important. Hawthorne Effect can be summarized as “Employees will respond positively to any novel change in work environment like better illumination, clean work stations, relocating workstations etc. Employees are more productive because they know they are being studied.

Reference: Learn more at www.technofunc.com.

Basic management models and theories associated with motivation and leadership and be able to apply them to practical situations and problems

Management and Change: Basic management models and theories associated with motivation and leadership

This section covers:

Classical Management Theory Human Relations Theory Neo-Human Relations Theory System Theory Classical Management Theory

Here we focus on three well-known early writers on management:

Henri Fayol FW Taylor Max Weber

Definition of management: Management takes place within a structured organizational setting with prescribed roles. It is directed towards the achievement of aims and objectives through influencing the efforts of others.

Classical management theory Emphasis on structure Prescriptive about 'what is good for the firm' Practical manager (except Weber, sociologist)

Henri Fayol (1841 - 1925), France

1.Division of workReduces the span of attention or effort for any one person or group. Develops practice and familiarity

2. AuthorityThe right to give an order. Should not be considered without reference to responsibility

3. Discipline Outward marks of respect in accordance with formal or


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informal agreements between firm and its employees

4. Unity of command One man superior

5. Unity of directionOne head and one plan for a group of activities with the same objective

6. Subordination of individual interests to the general interest

The interests of one individual or one group should not prevail over the general good. This is a difficult area of management

7. Remuneration Pay should be fair to both the employee and the firm

8. CentralizationIs always present to a greater or less extent, depending on the size of the company and quality of its managers

9. Scalar chainThe line of authority from top to bottom of the organization

10. OrderA place for everything and everything in its place; the right man in the right place

11. EquityA combination of kindliness and justice towards the employees

12. Stability of tenure of personnel

Employees need to be given time to settle into their jobs, even though this may be a lengthy period in the case of the managers

13. InitiativeWithin the limits of authority and discipline, all levels of staff should be encouraged to show initiative

14. Esprit de corpsHarmony is a great strength to an organization; teamwork should be encouraged

Advantages:

Fayol was the first person to actually give a definition of management which is generally

familiar today namely 'forecast and plan, to organize, to command, to co-ordinate and to

control'.

Fayol also gave much of the basic terminology and concepts, which would be elaborated upon

by future researchers, such as division of labor, scalar chain, unity of command and

centralization.


Disadvantages:

Fayol was describing the structure of formal organizations.

Absence of attention to issues such as individual versus general interest, remuneration and

equity suggest that Fayol saw the employer as paternalistic and by definition working in the

employee's interest.

Fayol does mention the issues relating to the sensitivity of a patients needs, such as initiative

and 'esprit de corps', he saw them as issues in the context of rational organizational structure

and not in terms of adapting structures and changing people's behavior to achieve the best fit

between the organization and its customers.

Many of these principles have been absorbed into modern day organizations, but they were not

designed to cope with conditions of rapid change and issues of employee participation in the

decision making process of organizations, such as are current today in the early 21st century.

F W Taylor - (1856 - 1915), USA- The Scientific Management School

Taylorism involved breaking down the components of manual tasks in manufacturing

environments, timing each movement ('time and motion' studies) so that there could be a proven

best way to perform each task. Thus employees could be trained to be 'first class' within their job.

This type of management was particularly relevant to performance drives e.g. 'Action On'

projects.

This was a rigid system where every task became discrete and specialized. It is fair to suggest

that this is unlikely to be of value to the NHS with the Modernization agenda suggesting that we

should have a flexible workforce.

Key points about Taylor, who is credited with what we now call 'Taylorism':

he was in the scientific management school

his emphases were on efficiency and productivity

but he ignored many of the human aspects of employment

For the managers, scientific management required them to:

develop a science for each operation to replace opinion and rule of thumb

determine accurately from the science the correct time and methods for each job (time and

motion studies)

set up a suitable organization to take all responsibility from the workers except that of the

actual job performance

select and train the workers (in the manner described above)


Accept that management itself be governed by the science deployed for each operation and

surrender its arbitrary powers over the workers, i.e. cooperate with them.

For the workers, scientific management required them to:

Stop worrying about the divisions of the fruits of production between wages and profits.

Share in the prosperity of the firm by working in the correct way and receiving wage increases.

give up their idea of time wasting and co-operate with the management in developing the

science

accept that management would be responsible for determining what was done and how

agree to be trained in new methods where applicable

The benefits (mainly for the management) arising from scientific management can be

summarized as follows:

its rational approach to the organizational work enables tasks and procedures to be measured

with a considerable degree of accuracy

measurement of paths and processes provide useful information on which to base

improvements in working methods, plant design, etc

improving work methods brought enormous increases in productivity

it enabled employees to be paid by results and to take advantage of incentive payments

it stimulated management into adopting a more positive role in leadership at shop floor level.

it contributed to major improvements in physical working conditions for employees

it provided the formation for modern work studies

The drawbacks were mainly for the workers:

it reduced the worker's role to that of a rigid adherence to methods and procedures over which

he/she had no discretion

it led to increased fragmentation of work due to its emphasis on divisional labor

it generated an economically based approach to the motivation of employees by linking pay to

geared outputs

it put the planning and control of workplace activities exclusively in the hands of the managers

it ruled out any realistic bargaining about wage rates since every job was measured and rated

'scientifically'

Max Weber (1864 - 1924), Germany

Bureaucracy in this context is the organizational form of certain dominant characteristics such as

a hierarchy of authority and a system of rules. Bureaucracy in a sense of red tape or officialdom


should not be used as these meanings are value-ridden and only emphasize very negative

aspects of the original Max Weber model. Through analyses of organizations Weber identified

three basic types of legitimate authority: Traditional, Charismatic, and Rational-Legal.

Weber presented three types of legitimate authority:

Traditional authority: where acceptance of those in authority arose from tradition and custom.

Charismatic authority: where acceptance arises from loyalty to, and confidence in, the personal

qualities of the ruler.

Rational-legal authority: where acceptance arises out of the office, or position, of the person in

authority as bounded by the rules and procedures of the organization.

The main features of bureaucracy according to Weber were:

a continuous organization or functions bounded by rules

that individuals functioned within the limits of the specialization of the work, the degree of

authority allocated and the rules governing the exercise of authority

a hierarchical structure of offices

appointment to offices made on the grounds of technical competence only

the separation of officials from the ownership of the organization

The authority was vested in the official positions and not in the personalities that held these

posts. Rules, decisions and actions were formulated and recorded in writing.

Human Relations Theories

Elton Mayo: Hawthorns studies Where Classical theorists were concerned with structure and

mechanics of organizations, the theorists of human relations were, understandably, concerned

with the human factors. The foci of human relations theory is on motivation, group motivation and

leadership. At the centre of these foci are assumptions about relationship between employer and

employee. Best summarized by Schein (1965) or Elton Mayo

they were academic, social scientists

their emphasis was on human behavior within organizations

they stated that people's needs are decisive factors in achieving an organization’s

effectiveness

they were descriptive and attempted to be predictive of behavior in organizations

A 'motive' = a need or driving force within a person.


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The process of motivation involves choosing between alternative forms of action in order to

achieve some desired end or goal:

Alternative forms of action of motivation depend on a manager's assumptions about his/her

subordinates:

Prime Motivators Theory

1. Rational- economic man

Self interest and maximization of gain

Basis of Classical, especially, Taylor/Scientific theory

2. Social manSocial need, being part of a group

Basis of Mayo

3. Self actualizing man

Self-fulfillment of individualMaslow, Likert, McGregor, Argyris, Herzberg

4. Complex manDepends on individual, group, task

'Systems approach'

Elton Mayo: Hawthorne Studies The ground-breaking Hawthorne studies carried out in the

Hawthorne plant of the Western Electric Company (USA) 1927 - 32.

Stage 1 (1924 -27)

Study of the physical surroundings (lighting level) on productivity of workers. Control group and

experimental group previously had similar productivity before study began

Control Group = constant lighting level

Experimental Group = varied lighting level


Result

both groups productivity increased - even when experimental group was working in dim light

Product leader called Mayo and colleagues to explain

Stage 2 (1927 - 29) 'Relay assembly room stage'

Still analyzing effect of physical surroundings (rest, pauses, lunch break duration, length of

working week) on output

Result

Output increased even when worsening conditions

Hypothesis was now that it was the attitudes of subjects at work and not the physical conditions.

This gave rise to the 'Hawthorne Effect' - employees were responding not so much to changes

in the environment as to the fact they were the centre of attention - a special group.

Stage 3 (1928 - 30)

A Total of 20,000 interviews were collected with the workers on employee attitudes to working

conditions, their supervision and their jobs.

Stage 4 (1932) 'Bank winning observation room'

this time the new subjects (14 men) put in separate room for six months

Result

Productivity restricted due to pressure from peers to adopt a slower rate to circumvent company

wages incentive scheme to generally adopt own group rules and behavior.

Advantages

first real attempt to undertake genuine social research in industrial setting

individuals cannot be treated in isolation, but function with group members

that individual motivation did not primarily lie in monetary or physical condition, but in need and

status in a group

the strength of informal (as opposed to formal) groups demonstrated a behavior of workers

(formal supervisors were powerless in Stage 4)

it highlighted need for supervisors to be sensitive and cater for social needs of workers within

the group

Disadvantages


from 1930s -1950s some doubt was cast on the increased applicability of these theories to

every day working life

Neo-Human Relations Theory This group was social psychologists who developed more complex theories:

Maslow McGregor (theory X and theory Y) Likert Argyris

Maslow is often-quoted still today, having developed a seminal theory of the needs of human

beings. Herzberg's and McGregor's neo-human relations theories both focus on motivation and

leadership, but their theories are, as we shall see, very different.

In this group we find a particular focus on human motivation including:

satisfaction

incentive

intrinsic

Maslow (1943)

1. This psychologist, from his studies, proposed a hierarchy of human needs building from basic

needs at the base to higher needs at the top.

2. Maslow made assumptions that people need to satisfy each level of need, before elevating

their needs to the next higher level e.g. a hungry person's need is dominated by a need to eat

(i.e. survival), but not to be loved, until he/she is no longer hungry.

3. Today the focus in most Western societies is on the elements towards the top of Maslow's

hierarchy - in which work environments and 'jobs' (including 'having a job' and the satisfaction

or otherwise such jobs provide - have become typical features. Notably the attainment of self-

esteem and, at the very top of the hierarchy, what Maslow calls 'self-actualization' -


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fundamentally the synthesis of 'worth', 'contribution' and perceived 'value' of the individual in

society.

McGregor (Theory X and Theory Y)

Managers were perceived by McGregor, whose theories are still often quoted, to make two

noticeably different sets of assumptions about their employees.

Theory X (essentially 'scientific' mgt) Theory Y

Lazy Like working

Avoid responsibility Accept/seek responsibility

Therefore need control/coercionNeed space to develop imagination/ingenuity

Schein type: 'rational economic man' Schein type: 'self-actualizing man'

Herzberg showed two categories of findings:

Motivators - factors giving rise to satisfaction

Hygiene factors - factors giving rise to dissatisfaction

Important Motivators Important Hygiene’s

Achievement Company policy and recognition

Recognition Supervision - the technical aspects

Work itself Salary

Responsibility Interpersonal relations - supervision

Advancement Working conditions

Likert Described 'new patterns of management' based on the behaviors’ of managers


Four main patterns:

1. Exploitative - authoritative where power and direction come from the top downwards', where threats and punishment are employed, where communication is poor and teamwork non-existent. Productivity is typically mediocre

'Rational economic man'

2. Benevolent - authoritative is similar to the above but allows some upward opportunities for consultation and some delegation. Rewards may be available as well as threats. Productivity is typically fair to good but at cost of considerable absenteeism and turnover

Weaker version of 'rational - economic man'

3. Consultative where goals are set or orders issued after discussion with subordinates, where communication is upwards and downwards and where teamwork is encouraged, at least partially. Some involvement of employees as a motivator

'social man'

4. Participative - group is reckoned by many to be the ideal system. Under this system, the keynote is participation, leading to commitment to the organization’s goals in a fully co-operative way. Communication is both upwards, downwards and lateral. Motivation is obtained by a variety of means. Productivity is excellent and absenteeism and turnover are low

Self - actualizing man(see also McGregor: theory Y)

Argyris study the needs of people; and the needs of organization. He felt that classical models of

organization promoted 'immaturity' (see below). He felt that it was important to understand the

needs of people and integrate them with needs of organization. Only in this way, he said, can

employees become co-operative rather than defensive or aggressive

Characteristics of EmployeeImmaturity Maturity

Passivity ---------------------------------------------------ActivityDependence--------------------------------------------------Relative independenceBehave in a few ways----------------------------------------Behave in many ways

Erratic, shallow interests----------------------------------Deeper interestsShort time perspective-------------------------------------Long time perspective

Subordinate position-------------------------------------------Equal or superior positionLack of awareness of self---------------------------------------Awareness and self control

System Theories

Attention began to focus on organizations as 'systems' with a number of inter-related sub-

systems. The 'systems approach' attempted to synthesize the classical approaches

( 'organizations without people') with the later human relations approaches that focused on the


psychological and social aspects, emphasized human needs - almost 'people without

organizations’. Systems theory focuses on complexity and interdependence of relationships.

A system is composed of regularly interacting or interdependent groups of activities/parts that

form the emergent whole. Part of systems theory, system dynamics is a method for

understanding the dynamic behavior of complex systems. The basis of the method is the

recognition that the structure of any system -- the many circular, interlocking, sometimes time-

delayed relationships among its components -- is often just as important in determining its

behavior as the individual components themselves. Early systems theorists aimed at finding a

general systems theory that could explain all systems in all fields of science. The term goes back

to Bertalanffys basic work 'General Systems Theory'. Sociologists like Niklas Luhmann also

worked towards a general systems theory. As of today, whilst no systems theory can live up to

this claims, there are general system principles which are found in all systems. For example,

every system is an interaction of elements manifesting as a whole. Miller and Rice likened the

commercial and industrial organisation to biological organisms. Systems theories took much more

of a holistic view of organizations, focusing on the total work organisation and the inter-

relationships between structures and human behaviors’ producing a wide range of variables

within organizations. They help us understand the interactions between individuals, groups,

organizations, communities, larger social systems, & their environments and help us enhance our

understanding of how human behavior operates in a context.

A system is a part, and it is a whole, at the same time. An example of this in the Modern NHS is

care pathways for patients which will often require a range of health disciplines to work together

and will often also include professionals from social services or the local authority as well.

System Theory Key Terms:

Boundary - an imaginary line around system of focus

Focal system - the system on which you are concentrating at any given time (eg: a

manufacturing plant or a family).

Subsystem - a part of the focal system (e.g., in a family, it may be children or parents),

sometimes referred to as 'sibling subsystem' & 'parental subsystem').

Supra system - is external to focal system; it is its environment. May include place of

employment, school, neighborhood, church, social service system.

Open system - Relatively open systems have a freer exchange of information and

resources within the system and also allow relatively free passage of energy from and to

the outside of the system.

Closed system - is more self-contained & isolated from their environment.


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RESEARCH

Experimental development comprise creative work undertaken on a systematic basis in order to increase the stock of knowledge, including knowledge of man, culture and society, and the use of this stock of knowledge to devise new applications

The word "research" is used to describe a number of similar and often overlapping activities involving a search for information.

is research that provides evidence used to support nursing practices. Nursing, as an evidence-based area of practice, has been developing since the time of Florence Nightingale to the present day, where many nurses now work as researchers based in universities as well as in the health care setting.

EVIDENCE-BASED PRACTICE (EBP)

EBM, a new paradigm in health care practice, is the integration of the best research evidence (clinically relevant patient-centered research) with clinical expertise (ability to use clinical skills and past experience for patient’s unique state and needs) and patient values (unique preferences, concerns and expectations of clients).

Fundamental Principles of EBP:

1. Evidence alone is never sufficient to make a clinical decision. Hence, clinicians must always trade the benefits and risks, inconveniences and costs associated with alternative management strategies, and in so doing consider the patient’s values.

2. EBM posits a hierarchy of evidence to guide clinical decision-making.The Five Steps of EBP Practice

1. Converting the need for information into answerable question/s.2. Tracking down best evidence (which will answer the question).


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3. Critically appraising evidence for its validity (closeness to truth), impact (effect), and applicability (usefulness).

4. Integrating the critical appraisal with clinical expertise and patients’ uniqueness.5. Evaluating effectiveness and efficiency.

The Focus Methodology for Performance Improvement

Focus on an opportunity for improvement

Organize a team

Clarity the current process

Understand the degree of change needed

Select a solution for improvement

Redesign

Plan

Do

Study

Act

Research is a systematic inquiry using scientific methods in answering questions or in solving problems. In nursing, it attempts to develop, refine and expand body of knowledge about matters that are important to the nursing profession (practice, education, administration).

Purpose of Nursing Research

Basic Research

To widen the knowledge base Formulation or refinement of theory For discovery of general principles

Applied Research

To find solutions for existing problems Focuses on factors which can be changed by intervention to achieve a desired goal For solving problems

Quantitative Research

Associated with positivist tradition 9there is reality out there that can be studied and known)

Gathers numerical values as its data Investigates concepts, construct and variables Uses deductive reasoning


Uses control (imposing condition so that biases are minimized and validity and precision are maximized)

Gathers empirical evidence 9from objective reality collected through senses) Takes place both in natural as well as in contrived laboratory setting

Qualitative Research

Associated with Naturalistic inquiry (reality is not a fixed entity but rather a construction of individual participating in research)

Gathers narrative description as its data Investigates phenomena and concepts Uses inductive process Uses subjectivity that enriches the analytical insights Gathers information, insights that lead to search for further evidence (subjective) Takes place in the field

Exploratory Research

Begins with a phenomenon of interest then investigates then investigates the full nature of the phenomenon, the manner in which it is manifested and the other factors to which it is related.

Explanatory Research

The goal is to understand the underpinnings of specific natural phenomena and to explain systematic relationships among phenomena.

Types of Quantitative Research

Descriptive research – Objective is accurate depiction of the characteristics of a person, situation or groups and or frequency with which certain phenomenon occurs.

Correlational research – Explores the interrelationship among variables of interest without any active intervention by the researcher.

Quasi-experimental research – Conducted to determine the effects of treatment or independent variables on the dependent or outcome variables. It lacks the control of the design, sample or setting.

Experimental research – It examines the cause-and-effect relationship between independent and dependent variables under highly controlled conditions.

Types of Qualitative Research

Phenomenological research – Concerned with lived experiences of humans. It is an approach to thinking about what life experiences of people are like and what they mean.

Grounded theory research – Seeks to describe and understand the key social psychological and structural processed that occur in a social setting. A major component is the discovery of a core variable that is central explaining what is going on in that social scene.

Ethnographical research – The primary research tradition within anthropology which provides a framework for studying the meanings, patterns, and experiences of a defined cultural group in a holistic fashion.

Historical research – Narrative description or analysis of events that occurred in the remote or recent past.


Case Studies – In-depth examinations and analysis of people or group of people in relation to nursing issues or problems that are important to the client and the researcher.

Field Studies – Natural investigations done in the community, such as in nursing homes, housing projects and clinical wards.

THE RESEARCH PROCESS

CONCEPTUAL PHASE

Problem Identification Statement of the Problem Hypothesis Conceptual and Theoretical Framework Significance of the Study Definition of Terms Scope and Limitation Review of Related Literature

DESIGN PHASE

Selecting research design Determining sampling technique Identifying method of data collection Conducting pilot study

IMPLEMENTATION PHASE

Developing a time table Appropriating a budget and/or seeking funds Recruiting and retaining subjects Data gathering and collation

ANALYSIS AND INTERPRETATION

Analyzing the data Interpreting and evaluating the findings the result of statistical treatments.

DISSEMINATION PHASE

Communicating the findings Utilizing research findings

Independent variables – The presumed causes (antecedent or influence to the dependent variable)

Dependent (criterion) variable – The presumed effect (output or outcome)

Intervening (extraneous or confounding) variable – Those ”in-between factors” present in research environment that threatens (cloud) the internal and external validity of the study.


Levels and Type of Evidence

Meta-analysis – Merging to findings from several controlled research studies Experimental Studies – Individual controlled, experimental research study Quasi-Experimental Studies – has less control over research variables Non-Experimental Studies – Does not have degree of control Program Evaluation, Research utilization – Literature review; Result from benchmaking Opinions (by experts) – Regarded as lowest level of evidence

ELITE Sources of Research Problems

Experience – the everyday practice of the nurse

Literature – the publication that suggest problem

Issues (social) – the global and community concerns

Theory – the test of what was earlier theorized

External Sources

HYPOTHESIS

Educated guess or tentative answer to a question that establishes the basis for statistical test.

Should be simple, specific and stated in-advance

Null Hypothesis

A negative statement which indicates that there is no association or relationship between & among variables

Formal basis for testing statistical significance (Ho) A positive research hypothesis that proposes association or significant relationship

between variables (Hay)

Directional Hypothesis (One-sided Alternative)

States whether the relationship between the variables is positive or negative; direct or inverse

Non-Directional Hypothesis (Two-sided Alternative)

Merely states the presence or absence of a relationship but does not specify the direction.

Research question: “Is there a relationship between the presence of an airbed and incidence of skin breakdown?” Independent variable – Presence of airbed; Dependent variable – incidence of


skin breakdown. Null Hypothesis: “There is no difference in incidence of skin breakdown between patients who are and who are not placed on air bed.

Alternative Hypothesis: “There is a significant difference in incidence of skin breakdown between patients who are and who are not placed in air bed.

Directional Hypothesis: “Comatose patients placed on an airbed will have a lower incidence of skin breakdown than those who are not.

Criteria for assessing the quality of a study

RELIABILITY – the accuracy and consistency of information obtained in the study

VALIDITY – The soundness of the evidence, measuring what it intends to measure

DEPENDABILITY – Consistency and stability of the evidence over time and over condition

CONFIRMABILITY – Objectivity

CREDIBILITY – Confidence in truth and interpretations (believability) of the data

TRIANGULATION – Use of multiple sources for conclusions

BIAS – Distorting or clouding influence that may come from research participants, subjective influences of researcher, sample and sampling technique, faulty data collection and design. Biases are controlled.

GENERALIZABILITY – The extent to which results can be applied to other groups

TRANSFERABILITY – The extent to which findings can be transferred to other settings.

Three Major Ethical Principles in Research

1. BENEFICENCE Protection of participants from physical and psychological harm Protection of participants from exploitation Performance of some good

2. RESPECT FOR HUMAN DIGNITYRight to self-determination (participants have the freedom to control their own activities, including study participation)Right of Self Disclosure (researcher have fully described to prospective participants their rights and nature of study)

3. JUSTICERight to fair treatmentRight to privacy (anonymity)


Confidentiality (safeguard the information participants provide)

RESEARCH DESIGN

Cross Sectional – Data are collected in one point in time

Longitudinal – Date are collected at two or more point in time over an extended period

Experimental – Manipulation of independent variables, control group, randomization

Quasi-experimental – Manipulation of independent variable, but no randomization or control group

Retrospective – Study begins with dependent variable and looks backward for cause of antecedent

Prospective – Study begins with independent variable and looks forward for the effect

SAMPLING

Population is the entire aggregation of cases in which research is interested

Sampling is the process of selecting a portion of the population who will serve as representative and/or respondents

Element is the most basic unit about which information is collected

Sample is the portion of a population from which data will be solicited for research purposes.

Probability Sampling

Involves random selection in choosing the elements

Researcher can specify the probability that each element of the population will be included in the sample/

There is less bias, as every element in the population has equal chance to be selected, but this is time-consuming, expensive and inconvenient


1. Simple Random Sampling – researcher establishes sampling frame (listing of elements), then numbering all elements, then selecting sample elements.)

2. Stratified Random Sampling – researcher divides the population into homogenous subgroups, from which elements are selected at random

3. Cluster (multistage) Sampling – researcher selects random samples successively from larger to smaller units by either simple or stratified random methods.

4. Systematic Sampling - researcher selects k case form a list (where , k = population divided by desired sample size); where k is the sampling interval (standard distance between the elements)

Non-probability Sampling

Does not involve random selection (non random methods)

The researcher cannot estimate the precise element of the population that will be included in the sample

It is convenient and economical; however, it is likely to produce biased samples

1. Convenience (accidental) Sampling – using most conveniently available people as participants

2. Snowballing (network or chain) Sampling – every sample identifies and refers other persons who meet the inclusion (eligibility) criteria

3. Quota Sampling – researcher identifies population strata (subpopulation) and determines how many participants are needed from each stratum.

4. Purposive (judgmental) Sampling – researcher decides purposely to select subject who are judged to be typical of the population or particularly knowledgeable about the issues under study.

METHODS OF DATA COLLECTION

1. Use of already existing or available dataa. Raw Data – from basic documents such as records of patient admission, birth dates,

discharges, etc.b. Tabular Data – indicating number of patients admitted or discharged in a year or

month or total number of deliveries, surgeries, or workload of nurses.2. Use of observer’s data – gathered through actual observation and recording of events.

Subjects must be informed for ethical consideration.

TYPES OF OBSERVER

Non-participant – observer does not share the same environment with the subjects and is not a member of the group.

Participant – observer shares the same environment and is better acquainted without their knowledge.

Overt

The observer identifies herself and her task of conducting research and informs the subject of the types of data being collected.


The observer is involved with the subject and has full knowledge and awareness of the subject to be observed.

Covert

The observer does not identify himself to the subject he will observe

Observer interacts with the subjects and observes their behavior without their knowledge

3. Use of Self-Recording or Reporting Approach – uses a specifically prepared document intended to collect data called instruments.

Types of Research Instrument

Questionnaire – a paper-and-pencil approach where participants are asked to answer a set of questions, it is the most frequently used research instrument to gather the needed data from the respondents pertinent to the purpose of the study.

Scanning Questionnaire – a software can scan questionnaire and produce files in a survey system.

Interview Guide – one-on-one dialogue with the subject, asks or reads a questions to elicit answer from the latter.

Methods of Interview

Personal Interview – the interviewer asks the questions facing the interviewee

Telephone Surveys – most popular method where people can be easily contacted.

Mail Surveys – allows the respondent to answer at their most convenient time, it is non-intrusive and the least expensive method

Computer Direct Interviews – interviewees enter their own answer directly into the computer.

E-mail Surveys – it is efficient and economical, more people have full internet access with no cost involved once set-up is complete.

Internet/Intranet (Web Page) Surveys – questions are posted on the website which can gather thousands of responses with a few hours.

4. Anecdotal Method and other Documentary Materials5. Mechanical Instruments (X-rays, ultrasound machines, BP apparatus, videos,

teleconferencing, etc.)

STATISTICAL METHODS

MEASURES OF CENTRAL TENDENCIES

1. Mode –the number that occurs most frequently (simplest measure of central tendency)


2. Median – divides the distribution at the 50th percentile (the number above which and below which half the observations fall)

3. Mean – the arithmetic average (summation of all scores divided by the number of cases) “Most reliable, stable and best measure and most useful summary statistics.

MEASURE OF DISPERSION

1. Range – simplest and easiest measure of variability distance between the highest and lowest scores in a distribution

2. Standard Deviation – a measure of spread of scores- Number indicating how closely the scores are clustered around the mean

3. Variance – mathematical index of the average distance of the scores on an interval or ratio scale from the mean in squared units – square of the standard deviation (mean square)

MEASURES OF DEGREE OF ASSOCIATION

1. Correlation – reflect relationship (degree of association) between two variables.Pearson CorrelationSpearman Rank Correlation(+/-) 1.0 is perfect correlation

2. Regression – a method of determination of the specific function relating one variable with anotherLinear regression; Multiple regression; partial regression, curvilinear regression

Commonly Used Statistical Methods

T-test – designed to examine statistical difference between two means

Z-test – Used to test the significant difference between means from totally different and unrelated groups

Chi-square (x2) – a descriptive measure of the discrepancy values between observed frequency and expected frequency

Analysis of Variance (ANOVA) – inferential statistics that is same as t-test but more versatile because it can be used to compare two or more groups. Used to determine the significance between the means of a number of different populations.


mark,, c.a2

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