NCM 119 LEC - Nursing Leadership & Management PDF

NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1...

NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1 millions of people to action, preaching a message of love, tolerance and avoiding greed CONCEPTS OF LEADERSHIP AND MANAGEMENT LEADERSHIP WINSTON CHURCHILL Winston Churchill is long remembered as one of  Leadership conjures up a variety of thoughts, the greatest leaders in modern history and the reflections and images. savior of democracy.  These may include power, influence, He was tasked with the daunting task of leading followership, dynamic personality, charisma, Britain and the Allied powers to victory against goals, autocratic behaviour, innovation, the Nazis during the Second World War. cleverness, warmth and kindness (Curtis, de Vries & Sheerin, 2011) MARTIN LUTHER KING JR  ‘The process by which an agent induces a “I have a dream that my four children will one subordinate to behave in a desired manner.’ day live in a nation where they will not be judged (Bennis, 1959) by the color of their skin but by the content of  ‘Leadership…is the ability to influence people their character.” – Martin Luther King Jr toward attainment of goals.’ (Daft, 2000) Very few Americans are as celebrated as Martin  ‘Leadership is defined as influence, that is, the Luther King Jr., the Baptist minister and social art or process of influencing people so that they activist who led the Civil Rights Movement in the will strive willingly and enthusiastically toward United States until his tragic death in 1968. the achievement of group goals.’ (Weihrich and Koontz, 2005) NELSON MANDELA  ‘Leadership involves the use of interpersonal He is South Africa’s first democratically elected skills to influence others to accomplish a specific President goal.’ (Sullivan and Garland, 2010) Much like Martin Luther King, Jr., Mandela was  A common theme that seems to run through one of the great transformative civil rights many definitions is that ‘leadership involves leaders of the 20TH century. influencing the attitudes, beliefs, behaviours and feelings of other people’(Spector, 2006). MOTHER THERESA  Although these definitions may be confusing, it is worth noting that there is no one correct He is South Africa’s first democratically elected definition of leadership. This vast range of President definitions can contribute to a greater Much like Martin Luther King, Jr., Mandela was understanding of the many factors that influence one of the great transformative civil rights leadership, as well as provide different leaders of the 20TH century. perspectives of the concept (Hughes et al, 2006). MANAGEMENT LEADERS > is defined as the coordination and integration of resources through planning, organizing, coordinating, MAHATMA GHANDI directing, and controlling to accomplish specific institutional goals and objectives. The leader in India’s Independence movement  Hersey and colleagues (2013) defined Form non-violent civil disobedience management as the “process of working with Gandhi is today remembered for his and through individuals and groups and other commitment to pacifism, peaceful protest and resources (such as equipment, capital, and simple living. He single-handedly inspired technology) to accomplish organizational goals”. 1|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1  They identified management as a special kind of 8. Mutually beneficial supplier relations leadership that concentrates on the achievement of organizational goal (Huber, Principle 1: Customer focus 2011).  The first, and arguably most important principle, argues that a business wouldn’t exist without its LEADER VS. MANAGER customers.  Therefore, organisations should strive to LEADER MANAGER understand their current and future customers,  Leaders create a  Managers create in order to better meet their requirements and vision goal expectations.  Leaders are  Managers  Key benefits of cultivating good customer change agents maintain the relationships include an increased market share  Leaders are status quo and boost to revenue, as well as improved unique  Managers copy customer loyalty.  Leaders take risks  Manages control  Leaders are in it risk  If you are seen as understanding and reacting for the long haul  Managers think appropriately to consumer demand, the success  Leaders grow short-term of your business is pretty much guaranteed, so personally  Managers rely on it’s worth paying close attention to this principle.  Leaders build existing, proven relationships skills  Leaders coach  Managers build Principle 2: Leadership  Leaders create systems and  This principle extols the virtues of strong, fans processes purposeful and unifying leadership.  Leaders think  Managers direct  Leaders are responsible for creating a productive ideas  Managers have and progressive business environment. They also employees are in charge of ensuring that future hires  Managers think maintain that atmosphere. execution  Implementing this principle in your workplace relies upon having an established vision for the business, as well as the right leaders in place to promote that vision to the rest of the team. UNIVERSAL PRINCIPLES OF MANAGEMENT  Spending some time getting this right from the get-go will save you time and stress in the future. What is “Principles of Management”? - Management principles are the statements of fundamental truth based in logic which provides Principle 3: People involvement guidelines for managerial making and actions.  Just as your business would be nowhere without a customer base, it also wouldn’t get very far The 8 universal principles of quality management without a balanced, multi-skilled team either. 1. Customer focus  Employees at every level of the organisation are 2. Leadership crucial to its success, and this principle is all 3. People involvement about recognising that. 4. Process approach  As an employer it's vital to ensure that your team 5. Systematic approach to management are motivated and engaged, not just in their day- 6. Continual improvement to-day responsibilities, but also in the company 7. Factual approach to decision making as a whole. 2|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1  For this to happen, staff need to understand the  Continual progress is a permanent goal of any importance of their role and how it fits into wider successful organisation. Take a look at the company objectives, as well as take responsibility world’s top 10 most prosperous organisations for any problems that might impede them from and you can guarantee that they have entire doing their job to the best of their abilities. teams dedicated to ensuring that they are always onto the next thing.  Commitment to improvement also allows you to Principle 4: Process approach be the market leader, as you’ll be the ones  A process-driven approach can help companies setting the agenda, rather than playing catch-up to avoid logistical problems that often stem from to your competitors. confusion over the right way to go about things.  It also future-proofs your business, as having set processes ensures that there’s no moment of flat Principle 7: Factual Approach to Decision Making panic when a key team member moves on,  This principle states that effective decisions are leaving everyone in the dark about key elements made based on rational analysis of data. of their job.  Whilst a gut feeling can be useful in some  Developing processes for every area of your situations, it won’t really stand up when you’re business, from sales to marketing, finance to HR, explaining to your board of investors why your will ensure that resources are used most profits are down by 10% this year. effectively, resulting in cost-effective and  Before making any business decisions, big or consistent results. small, ensure that you have all the facts. That  It also allows you to dedicate time and attention way, if you’re ever questioned about why you to bigger and more exciting tasks! made a certain decision, or asked to prove how that decision benefits your business, you’ll have all the data at your fingertips to fall back on. Principle 5: Systematic approach to management  This principle also relies upon having access to  This principle is linked to the previous one, and reliable and accurate data, another vital aspect argues that identifying, understanding and for a modern-day business. managing processes using a clear system will help to streamline your business.  By ensuring that team members are dedicating Principle 8: Mutually Beneficial Supplier Relations the right amount of attention to key tasks, you’ll  Okay, so you’ve got a fantastic management eliminate wasted time and make your business system, excellent customer relationships and a more efficient. comprehensive business plan.  A systematic approach also allows everyone to  There’s one thing missing – what are you have access to every stage of certain processes delivering to your customers? and stay up to date with progress.  Whether your business provides goods or  Plus, it looks great for prospective new clients services to customers, it’s likely you’ll rely on when your business is organised. Win-win. some sort of supplier.  This principle dictates that relationships between your company and any suppliers must Principle 6: Continual improvement be mutually beneficial in order to add value to  As the old adage goes, if you’re not going both parties. forwards, you’re going backwards. A business  It allows both of you to react more quickly and should always be pushing for improvements, flexibly to customer demands if things are because if you’re not, you can bet that your competitors will be. 3|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1 smooth and harmonious between you, as well as making it easier to negotiate on costs. 4|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1  They are defined as different combinations of LEADERSHIP THEORIES task and relationship behaviors used to influence others to accomplish goals. OVERVIEW I. Early Leadership Theories 1. AUTHORITARIAN A. Great Man Theory  Uses primarily directive behaviors. B. Trait theories  Decisions of policy are made solely by Authoritarian the leader who tends to dictate tasks and Democratic techniques to followers. Laissez-Faire  Leaders tell the followers what to do and II. Contemporary Leadership Theories how to do it. A. Quantum Leadership  This style can create hostility and B. Transactional Leadership dependency among followers; it may C. Transformational Leadership also stifle creativity and innovation. On D. Shared Leadership the other hand, this style can be very E. Servant Leadership efficient, especially in a crisis. F. Emotional Leadership 2. DEMOCRATIC  This approach implies a relationship and I. EARLY LEADERSHIP THEORIES person orientation. Policies are a matter of group discussion and decision. A. GREAT MAN THEORY  The leader encourages and assists  this theory assumed that all leaders were men discussions and group decision-making. and all were great.  Human relations and teamwork are the  Those who assumed leadership roles were focus. determined by their genetic and social  The leader shares responsibility with the inheritance. followers by involving them in decision  It was not conceivable that those from the making. “working class” could be leaders, that  In nursing, interdisciplinary teamwork is leadership could be learned or that women a major element in effectiveness. could be leaders.  The democratic style makes output appear to move more slowly and is thought to take longer than using an B. TRAIT THEORIES authoritarian style.  theorist have sought to understand leadership  Group consensus needs time and by examining the characteristics of leaders. facilitation to be fostered. Intergroup  Leaders arise in a context, and they are said to cohesion is a focus with this style. be made, not born. They appear to learn leadership skills in stages. 3. LAISSEZ-FAIRE  Thus, leadership skills can be both taught and  This style promotes complete freedom learned. It is important for nurses to recognize from group or individual decisions. that they can learn, practice, and improve their  There is a minimum of leader personal leadership competencies. participation.  Leadership theory began to move beyond a focus  A leader using this style may seem to be on traits to explore the concept of leadership apathetic. Because the style is based on styles. 5|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1 noninterference, a clear decision may never be formulated. II. CONTEMPORARY LEADERSHIP THEORIES  It results in a decision, conscious or otherwise, to avoid interference and let A. QUANTUM LEADERSHIP events take their own course.  is based on the concepts of chaos theory.  The leader is either permissive and  Is the process of leading from the future fosters freedom or in inept at guiding a  Reality is constantly shifting, and levels of group. complexity are constantly changing.  Followers may need greater structure  Movement in one part of the system than the leader gives them. reverberates throughout the system. Roles are  Despite its potential drawbacks, this fluid and outcome oriented. style has advantages when used with  It matters little what you did; it only matters what groups of fully independent care outcome you produced. providers or professionals working  Within this framework, employees become together. directly involved in decision making as equitable and accountable partners, and managers assume more of an influential facilitative role, rather C. BEHAVIORAL THEORIES than one of control (Porter-O’Grady & Malloch,  In this view, personal traits provide only a 2010). foundation for leadership; real leaders are made  Fundamental requirements of quantum through education, training and life experiences. leadership: o Acting with moral purpose to make a positive difference in the lives of D. CONTINGENCY THEORIES organizational members and soceity as a  This suggest that managers adapt their whole. leadership styles in relation to changing o Building relationships that nurture both situations. individuals and organization.  Leadership behaviors range from authoritarian o Patients and staff alike can access untold to permissive and vary in relation to current amounts of information. The challenge, needs and future probabilities. however, is to assist patients,  A nurse manager may use an authoritarian style uneducated about health care, how to when responding to an emergency situation such evaluate and use the information they as a cardiac arrest but use a participative style to have. Because staff have access to encourage development of a team strategy to information only the leader had in the care for patients with multiple system failure. past, leadership becomes a shared activity, requiring the leader to possess excellent interpersonal skills. B. TRANSACTIONAL LEADERSHIP  Is based on the principles of social exchange theory.  The primary premise of social exchange theory is that individuals engage in social interactions expecting to give and receive social, political, and psychological benefits or rewards. 6|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1  The exchange process between leaders and  They foster followers’ inborn desires to pursue followers is viewed as essentially economic. higher values, humanitarian ideals, moral Once initiated, a sequence of exchange behavior missions, and causes. Transformational leaders continues until one or both parties finds that the also encourage others to exercise leader- ship. exchange of performance and rewards is no  The transformational leader inspires followers longer valuable. and uses power to instill a belief that followers  The nature of these transactions is determined also have the ability to do exceptional things. by the participating parties’ assessments of what  Transformational leadership may be a natural is in their best interests; for example, staff model for nursing managers, because nursing respond affirmatively to a nurse manager’s re- has traditionally been driven by its social quest to work overtime in exchange for granting mandate and its ethic of human service. special requests for time off.  In fact, Weberg (2010) found that  Leaders are successful to the extent that they transformational leadership reduced burnout understand and meet the needs of followers and among employees, and Grant et al., (2010) use incentives to enhance employee loyalty and reports transformational leadership positively performance. affected the practice environment in one medical  Transactional leadership is aimed at maintaining center. equilibrium, or the status quo, by performing  Transformational leadership can be used work according to policy and procedures, effectively by nurses with clients or coworkers at maximizing self-interests and personal rewards, the bedside, in the home, in the community emphasizing interpersonal dependence, and health center, and in the health care routinizing performance (Weston, 2008). organization. D. SHARED LEADERSHIP C. TRANSFORMATIONAL LEADERSHIP  Reorganization, decentralization, and the  It goes beyond transactional leadership to inspire increasing complexity of problem solving in and motivate followers (Marshall, 2010). health care have forced administrators to  Transformational leadership emphasizes the recognize the value of shared leadership, which importance of interpersonal relationships. is based on the empowerment principles of  Transformational leadership is not concerned participative and transformational leadership with the status quo, but with effecting (Everett & Sitterding, 2011). revolutionary change in organizations and  Essential elements of shared leadership are human service. relationships, dialogues, partnerships, and  Whereas traditional views of leadership understanding boundaries. emphasize the differences between employees  The application of shared leadership assumes and managers, transformational leadership that a well-educated, highly professional, focuses on merging the motives, desires, values, dedicated workforce is comprised of many and goals of leaders and followers into a leaders. common cause. The goal of the transformational  It also assumes that the notion of a single nurse leader is to generate employees’ commitment to as the wise and heroic leader is unrealistic and the vision or ideal rather than to themselves. that many individuals at various levels in the  Transformational leaders appeal to individuals’ organization must be responsible for the better selves rather than these individuals’ self- organization’s fate and performance. interests.  Different issues call for different leaders, or experts, to guide the problem-solving process. 7|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1  A single leader is not expected always to have that spills over into future interactions. Or the knowledge and ability beyond that of other reverse. members of the work group.  A positive experience lightens the mood and  Appropriate leadership emerges in relation to affects the next encounter. When people feel the current challenges of the work unit or the good, they work more effectively. organization.  Emotional intelligence has been linked with  Individuals in formal leadership positions and leadership (Antonakis, Ashkanasy, & Dasbor- their colleagues are expected to participate in a ough, 2009; Cote et al., 2010; Lucas, Spence- pattern of reciprocal influence processes. Laschinger, & Wong, 2008).  One study, however, found no relationship between emotional intelligence and E. SERVANT LEADERSHIP transformational leadership (Linde- baum &  Founded by Robert Greenleaf (Greenleaf, 1991), Cartwright, 2010). servant leadership is based on the premise that  Nurses, with their well-honed skills as leadership originates from a desire to serve and compassionate caregivers, are aptly suited to this that in the course of serving, one may be called direction in leadership that emphasizes to lead (Keith, 2008; The Greenleaf Center for emotions and relationships with others as a Servant Leadership, 2011). primary attribute for success.  Servant leaders embody three characteristics:  These skills to better with the more o Empathy contemporary relationship-oriented theories as o Awareness well. Thus, the workplace is a more complex and o Persuasion (Neill & Saunders, 2008) intricate environment than previously suggested.  Servant leadership appeals to nurses for two reasons: o First, our profession is founded on principles of caring, service, and the growth and health of others (Anderson et al., 2010). o Second, nurses serve many constituencies, often quite selflessly, and consequently bring about change in individuals, systems, and organizations. F. EMOTIONAL LEADERSHIP  Emotional intelligence involves personal competence, which includes self-awareness and self-management, and social competence, which includes social awareness and relationship management that begins with authenticity.  Goleman (2007) asserts that attachment to others is an innate trait of human beings.  Thus, emotions are “catching.” Consider a person having a pleasant day. Then an otherwise innocuous event turns into a negative experience 8|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1 2. General Administrative Theory Henri Fayol (1841-1925) was a Frenchman who MANAGEMENT THEORIES is remembered for the development of general OVERVIEW administrative theory. He developed his I. Early Management Theories management strategy in the mining industry. A. Traditional Management, according to Fayol’s work, The Scientific Management includes 5 overriding concepts: Movement prevoyance, or the anticipation of the General Administrative Theory future and the development of a plan of Bureaucratic Management action to deal with it; B. The Behavioral Management organization of people and materials; Movement command of the activity among C. Theory Z: Japanese Management personnel; Style coordination of the parts of the organization into a unified whole; II. Contemporary Management Theories control through application of rules and A. Contingency Theory procedures. B. Systems Theory In order for an organization to be productive C. Complexity Theory leaders must participate actively in all five of D. Chaos Theory these areas. These principles introduced some ideas that continue to be used. In the 21st century, hospital personnel I. EARLY MANAGEMENT THEORIES departments continue to have a pay scale that strives to provide far remuneration based on A. TRADITIONAL educational preparation and years of experience. Every organization strives to retain its staff 1. The Scientific Management Movement because of the cost of recruiting, training, and Frederick Winslow Taylor (1856-1915) is known orienting new employees. as the father of scientific management. He The development of “esprit de corps”, or team detailed his principles on increasing the spirit, continues to be important in todays productivity of workers in the Midvale Steel workplace. Teamwork remains essential to Works plant in Pennyslvania. providing optimal patient care, and high morale The industrial Revolution gave rise to large is conducive to the levels of collaboration and factories and created the need to organize the team work that are required in the complex efforts of the superviors and workers in the health care environment. factories. Patient care is delivered by a collaborative team Taylor’s scientific management principles were of knowledge workers including nurses, based on managing time, materials and work physicians, and therapists from a variety of specialization. disciplines, all of whom are necessary to the He developed the concept of time and motion outcome of optimal patient care. study, with the idea that wasted time and effort could and should be eliminated. This was used in 3. Bureaucratic Management hospital facilities in 1980’s to determine  Max Weber (1846-1920) was a German patient:nurse ratios and staffing needs. sociologist who developed what was known as the “ideal bureaucracy”. 9|P LS D O N OT SHA RE T HE FI LE NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1  The ideal bureaucracy includes the concepts of Subsequently, he lowered the light levels, and division of labor, authority hierarchy, formal yet worker productivity continued to improve. selection, formal rules and regulations, His conclusion was that the environmental impersonality, and career orientation. changes were not responsible for the increasing  Within health-care organizations today, one sees level of productivity but rather the fact that the the continuing influence of traditional workers received attention from the management theory in, for example, job experimenters, which increased levels of self- descriptions that outline the responsibilities of esteem and group pride, which led to increased each person, thereby dividing the labor, and in production. organization charts that depict the hierarchical It was from this study that Mayo concluded that structure and the areas of authority for management must be concerned with particular positions. preserving the dignity of the workers,  Job descriptions emphasize the functions to be demonstrating appreciation for their associated with each job, and one of the accomplishments and, in general, recognizing functions of the manager is to avoid overlap workers as social beings with social needs (Mayo, between positions and to delineate clearly the 1953). functions expected. This has great implications for research because  These methods are helpful in that job it is always possible that results may be altered descriptions let workers know the expectations by the very acts of observation and increased and responsibilities associated with the positions attention. they occupy. This threat to validity has become known as the  However, it is also true that work would not get Hawthorne Effect, after the name of the done if the only functions carried out each day company where Mayo conducted his research. were limited to those outlined on the job Another well-known behavioral theorist, description. Douglas McGregor (1960), developed Theory X  The work to be accomplished is too complex to and Theory Y. be listed in a document of any reasonable length. In addition, the complexity of the health-care Theory X and Theory Y environment is such that people need to be Theory X represented the traditional viewpoints treated as knowledge workers and allowed to of management, which hold managers have both the responsibility and the authority to responsible for organizing money, materials, make decisions about operational issues. equipment, and people as well as for directing workers’ efforts and motivating workers, controlling their actions, and modifying their B. THE BEHAVIORAL MANAGEMENT MOVEMENT behavior to fit the needs of the organization. The recognized beginning of the behavioral Theory X suggests that, without active movement was a much cited study that lent its intervention by management, workers would be name to the Hawthorne Effect. Elton Mayo passive and nonproductive in their roles in the (1887–1957), a clinical psychologist working at organization. the Harvard Business School, conducted studies Theory Y assumes that the desire to work is just at the Hawthorne plant of the Western Electric as natural as the desire to play or rest, that Company from 1927 to 1932. external control and threat or punishment are Mayo designed a study in which light levels in the not required to achieve organizational objectives workplace were first increased, during which because workers are self-motivated, and that the time worker productivity increased. capacity to work creatively to solve problems is widely distributed in the workforce. 10 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1 McGregor believed that these were the two major managerial attitudes about employees II. CONTEMPORARY MANAGEMENT THEORIES and that these approaches directly affect how A variety of contemporary theories of management have the employee responds to managerial leadership arisen to help organize management thought. Four major (Marquis & Huston, 2006). management theories now predominate: Each one contributes principles useful for nursing management and administration and for nurse C. THEORY Z: JAPANESE MANAGEMENT STYLE managers working to coordinate and integrate health In 1981 William G. Ouchi wrote a book on care delivery Japanese management style, entitled Theory Z. In this book he discussed the management 1. CONTINGENCY THEORY methodologies used by Japanese corporations. Considered to be a leadership theory but it also This approach to management relied on applies to management. The basic principle is principles that were diametrically opposed to that managers need to consider the situation and those used in businesses in the West, including all its elements when making a decision. America, England, and Europe. Managers need to act on the key situational Employment in the Japanese corporation is aspects with which they are confronted. described as being lifelong, dependent upon the Sometimes described as “it all depends” decision development of consensus, collaborative work, making, contingency theory is often used for incentives for group work, and pride in the choosing a leadership or management style. product or service being developed or provided. The “best” style depends on the situation. In Japan, the word kaizen refers to the principle of encouraging all people in the organization to 2. SYSTEMS THEORY contribute improvement ideas on a biweekly  It has helped managers to recognize their work basis (Bodeck, 2002). as being embedded within a system and to better This results in 24 improvement ideas per understand what a system is. employee each year, compared with one idea per  Managers have learned that changing one part of employee per year in the United States and one a system inevitably affects the whole system. idea per 6 years, on average, in the United General systems theory is a way of thinking Kingdom. about studying organizational wholes. Organizational growth has been shown to be  It uses the following concepts: directly related to innovation. The more o Organization leadership encourages participation and o Wholeness ownership among the employees, the more o Control productive the organization becomes. o Self-regulation Ouchi (1981) discusses the importance of o Purposiveness encouraging group contributions. In Japan, o Environment individuals rarely desire personal recognition o Boundaries because they believe that nothing is possible o Equilibrium without everyone’s contributions. o Steady State Although in the United States the predominant o Feedback values focus on individual accomplishments, it is  A key principle of systems theory is that changes increasingly recognized that shared governance, in one part of the system affect other parts, which recognizes the importance of creating a ripple effect within the whole. contributions from every employee, is the desired model. 11 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1  Using systems theory implies a rational approach  Managers need to alter their reflexive behaviors, to common goals, a global view of the whole, and put an emphasis on “double-loop learning” that an emphasis on order rather than chaos. also examines the appropriateness of operating  In health care, concepts such as interrelatedness assumptions, foster diversity, be open to strategy and interdependence fit well with based on serendipity, welcome disorder as a multidisciplinary teamwork and shared partner, use instability positively, provoke a governance professional models. controlled ferment of ideas, release creativity,  However, concepts attaining a steady state and and seek the edge of chaos in the complex equilibrium are difficult to reconcile with the interactions that occur among people. reality of uncertainty, risk, change and ambiguity that characterize the turbulence of the change occurring in the health care delivery 4. CHAOS THEORY environment.  Most would agree that one characteristic of  Previously, managers were advised to draw up 5- nursing is its unpredictability, its chaos and year and even 10-year plans, managers today complexity. have seriously shortened their strategic planning  To use a theory about chaos and complexity and other related time lines in response to the is intuitively attractive. rapidity of change.  Sometimes no matter how hard nursing  An example of the use of systems theory leaders try to maintain consistency and is basing an analysis of a planned change, such as control, things do become chaotic. implementing a new program, on systems  Chaos is commonly known as disorganization concepts by identifying inputs, throughout, and disorderliness, but the meaning for this outputs, and feedback loops to more effectively concept in chaos theory is quite different. plan how the new program fits into the existing  It refers to behavior that is unpredictable in system. spite of certain regularities.  Sometimes this process is used for short time  There are many implications of chaos theory frame rapid response team projects. for health care delivery systems.  The slightest variation can have enormous results in a dynamic and changing system. 3. COMPLEXITY THEORY  What is important is the quality of a system, its complexity, its distinguishing shapes, how  It is a more general umbrella theory that it develops and changes, and how it differs encompasses chaos theory. from or compares with another system.  The focus of this theory is the behavior over time  In many ways, this highlights what nurses of certain complex and dynamically changing have known: the whole of nursing is complex systems. and crucial to health care delivery systems in  The concerns is about the predictability of the which nurses are major care coordinators. behavior of systems that under certain conditions perform in regular and predictable ways but in other conditions change in irregular and unpredictable ways, are unstable, and move further away from starting conditions unless stopped by an overriding constraints.  Key findings of complexity theory are the “effective unknowability” of the future and an understanding of the role of creative disorder. 12 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  to deliver critical judgment about patients’ critical situations and individualize approaches to NURSING PROCESS care (O’neil et, al 2011)  The Nursing Process is a process by which nurses  to organize, conduct and reflect care in a deliver care to patients, supported by nursing systematic organized manner models or philosophy. It was originally an  to make inferences about the meaning of a adopted form of problem-solving and is classified patient responses to health problems or as a deductive theory. generalize about his or her health functional  This is a cyclical, on going dynamic, goal directed state of health and client-centered, that can end at any stage if  to provide goal-directed patient-centered care the problem is solved. The nurses’ evaluation of care will lead to changes in the implementation of the care and the patients’ needs are likely to Benefits of the Nursing Process change during their stay in the hospital as their health either improves or deteriorates. It focuses To the client on the patient holistically.  continuity of care  Its a systematized and circular problem-solving  prevention of omission and duplication model for planning and delivering nursing care to  individualized care patients, families, and groups in a wide variety of  increases client participation settings. This interactive, productive and robust process helps ensure quality, customized and To the nurse holistic care.  Critical thinking (5) steps process that  job satisfaction professional nurses use to apply the best  life-ling learning available evidence in care giving and promoting  increased self-confidence human functions and responses to health and  facilities staffing illness (ANA, 2010). It is vital dynamic blueprint  standards of practice on how to care for patients. A patient-centered To the profession approach is holistic and essential nursing process is applied.  promotes collaboration  helps people to understand what nurses do Purposes of the Nursing Process:  to identify client’s status, actual or potential health care problems or needs STEPS OF THE NURSING PROCESS  to establish plans to meet the identified needs Nursing Assessment and gaps to deliver specific intervention to meet those needs  It involves the collection of information from the  to provide a framework for critical thinking in patient and their family/carers concerning their which the practice of nursing and its complexities condition and perceived problems. Hamilton and are based Price (2013) stated that this is the cornerstone in  to provide timely and appropriate care to establishing the needs of the patient and if done patients well, the nursing process will be a success. 13 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  Information gathered can either be subjective or Activities Include: objective, and primary or secondary (kozier et all,  interpreting and analyzing patient/client data 2008)  identifying px/client strength and health o Subjective information - what patient problems tells you, how they are feeling, levels and sensations of pain.  formulating and validating nursing diagnosis o Objective information - which can be  developing a prioritized list of nursing diagnosis measured such as bp or wt. o Primary information - gained from the patient themselves, whereas secondary Nursing Planning and Outcome Identification data is information from other sources,  It is where interventions are identified to reduce, such as family members. resolve or prevent the patients problems while o Observations - are taken a baseline and supporting the patient’s strengths in an again to identify anything abnormal organized, goal-directed way (Kozier et al, 2008). which may need urgent intervention. Care needs to be prioritized of the needs of the Once all the info are collected it can be patient and the seriousness of the problems documented and sorted (Merlin- identified. Johansson, 2017)  Hogston (2011) identifies two (2) steps in the Activities Include: planning stage: o setting goals and  establishing the database (nursing history, PA, o identiying actions. SMART short and long review of the patient/client’s records and nursing term goals should be identified which literature and consultations with px/clients are Specific, Measurable, Achievable, support persons and health care professionals) Realistic, and Timely.  continuously updating the database  These are all done in collaboration with the  validating data patient. (Hamilton and Price, 2013)  communicating data  In action planning, the actual care that is going to be implemented needs to be clearly stated. Hogston (2011) advises using the REEPIG Criteria Nursing Diagnosis to ensure that care is of highest standards o R- ealistic  Nurse’s clinical judgment about the patient’s o E - xplicity stated response to actual potential health condition or o E - videnced -based needs. The information gained from the o P - rioritized assessment is used to identify actual and o I - involve both the patient and other potential problems, as well as strengths. members of the multidisciplinary team (Yildirimand Ozkahramam, 2011) who are going to be involved in  Strengths might be self-caring abilities or implementing the care independence in certain areas or prior o G - oal-centered knowledge or experience of the illness. Actual problems are those that come directly out of the Activities include: assessment, for example pain from a fracture. Potential problems are those that arise from out  establishing priorities of the problem, for example the risk of  writing goals and developing evaluative developing a pressure sore if confined to bed strategies (Hogston, 2011).  selecting nursing measures 14 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  communicating the plan of nursing care PATIENT CARE CLASSIFICATION SYSTEM Nursing Implementation  The Patient Care Classification System is primarily developed to objectively determine  This is where the care is delivered. As each new workload requirements and staffing needs. member of the caring team comes on duty, they  It is a means of categorizing patients on the basis need to re-assess if the care being delivered is of certain needs that can be clinically observed still appropriate. by the nurse. Activities Include:  It aims to respond to the constant variation in the care needs of patients. It is essential to staffing  carrying out the plan of care the nursing unit of hospitals for it quantifies the  continuing data collection and modifying the quality of nursing care. The patient then can be plan of care as needed assigned to an acuity or complexity category that  documenting the care given will indicate how many actual hours of nursing care the patient needs during a particular shift.  The nursing care Hours Per Patient Day (NCHPPD) Nursing Evaluation is defined as a standard measure that quantifies the nursing time available to each patient by  The most important part of the nursing process available staff. It simply means the amount of after assessment is done to evaluate whether the time nurses spend with each patient per day. It is care given achieved the desired result. This calculated by dividing the total number of should occur constantly as care is being productive hours worked by nurses with direct implemented. patient care responsibilities with the total census  Evaluation at the end of the course of treatment of number of patients in a day or month or year. involves re-assessment of all the plan of care to determine of the expected outcomes have been achieved (Yildirin and Ozkahraman, 2011).  Hogston (2011:16) also states the evaluation is “an opportunity to review the entire process and determine whether the assessment was accurate and complete, the diagnosis correct, the goals realistic and the prescribed actions appropriate.” with evaluation the whole process starts again. Activities Include: MODALITIES OF CARE  measuring how well the client has achieved the desired goals  NURSING MODALITIES are ways where care is  identifying factors that contributed to the clients organized and delivered to patients. They have to success or failure do with arranging staff members and assigning  modifying the plan of care (if indicated) patients.  Care delivery methods take into account the total number of patients and tasks needed to be accomplished, as well as how many nurses are available. Most importantly, they are concerned 15 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE with meeting patient’s needs and continuity of as medication nurse, an Intravenous nurse, care. documentation or charge nurse. For each task that needs to be done, one nurse handles it for  However, patients’ needs go beyond mere health all the patients. care but encompass social, cultural, psychological, and even ethnic considerations. Advantage: Moreover, emphasis on long-term goals of  staff become very efficient and effective at ensuring the professional and technical skills performing their regular assigned tasks. enhancement of the employees shall be included in the use of nursing care models.  It is efficient and the best system that can be used when confronted with large number of load  A health institution may use multiple modalities and a shortage of nurses. of care to be responsive to the present situation  Implements classic scientific management, and health care needs. A mix of modalities of which emphasizes efficiency, division of labor care may also be necessary in the evolving health and rigid control environment. The choice of appropriate nursing  little confusion about roles and duties care modality is left to the judgment of the  it is less costly and requires few registered nurses nursing managers. Disadvantages:  Each nursing professional plays a critical role in patient care and the way in which patients  Uneven continuity experience their health care. Nursing care  Lack of holistic understanding of the patient models vary in administration and scope. While  Problems with follow-up some provide quality care for large number of  care tends to be fragmanted and depersonalized patient, other focus on serving the needs of  less oriented to individualized and holistic client individuals. Nursing care models are fluid, care and more oriented to task accomplishment allowing each hospital, clinic or private practice  registered nurse keeps busy with managerial and to advise a method to serve patients. non-nursing duties and nursing attendants deliver the majority of patient care  A mix of modalities of care may also be necessary  does not encourage patient-staff satisfaction in the evolving health environment. The choice  clients felt that they could not identify who was of appropriate nursing care modality is left to the their nurse caretaker. judgment of the nursing managers.  routinized patient care for patients with similar needs may meet those needs more consistently than other systems and some staff nurses maybe FUNCTIONAL NURSING satisfied by doing repetitious jobs well.  also called Task Nursing, began in hospitals in the mid-1940s in response to a national nursing shortage.  The needs of a group of patients are broken down into tasks that are assigned to RNs, LPNs, or UAPs so that the skill and licensure of each caregiver is used to his or her best advantage  It is a task or activity-oriented system of care that concentrates on duties. The nurse coordinates care for an entire unit or team. He/She performs 16 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  Resolving problems encountered by team members  Conducting nursing care conferences  Communicating with physicians and other health care personnel  With team nursing, the unit nurse manager consults with team leaders, supervises patient care teams, and may make rounds with all physicians. To be effective, team nursing requires that all team members have good communication skills. A key aspect of team TEAM NURSING nursing is the nursing care conference, where the  a team of nursing personnel provides total team leader reviews with all team members each patient care to a group of patients. patient’s plan of care and progress.  In some instances, a team may be assigned a certain number of patients; in others, the Advantages of team nursing are: assigned patients may be grouped by diagnoses  It allows the use of LPNs and UAPs to carry out or provider services. some functions (e.g., making beds, transporting  Team members provide patient care under the patients, collecting some data) that do not direction of the team leader. The team, acting as require the expertise of an RN. a unified whole, has a holistic perspective of the  It allows patient care needs requiring more than needs of each patient. The team speaks for each one staff member, such as patient transfers from patient through the team leader. bed to chair, to be easily coordinated.  The geographical boundaries of team nursing  It is a decentralized system of care in which a help save steps and time. nurse leads the group in providing the needs of  motivates full participation among team patients/clients through participative effort. members towards quality and safe care Through team plan, the contributions of all team  maximizes staff capabilities members are recognized and priority is given to  sets goal and priorities for patient care; and strengthening their weakness. These are carried centralizes information through the use of a out through conferences, meetings and other kardex forums. The team nursing utilizes type of care  directs the plan of care through conferences and modality effectively across all levels of care (Level other related activities like nursing audits, etc. 1, 2, 3 and 4 patients) so long as the nurse patient ratio is decreased as the level of care is Disadvantages of team nursing are: increased.  A great deal of time is needed for the team  The team nursing model of care involves pairing leader to communicate, supervise, and nurses who works as a team to deliver patient coordinate team members. care  Continuity of care may suffer due to changes in team members, leaders, and patient Typically, the team leader’s time is spent in indirect assignments. patient care activities, such as:  No one person considers the total patient.  Developing or updating nursing care plans 17 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  There may be role confusion and resentment as the critical care units of that in isolation, and against the team leader, who staff may view as for nursing students. more focused on paperwork and less directed at  As always in the case, government hospitals with the physical or real needs of the patient. limited financial capacity cannot sustain a one on  Nurses have less control over their assignments one total care nursing. For patients needing such due to the geographical boundaries of the unit. a care modality, an arrangement is made to avail  Assignments may not be equal if they are based of the services of a private duty nurses with on patient acuity or may be monotonous if added cost to the clients. nurses continuously care for patients with similar  Total Patient Care means that a Professional conditions (e.g., all patients with hip Nurse is accountable to provide and coordinate replacements). the care of a patient of groups of patients assigned to her/him during working hours. Advantages:  Continuous, holistic, expert nursing care  Total accountability for the nursing care of the assigned patient(s) for that shift  Continuity of communication with the patient, family, physician(s), and staff from other departments  focuses on the entire episode of illness TOTAL PATIENT CARE  emphasizes achievement of outcome  incorporates manage care  also called Case Method.  a registered nurse was responsible for all aspects of the care of one or more patients.  RNs work directly with the patient, family, physician, and other health care staff in Disadvantage: implementing a plan of care.  RNs spend some time doing tasks that could be  have one nurse give all care to the same done more cost-effectively by less skilled patient(s) for the entire shift. persons. This inefficiency adds to the expense of  a case method for organizing nursing care in using a which nurses are responsible for the total care of a client but only for the hours, in which that  total patient care delivery system. specific nurse is present.  take time and effort to coordinate to other  Equally important consideration in the choice of members of the health team modalities of care is the patient care needs.  limits communication and continuity of care for  Level 4 clients, total care nursing is most effective the client over time where one nurse is assigned to one patient for  restrict job mobility and nurses are limited to the delivery of total care. perform other task related to Nursing practice  The nurse plans, coordinates, implements, evaluates and documents the nursing care she has given during her shift. His or her entry point is anytime of the patient’s illness. The one-on- one pattern is a common assignment for private duty nurses, for nurses in special care units such 18 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  Decentralization of nursing care decisions, authority, and responsibility to the staff nurse  24-hour accountability for nursing care activities by one nurse  Improved continuity and coordination of care  Increased nurse, patient, and physician satisfaction.  provides for increased autonomy of the part of the nurse, thus, increasing motivation, responsibility and accountability  assures more continuity of care as a primary PRIMARY NURSING nurse gives or directs care throughout hospitalization  The primary nurse assumes 24-hour responsibility for planning the care of one or  makes available the increased knowledge of the more patients from admission or the start of patient’s psychosocial and physical needs treatment to discharge or the treatment’s end.  leads to increased rapport and trust between the nurse and the patient that will allow formation of  During work hours, the primary nurse provides therapeutic relationship total direct care for that patient. When not in  improves communication of information to the duty, associate nurses follows the care plan physician established by the primary nurse. Disadvantages:  Decentralized decision making by staff nurses is the core principle of primary nursing, with  It requires excellent communication between responsibility and authority for nursing care the primary nurse and associate nurses. allocated to staff nurses at the bedside.  Primary nurses must be able to hold associate nurses accountable for implementing the nursing  A primary nurse designs, implements, and is care as prescribed. accountable for the nursing care of patients in  Because of transfers to different units, critically ill the patient load for the duration of the patient’s patients may have several primary care nurses, stay on the unit. disrupting the continuity of care inherent in the  It is an approach to which a nurse has model. responsibility for the continuous care of specific  Staff nurses are neither compensated nor legally clients from hospital admission to discharge. It is responsible for patient care outside their hours also a modality though not to be cost-effective of work. because of the exclusive use of individualized  Associates may be unwilling to take direction holistic nursing care. from the primary nurse.  confines nurses’ competencies to a limited  Primary nursing is a method of nursing practice number of patients. Other patients cannot which emphasizes continuity of care one nurse benefit, and if a patient has a nurse who is not provides complete care for a small group of capable, the patient maybe worse off than if inpatients within a nursing unit of a hospital. cared for by a numerous people some of whom Advantages: might meet the patient’s needs.  problems may occur if the other nurse changes  A knowledge-based practice model the care plan without discussing the reasons with the primary nurse 19 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  problems in the implementation of primary client outcomes within effective and appropriate nursing have included the wide variation in its time frames and resources operationalization and implementation.  Also focus on containing health care costs first for  primary nurse autonomy under cost the patient, then for the facility. containment pressure, in all RN staff is difficult to justify  Practicing case management can also be - I get  total accountability may create burn out, and a this patient and I check him and I consult all poorly prepared RN may feel threatened by these specialists (like neurologist and social primary nursing workers) about his condition and checking his discharge stuff and looking over everything. Sometimes don't have specific case managers, but every nurse is expected to be their pat’s case manager Nursing case management requires:  Collaboration of all members of the health care team  Identification of expected patient outcomes within specific time frames  Use of principles of continuous quality NURSING CASE MANAGEMENT improvement (CQI) and variance analysis  Promotion of professional practice.  is a model for identifying, coordinating, and monitoring the implementation of services needed to achieve desired patient care outcomes within a specified period of time.  organizes patient care by major diagnoses or diagnosis-related groups (DRGs) and focuses on attaining predetermined patient outcomes within specific time frames and resources.  Case management in acute care hospital nursing MODULAR NURSING has been defined as a system of client care delivery that focuses on the achievement of 20 | P L S D O N O T S H A R E T H E F I L E NCM 119 LEC – NURSING LEADERSHIP & MANAGEMENT Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: MODALITIES OF NURSING CARE  A modification of team nursing and focuses on INNOVATIVE/CONTEMPORARY NURSING the patient's geographic location for staff  Innovation can be defined as invention + assignments; adoption + diffusion. Innovation denotes new,  the unit is divided into groups referred to as better, more effective ways of solving problems. modu