Chapter 41 : Spirituality

SPIRITUALITY - generally thought to refer to human tendency to seek

meaning & purpose in life, inner peace & acceptance, forgiveness & harmony,
hope, beauty, & so forth

RELIGION - usually applied to ritualistic practices & organized belief

AGNOSTIC - person who doubts the existence of God or a supreme being or

believes the existence of God has not been proven

ATHEIST - one without belief in a deity

>DEITY - a God, creator & supreme being

SPIRITUAL CARE - a.k.a Spiritual Nursing Care

- an intuitive, interpersonal, altruistic, & integrative expression that is
contingent on the nurse’s awareness of the transcendent dimension of life but
that reflects the client’s reality

SPIRITUAL DISTRESS - refers to a disturbance in the belief or value

system that provides strength, hope, & meaning to life

SPIRITUAL HEALTH - a.k.a Spiritual Wellness or Well-being

- often portrayed as the opposite of spiritual distress
- results when individuals intentionally seek to strengthen their spiritual
muscles, as it were, through various spiritual disciplines

SPIRITUAL or RELIGIOUS COPING - refers to the spiritual beliefs or

ways of thinking that help people cope with their challenges

GUIDELINES IN GIVING SPIRITUAL NURSING CARE

1. First seek a basic understanding of client’s spiritual needs, resources &
preferences (assess)
2. Follow the client’s expressed wishes regarding spiritual care
3. Do not prescribe or urge clients to adopt certain spiritual beliefs or
practices, & do not pressure them to relinquish such beliefs or practices
4. Strive to understand personal spirituality & how it influences caregiving
5. Provide spiritual care in a way that is consistent with personal belief

HOLY DAYS - solemn religious observances & feast days throughout the
year
- include fasting or special foods, reflection, rituals, & prayer

SACRED TEXTS - people often gain strength & hope from reading religious
writings when they are ill or in crisis
- each religion has sacred & authoritative scriptures that provide guidance for

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its adherents’ beliefs & behaviors

SACRED SYMBOLS - include jewelry, medals, amulets, icons, totems, or

body ornamentation (tattoos) that carry religious or spiritual significance
- worn to pronounce one’s faith, to remind the practitioner of the faith, to
provide spiritual protection, or to be a source of comfort & strength

PRAYER AND MEDITATION

> PRAYER - involves humans pleading or experiencing the divine

- inner experience for gaining awareness of self
- TYPES OF PRAYER EXPERIENCE :
1. RITUAL (memorized prayers, repeated)
2. PETITIONARY (requesting something)
3. COLLOQUIAL (conversational prayers)
4. MEDITATIONAL (moments of silence)

> MEDITATION - the act of focusing one’s thoughts or engaging in self-

reflection or contemplation

BELIEF AFFECTING DIET

- Health care providers prescribe diet plans with an awareness of the client’s
dietary & fasting beliefs

BELIEFS ABOUT ILLNESS AND HEALING

- Some clients may ascribe disease to the innate presence of sin and evil in this
world, whereas others may believe the disease is a punishment for sin in their
past.

BELIEFS ABOUT DRESS AND MODESTY

- Some religions require that women dress in a conservative manner, which
may include wearing sleeveless and modestly cut tops & skirts that cover the
knees

BELIEFS RELATED TO BIRTH

-Many religions have specific ritual ceremonies that consecrate the new child
to God

BELIEFS RELATED TO DEATH

- Many believe that the person who dies transcends his life for a better place or
state of being
- Some religions have special rituals surrounding dying & death that must be
observed by the faithful

PRESENCING - a term describing the art of being present, or just being

with a client during an existential moment
- a gift of self given by a nurse who maintains attitude of attentiveness toward
the client

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HOW TO INCREASE SPIRITUAL AWARENESS?
1. Write a self-epitaph (short statement about a deceived person often carved
on his/her tombstone, it can be poetic sometimes written by poets)
2. Explore personal end-of-life issues
3. Create a personal loss history
4. List significant values
5. Conduct a spiritual self-assessment

Chapter 42 : Stress and Coping

STRESS - a condition in which an individual experiences changes in the

normal balanced state

STRESSOR - any event or stimulus that causes an individual to experience

stress
> COPING STRATEGIES - coping responses/coping mechanisms
- responses when a person faces stressors

SOURCES OF STRESS

1. INTERNAL STRESSORS - originate within a person

- ex : infection, feeling of depression

2. EXTERNAL STRESSORS - originate outside the individual

- ex : a move to another city, a death in the family, pressure from peers

3. DEVELOPMENTAL STRESSORS - occur at predictable times throughout

an individual’s life
TABLE 42-1 Selected Stressors Associated with Developmental Stages
Developmental Stage Stressors
Child Beginning school
Establishing peer
relationships
Peer competition
Adolescent Changing physique
Relationships involving
sexual attraction
Exploring independence
Choosing a career
Young Adult Marriage
Leaving home
Managing a home
Getting started in an
occupation
Continuing one’s
education
Children
Middle Adult Physical changes of
aging
Maintaining social
status and standard of

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 living
Helping teenage
children to become
independent
Aging parents
Older Adult Decreasing physical
abilities and health
Changes in residence
Retirement and reduced
income
Death of spouse and
friends

4. SITUATIONAL STRESSORS - unpredictable and may occur at any time

during life
- may be positive or negative
- ex : death of a family member, marriage or divorce, birth of a child, new job,
illness

EFFECTS OF STRESS
1. PHYSICAL
2. EMOTIONAL
3. INTELLECTUAL
4. SOCIAL
5. SPIRITUAL

MODELS OF STRESS

1. STIMULUS-BASED MODELS - STRESS is defined as a stimulus, a life event

or a set of circumstances that arouses physiological & or psychological
reactions that may increase the individual’s vulnerability to illness

2. RESPONSE-BASED MODELS - STRESS is considered a response

- the non-specific response of the body to any kind of demand made upon it

3. TRANSACTION-BASED MODELS

GENERAL ADAPTATION SYNDROME (GAS) - a.k.a stress syndrome

- a chain or pattern of physiological events
- occurs with the release of certain adaptive hormones and subsequent
changes in the structure and chemical composition of the body

LOCAL ADAPTATION SYNDROME (LAS) - body reacts locally to

stress
- one organ or a part of the body reacts alone to stress
- ex : inflammation

3 STAGES OF GAS & LAS

1. ALARM REACTION - initial reaction of the body

- alerts the body’s defense

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- classified into 2 PHASES
> SHOCK PHASE - stressors stimulate the sympathetic nervous system,
adrenal medulla to secrete epinephrine & norepinephrine
- fight or flight response
> increased myocardial contractility
>bronchial dilation
>increase blood clotting
>increased cellular metabolism
>increase fat metabolism
>COUNTER SHOCK PHASE - changes produced in the body during shock
phase are reversed

2. RESISTANCE - when the body’s adaptation takes place

- the body attempts to cope with the stressor and to limit the stressor to the
smallest area of the body that can deal with it

3. EXHAUSTION - the adaptation that the body made during the second stage
cannot be maintained
- the ways used to cope with the stressor have been exhausted
- result : rest & return to normal, death

TRANSACTION-BASED MODELS - stimulus theory and response

theory do not consider individual differences
- people and groups differ in their sensitivity and vulnerability to certain types
of events, as well as in their interpretations and reactions

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INDICATORS OF STRESS

1. PHYSIOLOGICAL INDICATORS - the physiological signs and symptoms of

stress result from the activation of the sympathetic and neuroendocrine
systems of the body

2. PSYCHOLOGICAL INDICATORS
1. ANXIETY - common reaction to stress
- a state of mental uneasiness, apprehension, dread or foreboding or a
feeling of helplessness related to an impending or anticipated unidentified
threat to self or significant relationships

> 4 LEVELS OF ANXIETY

- MILD ANXIETY - produces slight arousal that enhances perception,

learning, and productive abilities

- MODERATE ANXIETY - increases the arousal to a point where the

person expresses feeling of tension, nervousness, or concern
- perceptual abilities are narrowed

- SEVERE ANXIETY - consumes most of the person’s energies and

require intervention
- perception is further decreased
- unable to focus on what is really happening

- PANIC - an overpowering, frightening level of anxiety causing the

person to lose control
- less frequently experience than other levels of anxiety

2. FEAR - an emotion or feeling of apprehension aroused by impending

or seeming danger, pain or another perceived threat

= ANXIETY AND FEAR DIFFER IN 4 WAYS

1. The source of anxiety may not be identified’ the source of fear is identified
2. Anxiety is related to the future, that is, to an anticipated event. Fear is
related to the past, present, and future
3. Anxiety is vague, whereas fear is definite
4. Anxiety results from psychological or emotional conflict; fear results from a
specific physical or psychological entity

3. ANGER - an emotional state consisting of a subjective feeling of

animosity or strong displeasure

4. DEPRESSION - a common reaction to events that seem overwhelming

or negative
- an extreme feeling of sadness, despair, dejection, lack of worth, or
emptiness

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 5. UNCONSCIOUS EGO MECHANISMS/ EGO DEFENSE
MECHANISMS - unconscious psychological adaptive mechanisms or
mental mechanisms that develop as the personality attempts to defend
itself, establish compromises among conflicting impulses, & calm inner
tensions.

3. COGNITIVE INDICATORS
1. PROBLEM-SOLVING - involves thinking thru the threatening
situation, using specific steps to arrive at a solution

2. STRUCTURING - the arrangement or manipulation of a situation so

threatening events do not occur

3. SELF-CONTROL/SELF-DISCIPLINE - assuming a manner & facial

expression that convey a sense of being in control or in charge.

4. SUPPRESSION - consciously & wilfully putting a thought or feeling out

of mind: “I won’t deal with that today. I’ll do it tomorrow.”

5. FANTASY/DAYDREAMING - to make-believe
- unfulfilled wishes and desires are imagined as fulfilled, or threatening
experiences is reworked or replayed so it ends differently from reality

COPING -the cognitive and behavioural effort to manage specific external

&/or internal demands that are appraised as taxing or exceeding the resources
of the person

COPING STRATEGY/COPING MECHANISM - a natural or learned

way of responding to a changing environment or specific problem or situation
> 2 TYPES OF COPING STRATEGY

1. PROBLEM-FOCUSED - refers to efforts to improve a situation by making

changes or taking action

2. EMOTION-FOCUSED - include thoughts, & actions that relieve emotional

distress
- does not improve the situation but the person often feels better

LONG & SHORT TERM COPING STRATEGIES

> LONG-TERM COPING STRATEGIES - can be constructive & practical

- ex : lifestyle patterns

> SHORT-TERM COPING STRATEGIES - can reduce stress to a tolerable

limit temporarily but are ineffective ways to permanently deal with reality
- may have a destructive or detrimental effect on the person

ADAPTIVE & MALADAPTIVE COPING

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>ADAPTIVE COPING - helps the person to deal effectively with stressful
events & minimizes distress associated with them
- effective coping

>MALADAPTIVE COPING - can cause unnecessary distress for the person &
other associated with the person or stressful event
- ineffective coping

CAREGIVER BURDEN- reaction to long term stress seen in family

members who undertake the care of a person in the home for a long term
period
- produces responses such as chronic fatigue, sleeping difficulties & high blood
pressure

CRISIS - an acute, time-limited state of disequilibrium resulting from

situational, developmental or societal sources of stress
- a person on crisis is temporarily unable to cope with or adapt to the stressor
by using previous methods of problem solving

CRISIS INTERVENTION - a process that includes not only the client in

crisis but also various members of the client’s support network
- a short-term helping process of assisting clients to:
> work through a crisis to its resolution &
> restore their precrisis level of functioning

BURN OUT - a complex syndrome of behaviors that can be likened to the

exhaustion stage of the general adaptation syndrome.

Chapter 43 : Loss, Grieving & Death

LOSS - an actual or potential situation in which something that is valued is

changed or no longer available

DEATH - a loss both for the dying person and those who survive

GENERAL TYPES OF LOSS

1. ACTUAL LOSS - can be recognized by others

2. PERCEIVED LOSS - experienced by one person but cannot be verified by

others

> PSYCHOLOGICAL LOSS - often perceived losses because they are not
directly verified

>ANTICIPATORY LOSS - can be actual or perceived loss

- experienced before the loss actually occurs

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 >SITUATIONAL LOSS - losing one’s job, the death of a child, & losing
functional ability

>DEVELOPMENTAL LOSS - losses that occur in normal development

which to some extent, be anticipated and prepared for
- ex : departure of grown children from the home, retirement from career,
the death of aged parents

SOURCES OF LOSS
1. ASPECT OF SELF - losing an aspect of self changes as person’s body
image, even though the loss may not be obvious

2. EXTERNAL OBJECTS
1. Loss of inanimate objects that have importance to the person
- losing money
-burning down of a family’s house
2. Loss of animate (live) objects
- pets that provide love and companionship

3. FAMILIAR ENVIRONMENT - separation from an environment and

people who provide security can cause a sense of loss

4. LOVED ONES - losing a loved one or valued person thru illness,

divorce, separation or death can be very disturbing
-a death of a loved one is a permanent and complete loss

GRIEF - the total response to the emotional experience related to loss

- manifested in thoughts, feelings & behaviors associated with
overwhelming distress or sorrow

BEREAVEMENT - the subjective response experience by the surviving

loved ones

MOURNING - the behavioural process thru which grief is eventually

resolved or altered
- often influenced by culture, spiritual beliefs & custom

TYPES OF GRIEF RESPONSES

1. ABBREVIATED GRIEF - normal grief reaction

- brief but genuinely felt
- can occur when the lost object is not significantly important to the
grieving person or may have been replaced immediately by another,
equally esteem object

2. ANTICIPATORY GRIEF - a normal grief reaction

- experienced in advance of the event

3. DISENFRANCHISED GRIEF - occurs when a person is unable to

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 acknowledge the loss to other people
-situations in which this may occur often relate to a socially unacceptable
loss that cannot be spoken about
> suicide, abortion, giving a child up for adoption, homosexuality,
extramarital relationships

4. COMPLICATED GRIEF - unhealthy grief

- a.k.a pathologic grief
- exists when the strategies to cope with the loss are maladaptive and out
of proportion or inconsistent with culture, religious, or age-appropriate
norms
- preoccupations lasts for more than 6 months and leads to reduced ability
to function formally
> FORMS OF COMPLICATED GRIEF

1. UNRESOLVED/CHRONIC GRIEF - extended in length and severity

- the bereaved may also have difficulty expressing the grief, may deny the
loss, or may grieve beyond the expected time.

2. INHIBITED GRIEF - many of the normal symptoms of grief are

suppressed and other effects, including somatic, are experienced instead

3. DELAYED GRIEF - occurs when feelings are purposely or

subconsciously suppressed until a much later time

4. EXAGGERATED GRIEF - using dangerous activities as a method to

lessen the pain of grieving

STAGES OF GRIEVING

1. Kubler-Ross (1969) stages/phases of grieving (DABDA)

Stage Behavioral Response

Denial Refuses to believe that loss is happening
Is unready to deal with practical problems
May assume artificial cheerfulness to prolong
denial
Anger Client or family may direct anger at nurse or
staff about matters that normally would not
bother them
Bargaining Seeks to bargain to avoid loss
Depression Grieves over what has happened and what
cannot be
May talk freely or may withdraw
Acceptance Comes to terms with loss
May have decreased interest in surroundings
and support people
May wish tobegin making plans

2. Engel (1964) six stages pf grieving

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Stage Behavioral Responses
Shock and disbelief Refuses to accept loss
Has stunned feelings
Accepts the situation intellectually, but
denies it emotionally
Developing awareness Reality of loss begins to penetrate
consciousness
Anger may be directed at agency, nurses,
others
Restitution Conducts rituals of mourning
Resolving the loss Attempts to deal with painful void
Still unable to accept new love object to
replace lost person or object
Idealization Produces image of lost object that is almosy
devoid of undesirable features
Represses all negative and hostile feelings
toward lost object
Outcome Behavior influenced by several factors:
importance of lost object as source of
support, degree of dependenve on
relationship, degree of ambivalence toward
lost object, etc

3. Sanders (1998) five phases of bereavement

Phase Description Behavioral Responses

Conservation During this phase, survivors feel a need to be Withdrawal
/withdrawal alone to conserve and replenish both Despair
physical and emotional energy. The social Diminished social support
support available to the bereaved has Helplessness
decreased, and they may experience despair Physical symptoms:
and helplessness weakness, fatigue, need for
more sleep, a weakened
immune system
Psychological symptoms:
hibernation or holding
pattern, obsessional review,
grief work, turning point
Awareness of Friends and family resume normal activities. Separation anxiety
loss The bereaved experience the full significance Conflicts
of their loss Acting out emotional
expectations
Prolonged stress
Physical symptoms:
yearning, anger, guilt,
frustration. Shame, crying,
sleep disturbance, fear of
death
Psychological symptoms:
oversensitivity, disbelief and
denial, dreaming, sense of
presence of the deceased
Conservation During this phase, survivors feel a need to be Withdrawal
/withdrawal alone to conserve and replenish both Despair
physical and emotional energy. The social Diminished social support
support available to the bereaved has Helplessness
decreased, and they may experience despair Physical symptoms:

FUNDA LEC : SET B by Gianina Louise Guilaran and Andrea Patriarca

 and helplessness. weakness, fatigue, need for
more sleep, a weakened
immune system
Psychological symptoms:
hibernation or holding
pattern, obsessional review,
grief work, turning point
Healing: the During this phase, the bereaved move from Assuming control
turning point distress about living without their loved one Identity restructuring
to learning to live more independently Relinquishing goals, such as
spouse, child or parent
Physical symptoms:
increased energy, sleep
restoration, immune system
restoration, physical healing
Psychological symptoms:
forgiving, forgetting,
searching for meaning,
closing of the circle, hope
Renewal In this phase, survivors move on to a new New self-awareness
self-awareness, an acceptance of Acceptance of responsibility
responsibility for self, and learning to live Process of learning to live
without the loved one without
Physical symptoms:
functional stability,
revitalization, caring for
phyiscal needs
Assumption of responsibility
for self care needs
Psychological symptoms:
living for oneself, loneliness,
anniversarry reactions,
reaching out to others, time
for the process of
bereavement

MANIFESTATION OF GRIEF
1. NORMAL GRIEF
- verbalization of loss
- crying
- sleep disturbance
- loss of appetite
- difficulty of concentrating
2. COMPLICATED GRIEF
- extended time of denial
- depression
- severe physiological symptoms
- suicidal thoughts

FACTORS INFLUENCING THE LOSS & GRIEF RESPONSES

 Age
 Significance of the loss
 Culture
 Spiritual beliefs

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 Gender
 Socioeconomic status
 Support systems
 Cause of the loss or death

HEART-LUNG DEATH - the traditional clinical signs of death were

cessation of the apical pulse, respiration & blood pressure

CEREBRAL/HIGHER BRAIN DEATH - another definition of death

- occurs when the higher brain center, the cerebral cortex, is irreversibly
destroyed
- permanent loss of cerebral & brainstem function

3 TYPES OF AWARENESS

1. CLOSED AWARENESS - the client is not made aware of impending death

2. MUTUAL PRETENSE - the client, family & health care personnel know that
the prognosis is terminal but do not talk about it & make an effort not to raise
the subject

3. OPEN AWARENESS - the client & others know about the impending death
& feel comfortable discussing it, even though it is difficult
- provides an opportunity to finalize affairs & even participate in planning
funeral arrangements

HOSPICE CARE - focuses on support & care of the dying person & family,
with the goal of facilitating a peaceful & dignified death.

PALLIATIVE CARE - an approach that improves the quality of life of

clients & their families facing the problem associated with life-threatening
illness, thru the prevention & relief of suffering by means of early
identification & impeccable assessment & treatment of pain & other problems,
physical, psychological & spiritual (WHO)

END-OF-LIFE CARE - included in hospice & palliative care

- care provided in the final weeks before death

POSTMORTEM CARE
1. RIGOR MORTIS - stiffening of body 2-4 hours after death
2. ALGOR MORTIS - decrease of body temperature
3. LIVOR MORTIS - discoloration in dependent areas

 Check client’s religion rituals and make every attempt to comply

 If family or friends wish to view the body:
-Make environment as clean and as pleasant as possible
- Make body appear natural and comfortable
 If family or friends wish to view the body:
- Remove all unnecessary equipment, soiled linen, and supplies from the

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 bedside
- Follow agency policy when caring for tubes
- Place body in a supine position
- Place arms either at sides, palm down, or across the abdomen
-Place one pillow under the head and shoulders
- Close eyelids
- Insert dentures
- Close mouth
- Wash soiled areas of the body
- Place absorbent pads under the buttocks
- Place a clean gown on the client
- Brush and comb the hair
- Remove all jewelry except a wedding band, which is taped to the finger
 Adjust top bed linen to cover the client to the shoulders
 Provide soft lighting and chairs for the family
 After body viewed by family
- Leave wrist identification tag on
- Apply additional identification tags
- Wrap body in a shroud
- Apply identification to outside of the shroud
- Take body to the morgue or arrange to have mortican/undertaker pick it
up from the client’s room
- Handle deceased with dignity

MORTICIAN/UNDERTAKER - a person trained in care of the dead

SHROUD - a large piece of plastic or cotton material used to enclose a body

after death

 The nurse collects data in accordance with desired outcomes

 Listen to client’s reports of feeling in control of the environment
surrounding death
 Observe client’s relationships
 Listen to client’s thoughts, feelings related to hopelessness, powerlessness

Chapter 43 : Nursing Leadership : Leading,

Manging & Delegating

LEADER - influences other to work together to accomplish a specific goal

MANAGER - an employee of an organization who is given authority, power

& responsibility for planning, organizing, coordinating & directing the work of
others & for establishing & evaluating standards

RESPONSIBILITIES OF NURSE MANAGER

1. Efficiently accomplishing the goals of the organization
2. Efficiently using the organization’s resources

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3. Ensuring effective client care
4. Ensuring compliance with institutional, professional, regulatory &
governmental standards
5. Development of licensed & unlicensed personnel within their work group

LEADERSHIP

1. FORMAL LEADER - a.k.a appointed leader

- selected by an organization & given official authority to make decisions & act

2. INFORMAL LEADER - not officially appointed to direct the activities

of others, but because of seniority, age, or special abilities is recognized by the
group as its leader & plays an important role in influencing colleagues, co-
workers or other group members to achieve the group’s goals

LEADERSHIP THEORY

1. CLASSIC LEADERSHIP THEORIES

2. CONTEMPORARY LEADERSHIP THEORIES

TRAIT THEORIES - focused on what leaders are

BEHAVIOURAL THEORIES - what leaders do

CONTINGENCY THEORIES - how leaders adapt their leadership style

according to the situation

LEADERSHIP STYLE - describe traits, behaviours, motivations & choices

used by individuals to effectively influence others

CLASSIC LEADERSHIP THEORIES

1. AUTOCRATIC/AUTHORITARIAN LEADER - makes decisions for

the group
- individuals are externally motivated (reward from others) & are incapable of
independent decision making
- similar to dictator, determines policies, giving orders & directions to the
group

2. DEMOCRATIC LEADER - encourages group discussion & decision

making
- acts as catalyst or facilitator, actively guiding a group toward achieving the
group’s goals
- group productivity & satisfaction are high
- members are self satisfied

3. LAISSEZ-FAIRE LEADER - recognizes the group’s need for autonomy

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& self-regulation
- assumes a “hands off approach”

4. BUREAUCRATIC LEADER - does not trust self or others to make

decision
- relies on the organization’s rules, policies & procedures to direct the group’s
work efforts

SITUATIONAL LEADER
- a popular contingency theory
- flexes task & relationship behaviours
- considers the staff members’ abilities
- knows the nature of the task to be done
- sensitive to the context or environment in which the task takes place

CONTEMPORARY LEADERSHIP THEORIES

1. CHARISMATIC LEADER - rare & is characterized by having an

emotional relationship with the group members
- the charming personality of the leader evokes strong feelings of commitment
to both the leader & the leader’s cause & beliefs

2. TRANSACTIONAL LEADER - has a relationship with followers based

on an exchange for some resource valued by the follower
- incentives are used to promote loyalty & performance

3. TRANSFORMATIONAL LEADER -foster creativity, risk taking,

commitment, & collaboration by empowering the group to share in the
organization’s vision
- inspires others with a clear, attractive, & attainable goal & enlists the group
to participate in attaining the goal

4. SHARED LEADERSHIP - recognizes that a professional workforce is

made up of many leaders
- no one person is considered to have knowledge or ability beyond that of
other members of the work group
> SHARED GOVERNANCE - an example of shared leadership
- a method that aims to distribute decision making among group of people

Effective leadership
 Leadership is a learned process

Characteristics of Effective leadership

Effective leaders:
 Use a leadership style that is natural to them
 Use a leadership style appropriate to the task and the members

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 Assess the effects of their behavior on others and the effects of others’
behavior on themselves
 Are sensitive to forces acting for and against change
 Express an optimistic view about human nature
 Are energetic
 Are open and encourage opennness, so that real issues are confronted
 Facilitate personal relationships
 Plan and organize activities of the group
 Are consistent in behavior toward group members
 Delegate tasks and responsibilities to develop members’ abilities, not
merely to get tasks performed
 Involve members in all decisions
 Value and use group members’ contributions
 Encourage creativity
 Encourage feedback about their leadership style
 Assess for and promote use of current technology

Principles of effective leadership

1. Vision
 A mental image of a possible & desirable future state
2. Influence
 An informal strategy used to gain the cooperation of others without
exercising formal authority
 Exercised thru persuasion & excellent communication skills
3. Role model
 Someone who sets example for others to follow

Management
 An art of getting things done through and with the people in formally
organized groups
 An art of creating an environment in which people can perform and
individuals can cooperate towards attainment of group goals

Nursing management
 Consists of the performance of the leadership functions of governance and
decision-making within organizations employing nurses
 Includes processes common to all management like planning,
organizing, staffing, directing & controlling

Chain of command
 The reporting relationship among staff & managers

Levels of management

1. First-level managers
 Responsible for managing the work of nonmanagerial personnel & the

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 day-to-day activities of a specific work group or groups
 Motivate staff to achieve the organization’s goals
 Examples:
 Primary care nurse
 Team leader
 Charge nurse

2. Middle-level managers
 Supervise a number of first level managers
 Responsible for the activities in the departments they supervise
 Liaisons between first & upper level manager
 Examples:
 Supervisors
 Nurse managers
 Head nurses

3. Upper-level (top-level) managers

 Organizational executives who are primarily responsible for establishing
goals & developing strategic plans
 Nurse executives are RNs who are responsible for the management of
nursing within the organization & the practice of nursing
 Examples:
 VP for client care services
 VP for nursing
 Director of nursing
 Chief nurse

Management Functions (PODC)

1. Planning
 An on-going process that involves
a. Assessing the situation
b. Establishing goals and objectives based on assessment of a
situation/future trends
c. Developing a plan of action that identifies priorities, delineates who is
responsible, determines deadlines, & describes how the intended
outcome is to be achieved & evaluated
Risk management
 An example of planning function
 Having in place a system to reduce danger to client and staff

2. Organizing
 Also an ongoing process of coordinating work
 Involves determining respinsibilities, communicating expectations &
establishing the chain of command for authority & communication

3. Directing

FUNDA LEC : SET B by Gianina Louise Guilaran and Andrea Patriarca

 The process of getting the organization’s work accomplished
 Involves assigning & communicating expectations about the task to be
completed, providing instruction & guidance, & on-going decision making

4. Coordinating
 The process of ensuring that plans are carried out & evaluating outcomes
 Measures results or actions against standards or desired outcomes & then
reinforces effective actions or changes ineffective ones

Principles of management
1. Authority
 Defined as the legitimate right to direct the work of others
 Integral component of managing
2. Accountability
 The ability & willingness to assume ownership for one’s actions & to
accept the consequences of one’s behaviour
3. Responsibility
 An obligation to perform a task
 Responsibility for nursing actions can be transferred to another
practitioner but accountability is always shared
Skills and competencies of nurse managers
1. Critical thinking
2. Communicating
3. Managing resources
4. Enhancing employee performance
5. Building & managing teams
6. Managing conflict
7. Managing time

Networking
 A process whereby professional links are established thru which people
can share ideas, knowledge & information

Mentor
 A wiser & more experienced person who guides, supports, & nurtures a
less experienced person

Preceptor
 Used to describe an experienced nurse who assist the new nurse in
improving clinical nursing skill & judgement

Effectiveness
 A measure of the quality or quantity of services provided

Efficiency

FUNDA LEC : SET B by Gianina Louise Guilaran and Andrea Patriarca

 A measure of the resources used in the provision of nursing services

Productivity
 A performance measure of both effectiveness & efficiency of nursing care
 Measured by the amount of nursing resources used per client or in terms
of required versus actual hours of care provided

Nurse as delegator
Delegation
 The act of transferring to a competent individual the authority to perform
selected nursing task in a selected situation

Delegate
 Assumes responsibility for the actual performance of the task or
procedure

Delegator
 Retains accountability for the outcome

Change
 The process of making something different from what it was
 Can involve gaining new knowledge or adapting what is currently known
in the light of new information
 Integral aspect of nursing

Change agents
 Individuals who initiate, motivate & implement change

Types of change

1. Planned change
 An intended, purposeful attempt by an individual, group, organization or
larger social system to influence its own current status
 Covert change
 Hidden
 without awareness
 Overt change
 Obvious or open
 Person is aware

2. Unplanned change
 An alteration imposed by external events or individuals
 Occurs when unexpected events force a reaction
 Drift change

FUNDA LEC : SET B by Gianina Louise Guilaran and Andrea Patriarca

  Occurs without effort on anyone’s part
 Situational or natural change
 Occurs without any control by the person on group impacted

The nurse’s role in change

 Lewin
 Unfreezing, moving, and refreezing stages
 Establish likelihood change will be accepted
 Determine markers that show acceptance
 Change takes time; test on small scale first
 Change accepted better if people are involved in the process
 Accessing optimal power
 Analyze organizational chart for formal and informal lines of authority
 Identify key person who will be affected by change and those directly
adjacent
 Find out as much as possible about these key people
 Build coalition of support before you start the change process
 Follow organizational chain of command and do not bypass anyone

Common driving and restraining forces for change

Driving forces
 Perception that the change is challenging
 Economic gain
 Perception that the change will improve the situation
 Visualization of the future impact of change
 Potential for self-growth, recognition, achievement and improved
relationships

Restraining forces
 Fear that something of personal value will be lost (e.g., threat to job
security or self-esteem)
 Misunderstanding of the change and its implications
 Low tolerance for change related to intellectual or emotional insecurity
 Perception that the change will not achieve goals; failure to see the big
picture
 Lack of time or energy
 Perceived loss of freedom to engage in particular behaviors
Change that is viewed as a threat by one nurse may be viewed as an
opportunity by another nurse

FUNDA LEC : SET B by Gianina Louise Guilaran and Andrea Patriarca