LEADERSHIP THEORIES

NURSING 1) GREAT MAN THEORY

LEADERSHIP &  Great leaders are born & not made

 Leaders are in the DNA

MANAGEMENT  E.g. Royal families

2) TRAIT THEORY
 Persons have certain innate abilities,
personality traits or other characteristics to
LEADERSHIP & MANAGEMENT be leader
LEADERSHIP/ MANAGEMENT/ a) Physical attributes
leaders managers b) Intelligence attributes
influencing the behavior Directs actions towards 3) CHARISMATIC THEORY
or actions of a person or common goals  Leaders possess an inspirational quality and
group to attain to the emotional commitment from followers
desired objectives
 E.g. Religious leaders, Politicians
May or may not have Holds an assigned
4) CONTINGENCY THEORY/SITUATIONAL
recognized authority in position
the organization THEORY
 Leader’s ability to lead depends upon the
Power to influence Decision making powers
situation
others
5) PATH GOAL THEORY
Effective communication Control over certain
and interpersonal skills processes  Focuses on motivation and productivity
 Positive Reinforcement (Rewards) increases
the repetition of a GOOD behavior
CHANGE: STRATEGIES  Negative Reinforcement (Punishment)
a) EMPIRICAL-RATIONAL decreases the repetition of a BAD behavior
 Objective Data  E.g. Improving attendance and punctuality of
 Logic & Reason staffs:
 E.g. you encourage your friend to stop  Giving recognition
smoking, how would you do it? 6) TRANSACTIONAL THEORY
 “Smoking is detrimental to your  Reward & punishment
health and it causes lung disease”  NOT long-lasting
b) NORMATIVE-REEDUCATIVE 7) TRANSFORMATIONAL THEORY
 Teaching to adapt more socially  Inspirational
acceptable alternatives  Transforms personalities and behaviors of a
 E.g. Smoking  Chewing Gum person within
c) POWER-COERCIVE
 With force
 E.g. Graphic images in the cigarette boxes

KURT LEWIN’S THEORY OF CHANGE

1) Unfreezing
 Realization a need for change
2) Moving
 Planning & implementation of the change
 E.g. Using 10 cigarette packs to 7 packs
3) Refreezing
 New habit/behavior becomes stable and
is integrated in one’s life
LEADERSHIP STYLES  Theorized by: Douglas McGregor
AUTOCRATIC DEMOCRATIC LAISSEZ- THEORY X THEORY Y
Goal of organization Goal of individual
FAIRE
People dislike work and Seek responsibility &
Bureaucratic Consultative Ultraliberal/ will avoid it display imagination
Permissive Workers have no Workers have self-
STRONG LESS control NO control ambition but desire direction
control security
Gives order Offer suggestion Non-directive Motivation by fear & Motivation by praise &
Does the Makes Gives up threats recognition
decision suggestions decision
making B. BLAKE-MOUTON MANAGERIAL GRID
LEADER does The GROUP NO planning
 Theorized by: Robert Blake & Jane Mouton
the planning does the
planning  People & Production
Directive Participative Uninvolved
Foster Foster Foster chaos
Dependence independence
MOST effective Most desirable Effective in
in crisis form of highly
intervention management motivated
professionals

RA 11332: MANDATORY Reporting of Notifiable

Diseases
a) Category 1: Immediately Notification
b) Category 2: Weekly Notification

RA 11223: UNIVERSAL HEALTH CARE ACT

a) POPULATION
b) SERVICES
c) FINANCIAL

TOP MORTALITY (DEATHS) IN THE

PHILIPPINES:
1) Ischemic Heart Diseases
2) Malignant Neoplasms (Cancer)
3) Cerebrovascular Diseases (Stroke)

MANAGEMENT THEORIES
1) Scientific Management
2) Classic Organization
3) Human Relations
4) Behavioral Science

A. THEORY X & THEORY Y

C. PRINCIPLES OF MANAGEMENT
1) PARETO PRINCIPLE (80-20 PERCENT RULE)
 80%: Output/Results
 20%: Inputs/Efforts
2) PRINCIPLE OF LEAST EFFORT
 People choose for convenience
 Creates processes in least efforts for
convenience of people

GANTT CHART
 Made by: Henry Gantt
 To graphically depict the timeline fort long-
term and complex projects, enabling a team PDCA (Plan, Do, Check, Act)
to gauge its progress  To control and continuous improvement of
processes and products

SIPOC (Suppliers, Inputs, Process, Outputs, Customers) MANAGEMENT ROLES

 To identify the basic elements or variables in a 1) INTERPERSONAL
process 1) Acts as a representative
2) INFORMATIONAL
2) Acts as a source & channel of information
3) DECISIONAL
3) Acts as a troubleshooter & decision maker

FUNDAMENTALS SKILLS OF MANAGERS

 According to KATZ,
1) TECHNICAL
 Use right techniques
 Proficiency
2) HUMAN
FISHBONE DIAGRAM (Ishikawa Diagram)  Communication & interpersonal skills
 To present a clear picture of the many causal 3) CONCEPTUAL
relationships between outcomes and the  To see details
contributing factors in those outcomes. PLANNING
 Decide in advance
  Predetermined course of action to an
organization
ORGANIZING
 Forecast estimated future  Establishing formal authority
 Set objectives  Authority
 Develop and schedule programs  Accountability
 Prepare budget allocate resources  Being answerable for one’s own actions
 Establish policies. Procedures, definite course  Responsibility
of action  Obligation to perform a task
 SCOPE:  Set-up organizational structure
1) STRATEGIC PLANNING  Identify groupings, roles and relationships
 LONG term
 2-5 years DOCTRINE OF RESPONDEAT SUPERIOR:
 VISION: FUTURE plans  Let the master, answer.
 MISSION: Reason or existence  To masters (managers) who tries to defend
himself to the court: Exercise through due
DOH: diligence
a) VISION: Filipinos are among the healthiest
people in Southeast Asia by 2022 and Asia DOCTRINE OF CORPORATE RESPONSIBILITY:
by 2040 
b) MISSION: To lead country in the
development of productive, resilient, DOCTRINE OF RES IPSA LOQUITOR:
equitable, people centered health system  “The thing speaks for itself”
for UHC

2) INTERMEDIATE PLANNING DOCTRINE OF FORCE MAJEURE:

 MEDIUM term  Act of GOD
 6 months -1 year  Acts of Nature
3) OPERATIONAL PLANNING  Unforeseeable
 SHORT term
 Daily, weekly, monthly, quarterly 4 REQUISITES OF NEGLIGENCE:
 Direct patient care 1) DUTY
 Scheduling & staffing 2) BREACH OF DUTY
3) INJURY
BUDGET: 4) FORESEEABILITY
 Final road map that estimates future costs
and a plan for utilization of resources WITNESS
1) OPERATING BUDGET 1) ORDINARY
a) REVENUE BUDGET:  Testifies what he see, hear, smell or
 expected outcome taste
b) EXPENSE BUDGET: 2) EXPERT
 Supplies (replenishable), utilities,  Testifies his expertise of knowledge
employee’s salary, etc.
2) CASH BUDGET:
 actual cash flow  Determine staff needed
3) CAPITAL EXPENDITURE BUDGET:  Develop description
 expensive items but used long term  Define qualifications and functions of personnel
 E.g. machines, infrastructure, etc.
MANAGEMENT LEVELS PATIENT CARE CLASSIFICATION
1) TOP  Method of grouping patients according to
amount and complexity of nursing
 Chief Nurse
requirement
 Administrators of the Hospital
LEVEL 1: MINIMAL  For discharge
2) MIDDLE  Non-emergency
 Nurse supervisors  1.5 hours per day
 Clinical managers LEVEL 2: MODERATE  Same help with
 Clinical coordinators ADLs, IV, VS
3) FIRST  3x/shift
 Head nurses  2hours per day
LEVEL 3:  Completely
 Senior nurses
TOTAL/INTENSIVE dependent
4) OPERATIONAL  VS every 40
 Frontliners minutes
 Staff nurses  6 hours per day
 Nursing attendants
LEVEL 4: CRITICAL  Continuous
PRINCIPLES OF ORGANIZING observation
 6-9 hours or
1) Unity of Command
higher per day
 Designated to ONE leader
2) Scalar Principle/Hierarchy RATIO OF PROFESIONALS AND NON-
 Chain of Command PROFESSIONALS
 Staff Nurse  Head Nurse  Nurse LEVEL I 55:45
Supervisor  Chief Nurse LEVEL II 60:40
3) Departmentalization LEVEL III 65:35
 Homogenous Assignment LEVEL IV 70:30 or 80:20
4) Span of Control
 Scope of Authority
DISTRIBUTION PER SHIFT
5) Decentralization AM 45%
 POWER is distributed PM 37%
NIGHT 18%
RA 7160: LOCAL GOVERNMENT CODE
 Local Government Organizations
formulate plans with autonomy DIRECTING
 Issuance of orders, assignments, and
ORGANIZATIONAL CHART instructions that enable the nursing personnel
 DIAGRAMMATIC PRESENTATION of the  Delegating nursing care assignments
organizational structure  Utilize/revise/update policies and procedures
 A line drawing that represents the  Supervise harmonize goals through guidance
relationship of the staff.  Coordinate unite personnel and services
 Communicate ensure common understanding
 Develop people, provide staff development
STAFFING
programs
 Allocating acceptable number of nursing and
 Decide, make judgment
non-nursing personnel
 Process of determining and providing the
acceptable
ELEMENTS OF DIRECTING
SCHEDULING 1) U
 Timetable showing planned work days and
shifts for nursing personnel
COMMUNICATION 5) CASE METHOD
1) DOWNWARD  Crosses all settings
 TOP to BOTTOM  Stays with patient on their entire period
 Chief Nurse to Staff Nurses of illness
 E.g. Performance appraisal
2) UPWARD SUPERVISION
 BOTTOM to TOP  Providing guidelines for the accomplishment
 Staff Nurses to Chief Nurse of a task or activity with initial direction and
 E.g. Incident report, Grievance periodic inspection
(complaints)
3) HORIZONTAL STAFF DEVELOPMENT
 Within the same level  Providing structure and assistance for
 Staff Nurses-Staff Nurses employees to learn more
 E.g. Endorsement (End of shift Report) 1) ORIENTATION: for new employees
4) OUTWARD 2) IN-SERVICE EDUCATION: provide by
 Outside to other organization employers
 Staff Nurse to Patient 3) SPECIALTY COURSES:
5) GRAPEVINE 4) FORMAL EDUCATION: Master’s Degree,
 E.g. Hearsays, gossips, rumors Doctoral Degree

DELEGATION CONTINUING PROFESSIONAL DEVELOPMENT

 Process by which a manager assigns specific (CPD)
tasks/duties to workers with commensurate  PRC license validity for renewal: 3 years on
authority to perform the jobs. the birthdate of the nurse
 Attending seminars, trainings, etc.
WHAT CANNOT BE DELEGATED?  RA 10912: CPD Act of 2016
1) Overall responsibility, authority &  CPD Units needed for Nurses: 15 CPD Units
Accountability  CPD Units needed for OFW Nurses: EXEMPTED
2) Sign one’s name  CPD Units needed for PWD + Senior Nurses: 10
3) Evaluation ort taking necessary corrective or CPD Units
disciplinary action  CPD Units needed for Newly Licensed Nurses:
4) To maintain morale of staff EXEMPTED
5) Those too technical  CPD COUNCIL: accredits units needed
6) Those that involve trust and confidence  Chairperson: BON
 2 Members:
NURSING CARE ASSIGNMENT 1) PNA
1) FUNCTIONAL NURSING 2) ADPCN
 Divide work to be done
2) TOTAL CARE NURSING CONFLICT MANAGEMENT
 Nurse responsible for total care for  Conflict (clash between two opposing parties)
meeting all needs of assigned patients for TYPES OF CONFLICT
the shift INTERPERSONAL CONFLICT WITH OTHERS
 E.g. ICU units
INTRAPERSONAL CONFLICT WITH ONE’S SELF
3) TEAM NURSING
INTERGROUP CONFLICT WITH OTHER
 1 nurse leads a group of nursing GROUP
4) PRIMARY NURSING INTRAGROUP CONFLICT WITHIN THE
 Accountability stays in ONE nurse GROUP
 24/7
 1 nurse: 4-6 patients (small group)
CONFLICT RESOLUTION TOTAL QUALITY MANAGEMENT (TQM)
TYPES OF CONFLICT RESOLUTION  Involves EVERYONE
AVOIDANCE IGNORING CONFLICT
CONTINUOUS QUALITY IMPROVEMENT (CQI)
(LOSE-LOSE  Done regularly and continuously
SITUATION)
ACCOMODATION ONE PARTY GIVES UP PATIENT CARE AUDIT
TO THE OTHER SIDE
 Evaluates patient in the nursing care services
(WIN-LOSE SITUATION)
received
COMPROMISE MEETING HALFWAY
1) CONCURRENT
(LOSE-LOSE BOTH PARTIES GIVE UP  Confined/Admitted patients
SITUATION) 2) RETROSPECTIVE
COLLABORATION BOTH PARTIES  Discharged patients
MUTUALLY HELP EACH
(WIN-WIN SITUATION) OTHER

COMPETITION CONTEST

(WIN-LOSE SITUATION)

CONTROLLING
 Performance appraisal
 Quality Assurance
 Nursing audit

PERFORMANCE APPRAISAL: TARGET Employees

1) Checklists
2) Rankings
3) Rating scales
4) Anecdotal recording
5) Essay (Narrative)

PEER REVIEW
 Audit done by peers evaluating another job
performance of the employees of the same
rank against accepted standards.

QUALITY ASSURANCE
1) Structure Criteria
 Looks at physical and philosophical
attributes
 E.g. manpower, budget, organizational
structure
2) Process
 Standards and protocols
3) Outcome
 Patient condition
 Patient satisfaction
DISCIPLINARY MEASURES
1) Counseling & Oral Warning
2) Written Warning
3) Suspension
4) Termination / Dismissal
4 ELEMENTS OF INFORMED CONSENT:
 Voluntarily given
 By one who has the capacity & competence to
understand
 That he must be given enough information to
be the ultimate decision maker
A. COMPETENCE
 Ability to think rationally
 LEGAL CAPACITY: 18 years old
 MINORS: Order of Preference
a) Parents
b) Judicially Appointed Guardian
c) Grandparents
d) Siblings at legal age
e) Nearest relative (e.g. uncle, auntie)
f) State/Government (e.g.
director, social worker)
 DOCTRINE OF PARENS PATRIAE
 MENTALLY INCOMPETENT:
a) Legal Spouse (Married)
b) Children at Legal age
c) Parents
d) Judicially Appointed Guardian
e) Grandparents
f) Siblings at legal age
g) Nearest relative (e.g. uncle, auntie)
h) State/Government (e.g.
director, social worker)
 ILLITERATE (cannot read & write):
a) Read the consent form verbatim
(Doctor)
B. UNDERSTANDING
 Comprehends the procedure
 ASSESS: Ask open-ended questions
C. PRESENTATION
 Put it on an understandable manner
D. VOLUNTARINESS
 Freedom of the patient to decide
 Most important element
 Patient is ultimate decision maker
RIGHT TO REFUSE
 Continues even after signing the consent
 It is important to verify that the client is
aware of the pros and cons of refusal and is
making an informed decision
 Notify healthcare provider at the client’s
refusal
 Document the refusal at the chart
ADVANCED DIRECTIVES:
 Allow specify aspects of care they wish to
receive should they become unable to make
or communicate their preferences
1) Living Will
 Provides specific instructions about
what medical treatment the client
chooses to omit or refuse in the event
that the client is unable to make those
decisions
medical
 E,g, DNR, ventilator support
2) Healthcare Proxy
 Appoint someone on the specific
instructions
DNR orders
 Renews order for 24 hours
 take effect after a cardiac or respiratory
arrest
medical
RA 10173: DATA PRIVACY ACT
 Health information is a sensitive personal
information
CONFIDENTIALITY
 Situations when confidential information may
be revealed:
a) When patient permits
b) Medico-legal cases
c) Communicable cases & public safety
may be jeopardized
d) To members oif the health team if
relevant to his care
e) Article 3, Section 3(1) of the 1987
Constitution of the Philippines
CODE OF ETHICS FOR NURSES
  Board of Nursing: Board Resolution No. 220 a) Continuous Professional Development
Series of 2004 (CPD)
 PROMULGATION OF THE CODE OF ETHICS b) Service Training
FOR REGISTERED NURSES c) Advance Education

ARTICLE 1: PREAMBLE ARTICLE 7: ADMINSTRATIVE PENALTIES,

1) HEALTH is a fundamental right REPEALING CLAUSE, AND EFFECTIVITY
2) Nurses have FOUR FUNDAMENTAL 1) Revocation or Suspension of license for
RESPONSIBILITIES: violation of any provisions of the Code of
a) Promote health Ethics
b) Prevent illness
c) Restore health HALLMARK OF NURSING ACCOUNTABILITY
d) Alleviate suffering  ACCURATE DOCUMENTATION
3) The need for nursing is UNIVERSAL

ARTICLE 2: NURSE – PEOPLE

1) Confidentiality
2) Autonomy
3) Respect
a) Values
b) Customs
c) Spiritual Beliefs
4) Safety

ARTICLE 3: NURSES – PRACTICE

1) Human life is INVIOLABLE
2) Quality and Excellence in Care (Goal of
Nursing Practice)
3) SCOPE of practice (RA 9173)
4) Accurate documentation (for legal basis)
5) Dimensions of care:
a) Moral
b) Legal
c) Professional
6) Rights and Privileges of patients

ARTICLE 4: NURSE – CO-WORKERS

1) Solidarity (good relationship of the
healthcare team)
2) Collegial and Collaborative Working
relationship

ARTICLE 5: NURSES, THE SOCIETY AND

ENVIRONMENT
1) Establishes linkages (benchmarking)
2) Maintain a safe environment
ARTICLE 6: NURSES AND PROFESSIONAL
1) Maintain LOYALTY in nursing profession
2) Laws & Organizations
a) Accredited Professional Organization (APO)
 Philippine Nurses Association
(PNA)
3) COMMITMENT to continual learning and
active participation