Unit X Leadership Final

MR.CHANNABASAPPA .K .
UNIT X-LEADERSHIP 1. CONCEPT, TYPES ,THEORIES INTRODUCTION: Leadership has probably been written about, formally researched and informally discussed more than any other single topic. Leadership still remains an unexplainable phenomenon. It is know to exist and to have tremendous influence on human performance, but its inner workings and specific dimensions cannot be precisely spelled out. CONCEPT OF LEADERSHIP: Leadership is the use of non-coercive influence to shape the groups or organization goals, motivate behaviour towards the achievement of those goals and help define group or organization. As a property, leadership is the set of characteristics attributed to Individuals who are perceived to be leaders. Thus leaders are people who can influence the behaviors of others without having to rely on force, leaders are people whom others accept as leaders. . Leadership is an important aspect of managing. The ability to lead effectively is one of the Keys to being effective manager. The essence of the leadership is followership. In other words it is the willingness of people to follow that makes a person a leader. Moreover, people tend to follow those whom they see as providing a means of achieving their own desires, wants and needs. Definition Leadership is interpersonal influence exercised in a situation and directed through communication process, towards the attainment of a specific goal or goals. (L.M.Prasad, 2006) Leadership is the process of influencing and supporting others to work enthusiastically towards achieving objectives. (BarnardKeys, 1990) Leadership refers to the relation between an individual and group around some common interest and behaving in a manner directed or determined by leader. (Encyclopedia of Social Sciences) Leadership is defined as influence, that is the are a process of influencing people so that they will strive willingly and enthusiastically toward the achievement of group goals. - Heinz Weihrich and K. Harold Every group of people that performs near its total capacity has some person as its head who is skilled in the art of leadership. This skill seems to be a compound of at least four major ingredients. 1. The ability to use power effectively and in a responsible manner. 2. The ability to comprehend that human beings have different motivation forces at different times and in different situations. 3. The ability to inspire and
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MR.CHANNABASAPPA .K .M
4. The ability to act in manner that will develop a climate conducive to responding to and arousing motivations. FEATURES OF LEADERSHIP 1. Leadership is a continuous process of behaviors, it is not one-shot activity. 2. Leadership may be in terms of relations between a leader and his followers which arise out of their functioning for common goals. 3. By exercising his leadership, the leader tries to influence the behavior of individuals or group of individuals around him to achieve common goals. 4. The followers work willingly and enthusiastically to achieve these goals. IMPORTANCE OF LEADERSHIP Leadership is an important factor for making any type of organizations successful. The importance of good leadership can be discussed as follow; i) Motivating employees Motivation is necessary for work performance, higher the motivation, better the performance. A good leader, by exercising his leadership, motivates the employees for high performance. ii) Creating confidence A good leader may create confidence in his followers by directing them, giving them advice and getting through them good results in the organization. iii) Building morale Morale is expressed as attitude of employees towards organization, management and voluntary co-operation to offer their ability to the organization. High morale leads to high productivity and organization stability. TYPES OF LEADERSHIP According to the personal research board of the Ohio university, there are five types of leadership, these are: a. The Bureaucrat Leadership Who sticks to routine, appease his superiors, and avoid his subordinates. b. The diplomat leadership Who, is opportunistic and exploits people. He generally rouses distrust. c. The autocrat leadership Who is directive and expects objects obedience. His subordinates to be antagonistic to him. d. The expert The leader, who is concerned only with his own field of specialization. He treats his subordinates as fellow-workers. e. The quarter back The leader, who identifies himself with his subordinates even at risk of displeasing his superiors.
THEORIES OF LEADERSHIP: The oldest view of leadership considered it a birth right. Kings and queens ascended to thrones because of custom. Kings begot kings and became king leader. Individuals in formal leadership roles were accepted without questions. This is similar to the great man theory which states the great leaders are born with the ability to lead, influence and direct others. Under this perspective leaders may not be developed, but researcher given a number of theories to explain leadership and its development. Some of leadership theories are:1. Great man theory or Charismatic theory 2. Trait theory 3. Behavioral theory 4. Situational theory or Contingency theory 5. New theory of leadership 6. Path goal theory of leadership 1. Great Man Theory or Charismatic Theory The Plato explained in Republic some insight of leadership. Subsequent studies based on the insights suggested that a leader is born and is not made. A leader has some charisma which acts as influencer. Charisma is a Greek word meaning Gift. Thus charisma is a god gifted attribute in a person which make him a leader irrespective of the situations in which he works. Charismatic leaders are those who inspired followers and have major impact on their organization through their personal vision and energy. Characteristics of charismatic leaders Charismatic leaders are having very high power of influencing others They have extremely high levels of self confidence, dominance and ability to convince the followers Basic assumptions Leaders in general and great leaders in particular have some exceptional inborn leadership qualities. These inborn qualities are sufficient for a leader to be successful. Since these qualities are inborn, these cannot be enhanced through education and training. Further, since these qualities are of personal nature, these cannot be shared by others. These leadership qualities make a leader effective and situational factors do not have any influence. Implication Charismatic leadership have importance to explain transformational leaders who inspires his followers through vision and energy, while other theories discuss more about transaction leaders, who determine what subordinates need to do achieve objective and help them. Limitations It implies that nothing can be done to develop leaders in the organizations.
A charismatic leader may fail in the changed situation thus the situational variable play their own role in determining leadership effectiveness. 2. Trait Theory Under the influence of the behaviorist psychological thought, researcher accepted the fact that leadership traits are not completely inborn can also be acquired through learning and experience. Ralph M. Stogdill (1974) suggested the trait theory after evaluation of various traits suggested by the researchers. Trait is defined as relatively enduring quality of an individual. Various trait theories have suggested these traits in a successful leader. Physical and constitutional factors (Height, Weight, Physique, Energy, Health, Appearance) Intelligence Self confidence Sociability Will Dominance The current research on leadership traits suggests that some factors do help differentiate leaders from non-leaders. Various traits that needed for leadership can be classified into innate and acquirable traits. A. Innate qualities These qualities which are possessed by various individuals since their birth. These qualities are natural often known as God-gifted. On the basis of such qualities, it is said that Leaders are born and not made. These qualities cannot be acquired by the individuals. The major innate qualities are:a) Physical features Physical features of a man are determined by heredity factors. Heredity is the transmission of the qualities from ancestor to descendant through a mechanism lying primarily in the chromosomes of the germ cells. To some extent, height, weight, physique, health and appearance are important for leadership. Intelligence For leadership level of intelligence is required. Intelligence is generally expressed in terms of mental ability. Intelligence to a great extent, is a natural quality in the individuals because it is directly related to brain. B. Acquired qualities These are qualities of leadership are those which can be acquired and increased through various processes. Many of these traits can be increased through training program. Following are the major qualities essential for leadership.
b)
Emotional stability A leader should have high level of emotional stability. He should be free from bias, is consistent in action and refrains from anger. He is self confident and believes that he can meet most situations successfully.
a)
Human relations A successful leader should have adequate knowledge of human relations that, is how he should deal with human beings. Since an important part of a leaders job is to develop people and get their voluntary cooperation knowledge of people and their relationship to each other.
b)
Empathy Empathy relates to observing the things or situation from others point of view. The ability to look at things objectively and understanding them from others point of view is an important aspect of successful leadership. d) Objectivity Objectivity implies that what a leader does should be based on relevant facts and information. He must assess these without any bias or prejudice.
c)
Motivating skill Not only a leader is self motivated but he has requisite quality to motivates his followers. Though there are many external forces which motivate a person for higher performance, there is inner drive in people also for motivation to work. f) Technical skills The leading of people requires adherence to define principles which must be understood and followed for greater success. The ability to plan, organize, delegate, analyze, seek advise, make decision, control and win cooperation requires the use of important abilities which constitute technical competence of leadership. g) Communicative skills A successful leader knows how to communicate effectively. Communication has great force in getting the acceptance from the receivers of communication. A leader uses communication skillfully for persuasive, informative and stimulating purposes. Normally, a successful leader is extrovert as compared to introvert. h) Social skills A successful leader has social skills. He understands people and knows their strengths and weakness. He has the ability to work with people and conducts himself so that he gains their confidence and loyalty and people cooperate willingly with him.
e)
Implications of the theory The two very implications are: The theory emphasis that a leader requires some traits and qualities to be effective. Many of these qualities may be developed in individuals through training and development programmes. Limitations 1. Generalization of traitsThere are problems in identification of traits which may relevant for a leader to be effective in all situations. 2. Applicability of traitsThe limitations that hinder the full application of trait theory in practice, is that leadership as a process of influence reflects in leaders behavior and not his traits.
3. BEHAVIORAL THEORY Behavioral theory of leadership given by Lewin K. Lippitt (1953) emphasis, that strong leadership is the result of effective role behavior. Leader ship shown by a persons acts more that by his traits. For a leader to operate effectively, groups need some one to perform two major functions I. Task related functions It is problem solving functions related to providing solution to the problems faced by the group, in performing jobs and activities. II. Group related functions It is also called as social functions, related to actions of mediating disputes and ensuring that individuals feel valued by the group. An individual who is able to perform both roles successfully would be an effective leader. These two roles may require to different sets of behavior from the leader, known as leadership styles. Leadership behavior may be viewed in two way: functional and dysfunctional. Functional behavior influence followers positively and includes such as setting clear goals, motivating, building team spirit etc. Dysfunctional behavior may be inability to accept employees ideas so it is unfavorable to the followers and denotes ineffective leadership. Implications of the theory Behavioral theory of leadership has some important implications for managers. They can shape their behavior which appears to be functional and discard the behavioral which appears to be dysfunctional. Limitations A particular behavior may be functional at a point of time but it may be dysfunctional at another point of time. Thus the time elements will be a decider of the effectiveness of the behavior and not the behavior itself. Effectiveness of leadership behavior depends on various factors which are not in the leader but external to him like nature of followers and the situations under which the leaders behavior takes place. These factors have not been given adequate consideration. 4. SITUATIONAL THEORY Situational leadership theory also known as contingency theory given by Paul Hersey and Ken Blanchard was first time applied in 1920 in the armed forces of Germany with the objectives to get good generals under different situations. The prime attention in situational theory of leadership is given to the situations in which leadership is exercised. There for, effectiveness of leadership will be affected by the factors associated with the leader and factors associated with the situation. The various factors affecting leadership effectiveness may be broadly be classified into two major categories: Leaders behavior and situational factors. The combination of these factors determines leadership effectiveness.
Leaders characteristics
Leaders hierarchical position
Leaders behavior
Leadership effectiveness
Group performance
SITUATIONAL
FACTORS
Subordinates characteristics
Leaders situation
Group factors
Organizational factors
Factors affecting leadership effectiveness

A. Leaders behavior
Leaders behavior is affected by two variables. Leaders characteristics and his hierarchical position in the organization Leaders characteristics An individuals behavior is influenced by intelligence and ability, his characteristics like his personality, attitudes, interest, motivation and physical characteristics such as age, sex and physical features. Thus the behavior of the leader is also influenced by all these factors. All these factors are internal to leader.
I. II.
Leaders hierarchical position Leaders hierarchical position in the organization is important because persons at different levels face different kind of problems. That affects the degree of participation between superior and his subordinates in arriving at decisions to solve the problems. Managers at higher levels are more concerned with long-run complex problems which require more participation in decision making. Managers at lower levels are more concerned with short run problems involving the daily operations which may not require high level of participation. The degree of participation affects the leaders behavior.
B. Situational factors
Besides the leaders related factors, leadership effectiveness is affected by situational factors are these factors affect the leaders behavior. To the extent, a leader matches the requirement of these factors, his leadership will be effective. The various situational factors may be group in four categories.
Subordinates characteristics The subordinates characters are relevant to the effectiveness of leadership such as personality, attitudes, interest, motivation and physical characteristics such as age, sex and physical features.
I. II.
Leaders situation The leaders situation in respect to his subordinates is an important factor affecting leadership effectiveness. There are two main variables which determine the leaders situation. Leaders position power and leader subordinate relations. Leaders position power helps in influencing other, while low position power makes the leaders task more difficult. Another factor, which is leader subordinate relations is based on the classic exchange theory which suggests that there is two way influences in a social relationship. Thus good followers need to succeed in their own jobs with the help of the leader while helping their leadership to succeed at theirs. Thus, if the leader has good subordinates and good relations with them, he is likely to be more effective. Group factors Various group factors like task design, group composition, group norms, group cohesiveness and peer group relationship affect leadership effectiveness and performance. If these factors are favorable, the leader will be effective. Organizational factors Organizational factors like organizational climate and organizational culture affect leadership effectiveness. If these are conductive, the leader will be effectiveness. Implications of the theory It offers clues why a manager who is successful in one situation, fails when there is change in the situation. A manager may do better by adopting management practices including leadership which match with the situational variables. Limitations The theory appears to be good on the surface but become quite complex in practice because of numerous contingent factors. This theory loses the insight of leadership and the leader is overwhelmed by the contingent. 5. NEW THEORY OF LEADERSHIPBennis and Manus (1995) suggest new theory of leadership based on an extensive study of 90 leaders who participated in interview for the purpose of discovering what is common to leadership and leadership. The findings of this study concluded that there are four types of human handling skills common to leaders. The authors elaborate in great detail the specific of these skills and refer to them as strategies.
III.
IV.
A. B. C. D.
Strategy I :- Attention through vision Strategy II :- Attention through vision Strategy III :- Attention through vision Strategy IV :- Attention through vision
Strategy I It is the management of attention through vision, refers to the leaders ability to create a focus or a clear picture of an outcome. The leaders who were interviewed were all results oriented. The ideas they held were very clear in their own minds, making it easy for people to see where they were going. Strategy II The meaning through communication means that this group of leaders was able to turn its vision into images that others could understand. These leaders had the ability to translate their ideas into symbols with real meaning. From this ability, referred to as the management of meaning and the mastery of communication, leaders are able to inspire by capturing the imagination of others. Strategy III Trust through positioning, refers to the leaders ability to inspire trust in others by contributing to the organizations integrity. This means the leader never loses sight of why the organizational exists. The leader knows what the organization stands for and what it has to do. A second component of a leaders contribution to the management of trust is the facilitation of constancy, or staying the course. Like a pilot and an airplane, the leader takes the organization in the right direction. In this way a leader, through positioning maintains the organizations harmony and purpose but also recognizes the need for change and in congruities and provides for innovations. It essence the leader provides stability for the organization but also allows for the necessary changes that provide for organizational growth. Strategy IV The development of self through positive self regard means that the leader leads in a very personal way. The leader will display a positive self image and especially self respect. This is achieved by the leader recognizing his or her strengths and compensating for weakness while nurturing the talents and skills that he or she posses. Implications of the theory Leadership can be learned and cultivated. Leaders are not necessary charismatic. In fact, leadership is more than a characteristic and charisma just may be the result of effective leadership. Leadership is not limited to those who reside at the top of the organization. Rather, leadership opportunities exist at all levels of the organization. It is not so much the exercise of power but the empowerment of others.
PATH-GOAL THEORY The path-goal theory of leadership associated most closely with Martin Evans and Robert House theory of direct extension of the expectancy theory of motivation. This theory of leadership suggesting that the primary functions of a leader are to make valued or desired rewards available in the workplace and to clarify for the subordinate the kinds of behavior that will lead to those rewards that is leader should clarify the paths to goal attainment. 1. Leader Behavior The most fully developed version of path goal theory identifies four kinds of leader behavior. 1). Directive behaviour It is letting subordinates know what is expected of them, giving guidance and direction and scheduling work. 2) Supportive leader behaviour It is being friendly and approachable, showing concern for subordinates welfare and treating members as equals. 3) Participative leader behaviour It is consulting subordinates, soliciting suggestions and allowing participation in decision making. 4) Achievement oriented leader behaviour It is setting challenging goals, expecting subordinates to perform at high levels encouraging subordinates, and showing confidence in subordinates abilities. In contrast to Fiedlers theory, Path-goal theory assumes that leaders can change their style a behaviour to meet the demands of particular situation. 2. Situational Factors Like other situational theories of leadership, Path-goal theory suggest that appropriate leader style depends on situational factors. Path-goal theory focuses on the situational factors of the personal characteristics of subordinates and environmental characteristics of the workplaces.
2. Leadership Styles Introduction Leadership does not mean dominating the subordinates The leaders job is to get work done by other people , and make people willingly want to accomplish some thing. So effective leadership means effective and productive group performance Definitions A. Leader ship: Leadership is the process of influencing the thoughts and actions of other people (a person r a group ) to attain the desired objectives. B. Style: A style is a particular form of a behavior directly associated with an individual. Or the way in which a leader uses interpersonal influences to achieve the objective of an organization .One should ask why the style of functioning of a leader need to be under stood. The reasons are ; A style of leadership affect the health care delivery system. A style allows the nurse to interact more productively and more harmoniously to achieve personal and organizational goals. Leadership style : Leadership style is how a leader uses interpersonal influence to accomplish goals of an organization. Types of Leadership Styles: 1.Autocratic style of leadership 2.Democratic style of leadership. 3.Laissez-faire style of leadership 1. Autocratic style of leadership : Autocratic leader ship is described as Authoritarian leadership Directive leadership and the leader is referred to as Extreme form of Dictator
2. Democratic Leadership Style: A democratic leader ship is described as Participative or Consultative style of leadership. 3.Laissez-faire leadership style: Also known as
Permissive Free rein, Anarchic, Ultra liberal style of leadership
Autocratic leadership The leader assumes complete control over the decisions and activities of the group. The authority for decision making is not delegated to persons in lower level positions (centralized organization) Personality of the leader: Firm personality ,insistent, self assured ,highly directive ,dominating, with or without intention Has high concern for work than for the people who perform the task Uses the efforts of the workers to the best possible shows no regard to the interests of the employees Sets rigid standards and methods of performance and expects the subordinates to obey the rules and follow the same. Makes all decisions by himself or herself related to the work & pass orders to the workers and expect them carry out the orders. There is minimal group participation or none from the workers Thinks that what he or she plans and does is the best. May Listen to them by not influenced by their suggestions. Has no trust or confidence in the subordinates in turn they fear and feel they have nothing much in common Exercises power ,.manipulates the subordinates to act according to his goals plans and keeps at the centre of attention. Advantages & Disadvantages of Autocratic leadership Sl.No 1 Advantages Disadvantages
Efficient in times of crisis, Easy to Does not encourage the individuals make decision by one person than by growth and does not recognize the group. And less time consuming potentials, initiative ness and creates less cooperation among members. It is useful when there is only leader The leader lacks supportive power that who is experienced having new and results in decisions made with essential information while subordinates consultation although he may be correct. are in experienced and new. It is useful when the workers are unsure Inhibits groups participation which of taking decision and expect the leader results in lack of growth, less job to tell them what to do. satisfaction can lead to less commitment to the goals of organization
The democratic leadership style: It is also referred to participative , consultative style of leadership. 1.This style is characterized by a sense of equality among leaders and followers. The leader is people oriented Focuses on the human aspects Builds effective work group Togetherness is emphasized 2.Open system of communication prevails The group participate in work related decisions .(sharing the thoughts in problem solving) 3.The interaction between the leader and the group is friendly and trusting The leader brings the subject to be discussed to the group Consults Decision of the majority is made and implemented by the entire group Makes final decision after seeking input from the total group. Therefore the group feels they have important contribution to make, Freedom ideas drawn, develop sense of responsibility for the good of the whole. 4. Leader works through people not by domination but by suggestions and persuasions The leader motivates the workers to set their own goals, makes their own work plans and evaluates their own performance. Informs the overall purpose and the progress of the organization 5.Performance standards exist to provide guide lines and permit appraisal of workers thus results in high productivity. Advantages & Disadvantages of democratic leadership style Sl.No Advantages 1 2 It permits and encourages all employees to practice decision making skills. It promotes personal involvement. suggestions are welcomed .this results in greater commitment to work and enhanced job satisfaction Decisions made by the group are more effective than by the leader alone. Members may have more information than the leader Disadvantages
It takes more time for making the decisions by the group than by leader alone. However the advantages over weigh the negative outcomes.
The Laissez faire Leadership style: It is also referred to as Free-Rein, Anarchic, Ultra liberal style of leadership. The leader gives up all power to the group.
Characteristic features 1. This encourages independent activity by the group members. An outsider would not be able to identify the leader in such a group The leader exerts little or no influence on the group members. There is lack of central direction, Supervision, coordination and control. 2.Group members are free to set their own goals determine their own activities and allowed to do almost what they desire to do. A variety of goals may be set by every individual and it will be difficult to carry out to accomplish the task by the group easily. 3. This style may be chosen by the leader or it may evolve because ; the leader is too weak to exert any influence on the group and attempting to please every one to feel good. And fails to function as an effective leader. 4.This style is effective in highly motivated professional groups.eg: research projects where independent thinking is rewarded or when the leader feels that the problem must be solved by the group alone 5.This style is not useful in a highly structured health care delivery system or any institution 6.The group where there is no appointed leader will fall in to this category. Advantages & Disadvantages of Laissez faire Leadership style Sl.No 1 Advantages Disadvantages
In limited situations creativity may May lead to instability ,disorganization, be encouraged for specific purposes inefficiency ,no unity of actions. . eg. highly qualified people plan a new approach to a problem that need freedom of action To try new methods of actions Neither the group nor any one in the group will feel to be responsible to solve the problems that may arise. The individual members will lose interest ,initiative and desire for achievement.
Bureaucratic style of leader ship: In this kind of leadership the leader functions only on lines with rules and regulations. The leader cannot be flexible and does not like to take any risk out of the rules. Example: Defense leaders. They are strictly adhering to the rules and maintain the discipline of group. 14 Padmashree college of nursing Bangalore -72
The effective leadership style: No one functions always with a particular leadership style. No single style is appropriate for all situations. At times combination of styles may be most appropriate
Eg: a midway between authoritarian and democratic or between democratic and laissez faire. Comparison of leadership styles Parameters Authoritarian Control Strong over the group Motivation By coercion Direction By command Decision Self making Status I& U difference Criticism Punitive Democratic Less Laissez faire Little or none
Economic / Ego By support awards suggestion / Little, upward& guidance down ward Participative Dispersed We Constructive The group None
The factors which influence the leadership of a nurse manager: The nature of work (ICU, regular unit) The characteristics of nursing staff (Knowledge, competencies, attitudes ) The time available The importance of the results (quality of care )
The qualities of a leader Managerial abilities Interpersonal relationships Temperament(nature of person) Credibility and forward thinking Professionalism Advocacy
1. Managerial abilities: Plans , organizes, makes decisions effectively encourages cooperation and participation Assists nurse/subordinates in solving the problems and provides consistent feed back Provides rationale for difficult decisions Assess abilities of the workers , guides them to develop new skills Knows her/his job and does it well and has confidence in self and others Welcomes different opinions and is more interested in giving than receiving Provides the workers with adequate facilities.
2. Interpersonal relationships : Shows supportive and caring behavior towards subordinates Is a good listener and sensitive to others needs Guides and motivates to act and work together Establishes relationships with all types of workers, and able to work with others harmoniously.
3. Temperament : ( Nature or character ) Reliable, open, honest and sincere Shows a sense of humor tactful, friendly and loyal Calm and charismatic, modest neat and patient Positive energetic, hard worker, happy and enthusiastic Shows a balance between work and home life or personal life
4. Credibility and forward thinking: Acts as a role model and influences others . Acts as an activist , challenger , creative thinker , change agent , innovator, risk taker and courageous . Acts as a facilitator and solution seeker.
5. Professionalism: Committed to the profession and maintains confidentiality Instills hope and pride in the profession Stands for rights while considering others rights( assertive )
6. Advocacy: Acts as an advocate for others specially for nursing profession and for nursing staff 16 Padmashree college of nursing Bangalore -72
Acts as an advocate with physician Acts as patient advocate Acts as an advocate for nursing education and students for the rights and standards
Implications to nursing: Regardless of the style selected the nurse managers should be aware of the effect of the style adopted in the hospital ,unit or educational institution ,staff and on the level of work performance. Effective leadership improves the job performance. And quality on the whole . BIBLIOGRAPHY1. Griffine, (2005), Management, 1st edition, AITBS Indian Edition, Delhi, Pp. 515530. 2. Heinz .W. et.al., (2001), Management, 10th edition, Tata Mc.Graw-Hill Publishing Company, New Delhi, Pp. 490-509. 3. Marquis et.al., (2000), Leadership Roles and Management functions in nursing, 3rd edition, Lippincott publication, Philadelphia, Pp. 3-24. 4. Swansburg. S, et.al., (2002), Introduction to management and leadership for nurse managers, third edition, Jones and Bartlett publishers, Pp. 393-405.
3. LEADER BEHAVIOR AND MANGER BEHAVIOR INTRODUCTION Leadership is a process of influence on a group. It is an important part of a managers job. The fact that a leader can have an immense-effect on the performance of those under him has been noted for centuries that while some other officers receive only grading obedience, others are able to inspire their men to do seemingly impossible and do it willingly. DEFINITION Leadership is generally defined simply as influence the art (or) process of influencing people so that they will strive willingly towards the achievement of group goals. - Koontz and ODonnel Leadership is the ability to secure desirable actions from a group of followers, voluntarily without the use of coercion. -Alford & Beathy CHARACTERISTICS OF LEADERSHIP Leadership is a process of influence. Leadership is related to situation. Leadership is the function of stimulation. Leadership gives an experience of helping attain the common objectives. Employees must be stratified with the type of leadership provided. FUNCTIONS OF LEADERSHIP i. Determination of goals ii. Organisation of activities iii. Achieving co-ordination iv. Representation of group v. Providing guidance vi. Inspiration of employees vii. Building employees moral viii. Facilitating change QUALITIES OF LEADERSHIP Traits of a leader are as follows. (i) Physical trait - Sound health - Good vitality and endurance - Performs duties - Satisfactory (ii) Psychological traits - Personal magnerism - Enthusiasm - Ability to inspire - Co-operation 18 Padmashree college of nursing Bangalore -72
- Forcefulness - Tactfulness (iii) Traits of Character - Integrity - Self discipline - Willingness to accept responsibility - Physical and moral courage - Humanism LEADERSHIP BEHAVIOUR There are several theories on leadership behavior. This section focuses on 1. Leadership based on the use of authority. 2. Likerts four systems of management. 3. The managerial grid. 4. Leadership involving a variety of styles, ranging from a maximum to a minimum use of power and influence. 1. Leadership based on use of authority Leaders were seen as applying three basic styles. The autocratic leader commands and expects compliance, is dogmatic and positive, and leads by the ability to with hold or give rewards and punishment. The democratic, or participative, leader consults with subordinates on proposed actions and decisions and encourages participation from them. This type of leader ranges from the person who does not take action without subordinates. Concurrence to the one who makes decisions but consult with subordinates before doing so. The free-rain leader uses his or her power very little, if at all, giving subordinates a high degree of independence in their operations. Such leaders depend largely on subordinates to set their own goals and the means of achieving them and they see their role as one of aiding the operations of followers by furnishing them with information and acting primarily as a contact with the groups external environmental. 2. Likerts four systems of management Professor Rensis Likert and his associates at the University of Michigan have studied the patterns and styles of leaders and managers. Likert has developed certain ideas and approaches important to understanding leadership behavior. All members of the group, including the manager or leader, adopt a supportive attitude in which they share in one anothers common needs, values, aspirations, goal and expectation. System 1 As guidelines for research and for the clarification of his concepts, Likert has suggested four system of management. System 1 management is described as exploitive authoritative, its managers are highly autocratic, have little trust in subordinates, motivate people through fear and punishment and only occasional rewards, engage in downward communication, and limit decision making to the top. System 2 The management is called benevolent-authoritative, its managers have a patronizing confidence and trust in subordinates, motivate with rewards and some fear and punishment
with rewards and some fear and punishment permit some upward communication, solicit some ideas and opinions from subordinates, and allow some delegation of decision making but with close policy control. System-3 Management is referred to as Consultative, managers in this system have substantial but not complete confidence and trust in subordinates, usually try to make use of subordinates, ideas and opinions, use rewards for motivation with occasional punishment and some participation, engage in communication flow both down and up, make broad policy and general decision and at the top while allowing specific decisions to be made at lower level, and act consultatively in other ways.
System-4 The management as the most important participativeof all and referred to it as Participative -group. System 4 managers have complete trust and confidence in subordinates in all matters, they always get ideas and opinions from subordinates and constructively used them. They engage in much communication down and up and with pears, encourage decision making throughout the organization, and operate among themselves and with their subordinates as a group. 3. The Managerial Grid A well known approach to defining leadership styles is the managerial grid, developed some years ago by Robert Blanke and Jane Mociton. Devised a clever device to dramatize this concern. The grid, has been used throughout the world as a means of training managers and of identifying various combinations of leadership styles.
Grid dimension The grid has two dimensions. Concern for people and concern for production. As Blake and Mouton have emphasized, their use of the phrase, concern for is meant by to convey how managers are concerned about production or how they are concerned about people, and not such things as how much production they are concerned about getting out a group. The four extreme styles Blake and Mouton recognize four extremes of styles. Under the 1.1. Style (referred to as improvised management) managers concern themselves very little with either people or production and have minimum. Involvement in their jobs, to al intents and purpose, they have abandoned their jobs and only mark time or act as managers communication information from superiors to subordinates. At the other extreme and the 9.9 managers. Who display in their actions the highest possible dedication both to people and to production. They are the real team managers who are able to mesh the production needs of the enterprise with the needs of individuals.
Another style is 1.9 management (called country club management by some), in which mangers have little or no concern for production but are concerned only for people. They promote an environment in which every on is relaxed, friendly and happy and no one is concerned about putting forth co-ordinated effort to accomplish enterprise goals. At another extreme are the 9.1 managers (some-times referred to as autocratic task managers), who are concerned only with developing an efficient operation, who have little or no concern for people and who are quite autocratic in their style of leadership.
4. Leadership as a continum The adaptation of leadership styles to different contingencies has been well characterized by Robert Tannenbaum and Warren H. Schmiolt developers of the leadership continuum concept. They see leadership as involving a variety at styles, ranging from one that is highly boss centered to one that is highly subordinates centered. The styles vary with the degree of freedom a leader or manager grants to subordinates. Thus instead of suggesting a choice etween the two-styles of leadership-authorization or democratic this approach offers a range of style, with no suggestion that one is always right and another is always wrong. The continuum theory recognizes that which style of leadership is appropriate depends on the leader, the followers and the situation. The most important elements that may influence a managers style can be seen along a continum as; i. The forces operating in the managers personality. Including his or her value system, confidence in subordinates, inclination toward leadership styles and feelings of security in uncertain situations. ii. The force in subordinates (such as their willingers to assume responsibility, their knowledge and experience, and their tolerance for ambiguity) that will affect the managers behaviour. iii. The forces in the situation, such as organization values and traditions, the effectiveness of subordinates working as a unit, the nature of a problem and the feasibility of safety delegating the authority to handle it and the pressure of time.
Fiedlers Contingency approach to Leadership Although their approach to leadership theory is primarily one of analysis leadership style, Fred. E. Fiedler and his associated at the University of illions have suggested a contingency theory of leadership. The theory holds that people become leaders not only because of the attributes of their personalities but also because of various situational factors and the interaction between leaders and group members. Critical dimensions of the leadership situation; On the basis of his studies, Fiedler described three critical dimensions of the leadership situation that help determine what style of leadership will be most effective. (i) Position power This is the degree to which the power of a position, as distinguished from others source of power, such as personality or expertise enables a leader to get group members to comply with directions, in the case of managers, this is the power arising from organizational authority. (ii) Task Structure It tasks are clear (rather than vague and unstructured), the quality of performance can be more easily controlled and group member can be hold more definitely responsible for performance. (iii) Leader-member relatives Since position power and task structure may be largely under the control of an enterprise. It has to do with their extent to which group members like, trust, and are willing to follow a leader.
Goal-path approach of leadership behaviour The path-goal theory suggests that the main function of the leader is to clarify and set goals with subordinates, help them find the best path for achieving the goals, and remove obstacles. Proponents of this approach have studied leaders which in a variety of situations. As stated Robert House, the theory builds on various motivational and leadership theories of others. Factors contributing to effective leadership should be considered. These situational factors include 1. Characteristics of subordinates, such as their needs, self-confidence, and abilities. 2. The work environment, including such components, as the task, the reward system and the relationships with co-workers. Leader behavior Leader behavior is categorized into four groups. 1. Supportive leadership : behavior gives consideration to the needs of subordinates, shows a concern for their well-being and creates a pleasant organizational climate. It has the greatest impact on subordinates performance when they are frustrated and dissatisfied. 2. Participate leadership allows subordinates to influence the decisions of their superiors and can results in increased motivation.
3. Instrumental leadership gives subordinates rather specific guidance and clarifies what is expected of them, this includes aspects of planning, organizing co-ordinating and controlling by the leaders. 4. Achievement oriented leadership involves setting challenging goals, seeking improvement of performance, and having confidence that subordinates will achieve high goals.
MANAGER BEHAVIOR Decision making is a process of identifying and choosing alternative course of action in a manner appropriate to the demand of the situation. The act of choosing implies that alternative courses of action must be weighted and weeded out. - Kreitner Management decision making is a work the manager performs to arrive at a conclusion an judgment. - Allen PROBLEM SOLVING It is a part of decision making. A systematic process that focuses on analyzing a difficult situation, problem solving always includes a decision making step. CRITICAL THINKING Critical thinking, sometimes referred to as reflective thinking s related to evaluation and has a broader scope than decision making and problem solving. Components of critical thinking include reason and creative analysis. - Pesut & Herman CHARACTERISTICS OF DECISION MAKING AND CRITICAL THINKING The basic characteristics of decision making and critical thinking are enumerated below. 1. It is a process of choosing a course of action from among the alternative course of action. 2. It is a human process involving to great extent the application of intellectual abilities. 3. It is the end process preceded by deliberation and reasoning. 4. It is always related to the environment. A manger may take one decision in a particular set of circumstances and another in a different set of circumstances. 5. It involves a time dimension and a time lag. 6. It always has a purpose. Keeping this in view, there may just be a decision not to decide. 7. It involves all actions like defining the problem and probing and analyzing the various alternatives which take place before a final choice is made. DECISION MAKING AND PROBLEM SOLVING PROCESS Different decision making procedures are required in different situations depending on the nature of the problem, environment, internal and external, time and cost. Each decision making process involves the following steps, known as element of decision making. Elements of decision making and problem solving process 1. Identification of problem situation 2. Definition of problem situation 3. Specification of objectives 4. Collection of data 5. Developing alternative course of action 6. Evaluation of alternative course of action 7. Selecting appropriate techniques 8. Implementation of decision
1. Identification of problem The process of decision making starts with the discovering of the problem for which internal and external situations are analysed. The problem may relate to an area of an operation or may related to the external environment. Along with location of the problem, its basic nature is ascertained as to whether it calls for a strategic operational, major or minor, and long and short-term decision. 2. Definition of problem Once the problem has been perceived, the manger proceeds to analyze it to determine its nature. Here, the manager has to clearly define the problem. A well defined problem is half-solved. The efficiency of the decision making process and its quality depends on clear definition of the problem which is a difficult task because the real problem may be quite different from what it appears. The problem situation has to be defined and described interms of its origin, scope, symptom causes, importance, gravity, intensity and ramifications. Defining a problem is a time consuming job and the manager may prefer to define its strategic and critical components. 3. Specification of objectives The decision making process does not work in isolation. It has certain objectives. Decisions are directed towards the achievement of objectives. The managers are expected to prepare a statement of the objectives which may be quantitative and qualitative and serve as a yardstick for measuring and evaluating the efficiency and effectives of various alternative course of action, particularly, the one, chosen or solving the problem. For example, the company facing the problem of cut throat competition may achieve the objectives of survival or maintenance of market share by solving the problem.
4. Collection of Data Required, relevant and reliable information has a very important role in decision making. Information is required not only for uncovering and defining the problem but is equally useful for other involved in the process. The required information is gathered from internal and external sources to provide a factual framework to managers. Availability and reliability of information is a critical input for decision making.
5. Developing alternative course of action After defining a problem and collecting information, a manager has to developed alternative solution. The process of decision making becomes relevant and meaningful and challenging exercise for managers, only I they have may more alternatives to be examined for making a final decisions. Alternative solutions may not be obvious and apparent. It is the duty of the managers quickly by reference to experience and expertise and others may be generated through research and analysis, creative thinking and innovativeness. 6. Evaluation of Alternative course of Action The objectives of decision making is to choose an alternative that will provide the greatest amount of wanted and the smallest of unwanted consequences. Each alternative is evaluated to satisfy the objectives of the managers. The probable consequence of alternatives can be estimate through forecasting and other devices. An alternative should be thoroughly evaluated in term of risk, time consumed, efficiency and resource position. While choosing an alternative, both quantitative and qualitative factors should be taken into account. 7. Selection of Appropriate Alternatives Here, the final choice is made by screening and conducting a critical evaluation to eliminate the large number of alternatives. But, for the final choice, the mangers have to rely on experience, skill and judgment and feasibility, acceptability, practicability and simplicity of the alternative choice. Various organizational plans, policies, rules, basic philosophy of management and other human factors are given due weightage. 8. Implementation of the decision Implementation of decision implies series of actions and utilization of resources. To implement decision, necessary structural administrative and logistic arrangements are made such as delegation of authority, allocation of resources, assignment of activities and installation of controlling mechanism. To secure maximum co-operation commitment and acceptance for implementing decision, the concerned employees are taken into confidence or involved in process. TECHNIQUES OR BASIS FOR DECISION MAKING AND CRITICAL THINKING The selection of an appropriate technique depends upon the judgement of decision making following techniques of decision making and critical thinking are generally employed of decision making and critical thinking are generally employed.
1. Intuition Decision making by intuition is characterized by inner feeling of the person. He takes a decision as per the dictates of his conscious. He thinks about the problem and an answer is found in his mind. The decision maker had his own preferences, influences, psychological makeup and these things play a vital role in taking a decision. The past knowledge, training and experience of the decision maker plays an important role in intuitive decisions. 2. Facts Facts are considered to be the best basis of decisions making. A decision based on facts has its roots in factual data. Such decisions will be sound and proper. The increasing use of computer has helped in systematic analysis of data. The information had become a major tool in managerial decision making. 3. Experience Past experience of a person becomes a good basis for taking decisions. When a similar situation arises the manager can rely on his past decisions and takes similar decisions. The person sees and understands. Things in terms of concepts with which he is familiar. Experience should not be followed blindly. The new situations. Should be analysed on the basis of past knowledge. A successful decision in the past may not prove useful this time also, on times in future. 4. Considered options Some managers use consideration opinions as a basis of decisions making. Besides, pertinent statistics, opinion and also given due weightage. Sometimes discussed and considered by more persons become logical and may form a sound basis for decision making. A marketing manager, before deciding whether to market a new product or not, will like to see marketing statistics as will as considered opinions before finally making choice. 5. Operations research The traditional methods of taking decision on the basis of intuition, experience, etc. are replaced by systematic techniques based on analysis of data. The operations research is one of the techniques used by modern management for decision important maters. It helps managers by providing scientific basis for solving organized problems involving interaction of components of the organization. 6. Linear programming This technique is used to determine the best use of limited resource for achieving given objectives. This method is based on the assumption that there exists a linear relationship between variables and that the limits of variations could be ascertained. Linear programme can be used for solving problems in areas like production, transportation, warehousing, etc. 7. Values Being confused and unclear about ones values may affect decision-making ability. Overcoming a lack of self-awareness through values clarification decreases confusion.
People who understand their personal beliefs and feelings will have a conscious awareness of the values on which their decisions are based. This awareness is an essential component of decision making and critical thinking. 8. Individual Preference Overcoming this area of vulnerability, involves self-awareness, honesty and risk taking. The need for self-awareness was discussed previously but it is not enough top be selfaware, people also must be honest with themselves about their choices and their preferences for those choices. Additionally, the successful decision makers must take some risks. Nearly every decision has some element of risk, and most involve consequences and accountability. Those who are able to do the right but unpopular thing and who dare to stand alone will emerge as leaders. QUALITIES OF MANAGER FOR DECISION MAKING AND CRITICAL THINKING Courage Courage is of particular importance and involves the willingness to take risks. Sensitivity Good decision makers seem to have some sort at antenna that makes them particularly sensitive to situation and others. Energy People must have the energy and desire to make things happen. Creativity Successful decision makes tend to be creative thinkings. They develop new ways to solve problems. Similarities and differences between the leader and manager
Leader May or may not have official appointment Have power &authority to enforce decisions as long as followers are willing to be lead. Influence others either formally or informally Interested in risk-taking and exploring new ideas Relate to people personally in an empathetic manner Feel rewarded from personal achievements May or may not be successful as manager
Manager Appointed officially to the position Have power and authority to enforce decisions Carry out predetermined policies , rules and regulations Maintain an orderly ,controlled ,rational &equitable structure Relate to people according to their roles Feel rewarded when fulfilling organizational goals or mission They are managers as long as they hold the appointment
CONCLUSION Leadership is the art or process of influencing people so that they contribute willing and enthusiastically toward group goals. Leadership requires followership. There are various approaches to they study of leadership, ranging from the trait to the contingency approach. BIBLIOGRAPHY Marquis .L.B. and Huston .J.C., (2003), Leadership roles and management functions in nursing theory and application, 4th edition, Philadelphia, Lippincott Williams & Wilkins Company, Pp. 28-39. Weihrich. H and Koontz. H, (2003), Management of a global perspective, 10th edition, New Delhi, Tata McGraw-Hill publishing company limited, Pp. 489-509. Sakthivel (2004), Management principles and practice, 1st edition, Delhi, New Age publishers, Pp. 102-115. Prasad .L.M. (2004), Principles and practice of management, 6th edition, New Delhi, Sultan Chand and Sons Publishers, Pp. 239-245.
4. LEADER Introduction Leadership is the ability of individual to influence a group toward the achievement of goals, so that they strive willingly and enthusiastically toward the achievement of group goals. People should be encourage to develop not only willingness to work, but also willingness to work with zeal and confidence leaders act to help a group attain objectives through the maximum application of its capacities. Definition Leadership is the ability to persuade others to seek defined objectives enthusiastically. It is human factor that binds a group together and motivated it toward goal. (Keith Davis) Leader Leaders act to help a group attain objectives through the maximum application of its capabilities. They dont stand behind a group to push and prod; they place themselves before the group as they facilitate progress and inspire the group to accomplish organizational goals. A good example is an orchestra leader, whose function is to produce coordinated sound and correct tempo through the integrated effort of the musicians. Depending upon the quality of the directors leadership, the orchestra will respond. Functions of leader Development of team work
One of the primary functions of leader is to develop and combine his followers as a team. Given the followers competence, potential and needs, the leader needs to create a congenial and healthy working environment for his work team. Representing the team The leader serves as a linking pin between his/her team members and grievance of his subordinates to the management and also helps to solve problems by participating in problem solving process. Counseling the work men When team member face problems in doing their work, they seek guidance and advice from their leader. Problems may be technical or emotional in nature. Managing time One of the functions of the leader is to ensure the timely completion of activities undertaken by his/her members. He has to appreciate the trite saying a stitch in time saves nine. Using proper power Leader has to exercise his power and authority over his subordinates as per the demand of the situation exercise response from the subordinates. Securing group effectiveness Leader needs to provide for a reward system to improve the efficacy of capable workman, delegate authority and invite participation of employees in decisionmaking. Availability of necessary and adequate resources and communicating necessary information to the employees also help leader to secure effectiveness of group effort.
Core functions of a leader

Valuing Promoting quality Core functions Team building Empowering
Visioning
Coaching
Qualities of a good leader 1. Intelligence 2. Physical features 3. Maturity 4. Vision and foresight 5. Inner motivation 6. Sense of responsibility 7. Empathy 8. Human relations attitude 9. Emotional balance Classification of leader 1. Formal leader Formal leadership is institutional Formal leader is enabling to identify him with the aspiration of group Formal leader fail to achieve voluntary cooperation of subordinates due to different work groups has different leaders for different purposes. Formal leaders find it difficult to build better industrial relations. 2. Informal leaders Informal leadership is personal Informal leaders are more acceptable and influential to other employees. Informal leader can achieve voluntary co-operation of the members in different work groups due to their social and cultural understanding environment. Informal leaders can build better industrial relations due to their influence on group members. Leadership style and behavior Style based on use of authority 1. Autocratic Leader The leader centralizes power and decision making on himself/herself. The leader has complete command over the subordinates who arte compelled to obey the orders. Subordinates have no opportunity to make suggestions or take part in decision-making function. 2. Democratic or Participative Leader The leader takes decisions consultation with the subordinate participation in decision-making enables subordinate to satisfy their social and ego needs. The leader consistently receives useful ideas, suggestions, and feedback from the follower. Job satisfaction, morale and motivation tend to the work and organization. 3. Laisses-Fair or Free Rein Leader Allow group to establish its own goals and workout its own problems entire decision-making power is entrusted to subordinates and leader do not direct them. This
also known as permissive style. The leader is passive observer and he intervenes only during crisis.
The flow of the influence with three leadership styles
Autocratic Leader
Follower
Follower
Follower
Democratic or Participative leader
Follower
Follower
Follower
Free Rein Leader
Follower
Follower
Follower
Attributes of effective leader 1. Awareness 2. Assertiveness 3. Accountability 4. Advocacy 1. Awareness Leader must be aware of themselves and of all their personal characteristics. Therefore, they are able to assess the effects on the group. Leader should analyze several specific areas of self-awareness. Maturity Maturity is defined as the willingness and ability to do a task. Being a leader is a task; it involves the willingness and ability to a leader to accept responsibility, not only for his or her own action but also for action of the group. Power Ability to obtain, retain and move resources, awareness of power, how it is achieved and used, power is achieved by virtue of position. Personal power is the extent of to which leader believes that he/she can influence action with his effort that can be directed towards goal achievement. The interaction of leader and members help to establish a group power base that can be directed towards goals achievement. Leader personality Leaders should be aware of the extent of their self-confidence, enthusiasm, flexibility, creativity, honestly, fact and friendliness, since this awareness will lead to clear understanding of how affect others. Good interpersonal relationship Leader uses communication skills and attempts to convey a clear straightforward message to the group. An awareness of both the leader and groups verbal and nonverbal communication behavior is important. Self-awareness For leader to analyze his or her endurance, communication among group members is essential for any productive work to occur. 2. Assertiveness Leader behavior includes expression ones feeling, needs, ideas and standing up for ones right while considering the right of others. Assertive person generally feel good about themselves and others. There are five ways for the leader to act assertively: 1. Assertive behavior 2. Empathic assertion 3. Escalating assertion 4. Confrontive assertion 5. Language assertion Assertive behavior It is using basic assertion, which is to simple statement of ones feeling, needs or ideas. Basic assertion could be simple Yes or No.
Empathic assertion When using empathic assertion, the leader first gives recognition to the other feeling or situation and then makes a statement about his or her own position. Escalating Assertion Escalation is used when the other person fails to respond. It involves making successive assertive statements that gradually became more and more firm. Sentences may also become shorter and more blunt. Confrontive assertion Leader makes a four part statements that includes you do the effect of means 1 feel Purpose pf this type of assertion is for the person to state his or her own feeling and expectations. It is often used when the leader feels hurt or irritated. Non-Assertiveness: it can be described as denying ones own felling needs and ideas, ignoring ones own right or permitting others to infringe on ones right Non-assertive persons tend to put themselves down and let other make choices and decision for them. People who are nonassertive usually behave this way to avoid conflict; they usually end up being angry with others and with themselves. Aggressiveness It can be describes as expressing ones feeling needs and ideas at the expense of another person, standing for ones own right but ignoring the rights of others, and trying to persons just want to achieve their goals, but because of their methods they often end up feeling bitter guilty and lonely. 3. Accountability It is the obligation to carryout responsibility and exercise authority in terms of established standards of performance. Basic features of accountability 1. It is the obligation to carryout responsibility and exercise authority in terms of established standards of performance. 2. It is always moves upwards from a subordinate to superior. 3. It cannot be delegated. A superior remains accountable for the lapses of his subordinates. 4. It requires a formal report by subordinate to his superior. 5. Accountability is different from responsibility. Responsibility is work to be done while accountability is the obligation to do it is satisfactorily. 6. Accountability is necessary because, a superior must know if he was justified as in delegation of authority or not. 7. Just as responsibility is a derivative of authority, accountability is a derivative responsibility. 8. Accountability to ones profession includes a willingness to judge ones professional peers and a conscientious development of ability to judge. 4. Advocacy Advocacy helping others to grow and self-actualize is leadership role. Actions of advocacy are to inform client of their right and to as certain that clients have sufficient information on which to be their decision.
With regard to distribution of resource and use of technology. First and middle level managers are in the best position to advocate for clients problem. Newer interpretation of advocates is promoting the self-determination of the client; leader-advocate works to change the power structure, so that the situation of his/her group or client where social, political deprivation is improves. To develop a great leader Uncompromising integrity Absence of pettiness Work on things by priority Courageous Committed Goal oriented Unorthodox Inspired enthusiasm that is contagious Level headed in times of crisis Desire to help others. Factor influencing dynamic leaders in nursing Nursing education Nursing practice Appropriate selection of candidates Promoting competence, efficiently and a personal value system Research and literature based Developing potential human resources and investing in the future. Furthering education, mastery of interdependence high students of integrity Critical thinking and problem solving.
Nursing Administration Delegation and decentralization Providing challenges to meet unique abilities. Reversing negative situations.
Developing ones own style and making unique contribution to the organization Source: Lakshmi Ravi; developing leadership abilities in nursing. Role of leaders in the group process Group leader may be formal and informal or specialized formal leaders are appointed by management they carry the line of authority and the power to discipline and control group members. Leader guide members to summarize express feelings and come to closere. Understands and appropriates uses the informal communication network in organization. Communication clearly and precisely. Leader inspires people to put sprit into working for a shored goal. Being a group leader requires a thinking skilled performance based on knowledgandability acquired through management and training. 35 Padmashree college of nursing Bangalore -72
5. GROUP DYNAMICS INTRODUCTION
Never doubt that a small group of thoughtful citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead In todays explosion of information technology, communication continues to be a complex process. Group dynamics can be very positive and helpful where team members support each other and do what is best. It can alternately become destructive if individuals are allowed to continue with more selfish behaviors such as never helping someone else, making their personal life and personal problems permeate their work, being negative about everything that happens or complaining all the time. The word dynamic means force. The term group dynamics refers to the forces operating in groups. Group dynamic is concerned with the dynamic interaction of individuals in face to face relationship. The task goal of the group originating from the basic organization objectives provide for their continued interaction. As a leader understanding the group dynamics is essential in order to both compose and guide individuals within a group for the purpose of successfully and efficiently completing an assignment. Ideally an understanding of group dynamics and effect of the interplay of personalities and abilities would enable a leader to structure the composition of a group so as to partner complementary characteristics The nurse manager has an important role in this situation, because it may be necessary to counsel individuals exhibiting negative behavior to achieve positive group dynamics. DEFINITION GROUP: A a goal. People join groups to achieve goals that cannot be achieved by them alone. group may be defined as a number of individuals who join together to achieve Johnson & Johnson (2006) A collection of people who interact with one another, accept rights and obligations as members and who share a common identity. A group is an association of two or more people in an interdependent relationship with shared purposes. GROUP DYNAMICS: Group dynamics may be defined as the social process by which people interact face to face in small groups. A branch of social psychology which studies problems involving the structure of a group.
The interactions that influence the attitudes and behavior of people when they are grouped with others through either choice or accidental circumstances. A field of social psychology concerned with the nature of human groups, their development, and their interactions with individuals, other groups, and larger organizations. TYPE OF GROUPS Formal groups: refers to those which are established under the legal or formal authority with the view to achieve a particular end results. Eg: trade unions. Informal groups: refers to aggregate of personal contact and interaction and network of relationship among individual. Eg: friendship group. Primary groups: are characterized by small size, face to face interaction and intimacy among members of group. Eg: family, neighbourhood group. Secondary groups: characterized by large size, individual identification with the values and beliefs prevailing in them rather than cultural interaction. Eg: occupational association and ethnic group. Task groups: are composed of people who work together to perform a task but involve cross-command relationship. Eg: for finding out who was responsible for causing wrong medication order would require liaison between ward in charge, senior sister and head nurse. Social groups: refers to integrated system of interrelated psychological group formed to accomplish defined objectives. Eg: political party with its many local political clubs. friendship group. Reference groups: A reference group is a type of group that people use to evaluate themselves. According to Cherrington, the main purposes of reference groups are social validation and social comparison. Membership groups: those where the individual actually belongs. Command groups: Command groups are specified by the organizational chart and often consist of a supervisor and the subordinates that report to that supervisor. An example of a command group is an academic department chairman and the faculty members in that department. Functional groups: the individuals work together daily on similar tasks. Problem solving groups: it focuses on specific issues in their areas of responsibility, develops potential solution and often empowered to take action. CRITERIA FOR A GROUP

Formal social structure Face-to-face interaction 2 or more persons Common fate Common goals Interdependence Self-definition as group members 37
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Recognition by others
OBJECTIVES OF GROUP DYNAMICS To identify and analyze the social processes that impact on group development and performance. To acquire the skills necessary to intervene and improve individual and group performance in an organizational context. To build more successful organizations by applying techniques that provide positive impact on goal achievement. PRINCIPLES OF GROUP DYNAMICS The members of the group must have a strong sense of belonging to the group. Changes in one part of the group may produce stress in other person, which can be reduced only by eliminating or allowing the change by bringing about readjustment in the related parts The group arises and functions owing to common motives. Groups survive by placing the members into functional hierarchy and facilitating the action towards the goals The intergroup relations, group organization and member participation is essential for effectiveness of a group. Information relating to needs for change, plans for change and consequences of changes must be shared by members of a group.
CURATIVE FACTORS OF GROUP DYNAMICS: Yalom (1985) identified 11 curative factors that individuals can achieve through interpersonal interactions within the group: 1. The instillation of hope: By observing the progress of others in the group with similar problems, group members garner hope that their problem can also be resolved. 2. Universality: Individuals realise that they are not alone in the problems, thoughts and feelings they are experiencing. Anxiety is relieved by the support and understanding of others in the group who share similar experiences. 3. The imparting of information: Knowledge is gained through formal instruction and the sharing of advice and suggestions among group members. 4. Altruism: Altruism is assimilated by group members through mutual sharing and concern for each other. Providing assistance and support to others creates a positive self- image and promotes self growth. 38 Padmashree college of nursing Bangalore -72
5.
The development of socializing technique: Through interaction with and feedback from other members in the group, individuals are able to correct maladaptive social behaviour and learn and develop social skills. 6.Imitative behaviour: In this setting ,one who has mastered a particular psychosocial skill or developmental task can be a valuable role model for others. Individuals may imitate selected behaviours that they wish to develop in themselves. 7.Interpersonal learning: The group offers many and varied opportunities for interacting with other people. Insight is gained regarding how one perceives and is being perceived by others. 8. Group cohesiveness: Members develop a sense of belonging. Out of this alliance emerges a common feeling that both individual members and the total group are of value to each other. 9. Catharsis : Catharsis ,or open expression of feelings , is beneficial for the members in the group. In the group ,members are anle to express both positive and negative feelings. 10. Existential factors: The group is able to help individual members take directions of their own lives and to accept responsibility for the existence of their relationship. ELEMENTS OF GROUP DYNAMICS COMMUNICATION One of the easiest aspects of group process to observe is the pattern of communication. The kinds of observations we make give us clues to other important things which may be going on in the group such as who leads whom or who influences whom. Who talks? For how long? How often? Who do people look at when they talk? Who talks after whom, or who interrupts whom? Style of communication used? How are silent people treated? Is silence due to disagreement, disinterest, fear, fatigue? CONTENT VS PROCESS When we observe what the group is talking about, we are focusing on the content. When we try to observe how the group is handling its communication, i.e., who talks how much or who talks to whom, we are talking about group process. In
fact, the content of group discussion often tells us what process issue may be on people's minds. At a simpler level, looking at process really means to focus on what is going on in the group and trying to understand it in terms of other things that have gone on in the group . DECISION Many kinds of decisions are made in groups without considering the effects these decisions have on other members. Some try to impose their own decisions on the group, while others want all members to participate or share in the decisions that are made. Some decisions are made consciously after much debate and voting. Others are made silently when no one objects to suggestion.
INFLUENCE Some people may speak very little, yet they may capture the attention of the whole group. Others may talk a lotbut other members may pay little attention to them TASK VS RELATIONSHIPS The group's task is the job to be done. People who are concerned with the task tend to: Make suggestions as to the best way to proceed or deal with a problem Attempt to summarize what has been covered or what has been going on in the group Give or ask for facts, ideas, opinions, feelings, feedback, or search for alternatives. Relationships means how well people in the group work together. People who are concerned with relationships tend to: Be more concerned with how people feel than how much they know Help others get into the discussion Encourage people with friendly remarks and gestures. ROLES Behavior in the group can be of 3 types: TASK ROLES (which helps the group accomplish its task) Initiator: proposing tasks or goals; defining a group problem; suggesting ways to solve a problem. Information/opinion seeker: requesting facts; asking for expressions of feeling; requesting a statement; seeking suggestions and ideas. Information or opinion giver: offering facts; providing relevant information; stating an opinion; giving suggestions and ideas. Clarifier and elaborator: interpreting ideas or suggestions; clearing up confusion; defining terms; indicating alternatives and issues before the group.
Summarizer: pulling together related ideas; restating suggestions after the group has discussed them; offering a decision or conclusion for the group to accept or reject. Energizer; who stimulates and prods the group to act and raise the level of their actions. Coordinator: who clarifies and coordinates ideas, suggestions and activities of the group members. RELATIONSHIP ROLES (which helps group members get along better) Harmonizer: who mediates, harmonizes and resolve conflicts. Gate keeper: helping to keep communication channels open; facilitating the participation of others; suggesting procedures that permit sharing remarks. Encourager; being friendly, warm, and responsive to others; indicating by facial expression or remarks the acceptance of others' contributions. Compromiser: when one's own idea or status is involved in a conflict, offering a compromise which yields status; admitting error. Follower: who accepts the groups ideas and listens to their discussion and decisions. SELF-ORIENTED ROLES (which contributes to neither group task nor group relationship) Dominator: interrupts others; launches on long monologues; is over-positive; tries to lead group and assert authority; is generally autocratic. Negativist: rejects ideas suggested by others; takes a negative attitude on issues; argues frequently and unnecessarily; is pessimistic, refuses to cooperate; pouts. Aggressor: tries to achieve importance in group; boasts; criticizes or blames others; tries to get attention; shows anger or irritation against group or individuals; deflates importance or position of others in group. Playboy: is not interested in the group except as it can help him or her to have a good time. Storyteller: likes to tell long "fishing stories" which are not relevant to the group; gets off on long tangents. Interrupter: talks over others; engages in side conversations; whispers to neighbour. MEMBERSHIP One major concern for group members is the degree of acceptance or inclusion they feel in the group. Are there any sub-groupings? Sometimes two or three members may consistently agree and support each other or consistently disagree and oppose one another. Do some people seem to be outside the group? Do some members seem to be "in"? How those outside are treated?
Do some members move in and out of the group? Under what conditions do they move in and out? FEELINGS During any group discussion, feelings are frequently generated by the interactions between members. These feelings, however, are seldom talked about. Observers may have to make guesses based on tone of voice, facial expressions, gestures and many other forms of nonverbal cues. NORMS Standard or group rules always develop in a group in order to control the behavior of members. Norms usually express the beliefs or desires of the majority of the group members as to what behaviors should or should not take place in the group. These norms may be clear to all members (explicit), known or sensed by only a few (implicit), or operating completely below the level of awareness of any group members. Some norms help group progress and some hinder it. GROUP ATMOSPHERE Something about the way a group works creates an atmosphere which in turn is revealed in a general impression. Insight can be gained into the atmosphere characteristic of a group by finding words which describe the general impression held by group members.
GROUP MATURITY Group maturity is defined as the ability and willingness of group members to set goals and work toward their accomplishment. Characteristic of mature group: An increasing ability to be self-directed (not dependent on the leader). An increased tolerance in accepting that progress takes time. An increasing sensitivity to their own feelings and those of others. Improvement in the ability to withstand tension, frustration and disagreement. An increased ability to change plans and methods as new situations develop. Assessing group maturity is especially important for a group leader. An immature group needs direction. Directive leadership is usually best. If a group is very mature, nondirective leadership is usually best. In between the extremes of very mature and very immature, democratic leadership will be the best bet depending on the situation. GROUP DEVELOPMENT As applied to group development, group dynamics is concerned with why and how groups develop. There are several theories as to why groups develop. A classic theory, developed by George Homans, suggests that groups develop based on activities, interactions, and sentiments. Basically, the theory means that when individuals share common activities, they will have more interaction and will develop attitudes (positive or negative) toward each other. The major element in this theory is the interaction of the individuals involved. 42 Padmashree college of nursing Bangalore -72
Social exchange theory offers an alternative explanation for group development. According to this theory, individuals form relationships based on the implicit expectation of mutually beneficial exchanges based on trust and felt obligation. Thus, a perception that exchange relationships will be positive is essential if individuals are to be attracted to and affiliate with a group. Social identity theory offers another explanation for group formation. Simply put, this theory suggests that individuals get a sense of identity and self-esteem based upon their membership in salient groups. The nature of the group may be demographically based, culturally based, or organizationally based. Individuals are motivated to belong to and contribute to identity groups because of the sense of belongingness and self-worth membership in the group imparts. Group dynamics as related to development concerns not only why groups form but also how. The most common framework for examining the "how" of group formation was developed by Bruce Tuckman in the 1960s. In essence, the steps in group formation imply that groups do not usually perform at maximum effectiveness when they are first established. They encounter several stages of development as they strive to become productive and effective. Most groups experience the same developmental stages with similar conflicts and resolutions. According to Tuckman's theory, there are five stages of group development: forming, storming, norming, performing, and adjourning. During these stages group members must address several issues and the way in which these issues are resolved determines whether the group will succeed in accomplishing its tasks. 1. Forming. This stage is usually characterized by some confusion and uncertainty. The major goals of the group have not been established. The nature of the task or leadership of the group has not been determined (Luthans, 2005). Thus, forming is an orientation period when members get to know one another and share expectations about the group. Members learn the purpose of the group as well as the rules to be followed. The forming stage should not be rushed because trust and openness must be developed. These feelings strengthen in later stages of development. Individuals are often confused during this stage because roles are not clear and there may not be a strong leader. 2. Storming. In this stage, the group is likely to see the highest level of disagreement and conflict. Members often challenge group goals and struggle for power. Individuals often vie for the leadership position during this stage of development. This can be a positive experience for all groups if members can achieve cohesiveness through resolution. Members often voice concern and criticism in this phase. If members are not able to resolve the conflict, then the group will often disband or continue in existence but will remain ineffective and never advance to the other stages.
3. Norming. This stage is characterized by the recognition of individual differences and shared expectations. Hopefully, at this stage the group members will begin to develop a feeling of group cohesion and identity. Cooperative effort should begin to yield results. Responsibilities are divided among members and the group decides how it will evaluate progress. 4. Performing. Performing, occurs when the group has matured and attains a feeling of cohesiveness. During this stage of development, individuals accept one another and conflict is resolved through group discussion. Members of the group make decisions through a rational process that is focused on relevant goals rather than emotional issues. 5. Adjourning. Not all groups experience this stage of development because it is characterized by the disbandment of the group. Some groups are relatively permanent (Luthans, 2005). Reasons that groups disband vary, with common reasons being the accomplishment of the task or individuals deciding to go their own ways. Members of the group often experience feelings of closure and sadness as they prepare to leave.
DIMENSIONS OF GROUP PROCESS Some of the aspects of group process that a process consultant would look at include: Patterns of communication and coordination Patterns of influence Roles / relationship Patterns of dominance (e.g. who leads, who defers) Balance of task focus Vs social focus Level of group effectiveness GROUP DYNAMICS PROCESS A. GROUP FORMATION A group is able to share experiences, to provide feedback, to pool ideas, to generate insights, and provide an arena for analysis of experiences. The group provides a measure of support and reassurance. Moreover, as a group, learners may also plan collectively for change action. Group discussion is a very effective learning method. Participation Participation is a fundamental process within a group, because many of the other processes depend upon participation of the various members. Levels and degrees of participation vary. Some members are active participants while others are more withdrawn and passive. In essence, participation means involvement, concern for the task, 44 Padmashree college of nursing Bangalore -72
and direct or indirect contribution to the group goal. If members do not participate, the group ceases to exist. Factors which affect members participation are; The content or task of the group- is it of interest, importance and relevance? The physical atmosphere - is it comfortable physically, socially and psychologically? The psychological atmosphere - is it accepting, non-threatening? Members personal preoccupations - are there any distracting thoughts in their mind? The level of interaction and discussions - is adequate information provided for everyone to understand? - is it at a level everyone understands? Familiarity - between group members- do members know each other from before? Communication Communication within a group deals with the spoken and the unspoken, the verbal and the non-verbal, the explicit and the implied messages that are conveyed and exchanged relating to information and ideas, and feelings. Two-way communication implies a situation where not only the two parties talk to each other, but that they are listening to each other as well. It helps in clarification of doubts, confusions and misconceptions, both parties understanding each other, receiving and giving of feedback. Helpful hints for effective communication Have a circular seating arrangement so that everyone can see and interact with everyone else If there are two facilitators, they should sit apart so that communication flow is not in one direction Respect individuals- let everyone call everyone else by name respectfully Encourage and support the quiet members to voice their opinions Try and persuade the people who speak too much to give others a chance Ensure that only one person speaks at a time or no one else will be heard Discourage sub groups from indulging in side talk Problem solving Most groups find themselves unable to solve problems because they address the problem at a superficial level. After that they find themselves blocked because they cannot figure out why the problem occurred and how they can tackle it. An effective problem solving procedure would be to: Clearly define the problem: Is it what appears on the surface or are there deep hidden aspects? Try to thoroughly explore and understand the causes behind the problem Collect additional information, from elsewhere if necessary, and analyze it to understand the problem further The group should suspend criticism and judgment for a while and try to combine each other's ideas or add on improvements. The objectives should be to generate as many
ideas and suggestions as possible. This is called "brainstorming" in a group, when individuals try lateral thinking.
Leadership Leadership involves focusing the efforts of the people towards a common goal and to enable them to work together as one. In general we designate one individual as a leader. This individual may be chosen from within or appointed from outside. Thus, one member may provide leadership with respect to achieving the goal while a different individual may be providing leadership in maintaining the group as a group. These roles can switch and change. THE ROLE OF THE GROUP LEADER

A person who is not in a position of authority, who is outranked and is new to the organization, can still be a leader. Managing or Leading - refers to a person's ability to successfully lead a group of people. Organizations have realized that more leading characteristics are needed to be more competitive in the work world. Success of an organization or the individual person (nurse) can be examined and fostered through mentoring other nurses in reaching a professional or personal goal (i.e. furthering their education or obtaining certifications in specialized procedures or areas of nursing), in attaining a leadership role (i.e. charge nurse or supervisor) or being rewarded in performance (recognition or raises). The nurse leader provides an atmosphere that allows open communication among group members. What are the characteristics that may affect attitudes and behaviors of the group members? Group size, gender composition, race, ethnicity and age
Cohesion - refers to the degree of attraction and motivation to stay in the group. Commitment - refers to a person's feelings and how they identify and are attached to the group's goals or activities. The following are effective technique in group process leadership: o Use open-ended questions to start discussions. o Encourage all members to ask questions. o Respond with a positive comment or summary each time a member makes a contribution. o Give your full attention to each person's contribution. o Refrain from negative comments about member's contributions. o Don't take sides, instead summarize opinion differences. State that issue can be viewed from different perspectives. o Seek equal input from all members. o ACTIVELY LISTEN to all members. 46
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o o o o o o o o
Focus discussion on the purpose of the group. Check perceptions of the group. Convey the meaning of what a team member has said so that all members can understand. Clarify statements. Sort out the confusing and conflicting. Restate and summarize major ideas and feelings. Summarize points of opinion differences among team members. Encourage open expression of member's feelings and thoughts. Avoid frequent questioning. Too many questions at one time are annoying. Confirm members' ideas, emphasize the facts and encourage further discussion.
B. DEVELOPMENT OF GROUPS The developmental process of small groups can be viewed in several ways. Firstly, it is useful to know the persons who compose a particular small group. People bring their past experiences People come with their personalities (their perceptions, attitudes and values) People also come with a particular set of expectations. The priorities and expectations of persons comprising a group can influence the manner in which the group develops over a period of time Stages Viewing the group as a whole we observe definite patterns of behavior occurring within a group. These can be grouped into stages. FIRST STAGE The initial stage in the life of a group is concerned with forming a group. This stage is characterized by members seeking safety and protection, tentativeness of response, seeking superficial contact with others, demonstrating dependency on existing authority figures. Members at this stage either engage in busy type of activity or show apathy. SECOND STAGE The second stage in this group is marked by the formation of dyads and triads. Members seek out familiar or similar individuals and begin a deeper sharing of self. Continued attention to the subgroup creates a differentiation in the group and tensions across the dyads /triads may appear. Pairing is a common phenomenon. THIRD STAGE The third developmental stage is marked by a more serious concern about task performance. The dyads/triads begin to open up and seek out other members in the group. Efforts are made to establish various norms for task performance. Members begin to take greater responsibility for their own group and relationship while the authority figure becomes relaxed.
FOURTH STAGE This is a stage of a fully functional group where members see themselves as a group and get involved in the task. Each person makes a contribution and the authority figure is also seen as a part of the group. Group norms are followed and collective pressure is exerted to ensure the effectiveness of the group. The group redefines its goals in the light of information from the outside environment and shows an autonomous will to pursue those goals. The long-term viability of the group is established and nurtured.
C. FACILITATING A GROUP
A group cannot automatically function effectively, it needs to be facilitated. Facilitation can be described as a conscious process of assisting a group to successfully achieve its task while functioning as a group. Facilitation can be performed by members themselves, or with the help of an outsider. To facilitate effectively the facilitator needs to: Understand what is happening within the group Be aware of his/her own personality and Know how to facilitate ROLE OF NURSE MANAGER IN GROUP DYNAMICS: Knowledge of group dynamics is needed by nurse managers to improve leadership competencies and facilitates group discussions and communication. Groups are a common feature of a majority of experiences of all nurses in such roles are outcome management, team co-ordination and teaching of students, patients and families. The nurse manager usually has following role in group dynamics: 1. Supervise and manage the overall performance of staff in department. 2. Analyzing, reporting, giving recommendations and developing strategies on how to improve quality and quantity of nursing care. 3. Achieve business and organization goals, visions and objectives. Involved in employee selection, career development, succession planning and periodic training. 4. Working out compensations and rewards. 5. Responsible for the growth and increase in the organizations' finances and earnings. 6. Identifying problems, creating choices and providing alternatives courses of actions. GROUP EVALUATION: Evaluation may be powerful internal force that affects group productivity. We should recognize that evaluation is ever present in groups. In some more or less systematic fashion, consciously or subconsciously, each of us is evaluating our role, status, contribution or feelings towards the group. We evaluate other group members in same fashion. We evaluate how well our interests or needs are being met by this group. We evaluate other groups about us. Evaluation is the force that is always present in a group. The main point to be made in relation to this force is that systematic, rational evaluation has great potential in leading group members and the group to greater 48 Padmashree college of nursing Bangalore -72
productivity. Members participate the most in group activities when they understand the goals and objectives of the group and evaluate the group as making satisfactory progress toward these goals. The more satisfied members are with the progress of the group toward its goals, the more they participate. Those who evaluate the group and its progress and are satisfied with that progress, identify better with the group. Leaders who make greater use of the various procedures for evaluating their work and the work of the group are more often rated as the most effective. It is even more important in terms of group productivity and morale to know exactly how well the group or individual is doing even when the evaluation is not high. It seems more important to know where you are in terms of progress than to have a hazy idea of where you might be. Following points should be kept in mind while evaluating groups: 1. Does the group take time to adequately evaluate progress toward action or content goals? 2. Does the group adequately evaluate group process? 3. Are many group members involved in the evaluation process? 4. Is the group objective about its functioning? 5. Does the group make rational decisions regarding its functioning and does it implement changes suggested? 6. Does the group evaluate accomplishments as well as disappointments? 7. Is evaluation periodic, or is it continuous? 8. Are the results of evaluation available to all members? Every group has an actual or a potential dynamic state from which will arise the processes and the productivity of the group. Many of the forces which go to establish this dynamism do provide a further step in the development of information which may be applied to all groups both to encourage their progress and to further their ends. CONCLUSION: Group dynamics refers to the understanding of the behavior of people in groups, such as task groups, that are trying to solve a problem or make a decision. Group norms are followed and collective pressure is exerted to ensure the effectiveness of the group. The group provides a measure of support and reassurance. Moreover, as a group, learners may also plan collectively for change action . BIBLIOGRAPHY 1. BT Basavanthappa. Nursing administration. Ist edn. New Delhi: Jaypee brothers; 2000. 2. Management and leadership for nurse managers, second edition, russel c.swansburg 3. Function of nursing management- Nursing management- open access articles on nursingmanagement http://currentnursing.com/nursing_management/staffing_nursing_units.html 4. Rebecca Samson. Leadership and management in nursing practice and education.jaypee publication newdelhi. page no.50-55. 5. IGNOU nursing administration and management.volume 4 .page no .47-50 6. www.gogle.com 49 Padmashree college of nursing Bangalore -72
6. POWER AND POLITICS IN NURSING INTRODUCTION: Nursing is a fast developing professional field. One of the characteristics of a profession is that professionals have power over the practice of their discipline which is often referred to as professional autonomy. In earlier period nurses are unaware of the term power. Autonomy represents one kind of power that nurses need, and has been defined as "the freedom to act on what one knows". ". Therefore power is a key element of empowerment is nurses control over their practice. HISTORY OF POWER IN NURSING: Power was considered as a taboo in nursing. Any one nurse who excised power were not appreciated; it was looked upon as inappropriate, unlady like, and out of nursing profession. Major decisions about nursing education and practice were taken by persons out of nursing. Slowly and gradually nurses began to exercise their collective power, as there was a rise of nursing leaders like Lillian Wald, Isabel Stewart, Auvie Goodrish, Lavinia Dock, M. A Delaide Nutting and Isabel Hamptal Robb. Also there was development of organizations and associations at national level for nurses. Over the last century, many social, technological, scientific, and economic trends have shaped nursing and nurses, and their ability to exercise power towards the development of the profession. However, even these days we the nurses behave like oppressed group and get involved in intra and intergroup conflicts and dont feel the need to join professional organizations/associations. DEFINITIONS: Power - ability to influence behavior. Power can be defined as the capacity to produce or prevent changes. Sullivan and Decker 1997. Power is the force of energy to accomplish a task, meet a goal, promote changes or influence others. Power is the capacity to control behaviours surrounding life events, the freedom to make choices and decisions, the capacity to create order and sustain influence. Power is a means of protecting ourselves against the cruelty, indifference or ruthlessness of other people. Korda 1975
Henin (1998) state that to process power implies the ability to change the attitude and behaviors of individual people and groups. Power can be defined as the capacity to act or the strength and potency to accomplish something.
CHARACTERISTICS OF POWER: Power is fleeting, never permanent. Power is a neutral concept, neither good nor bad in itself. Power can be constructive and useful / it can be destructive and harmful. Power controls, corrects and corrupts. Power is reciprocal ie, when one person answers control other person gives it up. TYPES OF POWER: Power is to influence ,and the most important ingredient of a leader or manager in an organization. 1 Legitimate power Reward power Coercive power Expert power Referent power
Reward Power Reward Power is obtained by the ability to grant favors or reward others with whatever they value. The arsenal of Reward that a manager can dispense to get employees to work toward meeting organization goals is very broad a great deal of loyalty towards leader. Punishment Power The Punishment Power is opposite of Reward power is based on fear of punishment if the expectation are not met. The manager may obtain compliance through Threat of Transfer, demotion, or dismissal Legitimate Power It is the position power. Authority also is called legitimate power. It is the power gained by a title or official position with in an organization. The socialization and culture of sub ordinate employees will influence to some degree how much power a manager has due to his or her position. 4. Expert power It is gained through knowledge, expertise or experience having critical knowledge allows a manager to gain power over others who needs that knowledge. This type of power is limited to a specialized area. For e.g. Some one with vast expertise in music would only be powerful in that area, not in another specialization. 5. Referent power. Referent power is power a person has because others identify with that leader. Referent power is given to others through association with the powerful. People also may develop referent power because others perceive them a powerful it is based on respect
TYPES OF POWER 1. Legitimate power
2. Reward power
3.Coercive power
4.Expert power
BASIS HOW TO USE THE POWER given by an organization > Make polite requests according to the > Use clear and simple languages position.eg: principal. > Explain the reason > Follow-up to check compliance. the leader can provide for >Do not over emphasis the subordinates and value >Reinforce good behavior by the group. >Size of the reward should reflect total performance >Money is not only the reward.eg: awards, certificates. found in fear. eg: oral or >Avoid it except when absolutely needed. written warnings, >Determine genuine fault. suspension and >Discipline promptly without favoritism. termination. >State warnings without hostility. >Fit the punishment to the seriousness of the fault >Warn before punishing. Special ability, skill and >Avoid careless decisions, rash statements. knowledge by virtue of >remain calm in crisis and act confidently. education and experience. >respect staff ideas and include them >keep abreast with current development >do not threaten staff self esteem Admiration and respect the >treat them fairly staff feels towards a leader. >avoid hostility and indifference >make requests reasonable. >be a good role model.
5.Referent power
Other types of power are: Personal power It is the drive within a person to overcome both internal and external resistance to reaching ones goal; not to exercise control over others, but to have control within one self. Shared power It is the interdepence in relationships and human interaction as source of power. Research indicates that women tend to prefer shared power more than personal power. Political power It is associated with governmental control of people, using the prestige of office and the coercive power of the state. Collective power / associative power It is the power of a group of members which raises from sheer weight of numbers of people, uniting their collective energy to achieve a goal. When a professional group exersices such power, it is called Professional Power.eg: Nurses Professional Power, alumni of great universities and friends.
Position power It is the power as being a dean, vice principal or chief executive. Knowledge based power It is the power used by an expert in any field to affect an outcome. Latent power power hidden within an individual. Recently more nurses are using their expertise to participate in the development of health policy, her knowledge with legislature and serve in community organization to develop health services. Charismatic power It arises from a personal sense of selfcare and ability to communicate personal attributes so that other admire, identify and get motivated to follow the person.eg: natural leaders, respected teachers. INDIVIDUAL SKILLS AND ATTRIBUTES AS SOURCES OF POWER: Pfeffer's (1992) research and observations emphasize the following characteristics as being especially important for acquiring and maintaining strategic power bases: High energy and physical endurance is the ability and motivation to work long. Absent this attribute other skills and characteristics may not be of much value.
Directing energy is the ability and skill to focus on a clear objective and to subordinate other interests to that objective. Attention to small details embedded in the objective is critical for getting things done. Successfully reading the behavior of others is the ability and skill to understand who are the key players, their positions and what strategy to follow in communicating with and influencing them. Equally essential in using this skill is correctly assessing their willingness or resistance to following the Strategic Leader's direction. Adaptability and flexibility is the ability and skill to modify one's behavior. This skill requires the capacity to re-direct energy, abandon a course of action that is not working, and manage emotional or ego concerns in the situation. Motivation to engage and confront conflict is the ability and skill to deal with conflict in order to get done what you want accomplished. The willingness to take on the tough issues and challenges and execute a successful strategic decision is a source of power in any organization. Subordinating one's ego is the ability and skill to submerge one's ego for the collective good of the team or organization. Possessing this attribute is related to the characteristics of adaptability and flexibility. Depending on the situation and players, by exercising discipline and restraint an opportunity may be present to generate greater power and resources in a future scenario.
The skills and attributes are relevant not only to the work of strategic leaders but may contribute to the overall capacity to acquire and use power effectively. These skills and attributes are grouped as conceptual skills and attributes and positive attributes.
CONCEPTUAL SKILLS AND ATTRIBUTES:
Professional Competence is one of the many ways leaders "add value" by grasping the essential nature of work to be done and providing the organizing guidance so it can be done quickly, efficiently, and well. Conceptual Flexibility is the capacity to see problems from multiple perspectives. It includes rapid grasp of complex and difficult situations as they unfold, and the ability to understand complex and perhaps unstructured problems quickly. It also includes tolerance for uncertainty and ambiguity. Future Vision reflects strategic vision, appreciation of long-range planning, and a good sense of the broad span of time over which strategic cause and effect play out. Conceptual Competence relates to conceptual flexibility in that both are essential for strategic vision. It has to do with the scope of a person's vision and the power of a person's logic in thinking through complex situations. Political Sensitivity is being skilled in assessing political issues and interests beyond narrow organizational interests. It means possessing the ability to compete in an arena immersed in the political frame to ensure that your organization is adequately resourced to support your stated organization interests and those of the nation.
POSITIVE ATTRIBUTES.
Interpersonal Competence is essential for effectiveness in influencing others outside your chain of command, or negotiating across agency lines. It suggests high confidence in the worth of other people, which is reflected in openness and trust in others. Empowering Subordinates goes beyond simple delegation of tasks and is crucial for creating and leading high performing organizations. It involves the personal capacity to develop meaningful roles for subordinates and then to encourage initiative in the execution of these roles. Team Performance Facilitation includes selecting good people in assembling a team, getting team members the resources to do a job, providing coordination to get tasks done and moving quickly to confront problem individuals. Objectivity is the ability to "keep one's cool" and maintain composure under conditions that might otherwise be personally threatening. Initiative/Commitment is the ability to stay involved and committed to one's work, get things done, be part of a team effort and take charge in situations as required.
Understanding the character of strategic leader power and the requisite personal attributes and skills sets the stage for employing power effectively. We need to know more than the conceptual elements that constitute power in organizations at the strategic level. But, we need to know the strategies of how to use power effectively and to get things done. LEADING WITH POWER The acquisition and use of strategic leader power involves managing a sequential process that is described below: 54 Padmashree college of nursing Bangalore -72
1. The first task is to decide what it is the leader is trying to achieve that necessitates the use of power. 2. With the goal in mind, the leader must assess the patterns of dependence and interdependence among the key players and determine to what extent he or she will be successful in influencing their behavior. It is critical that the leader develop power and influence when the key players have expressed a differing point of view. It is important to remember there is more interdependence at the strategic level of the organization where task accomplishment is more complex. 3. Getting things done means the leader should "draw" a political map of the terrain that shows the relative power of the various players to fully understand the patterns of dependence and interdependence. This involves mapping the critical organization units and sub-units and assessing their power bases. STRATEGIES FOR DEVELOPING POWER / POWERFUL IMAGE: Self image Grooming and well dressed grounded hair and face, good clothing and neat appearance. Good manners treating people with courtesy and respect. Good body language good postures, good eye contact, confident movement. Speech - firm, confident voice, good grammer, appropriate vocabulary,good communication skills. Own values, attitude and beliefs. Career commitment. Networking political skill Mentoring mentors are competent, experienced professionals who develop a relationship with a trainee for the purpose of providing advice and support. Goal setting Developing expertise.
EXERCISING POWER IN THE WORK PLACE / ORGANIZATION: Collegiality and collaboration An empowering attitude Developing coalitions coalitions are groups of individuals or organizations that join temporarily around a common goal.
STRATEGIES TO ENHANCING POWER Marquis and Hustorn (1998) suggest that following strategies for enhancing power. 1. Expend personal resources:- Power nd energy goes hand in hand. The manager must relax and talking time for significant relationship as well as develop outside interest to expand their resources. 2. Present a powerful picture to others 55 Padmashree college of nursing Bangalore -72
3. Determine the powerful in the organization 4. Understanding and working with in the formal and informal power structures are necessary 5. Learn the language and symbols of the organization 6. Learn how to use the organization priorities 7. Increase professional skill and knowledge 8. Maintain a broad vision 9. Use experts and seek and knowledge 10. Be flexible 11. Develop visibility and voice in the organization 12. Maintain a sense of humor 13. Empower others. USES OF POWER: 1.WITH THE SELF: To use power for yourself and you must take control of your life; ie self-aware. Assess your physical, emotional and intellectual capacities, values, beliefs, talents etc. Package yourself to fit your objectives.eg: If you want to be a peofessor go for higher studies and if you want friends, be a friend. Be adaptive and flexible. Practice assertive communication.eg: say what you see (objectively), say how you feel (honesty). 2.WITH PEERS: To use power with peers you must demonstrate respect, collegiality, accountability and professionalism. Too often interpersonal powers have been found to be destructive. 3. WITH SUBORDINATES: Accepting responsibility, communicating clearly, delegating duties, fair competence, using assertive communication and being flexible and willing to compromise.
4. WITH THE PUBLIC: Nursing is one of the professional field most frequently focused by media. Nurse can change this state of affairs and use power with the public like; Support health and human welfare legislation. Submit stories of courage, achievement. Communicate the objections through media. 56 Padmashree college of nursing Bangalore -72
POWER MECHANISM: Power is expressed through eight mechanisms. They are; 1. Assertiveness: means expressing ones own position to another without inhibiting the rights of others. 2 .Ingratiation: it is trying to make other person feel important giving praise or sympathysing. 3. Rationality: means using logical and rational arguments providing pertinent information, presenting reasons and lying an idea out in a logical structured way. 4. Sanctions: is the use of threats. Positive sanctions or rewards are addressed within motivation mechanism. 5. Exchange: means that in order to pursued an exchange is offered, sanctions called scratching each others back. 6. Upward appeal: means appealing to higher authority. 7. Blocking: means deliberately blocking others from gelling their way, threatening to stop working with them, ignoring them not being friendly or simply attempting to make sure others cannot accomplish their aims. 8. Coalitions: is the result of a group of people getting together in order to speak or negotiate as one voice. POWER IN NURSING: There are at least three types of power that nurses need to be able to make their optimum contribution. The various types of power can all be categorized as stemming from nurses' control in three domains: control over the content of practice, control over the context of practice, and control over competence. The continued lack of control over both the content and context of nursing work suggests that power remains an elusive attribute for many nurses. Now power will be discussed as it is manifested by nurses' control over the content, context, and competence of nursing practice. Power and Nurses Roles Nurse historically had limited power in the health care system. But nor nursing organization are working to provide nurses with a voice at higher decision making level in health care 1. Working together: By understanding the political realities and the way in which decisions are by working together to speak with a unified voice, nurses can increase their power in the system 2. Nursing education programs Increasingly try to educate nurses to out as client advocate and agent of change. The higher educations like M.Sc (N), M.Phil(N), and Ph.D in nursing and specialized courses will help the nurses to gain power in health system. 3. Collective bargaining and shared governance It helps the nurses with mechanism for demanding recognition of the importance of their role for being participants in decision-making process.
a. Collective bargaining It is a process that allows employees who are member of the union to participate in management decisions with regard to terms of employment salaries, benefits, working conditions and similar issues. Nurses believe that people who choose nursing as a carrier should have the opportunity to have same voice in patient care assignment length of work day and week benefits any wages etc. b. Shared governance It is a professional proactive modern in which the nursing staff and the nursing management are both involved in decision-making this allows the nursing staff to make major decisions with in the organization and helps in quality improvement and gaining power 4. Power as a tool for leadership Power is an increasingly important form of influence of nursing leader. Leaders are found throughout the organization and have formal and informal leadership responsibility gain from respect and regard for the knowledge and good judgment of the person
POLITICS Politics is the science or art. It is the business of conducting the affairs of state or organization, exploring public policy and implementing laws that affect the lives of public. Nurses are even still uncomfortable about politics, treating politics as if it is a dirty word. HISTORY OF POLITICS IN NURSING: Nurses involvement in politics are limited. Florence Nightingale used her contacts with powerful men in the government to obtain supplies and the personnel she needed to care for wounded soldiers. Hannah Ropes was able to fight incompetence and obtain decent care for wound civil war soldiers because she understood who the influential people in Washington. Lillian and Margaret Sangar have influenced decision making in areas such as sanitation, nutrition, and birth control. In 1974, the ANA formed the nurses coalition in politics(N-CAP), which was the first political action committee (PAC) for nurses. DEFINITION 1.Politics is the art of influencing the allocation of scarce resources. [ Mason & albott, 1985.] 2. Politics means influencing the allocation of scarce resources Talbott and Vance 1981. 2. Politics is a means to an end, a means for influencing events and the decisions of others [Stevens, 1980] PURPOSES:1. Protection of the interests of the whole group or a particular part of a group against subordinates groups. 2. The preservation of order in the interest of the group of power or of the whole population. 58 Padmashree college of nursing Bangalore -72
3. It is important for Analysis and planning. A FRAMEWORK FOR POLITICAL ACTION:Although most people associate the word politics with government, it pertains to every aspect of life that involves competition for allocating scarce resources or influencing decision making. As such, it is relevant to what Nurse do in their daily practice, whether as a Nurse in a home health agency, a Nurse practitioner in a clinic, or a Nurse Manager in a hospital. What nurse do in their every day practice is influenced by, and in Turn influences. What governments do, what professional organization do. These are over all political power. 1. Politics in work place Politics in the work place is often regarded with disdain, as reflected in the Remark, She plays politics. This statement is used to imply that the individual got what he or she wanted because of personal connections rather than on Marit Ehrat(1983) pointed out that politics is inherent in heath care delivery because heath care involves multiple special interest groups all competing for their piece of a limited pool of resources. 2. Politics in Government Politics in government can influence who gets what kind of heath care, where, and why. Inspite of many efforts to limit heath care costs, they continue to rise much faster than inflation in general. In an attempt to control cost and Medicaid programs are anticipated. Towers in 1995 suggested Nurse Take Responsibility for educating and communicating with new legislators. Nurses must use their authoritative voices and political muscle to shift resources to expend community Based services that promote greater access to and availability of health care. 3. Politics in financing:Which individual qualifying to be cared for by a Nurse in an organization is, to a certain extent, determined by the politics of heath care financing in the United States. Finance also influences where patients receive their care. In metropolitan Regions, one can find at least two tiers of heath care. One for the poor (Public Hospital) and one for the middle and upper classes (Private Institution and Private Physician). Although public heath care institution and agencies can often provide excellent care, they frequently are underfinanced and have limited resources (Staff, Equipment, Medication). 4. Politics in organization:Once a patient gets into a hospital bed, the kind and quality of nursing care he or she receives also can be influenced by politics. Politics decides policies of government; they also determine the shape and focus of nursing organizations. These organizations are an important forum for nurses to learn, develop, and apply their political skills.
5 Politics in the community:The workplace, government and organization all interact with the community, whether local, regional, national or international. One nurse found that her leadership in a community effort to eliminate improper garbage dumping in her town enabled her to develop important connection to government officials on both the state and local levels. Applying power and politics to managing nursing care:The delivery of nursing services occurs at many levels in health care organization. The effectiveness of care depends or linked to the application of power and politics and marketing. For the staff nurse, the politics of beside care involve influencing the allocation of scarce resources (e.g.- equipment, supplies, time) for the delivery of nursing care. To maintain access to the resources needed for patient care. Nurses must connect to the whole organization and beyond not just their own nursing unit. Staff nurse can use their power when the limitation Interfere with and place restrictions on patient care whether the restriction come in the from of limited supply, money or time, nurse can use their power and the political skills of artful collaboration and networking to obtain the necessary resources to provide care. Politics of nursing care calls for an action plan, not just a care plan. It is time to force those who seek to establish policy without nursings input to listen to what nurse have to say. POLITICAL ACTION: Political action means getting involved in the process of changes, such involvement is most effective when nurses use what Vance(1985) calls the 3 Cs of political action. Communication that is assertive, clear and concise. Collectivity, a source of power and the foundation for neat networking coalitionbuilding and collaboration. Collegiality, a sense of community, birth hood and foundation for building esteem. Nurses can use communication, collectivity and collegiality to take political action. To do so they must Become informed and Vote Communicate with elected representatives Contribute time, money and effort. SKILLS that make up a nurse politician: Ability to analyze an issue / assessment skills Ability to present a possible frame and present arguments in support of her /his recommendation. Ability to participate in a constructive way Ability to voice your opinion. POLITICAL FOCUS: In the community nurses can become politically active in the community.eg: school lunch committee, health facilities and prisons, infant and aged care, highway safety, air quality, self help groups, food distribution centers. 60 Padmashree college of nursing Bangalore -72
In the professional organizations for the advancement of profession, influencing health care, advisory capacity to governmental agencies, support public and private initiative.
In the workplace political action at the work place of nurses is limited because of enormous workload. How nursing voice can become powerful:The first step in improving nursings power is to seek out opportunity for change. When you are ready to influence policy, start in your own workplace, where individuals and families known and understand the difference nurses make in the health and healing process. Identify where decisions are made and asked to be invited (e.g.- Nursing council, policy and procedure committee). Focus your power on political and policy issues that evolve from personal and professional value and visions. The professional organization provides an opportunity for developing political skills that its member can use both in the association and in other area. Seeking a leadership position with the committee provides additional influence and visibility. Such visibility often is needed if you are interested in serving on the major policy making body of the organization. Such as the board of directors. There is no perfect strategy to using power and politics to manage nursing care. It requires skill, Tact, and relationship building. THE IMPACT OF POWER AND POLITICS ON NURSINGS FUTURE:Health care is in a state of constant change. Acute care hospitals are down sizing and reorganizing while, at the same time, community sites to deliver nursing care are expanding. Nurses know the problems and have many of the solutions. Making a case for nursing input into health care policy is no longer an option for nurse. Nurses can have a tremendous impact on health care policy. The best impact is often made with a bit of luck and timing, but never without knowledge of the whole system. This includes knowledge of the policy agenda, the policy makers, and the politics that are involved once you gain this knowledge; you are ready to move forward with a political base to promote Nursing. To convert your policy ideas into political realties, consider the following power point: 1) Use Persuasion over coercion:Persuasion is the ability to share reasons and rational when making a strong care for your position. 2) Use patience over impatience:Despite the inconveniences and failing caused by health care restructuring, impatience in the nursing community can be detrimental. Patience, along with a long term perspective on health care re-form, is needed. 3) Be open minded rather than closed minded:Acquiring accurate information is essential if you want to influence others effectively. 4) Use compassion over confrontation:In times of change, error and mistakes are easy to pin point. 61 Padmashree college of nursing Bangalore -72
5) Use integrity over Dishonesty:Honest discourse must be matched with kind thoughts and actions. To manage nursing care in the future, nurses must come to realize that nursing expertise and clinical judgment are the best combination to effectively influence nursing practice and policy changes. By applying power and politics to the work place, nurse increase their professional influence. SUMMARY:So far, we have discussed in this seminar about the introduction of power and politics, Definitions, Types, sources, use in organization, Power as a tool for leadership, frame work of political action, Applying power to manage Nursing care, impact of power and politics on nursing future. 7. LOBBYING Nurses can take an active role in the legislative and political process to affect change. They may become involved in influencing one specific piece of legislation or regulation, or they can become involved more universally and systematically to influence health care legislation on the whole. DEFINITIONLOBBYING: Lobbying is the deliberate attempt to influence political decisions through various forms of advocacy directed at policymakers on behalf of another person, organization or group. Lobbying is the practice of private advocacy with the goal of influencing a governing body by promoting a point of view that is conducive to an individual's or organization's goals. LOBBYIST: 1) A lobbyist is an individual who attempts to influence legislation on behalf of others, such as professional organizations or industries. 2) Lobbyists are advocates. That means they represent a particular side of an issue. 3) A person who receives compensation or reimbursement from another person, group, or entity to lobby.
TYPES OF LOBBYING: Direct Grassroots
DIRECT LOBBYING Is communicating your views to a legislator or a staff member or any other government employee who may help develop the legislation To be lobbying, one must communicate a view on a "specific legislative proposal." Even if there is no bill, one would be engaged in lobbying if one asked a legislator to take an action that would require legislation, such as funding an agency. Asked ones members to lobby for this bill is also considered as direct lobbying. GRASSROOTS LOBBYING Is simply citizen participation in government. The key to successful grassroots lobbying efforts is assembling people who share common goals and concerns. Grassroots communications are vital in educating legislators to the concerns of the voting population in their state. If you do not share your views with your representative, then your views will not be considered by your state representative when he votes on an issue which affects you. You can make a difference by simply writing, calling, meeting, or faxing your representative.
TYPES OF LOBBYISTS The Lobbyists Registration Act identifies three types of lobbyists: The consultant lobbyist: The consultant lobbyist is a person who is gainfully employed or not and whose occupation is to lobby on behalf of a client in exchange for money, benefits or other forms of compensation. Consultant lobbyists may work for public relations firms or be self-employed. For example, he or she might be a public relations expert, a lawyer, an engineer, an architect. The enterprise lobbyist: This is a person who holds a job or has duties in a profit-making organization, whose duties include, for a significant part, lobbying on behalf of the firm. The organization lobbyist: This is a person who holds a job or has duties in a non-profit organization. Like the enterprise lobbyist, this lobbyist is affected by the Act if a significant part of his or her duties is to lobby on behalf of this organization. PREPARING FOR LOBBYING CAMPAIGN: An effective lobbying initiative takes background work. 1. Develop plan of action. Consider, rework, revamp, and define the plan in advance of the trip to the legislators office. 2. Be sure one is fully aware of all similar initiatives on the same topic and the position of those opposing ones idea. 3. Check with other nursing organizations to determine their positions and if they have information to help support ones position. 63 Padmashree college of nursing Bangalore -72
4. Fine-tune ones presentation to several key points because time will be limited. 5. Follow up after the meeting with a call or correspondence outlining the points.
PREPARING FOR AN EFFECTIVE LETTER-WRITING CAMPAIGN: Define the goals of this grass-roots campaign. Develop a plan Assess the knowledge level of the participants concerning the legislative process and the issues that impact the organization. Use this information to plan educational sessions with the goal of improving the political sophistication of the group. Give interested participants information about the bill in question and how this bill would directly affect their practice. Clearly state what action the legislative body needs to take to meet the goal, and include the specific bill number and name. Set up effective telephone or e-mail networks that can contact key members quickly. Often legislative issues are scheduled and moved up quickly on that schedule, requiring an immediate change of plan. Identify and set up contacts with the key legislators involved in your issue. Set numerical goals for how many letters or mailings will be generated. On large issues, focus groups or polls may be used to acquire information that can be analysed and send to the legislators. Get the timing right. The time to begin your campaign is just before the committee hearings begin or just prior to the vote o the floor. Too early is ineffective; too late is wasted effort. You must follow the progress of your issue closely so as to mobilize your members at the right time.
USEFUL TIPSDos: a. Do write legibly or type. Handwritten are perfectly acceptable so long as they can be read. b. Do use persona stationary. Indicate that you are a registered nurse. Sign your full name and address. If you are writing for an organization, use that organizations stationary and include information about the number of members in the organization, the services you perform, and the employment setting you are found in. c. Do state if you are a constituent. If you campaigned for or voted for the official, say so. d. Do identify the issue by number and name if possible or refer to it by the common name. e. Do state your position clearly and state what you would like your legislator to do. f. Do draft the letter in your own words and convey your own thoughts.
g. Do refer to your own experience of how a bill will directly affect you, your family, your patients, and members of your organization or your profession. Thoughtful, sincere letters on issues that directly affect the writer receive the most attention and are those that are often quoted in hearings or debates. h. Do contact the legislator in time for your legislator to act on an issue. After the vote is too late. If your representative is a member of the committee that is hearing the issue, contact him/her before the committee hearings begin. If he/she is not on the committee, write just before the bill is due to come to the floor for debate and vote. i. Do write the governor promptly for a state issue, after the bill passes both houses, if you want to influence his/her decision to sign the bill into law or veto it. j. Do use e-mails to state your points. k. Do be appreciative, especially of past favourable votes. Many letters legislators receive feedback from constituents who are unhappy or displeased about actions taken on an issue. Letters of thanks are greatly appreciated. l. Do make your point quickly and discuss only one issue per letter. Most letters should be one page long. m. Do remember that you are the expert in your professional area. Most legislators know little about the practice of nursing and respect your knowledge. Offer your expertise to your elected representative as an advisor or resource person to his or her staff when issues arise. n. Do ask for what you want your legislator to do on an issue. Ask him/her to state his/her position in the reply to you. Donts: a. Do not begin a letter with as a citizen and a taxpayer. Legislators assume that you are a citizen, and all of us pay taxes. b. Do not threaten or use hostility. Most legislators ignore hate mail. c. Do not send carbon copies of your letter to other legislators. Write each legislator individually. Do not send letters to other legislators from other states-they will refer your letter to your congressional representative. d. Do not write House members while a bill is in the Senate and vice versa. A bill may be amended many times before it gets from one house to the other. e. Do not write postcards; they are tossed. f. Do not use form letters. In large numbers these letters get attention only in the form that they are tallied. These letters tend to elicit a form letter response from the legislator. g. Do not apologize for writing and taking their time. If your letter is short and presents your opinion on an issue, they are glad to have it.
KEEP ABREAST OF LEGISLATION AND REGULATION: When issues are important to your professional, contact the legislator and provide the important facts that support your position and be sure to follow up routinely so your opinions stay fresh in his/her mind. Legislation: To keep in contact with the legislature, it is important to identify key committees and subcommittees in the legislative bodies, and to identify and develop communication with the members of those committees. Ways to keep abreast of new information include the following: Volunteer for campaign work and develop contacts with legislators. Obtain pertinent government documents using online resources. Get the general telephone number for the state government and the mailing addresses for correspondence. Develop liaisons with other health professionals and utilize them as information sources and allies in lobbying for health care issues. Register a member of your group as a lobbyist- the fee is generally small. If possible, hire a lobbyist Once you have notified your legislator about your interest in a particular issue, the legislators office may routinely send literature outlining his or her activities throughout the sometimes arduous process. Regulation: Because lobbying activities can significantly affect individuals and industry, regulation is essential to avoid abuse. Lobbyists have created ethics codes, guidelines for professional conduct and standards. The following will help you keep abreast o the newest regulations and standards: Subscribe to the state register (which contains all state regulations under consideration). Identify and develop contacts with state agencies that exert control on or impact your practice and ask to be added to their mailing lists. A limited list includes the following: i. Nurse practice act: rules and regulations ii. Medical practice act: rules and regulations iii. Pharmacy act: rules and regulations iv. Dental practice act: rules and regulations v. Hospital licensing act: rules and regulations vi. Ambulatory surgical center licensing act: rules and regulations vii. Insurance statute: rules and regulations viii. Trauma center statute: rules and regulations ix. Department of Health x. Podiatric Act: rules and regulations
CONCLUSION: Power and politics are often discussed together in the nursing literature. Those in power find it easy to participate in politics, and those who participate in politics gain power. Both power and politics serve to achieve goals, and both do so through the ability to use skills to convince others to serve the power holders purposes. Power and politics are the means to achieve health-care goals in a compassionate and humane way. Application of power and politics through collaboration, creativity, and empowerment are effective ways to influence policy. BIBLIOGRAPHY: 1. Rebecca Samson, leadership and management in nursing practice and education, jaypee brothers publications, 2009, pp: 5 7. 2. Persis Mary Hamilton, Realities Of Contemporary Nursing, California, 2 nd Edition 1996, Pp: 276. Sullivan J. Eleanor and Decker J. Phillip (1997), Effective Leadership and Management in Nursing. Forth Edition, Addison Wesley Longman, Menlo Park, Page No 56-57, 435-449. 4. Wise Yoder (1995), Leading and Managing in Nursing. First edition, Mosbyyear book publication St.Louis Page No. 480-493.Tomey- Ann Marriner(1996). Nusing Management and Leadership, 5th Edition, Mosby year book publication, St.Louis Page No.- 299-308. 5. Marquis L. Bessie and Huston J. Carol (2000). Leadership Roles and Management Functions in Nursing. 3rd Edition, Lippin Cott Publishers, Page No-166-183. Net Reference:1. http://www.georgianursing.org Retrieved on 24/08/08 http://www.google.com 3.
8. CRITICAL THINKING AND DECISION MAKING Introduction: There is nothing more practical than sound thinking. Critical thinking is essential to safe, competent, skillful nursing practice. The amount of knowledge that nurses must use and the continuing rapid growth of this knowledge prevent nurses from being effective practitioners if they attempt to function with only the information acquired in school or outlined in books. Decisions that nurses must make about client care and about the distribution of limited resources force them to think and act in areas where there are neither clear answers nor standard procedures and where conflicting forces turn decision making into a complex process. Nurses therefore need to embrace the attitudes that promote critical thinking and master critical- thinking skills in order to process and evaluate both previously learned and new information. CRITICAL THINKING You assist an evil system most effectively by obeying its orders and decrees. An evil system never deserves such allegiance. Allegiance to it means partaking of the evil. A good person will resist an evil system with his or her whole soul. ~ Mahatma Gandhi Meaning: "Critical" as used in the expression "critical thinking" connotes the importance or centrality of the thinking to an issue, question or problem of concern. "Critical" in this context does not mean "disapproval" or "negative." There are many positive and useful uses of critical thinking, for example formulating a workable solution to a complex personal problem, "Critical" as used in the expression "critical thinking" connotes the importance or centrality of the thinking to an issue, question or problem of concern. "Critical" in this context does not mean "disapproval" or "negative." There are many positive and useful uses of critical thinking, for example formulating a workable solution to a complex personal problem, Definition: Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. National Council for Excellence in Critical Thinking,1987 "Critical thinking in nursing practice is a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns. - National League for Nursing (2000) Critical thinking is the skillful application of a repertoire of validated general techniques for deciding the level of confidence you should have in a proposition in the light of the available evidence. - Tim van Gelder
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Levels of Critical Thinking According To Bloom Bloom identified six thinking levels: 1. Knowledge (knowing things) 2. Comprehension (understanding things) 3. Application (being apply to apply knowledge in the real world) 4. Analysis (ability to pull things apart intellectually) 5. Synthesis (ability to see through the clutter to the core issues) 6. Evaluation (the ability to make good judgments) Levels 4, 5 and 6 are the most important one for mid and higher levels of management. Stages Of Critical Thinking Stage One: We Begin as Unreflective Thinkers. We all begin as largely unreflective thinkers, fundamentally unaware of the determining role that thinking is playing in our lives. We dont realize, at this stage, the many ways that problems in thinking are causing problems in our lives. We unconsciously think of ourselves as the source of truth. We assume our own beliefs to be true. We unreflectively take in many absurd beliefs merely because they are believed by those around us. We have no intellectual standards worthy of the name. Wish fulfillment plays a significant role in what we believe. Whatever we want, we believe we should have Stage Two: We Reach the Second Stage When We Are Faced with The Challenge Of Recognizing the Low Level at Which We and Most Humans Function as Thinkers. For example, we are capable of making false assumptions, using erroneous information, or jumping to unjustifiable conclusions. This knowledge of our fallibility as thinkers is connected to the emerging awareness that somehow we must learn to routinely identify, analyze, and assess our thinking. Stage Three: We Reach the Third Stage When We Accept the Challenge and Begin to Explicitly Develop Our Thinking Having actively decided to take up the challenge to grow and develop as thinkers, we become "beginning" thinkers, i.e., thinkers beginning to take thinking seriously. Stage Four: We Reach the Fourth Stage When We Begin to Develop A Systematic Approach to Improving Our Ability to Think. At this stage, we now know that simply wanting to change is not enough, nor is episodic and irregular "practice." We recognize now the need for real commitment, for some regular and consistent way to build improvement of thinking into the fabric of our lives. Stage Five: We Reach the Fifth Stage When We Have Established Good Habits of Thought Across the Domains of Our Lives. We know that we are reaching the stage we call the Advanced Thinker stage when we find that our regimen for rational living is paying off in significant ways. We are now routinely identifying problems in our thinking, and are working successfully to deal with those problems rationally. We have successfully identified the significant domains in our lives in which we need to improve (e.g. professional, parenting, husband, wife, consumer, etc.), and are making significant progress in all or most of them
Stage Six: We Reach the Sixth Stage When We Intuitively Think Critically at a Habitually High Level Across all the Significant Domains of Our Lives. The sixth stage of development, the Master Thinker Stage, is best described in the third person, since it is not clear that any humans living in this age of irrationality qualify as "master" thinkers. It may be that the degree of deep social conditioning that all of us experience renders it unlikely that any of us living today are "master" thinkers. Nevertheless, the concept is a useful one, for it sets out what we are striving for and is, in principle, a stage that some humans might reach.
Components of the Critical Thinking The eight components that have been identified as part of the critical thinking process include: 1. 2. 3. 4. 5. 6. 7. 8. Perception Assumption Emotion Language Argument Fallacy Logic Problem Solving
1. Perception: Perception refers to the way we receive and translate our experiences how and what we think about them. For some, plain yogurt is delicious, while for others it is disgusting. For the most part, perception is a learned process. Eg: In the workplace, one employee will perceive a co-worker to be a constructive decision-maker, while at the same time, another sees the same employee as an adversarial roadblocto progress.
2. Assumptions: Trying to identify the assumptions that underlie the ideas, beliefs, values, and actions that others and we take for granted is central to critical thinking. Assumptions are those taken-for-granted values, common-sense ideas, and stereotypical notions about human nature and social organization that underlie our thoughts and actions. Assumptions are not always bad. For example, when you buy a new car, you assume that it will run without problems for a while. When you go to sleep at night, you assume that your alarm will wake you up in the morning. Remember, assumptions depend on the notion that some ideas are so obvious and so taken for granted that they dont need to be explained. Yet, in many cases, insisting on an explanation reveals that we may need more factual evidence in order to develop well-supported viewpoints and to come to sound decisions. The problem with assumptions is that they make us feel comfortable without present beliefs and keep us from thinking about alternatives. 3. Emotion: Emotions/feelings are an important aspect of the human experience. They are a critical part of what separates humans from machines and the lower animals. They are part of everything we do and everything we think. Emotions can affect and inspire thought, stated William James, but they can also destroy it. We all have personal barriers 70 Padmashree college of nursing Bangalore -72
enculturation, ego defenses, self-concept, biases, etc.shaped by our exposure to culture and genetic forces. But to the critical thinker, personal barriers are not walls, merely hurdles. Critical thinkers dont ignore or deny emotions; as with other forces of influence on our thinking, they accept and manage them. 4. Language: Some say that language is the landscape of the mind. Others say that language is the software of our brain. Whatever the metaphor, it is clear that thinking cannot be separated from language. Furthermore, for the multitude that define thinking itself as expressed thought, language carries the content and structures the form of the entire thinking process 5. Argument: Many people think that arguing means fighting or quarreling. In the context of critical thinking, however, this definition does not fit. An argument is simply a claim, used to persuade others, that something is (or is not) true and should (or should not) be done. When someone gives reasons for believing something hoping that another person will come to the same conclusion by considering those reasons the discourse is geared toward persuasion. An argument contains three basic elements: an issue, one or more reasons called premises in logic, and one or more conclusions. Arguments can be valid or invalid, based on how they are structured. Arguments are not true or false only premises and conclusions are true or false. The goal of a critical thinker is to develop sound arguments that have both validity (are structured properly) and true premises. When we have a validly structured argument with true premises, we have a sound argument. In sound arguments the conclusion must be true and therein lies the beauty and usefulness of logic. 6. Fallacy: Since we use language for the three primary purposes of informing, explaining, and persuading, we must be careful how we use it. We must make every effort to apply sound reasoning, particularly when language is used to persuade. To be sound, reasoning must satisfy three conditions: 1. it must be valid (structured properly); 2. the premises must be true; and 3. all relevant information must be included. If the reasoning fails to satisfy any of these three criteria, it is said to be fallacious. A fallacy, then, is an incorrect pattern of reasoning. Remember, finding a fallacy in your own or someone elses reasoning does not mean that the conclusion is false. It means only that the conclusion has not been sufficiently supported because one or more of the above three conditions were not satisfied. Fallacies can be committed through any of our communication methods, especially in the print, visual, and sound media. 7. Logic: Traditionally, philosophy has distinguished between two methods of reasoning: deductive logic and inductive logic. In logic, moving from observations to conclusions is called induction. Moving from conclusions to predictions that something will follow, given a set of circumstances and then verifying the prediction is called deduction. 71 Padmashree college of nursing Bangalore -72
Inductive reasoning is characterized by reasoning from diverse facts, probability, generalizations, hypotheses, and analogies, leading to inductive strength. Deductive reasoning is characterized by reasoning from known facts, certainty, syllogisms, validity, and truth of premises, leading to sound arguments and conclusions. 8. Problem Solving: Solving logic problems is like solving any problem that we encounter or identify in life. The following general model for problem solving is suggested: 1. Read and heed the problem. What is it telling you? What is it asking? Define terms that you do not understand. 2. Identify the unknown(s). It is helpful to name these with a symbol. Math uses a letter known as a variable, but any symbol will do. 3. Identify the knowns. Write down all the information that the problem tells you. Even if you just repeat the givens in the problem, list them. 4. Start to identify the relationships between the knowns and the unknowns. This is the critical and creative part of solving a problem. Create a visual aid like a diagram, sketch, table, etc., that allows you to see the relationships. 5. Use the relationships identified in step (4) to generate a problem-solving strategy. 6. Apply the strategy and solve. 7. If something doesnt seem to work, repeat steps 1-6. The secret to problem solving is continuing to try and learning something new on each successive iteration. The solution will ultimately be reached. METHODS OF CRITICAL THINKING a. Debate: it involve enquiry, advocacy, and reasoned judgement on a proposition. A person or group may debate or argue the pros and cons of of a proposition in coming to a reasoned judgement. b. Individual decision: an individual may debate a proposition in his or her mind using problem solving or decision making process. When consent or cooperation of others is needed, the individual may use group discussion, persuasion, propanda, coerction or a combination of this method c. Group discussion: five conditions for reaching decision through group discussion are group members agree that a problem exist, have comparable standard of value,have comparable purposes, are willing to accept concensus of the group, and relatively few in number d. Persuasion: it is communication to influence the acts, beliefs, attitude, and value of others by reasoning, urging or inducement. Debate and advertising are two forms of communication which intent is to persuade e. Propanda: it can be good or bad; it is multiple media communication designed to persuade or influence a mass audience. 72 Padmashree college of nursing Bangalore -72
f. Coerction: threat or use of force is coerction. An example of coerction is brainwashing in which subjects are completely controlled physically controlled for a indefinite period of time. g. Combination of method: Some situation require a combination of foregoing communication techniques to reach a decision. PROCESS OF CRITICAL THINKING The critical thinking process, as described by Wolcott and Lynch , includes four steps. Students generally begin their critical thinking at step one and, with practice, progress to step 2 and up the ladder. Identify the problem, the relevant information, and all uncertainties about the problem. This includes awareness that there is more than one correct solution. (low cognitive complexity) Explore interpretations and connections. This includes recognize one's own bias, articulating the reasoning associated with alternative points of view, and organizing information in meaningful ways. (moderate cognitive complexity) Prioritize alternatives and communicate conclusions. This includes thorough analysis, developing the guidelines used for prioritizing factors, and defending the solution option chosen. (high cognitive complexity) Integrate, monitor, and refine strategies for re-addressing the problem. This includes acknowledging limitations of chosen solution and developing an ongoing process for generating and using new information. (highest cognitive complexity)
Step 1:
Step 2:
Step 3:
Step 4:
Models of critical thinking Benjamin Bloom's Model of Critical Thinking Perhaps most familiar to educators is "BLOOM'S taxonomy." Benjamin Bloom describes the major areas in the cognitive domain. The taxonomy begins by defining knowledge as the remembering of previously learned material. Knowledge, according to Benjamin Bloom, represents the lowest level of learning outcomes in the cognitive domain. comprehension, the ability to grasp the meaning of material and goes just beyond the knowledge level. Comprehension is the lowest level of understanding. Application is the next area in the hierarchy and refers to the ability to use learned material in new and concrete principles and theories. Application requires a higher level of understanding than comprehension. Aanalysis, the next area of the taxonomy, the learning outcomes require an understanding of both the content and the structural form of material. synthesis, which refers to the ability to put parts together to form a new whole. Learning outcomes at this level stress creative behaviors with a major emphasis on the formulation of new patterns or structures.
evaluation. Evaluation is concerned with the ability to judge the value of material for a given purpose. The judgments are to be based on definite criteria. Learning outcomes in this area are the highest in the cognitive hierarchy because they incorporate or contain elements of knowledge, comprehension, application, analysis, and synthesis. In addition, they contain conscious value judgments based on clearly defined criteria. The activity of inventing encourages the four highest levels of learning--application, analysis, synthesis, and evaluation--in addition to knowledge and comprehension.
evaluation
synthesis
analysis
application
comprehension
knowledge
Techniques of critical thinking Here are 16 basic techniques of critical thinking. 1. Clarify. State one point at a time. Elaborate. Give examples. Ask others to clarify or give examples. If youre not sure what youre talking about, you cant address it. Unclear: How can we fix education? Clear: How can teachers better prepare students for the workforce? or How can we change policies to encourage better teaching? 2. Be accurate. Check your facts. Inaccurate: Most people these days are obese or Just vent your anger; youll feel better. Accurate: Most people in the U.S. are not obese or Studies show that venting your anger actually increases angry feelings and actions. 3. Be precise. Be precise, so you are able to check accuracy. Avoid generalizations, euphemisms, and other ambiguity. 74 Padmashree college of nursing Bangalore -72
Imprecise: Mary is overweight. Precise: Mary is 6 pounds overweight according to her Body Mass Index, which is a deceptive measure of healthy weight anyway. 4. Be relevant. Stick to the main point. Pay attention to how each idea is connected to the main idea. Irrelevant: Why do I believe in the Christian God? Well, the human eye is too complex to have happened by chance, so God must have created it. Relevant: The human eye is a complex system. Its origins, Darwinian or otherwise, are not fully understood. But ourignorance is not evidence for God or anything else. 5. Know your purpose. What are you trying to accomplish? Whats the most important thing here? Distinguish your purpose from related purposes. 6. Identify assumptions. All thinking is based on assumptions, however basic. Assumptions not identified: Logically, God cannot exist. Assumptions identified: Logic is only a process applied to assumptions. If you apply logic to the assumption that scientific evidence is the only reliable means of knowing something, then of course non-physical entities cannot be known using your assumptions. 7. heck your emotions. Emotions only confuse critical thinking. Notice how your emotions may be pushing your thinking in a certain direction. 8. Empathize. Try to see things from your opponents perspective. Imagine how they feel. Imagine how you sound to them. Sympathize with the logic, emotion, and experience of their perspective. 9. Know your own ignorance. Each person knows less than 0.0001% of the available knowledge in the world. Even if you know more about relevant issues than your opponent, you still might be wrong. Educate yourself as much as possible, but still: be humble. 10. Be independent. Think critically about important issues for yourself. Dont believe everything you read. Dont conform to the priorities, values, and perspectives of others. 11. Think through implications. Consider the consequences of your viewpoint. Not thinking through implications: A fetus is biologically alive and mentally conscious. Therefore, killing a fetus is wrong. Thinking through implications: Monkeys, dogs, and many other animals are alive and almost certainly conscious. Is killing them always wrong, too? Why do they have less rights than a fetus? Lets think about this. 12. Know your own biases.
Your biases muddle your thinking. Notice how they might be pushing your thought toward a particular end, regardless of the logical steps it took to get there. Biased: Im not sure how to defeat the Kalam cosmological argument for Gods existence, but I know its flawed somewhere because God doesnt exist. Unbiased: The Kalam cosmological argument is compelling. Ill have to think it through before I can say whether or not it indicates Gods existence. 13. Suspend judgment. Critical thinking should produce judgments, not the other way around. Dont make a decision and then use critical thinking to back it up. If anything, use the method of science: take a guess about how things are and then try to disprove it. Immediate judgment: Were here to promote Johnsons plan for education reform. What logical arguments can we construct in its favor? Suspended judgment: What do we want from our educational system? Once we know, lets use critical thinking to find the best ways to do those things. 14. Consider the opposition. Listen to other viewpoints in their own words. Seriously consider their most persuasive arguments. Dont dismiss them. Narrow-minded: Reading an essay and letting it persuade you. Open-minded: Reading an essay, then reading an essay that argues the opposite point. 15. Recognize cultural assumptions. People from different times and cultures thought much differently than you do. In fact, your ideas might have arrived only in the last 50 years of human history! Why is your perspective better than that of everyone else in the world today and throughout history? 16. Be fair, not selfish. Each persons most basic bias is for themselves. Selfish: I cant know everything. Its not my fault I made that error. Benefits of critical thinking We have too much information. Critical thinking helps you focus on what matters. We have too many options. Critical thinking helps you do what matters. Millions of scam artists want to steal your time and money. You can use critical thinking to defeat them. Critical thinking helps you avoid false beliefs. Do you believe something because you read it somewhere? Because your family or government or culture told you so? Because it makes you feel good? Because you just believe it? If so, you probably have many false beliefs. Critical thinking can help you avoid those. Who knows? It might even help you form some truebeliefs. But we probably already agree that critical thinking is good. How do we do it?
Use of critical thinking skills in nursing: Nurses use knowledge from other subjects and fields. 76 Padmashree college of nursing Bangalore -72
Because nurses deal holistically with human responses, they must draw meaningful information from other subject areas (i.e., make interdisciplinary connections) in order to understand the meaning of client data and to plan effective interventions. Nursing students take courses in the biologic and social sciences and in the humanities so that they can acquire a strong foundation on which to build their nursing knowledge and skill. Nurses deal with change in stressful environments. Nurses work in rapidly changing situations.Treatments, medications, and technology change constantly, and a client's condition may change from minute to minute. Routine actions may therefore not be adequate to deal with the situation at hand.Familiarity with the routine for giving medications, for example, does not help the nurse deal with a client who is frightened of injections or with one who does not wish to take a medication. When unexpected situations arise, critical thinking enables the nurse to recognize important cues, respond quickly, and adapt interventions to meet specific client needs.
Nurses make important decisions. During the course of a workday, nurses make vital decisions of many kinds. These decisions often determine the well-being of clients and even their very survival, so it is important that the decisions be sound. Nurses use critical thinking to collect and interpret the,information needed to make decisions. Nurses must use good judgment, for example, to decide which observations must be reported to the primary care provider immediately and which can be noted in the client record for the primary care provider to address later, during a routine visit with the client. Nurses provide care according to nursing process: each step of the nursing process requires critical thinking for nurses to provide sound care for the patient. It starts from collecting history and information, prioritizing nursing diagnosis, implementing care to evaluation. Each step she is using cognitive skills of critical thinking.
DECISION MAKING
INTRODUCTION Effective decision-making is an art. It involves finding and selecting the best alternative and having the most appropriate person to make and implement the decision at the right time. To function successfully the nurse must constantly demonstrate the ability to solve problems in rapidly changing and uncertain situations in which indecisive man and poor decisions are costly. The ability to foster organized decision making and problem solving is an essential skill for the nurses. DEFINITION 1. Decision-making is a necessary component of leadership, power, influence, authority and delegations. [ John 1993] 2. Decision-making calls for systematic process in which a manger chooses among the alternatives, come to a conclusion and select an action. [ Rebecca Samson ] 3. Decision making is a systematic process of choosing among alternatives and putting the choice in to action. [ Lancaster and Lancaster] Decision making is the heart of all managerial and administrative functions. It is true that the decision making is a part of everyday life. Decision making is at the core of al planned activities. It is the last step of process by which an individual chooses one alternatives from several to achieve a desired objective. TYPES 1. There are 4 managerial decisions a. Mechanistic routine and repetitive in nature It usually occurs in a situation involving a limited number of decision variables where the outcome of each alternative is known. Tools used for these kinds of decisions are charts, list, decision tree etc. b. Analytical decision this decision helps to solve the complex problems It involves a problem with a large number of decision variables where the outcome of each decision alternatives can be computed. Computational techniques involve linear programming and statistical analysis. c. Judgmental decision Decision involves a problem with a limited number of decision variables but the out of the decision alternatives are unknown. These types of decision are useful in marketing investment and to solve the personal problems. d. Adaptive decision Decisions involving a problem with a large number of decision variables where outcomes are not predictable.
Such ill structured problems require contribution of many people with diverse technical background. E.g. research finding 2. Nursing Administration Decision Making According to Ann Bill Taylor a. Non routine decision: made by directors of nursing. The out of the problem will be unpredictable. E.g. changing ways of organizing for the delivery of nursing care b. Routine decision: made by mid level and low level managers, the outcome will be predictable E.g. assigning the duty roster, assign the security laws. DECISION STRATEGIES A strategy is an artful or cleaver plan for applying technique in pursuit of a goal. Before selecting any method of decision manager should adopt a decision strategy. Some strategy suited for some type of problems than others, they are; Optimizing: it is an approach in which an individual analyze a problem, determines desired out comes, identifies possible solutions, predict the consequences of each actions, and select the courses that yields the greatest amount of preferred outcomes. Satisfying: it is an approach, where by an individual chooses a problem solution that is non-ideal but that is good enough to meet a set of minimum requirements and minimum standards of acceptance. Mixed scanning: making a decision that satisfies to remove least promising solutions, and then select best of remaining options. Opportunistic: making a decision for the solution chosen by problem identifier. Do nothing: taking decision after waiting for the storm to pass. Eliminate critical limiting factor: making a decision by removing most powerful obstacle to success. Maxima: an optimistic approach in which, while assuming the highest possible payoff from use of any action the individual chooses that action alternative that will yield the largest payoff. Mini- regret: an approach designed to minimize the surprise resulting from any action decision by selecting the action alternative that will yield a result midway between the most desired and the least desired out comes. Precautionary: making a decision by choosing the action that will maximize gain or minimize loss regardless of opponents actions. It is useful when the manager engaged in a zero- sum conflict with another.
Evolutionary: while taking a decision individual has to make series of small changes leading towards goal. It is based on the assumption that subordinates can better adjust to series of small changes than a quantum leap. Chameleon: taking a decision by making vague plan, adjusted to changing circumstances. It consists of farming management decision in general terms, so that they can be interpreted, differently at different times.
STEPS IN DECISION MAKING The decision making task can be divided in to 6 steps which are stated in order of their sequence as; 1. Making the diagnosis 2. Analyzing the problem 3. Searching alternative solution 4. Selecting best possible solution 5. Putting the decision in to effort 6. Follow up the decision 1. Making the diagnosis The first step is to determine what the real problem is. The diagnosis should not be merely based on one or two visible symptoms. But I should be diagnosed after the analysis of the whole situation. 2. Analyzing the problem The problem should be thoroughly analyzed to find out adequate background information and data relating to the situation. This analysis will provide the manager an insight in to the problem. From the information gathered the facts should be identified and separated so as to provide the solid foundation for making sound decision. 3. Searching alternative solution After anodizing the problem attempts are made to find alternative solutions to the problem. In the absence of alternatives decision making process will become mechanical. 4. Selecting best possible solution Selection of one best course of action among the several alternatives developed; require an ability to draw distinctions between tangible and intangible factors as well as facts and guesses. The four criteria have been suggested by Mr. Dracker in selecting the best solution. 1. Proportion of risk to the expected gain 2. Relevance between the economy of effort and the possibility of results. 3. The time considerations that meet the needs of the situation. 4. The limitation of recourses. Instead of picking the best solution mangers have to really on a course of action that is satisfactory enough under the existing circumstances and limitations. 5. Putting the decision in to effort
The decisions can be made effective through the action of other people. In order to overcome the opposing on the part of employees mangers can make three important preparations. a. Communication of decisions b. Securing employee acceptance c. The timing of decisions. 6. Follow up the decision As a safe guard against the incorrect decisions mangers are required to a system of followup care of the decisions so as to modify them at the earliest. DECISION MAKING AUTHORITIES 1. Individual 2. Group 3. Committees INDIVIDUALS AS DECISION MAKERS The autocratic mangers fears that decisions made by others may be more costly, less effective and represents a threat to his / her position. There are mainly 3 behavioral characteristics that influence the decision making, Perception of the problem: it is affected by ones previous experience and value system. Personal value system: basic convictions about what is right, good or desirable. The role theory: it predicts how actions will be performed in certain roles and how t will be affected certain circumstances. Specific behavior associated with position constitutes roles. GROUP FACTORS IN DECISION MAKING Group comprises two or more people who share common interest and come together to accomplish an activity through face to face interaction. Commitment to the decision and to the implementation is important and may be increased by participation in the decision making process. ADVANTAGES OF GROUP PARTICIPATION Increasing self expression, innovation and development. Increases the commitment. DISADVANTAGES OF GROUP PARTICIPATION Change in the participants may create problems. Few people may dominate in the group Members may become more interested in arguments and winning than finding a solution The decisions can be most acceptable but not optimal. COMMITTEE ASPECTS IN DECISION MAKING A committee a group of people chosen to deal with a particular topic or problem. It can be formal or informal committee. A committee appointed to collect data analyze finding make recommendations is an an hoc committee.
ADVANTAGES OF DECISION MAKING BY COMMITEE The buden of decision making can be shared. Preseence of group deliberations and judgement can be possible. Complex problems can be easily solved. Increases the understanding of the sitution and commitment hrough sharing process. Increases the support and cinfidence of the ubordinats. DISADVATAGES OF DECISION MAKING BY COMITEE Time consuming. Expensive Indecisiveness can be result in the adjournment of the committee. Pressure for unanimity discourages creativity from the members.
FACTOR AFFECTING DECISION MAKING Internal factors Decision makers physical and emotional status Personal characteristics and values Past experience and interest Knowledge and Attitude Self awareness and courage Energy and creativity Resistance to change Sensitivity and flexibility
External factors Cultural environment Philosophical environment Social back ground Time Poor communication Cooperation Coordination\
BEHAVIOURAL ASPECT OF DECISION MAKING Participation in decision making is based on the principle that all members of a group or an organization should be encouraged to contribute to the process of decision making. The extend of participation is allowed is dependent on factors such as organizational philosophy, managerial style, and organizational style. Agencies that 82 Padmashree college of nursing Bangalore -72
discourage participation have an authoritarian climate, agencies that allow greater participation are democratic in nature. Tannenbaun and Schmidt developed the continuum of leadership behavior and participation related to the degree of authority used by the leader and the amount of freedom grated to the subordinates in taking decisions.
Boss centered Leadership
subordinates centered leadership
use of authority by managers
areas of freedom for the subordinates
Manager Makes decision And announces it
Manager presents ideas and invites questions
Manager sells decision
Manager presents tentative decision subjects to change
Manager presents problems, get suggestions, and make decisions
Manager defines limits; ask group to make decision
Manager permits subordinat es to function within limits defined by superior
MODELS OF DECISION MAKING VROAN AND YELTON NORMATIVE/ PERSCRIPTIVE MODEL They define decision making as a social process and emphasis how managers work rather than should behave in their normative way. It is used when information is objective, the problem is structured or routine, and options are known and predictable. Vron and Yelton identified 5 alternative decision making process. A---- Autocratic C---- Consultative G---- Group I. --- first variant II. ---- second variant 83 Padmashree college of nursing Bangalore -72
AI making decision by yourself using information available to you at that time. AII obtain necessary information from your subordinates then decide on a solution to your problem. But subordinates will be unaware about the problem. CI- shares the problem with subordinates individually, and gets their ideas and suggestions. Then you make a decision that may or may not reflect your subordinates influence. CII- you share the problem with subordinates as a group, and gets their ideas and suggestions. Then you make a decision that may or may not reflect your subordinates influence. GII- you share the problem with subordinates as a group, together you generate and evaluate alternatives and attempt to reach agreement on a solution. You do not try to influence the group to adopt your solutions but are willing to accept and to implement any solution that has the support of the entire topic. GI is applicable only in more comprehensive models. Vroan identified 7 rules that do most of the work of the model. Three rules protect the decision and quality and four rules protect the acceptance. The information rule: If the quality of decision is important and the leader doesnt poses adequate information to solve the problem then AI is eliminated from the feasible set. The goal congruence rule: if the quality of decision is important and the subordinates do not share the organizational goals to be obtained in solving the problem then GII is eliminated. The unstructured problem rule: If the quality of decision is important and the leader doesnt poses adequate information to solve the problem and if the problem is unstructured then eliminate AI, AII, and CI. The acceptance rule: if the acceptance of the decision by the subordinates is critical for the effective implementation, if it is uncertain that an autocratic decision made by the leader would receives the acceptance then AI, AII are eliminated from the feasible set. The conflict rule: if the acceptance of the decision is critical and if it is uncertain that an autocratic decision made by the leader would receives the acceptance and subordinates are likely to be in conflict over the appropriate solution then AI, AII, CI is eliminated from the feasible set. The fairness rule: if the quality of the decision is unimportant, acceptance is critical, and an uncertain to result from an autocratic decision.AI, AII, CI, and CII are eliminated. The acceptance priority rule: if acceptance is critical, not assured by an autocratic decision and if subordinates can be trusted then AI, AII, CI, and CII are eliminated. DESCRIPTIVE OR BEHAVIOURAL MODEL Used when information is subjective, non routine or unstructured. Uncertainty exists because outcomes are unpredictable. Situational that fall in to this category can be better handled by gathering more data, using past experience, employing creative approaches, etc... OPTIMIZING MODEL Decision maker select the solution that maximally meet the objective for a decision. Usually this process involves assessing the pros and cons of each known outcomes as well as
listing benefits and costs associated with each option. The goal is to select the most ideal solution. This process is more likely to result in better decision, but takes long time. SATISFICING MODEL Decision maker selects the solution that minimally meets the objective for a decision. It is more conservative method compared to an optimizing approach. This process is most expedient and may be the most appropriate when time is an issue. TOOLS OF DECISION MAKING 1. Judgmental technique. 2. Operational research technique. 3. Delphi technique. 4. Decision tree. 1. Judgmental technique. This is the oldest technique and subjective in decision making. Based on past experience and intuition about future. Useful in making routine decision. Cheap and not time consuming. Hazardous due to a chance for taking wrong decision. Rarely used in large capital commitments.
2. Operational research technique. It can be defined as the analysis of decision problem using scientific method to provide manger the needed quantitative information in making decision. Operational research makes the decision analytic, objective and quantitative based. Steps of OR technique Construction of mathematical model that pinpoints the important factor in the situation. Definition of criteria to be used for comparing the relative merits of various possible courses of action. Procuring empirical estimates of the numerical parameters in the model that specify that particular situation to which it is applied. Carrying out through the mathematical process of finding and series of action which will give optimal solution. Types Of OR Technique 1. Linear programming : Uses linear mathematical equations to determine the best way to use limited recourses to achieve maximum results. This technique is based on the assumption that a linear relationship exists between the variables and the limits of variation can be calculated. Linear programming is a sophisticated short cut technique in which computers can be used. Three conditions must be existing before linear programming must be utilized; a. Either a maximal or a minimal value is sought to optimize the objective. The value may be expressed in terms of cost time or quantity.
b. The variables affecting the goal must have a linear relationship. The ratio of change in one variable to the changes in the other variable must be constant. c. Constraints to the relationship of the variables exist. It can be used to determine a minimal cost nutrition diet or determine a class size, class hours, and instructors in school of nursing. 2. Queuing theory: It deals with waiting lines or intermittent servicing problems. It balances the cost of waiting versus the prevention of waiting by increasing the services. A group of items waiting to receive service is known as a queue. By decreasing or eliminating the waiting line to reduce waiting line cost, there is an increase in cost of labor and physical facilities. 3. Games theory: In normal games, each player or group of player tries to choose a course of action which will frustrate opponents action and help in winning the game. The same will apply in the context of business by maximize the profit and minimize the loss and thus minimizing the opponents profit and maximize his loss. 4. Programme evaluation and review technique [PERT] PERT is a network system model for planning and control under certain conditions. It involves identifying the key activities in a project, sequencing the activities in a flow diagram, and assessing the duration for each phase of work. It is appropriate for project work that involves extensive research and development. Helps to predict time. Helps to determine priorities. Use of recourses can be considered when setting priorities. Assignment can be changes temporarily Overtime or temporary help can be given to facilitate the activity flow. Can manipulate the time required to move from one event to another. 5. Critical path method [CPM] Closely related to PERT, CPM calculates a single time estimate for each activity, and the longest possible time. CPM is useful where the cost is a significant factor. 6. Computers in decision making. In management information system, computers can be used for various activities like patient classification system, supplies and material management system, staff scheduling, policy and procedure changes and announcements, patient charges, budget information and management, personal records, statistical reports, administrative reports and memos etc. 3. Delphi technique It allows members who are dispersed over a geographic area to participate in decision making without meeting face to face. This is possible through the use of questionnaire. The members will return the questionnaires anonymously; the results of the first questionnaire are centrally complied and sent to each member. Again the members are asked for suggestions. This process continues until the consensus is reached. Little changes usually occur after the second round. The Delphi technique is free from others influence
Doesnt require physical presence. Appropriate for scattered group. But it is time consuming. 4. Decision trees A decision tree is a graphic method that can help the supervisor in visualizing the alternatives available, outcomes, risk and information needs for a specific problem over a period of time. It helps to see the possible directions that actions may take from each decision point and to evaluate the consequences of a series of decisions. The process begins with a primary decision having at least two alternatives. Then the predicted outcome of each decision considered and the need for further decision is contemplated.
A1 Decision point 1 A2 Probable consequences A3 A4 Alternatives Chance events The Nurse Leader Role In Decision Making The nurse leader has to select the type of decision appropriately based upon the characteristics of the problem. Accumulate carefully the detailed facts their analysis and interpretation and to use the broad concepts of human and physical behaviors to predict future development. Take the decision according to the institution and success. Apply her knowledge and skills while relating the type of decision Obtain as well as consider the aspiratory tradition and attitudes of the agency Use statistics, work study, operational research and management survey to select the type of decision. Be tactful and viplomatary in taking the decision Create non threatening creative and conducive environment while taking group decision. Provide positive feed back to her subordinate.
ADVANTAGES OF DECISION MAKING. 1. It is characterized by order and direction that enables mangers to determine where they are. 2. Provide a frame work data gathering which is relevant to the decision. 3. Allows application of previous knowledge and experience that minimize errors and improve quality of patient care and work of an organization. 4. Increase managers confidence and ability in making decision. FACTORS AFFECTING DECISION MAKING S.NO 1 2 3 4 5 6 7 8 INTERNAL FACTORS Decision makers physical and emotional status Personal characteristics and values past experience and Interest Knowledge and Attitude Self awareness and courage Energy and Creativity Resistance to change Sensitivity and flexibility EXTERNAL FACTORS Cultural environment Philosophical environment Social back ground Time Poor communication Cooperation Coordination
CONCLUSION Decision making lies deeply embedded in the management process and is the only vehicle for carrying managerial work load. Nurses should actively involve in decision making in all levels rather than simply obeying the decisions. It is effective only when it is timely done. It needs courage as well as creative thinking from the part of the nurse administrator. BIBLIOGRAPHY 1. Petricia S. Yoder-Wise, LEADING AND MANGING IN NURSING, Mosby publications, 2nd edition,1999 P.p- 96-104 2. Mary Lucita, NURSING: PRACTICE AND PUBLIC HEALTH ADMINISTRATION, Elsevier, 2nd edition, P.p- 35-54 3. Russell.C. Swansburg,Richard j Swanburg, INTRODUCTION TO MANGEMENT AND LEADERSHIP FOR NURSE MANGERS, Jones and Bartlett publications, 3rd edition,2002, P.p- 255-263 4. B.T. Basavanthappa, NURSING ADMINISTRATION,, Jaypee publications,1st edition, 2002P.p- 55-60
9. STRESS MANGEMENT INTRODUCTION Stress and anxiety are basic to life, no matter how wealthy, powerful; good working and happy you might be mild stress can be stimulating, motivating and sometimes even desirable. The word stress was originally used by Selyle in 1956 to describe the pressure experienced by a person in response to life demands. These demands are referred to as stressors. DEFINITION Stress is a process of adjusting to or dealing with circumstances that disrupt or threaten to disrupt a persons physical or psychological functioning Selyle 1976 According to Brunner and Suddart stress is a state produced by a change in the environment that is perceived as challenging, threatening or damaging to the persons dynamic balance or equilibrium. Stress is a state of difficulty, pressure, or strain (ttp://www.thefreedictionary.com/stress) Stress is a physical or emotional state always present in a person as a result of living. Stress is the bodys automatic response to any physical or mental demand placed on it. DEFINITION OF STRESS MANAGEMENT Stress management is the amelioration of stress for the purpose of improving everyday functioning. TYPES OF STRESS According to Hans Selye it is of two types: 1. Eustress 2. Distress Eustress: Stress that helps us function better. In fact, a bit of stress can be energizing and motivating, that is why many of us work best under pressure. Distress: Stress that cause mental agony. Stress can be mild moderate or severe
SOURCES OF STRESS There are many sources of stress: there are broadly classified as: Internal stress: they originate within a person eg: cancer, feeling of depression External stress: it originates outside the individual eg: moving to another city, a death in family.
Developmental stress: it occurs at predictable times throughout an individuals life. Eg: child- beginning of school. Situational stress: they are unpredictable and occur at any time during life. It may be positive or negative eg death of family member, marriage/ divorce. SOURCES OF CLINICAL STRESS For patients Uncertainty Fear Pain Cost Lack of knowledge Risk for harm Unknown resources For nurses Poor patient outcomes Risk of making an error Unfamiliar situations Excessive workload Inadequate resources COMMON SYMPTOMS OF STRESS Insomnia Fatigue Depression Irritability Anger Hopelessness Change in appetide
STRESS ASSOCIATED DISEASES Hypertension Coronary heart disease Migraine, tension headache Ulcers Asthmatic conditions Chronic backaches Arthritis Diminished Immunity Fatigue
Psoriasis/Eczema Decreased sex drive
INDICATORS OF STRESS It may be physiological, psychological and cognitive: Physiological indicators: the physiological signs and symptoms of stress result from activation of sympathetic and neuro- endocrine systems of body. Pupils dilate to increase visual perception Sweat production increases Heart rate and cardiac output increases Skin is pallid due to peripheral blood vessel constriction Mouth may be dry Urine output decreases Blood sugar increases Psychologic indicators: the manifestations: of stress includes anxiety, fear, anger, depression and unconscious ego defense mechanism. Anxiety: state of mental uneasiness, apprehension, dread or feeling of helpness. It can be experienced at conscious, subconscious or unconscious level. Fear: it is an emotion/ feeling of apprehension aroused by impending or seeming danger, pain or threat. Depression: it is an extreme feeling of sadness, despair, lack of worth or emptiness. Unconscious ego defense mechanism: it is a Psychologic adaptive mechanism developing as the personality attempts to defend itself and alay inner tensions. Cognitive indicators: problem solving: the person assesses the situation or problem analyzes, chose alternatives, carries out selected alternatives and evaluates. Structuring: arrangement/ manipulation of a situation so that threatening events does not occur. Self control: assuming a manner and facial expression that conveys a sense of being in control or in change. Suppression: willfully putting a thought or feeling out of mind. Day dreaming: unfulfilled wishes and desires are imagined as fulfilled or a threatening experience is re worked or re played so that it ends differently from reality: STRESSORS Each person operates at a certain level of adaptation and regularly encounters a certain amount of change. Such change is expected; it contributes to growth and enhances life Types of stressors: 1. Physiological stressors: a. Chemical agents b. Physical agents c. Infectious agent d. Nutrition imbalances e. Genetic or immune disorders
2. Psychological stressors: a. Accidents can cause stress for the victim, the person who caused the accident and the families of both b. Stressful experiences of family members and friends c. Fear of aggression or mutilation from others such as murder, rape, terrorist and attacks. d. Events that we see on T.V. such as war, earthquake, violence e. Developmental and life events f. Rapid changes in our world, including economic and political structures and technology. SELECTED STRESSOR WITH DEVELOPMENTAL STAGES DEVELOPMENTAL STAGE 1.Child 2.Adolescent 3 Young adult STRESSOR 1. Beginning school, establishing a peer relationship, peer competition 2. Changing physique, relationship involving sexual attraction 3. Marriage, leaving home, managing a home, getting started in an occupation, continuing ones education 4. Physical changes of aging, maintaining social status and standards of living, helping teenage children to become independent, aging parents 5. Decreasing physical abilities and health, changes in residence, retirement and reduced income, death of spouse and friend
4 Middle adult 5 Older adult
STRESS MODELS STIMULUS BASED MODELS: in this model, stress is defined as a stimulus, a life event or a set of circumstances that arouses physiologic or Psychologic reactions may increase the individuals vulnerability to illness TRANSACTION BASED MODEL: It is based on the works of Lazarus (1966) who states that stimulus theory and response theory do not consider individual differences. It encompasses a set of cognitive, affective and adaptive responses that arises out of person environment transactions. As the person and environment are inseparable, each affects and is affected by other.
RESPONSE BASED MODEL: it consists of mainly 2 responses, 1. Local adaptation syndrome: it is a localized response of body to stress. The local adaptation syndrome may be traumatic or pathologic,. Eg: inflammatory responses of a body part in response to a trauma or injury. 2. General adaptation syndrome:(Stages of the Stress Response) it describes bodys general response to stress. It consists of 3 stages The alarm reaction: it is initiated when a person perceives a specific stressor, various defence mechanisms are activated. The autonomic nervous system initiates the flight or flight response preparing the body to either fight off the stressor or to run away from it. Resistance: the body attempts to adapt to stressor, after perceiving the threat. Vital signs and hormone levels return to normal. If the stress can be managed or confirmed to small area the body regains homeostasis. Exhaustion: it results when the adaptive mechanism are exhausted. Without defence against the stressor, the body either rest or mobilize its defence to return to normal or reach total exhaustion and die. STRESS ADAPTATION MODEL: The model was given by Gail stuart so it is called Stuart stress adaptation model. It integrates biological, socio cultural, psychological, environmental and legal- ethical aspects of patient care in to a unified frame work for practice. The first assumption of Stuart stress adaptation model is the nature is ordered as a society hierarchy from the simplest unit to the most complex. Each level is a part next higher level, so nothing exists in isolation. Thus individual is a part of family, group, community, society and the large biosphere, through which material and information flows across various levels
BIOSPHERE Society Community
Group
Family
Individual
Body system
Organ
Tissue
Cell
Second assumption of the model is that nursing care is provided within a biological, psychological, sociolcultural, environmental and legal- ethical context. The nurse must understand each of them to provide holistic nursing care. Third assumption of the model is that health/ illness and adaptation / maladaptation are 2 distinct continuums:
The health/illness continuum comes from a medical world view. The adaptation/ maladaptation continuum comes from a nursing world view. This means that a person with a medically diagnosed illness may be adapting well to it. In contrast a person without a medical illness may have adaptative coping resources. Fourth assumption is that the model includes the primary, secondary, and tertiary levels of prevention by describing four stages of psychiatric treatment: crisis, acute, maintenance and health promotion. For each stage of treatment, the model suggests a treatment goal, a focus of nursing assessment, nature of interventions and expected outcomes of nursing care. Fifth assumption is based on the use of nursing process and standards of care professional performance. Each step of the process is important and the nurse assumes full responsibility for all nursing implemented. PSYCHOLOGICAL RESPONSE TO STRESS: Various emotional responses occur due to stress including depression and anger. The most common response is anxiety. Anxiety- it is vague, uneasy feeling of discomfort or dread accompanied by autonomic response.
The four levels are: Mild: present in day to day living. It is manifested by restlessness and increased questioning. Moderate: narrows the person perceptual field and focus on immediate concerns. Manifested by a quivering, voice, tremors, increased muscle tension, slight increase in respiration and pulse. Severe: creates the person to lose control and experience dread and terror. Manifested by difficulty to communicate verbally, agitation, trembling, poor motor control, sweating tachycardia, dyspnoea palpitations, chest pain or pressure in chest Panic: state of apprehension. Here mild anxiety has a positive effect. For eg: mild anxiety motivates a student to do the required reading for an upcoming examination PHYSIOLOGICAL RESPONSES TO STRESS: It is a response of body to stress and it involves only specific body part (tissues, organs) instead of the whole body. It is a short term adaptive response which primarily is homeostatic. 2 most common stress responses that influence nursing care are reflex pain response and the inflammatory response Reflex pain response: It is the response of central nervous system to pain. It is rapid, automatic and serves as a protective mechanism to prevent injury. Eg: if you are about to step into a bath tub filled with dangerous hot water, skin senses the heat and immediately sends a message to the spinal cord. A message is then sent to motor nerve, which consciously realize that the water is too hot not safe. Inflammatory response: It is a local response to injury or infection. It helps to localize and prevent the spread of infection and promote wound healing. There are 3 phases: First phase: vasoconstriction occurs to control bleeding initially. Histamines are realised and capillary permeability increases resulting in increased blood flow to wbcs to the area. Then the blood flow returns to normal but wbcs remain to help resist the infection. Second phase: exudates (made up of fluids, cells and inflammatory by products) are realised from the wound. The amount of exudates depends up on the site, severity of wound. Third phase: damaged cells are repaired by regeneration (replacement with identical cells) or formation of scar tissue. COPING MECHANISMS They are behaviors used to reduce stress and anxiety like Crying, laughing, sleeping and cursing Coping: coping may be described as dealing with problems or situations or contending with them successfully. A coping mechanism is an innate or acquired way of responding to changing environment or specific situation. TYPES OF COPING 1. Problem focused coping: it refers to efforts to improve a situation by making changes or taking some action.
2. Emotion focused coping: it includes thoughts and actions that relieve emotional distress. It does not improve the situation but the person often feels better. Coping can also be classified as Short term coping: it reduces stress to a tolerable limit temporarily, but ineffective way to deal with reality. Eg: day dreaming Long term coping: it is constructive and realistic.eg: talking to others about problems. Adaptive coping: It helps a person to deal with a stressful event and minimizes distress associated with them. Maladaptive coping: it can result in unnecessary distress for a person and others associated with person or stressful events. Avoid Maladaptive Coping Blurring of boundaries Avoidance/withdrawal Negative attitude Anger outbursts Alcohol/Drugs Hopelessness Negative self-talk Resentment Violence
STRESS MANAGEMENT Stress management encompasses techniques intended to equip a person with effective coping mechanisms for dealing with psychological stress, with stress defined as a person's physiological response to an internal or external stimulus that triggers the fight-or-flight response. Stress management is effective when a person uses strategies to cope with or alter stressful situation. STRESS MANAGEMENT STRATEGIES Take a breath: when you feel uptight try taking a minute to slow down and breathe deeply. Breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count as you exhale- slowly. Practice specific relaxation techniques: Techniques are meditation, self hypnosis, and deep muscle relaxation work in a similar fashion. In this state both body and mind are at a rest and outside world is screened out for a time period. The practice of this for a regular basis provides calming and relaxing feeling that seems to have lasting effect for many people.
Manage time: Give priority to important ones. And do those first. If a particularly unpleasant task faces you, tackle it early in the day and get over with it; the rest your day will include much less anxiety. Schedule time for both work and recreation. Connect with others: A good way to combat sadness, boredom and loneliness is to see out activities involving others. Talk it out: Share your feelings. Bottled up emotions increase frustration and stress. Talking with someone else can help clear your mind of confusion so that you can focus on problem solving. Also consider writing down thoughts and feelings. Putting problems on paper can assist you in clarifying the situation and allow you a new perspective. Take a minute vacation: Imaging a quiet country scene can take you out of a stressful situation. When you have opportunity, take a moment to close your eyes and imagine a place where you feel relaxed. Notice all details of your chosen place, including pleasant sounds, smells and temperature or change your mental channel by reading a good book or playing relaxing music to create a sense of peace. Monitor your physical comfort: Wear comfortable clothing. If its too hot, go somewhere where its not. If chair is comfort is uncomfortable change it. If computer causes eye strain change it. Dont wait until discomfort changes to real problem. Get physical: When you feel nervous, angry or upset, release the pressure through exercise or physical activity. Running, walking or swimming are good options for some people, while others prefer dance etc. working in the garden, washing your car or playing with children can relieve uptight feeling. Aerobics can be done for 20 min daily to reduce stress. Take of your body: Healthy eating and adequate sleep fuels your mind as well as body. Avoid consuming too much caffeine and sugar. Take time to have breakfast in morning. Well nourished bodies will cope better with stress. Increase the amount fruits and vegetables in diet. Take time for personal interests and hobbies. Listen to ones body. Laugh: Maintain your sense of humour, including the ability to laugh at yourself. Know your limits: There are many circumstances in life beyond your control, consider the fact that we live in an imperfect world. Know your limits. If a problem is beyond your control and cannot be changed at the moment, dont fight the situation. Learn to accept what is, for now, until such time when you can change things. Think positively: Refocus the negative to be positive. Make an effort to stop negative thoughts.
Clarify your values and develop a sense of life meaning: Clarify your values and deciding what you really want out of your life, can help you feel better about yourself and have that sense of satisfaction and centeredness that helps you deal with the stresses of life. Compromise: Consider cooperation or compromise rather than confrontation. A little give and take on both sides may reduce the strain and help you feel more comfortable. Have a good cry: A good crying during periods of stress can be a healthy way to bring relief to your anxiety, and it might prevent a headache or other physical consequences of bottling things up. Avoid self medication: Alcohol and other drugs do not remove stress. Although they may seems to mask or disguise problems. In the long run, alcohol use increases rather than decreases stress, by changing the way you think and solve problems and by impairing your judgments and other cognitive capacities. Look for the pieces of gold around you: Pieces of gold are positive or enjoyable moments or reactions thee may seem like small events but as these pieces of gold accumulate them can often provide a big lift to energy and spirits and help you begin to new, more balanced way. Identify your Strengths Recognize skills and talents Use your strengths and talents Actively cope Social Support Social support has a profound effect on life expectancy Patients have better outcomes with strong social support Isolation and poor social support are associated with a poor stress response Few hardy individuals go it alone
Religion & Spirituality Associated with psychological and physical well being Guards against despair Provides social support Provides positive role models Provides a positive mission Altruism: Unselfish regarding the welfare of others Believe in a meaningful cause Mutual cooperation
BENEFITS OF STRESS MANAGEMENT Improves physical health More energy and stamina Stabilizes emotions Positive attitude Hopeful/happier Improves ability to focus Able to learn and achieve ROLE OF A NURSE IN A STRESS MANAGEMENT: Assessment: Assessment of the person: o -Assess for the following characteristics in the individual. Such individuals are at high risk of developing stress related disorders o -Rigid and self punishing and moral standards o -High and unrealistic expectations o -Too much dependence on others for love and affection and approval o -Inability to master change or learn new ways of dealing with frustration. o -Easily prone to extreme emotional responses of fear, anxiety and depression o -Type personality persons o -In addition the stressful events like birth, deaths, marriages, divorces, retirement etc. can predispose to stress related illness. Assessment of the family: -Assess the family perception of the problem, and whether it is supportive of the clients efforts at coping. -Assessment of the environment: -Occupations with a high degree of stress; adverse environmental influences like too much of lightning, temperature etc. Interventions: -They are directed towards relief of acute or chronic stress. a nurse can help person to examine the situation, identify possible solutions and accept his feelings without guilt or fear. -People suffering from acute stress related illness often needs to change their life styles and ways of relating to others. The initial work of nurse involves helping the client to recognize that change is essential in relation to the change. -Some clients show resistance to necessary changes. These includes -Increasing the client awareness as an actual or potential health problem exists. -Helping him realize that the health problem can increase if personal changes do not occur. -Identifying all personal resources. To support the client through the process of change and cooperation with the treatment 99 Padmashree college of nursing Bangalore -72
-When the client becomes aware of the nature of the health problems and is told of the change need, he often experiences a feeling of anxiety, depression and anger. -The client is encouraged to talk about the losses that has resulted from the behaviour change. -Family members also need accurate information about nature of the disorder, and how they can help the client in coping with stress. The client and families also need to be informed about various alternatives such as meditation, yoga, relaxation training etc. these technique have a valuable role to play in helping individuals cope with stressful life events. -In all this, the nurse must always bear in mind that they are only facilitators of the change process, and the clients have rights and responsibilities in relation to change. LEARN Stress Management L-Laugh E-Exercise A-Attitude R-Rest/ Relax N-Nutrition S-Sleep/Sex SUMMARY AND CONCLUSION Stress is mental or physical tension brought about by external pressures. Researchers have found significant biochemical changes that take place in the body during stress. Exaggerated, prolonged, or genetic tenderness to stress caused destructive changes which lower the bodys immune system response and can lead a variety of disease and disorders. These include depression cardiovascular disease, stroke and cancer. 1. Mary C. Townsend Psychiatric Mental Health Nursing First edition, Philadelphia publisher, Page 4-12 2. Gail W Stuart Michelet Laraia. Principles and Practice of Psychologic Nursing 8 th edition. Published by Elsevier. Pp 60-73 3. Suzzanne C. Smeltzer.Textbook of Medical and Surgical Nursing. 10th edition. Published by Lippincott Williams & Wilkins, pp 81-87. 4. Kozier & Erbs. Fundamentals of Nursing. 8th edition. Published by Dorling Kindersley, pp: 1063 -1071. 5. Ruth F. Craven. Fundamentals of nursing. Third edition. Lippincott Raven Publisher. pp- 1296-1300 6. http://www.informaworld.com/smpp/content~content=a910016920
10. TIME MANAGEMENT INTRODUCTION The too much to do and not enough time to do it phenomenon is rampant. - Polly Gerber Zimmermann Time is an equally important resource. If managers are to direct employees effectively and maximize other resources, they must first able to find the time to do so. Time management is making optimal use of available time. Because time is a finite and valuable resource, learning to use it wisely requires both leadership skills and management functions. The effective use of time management tools becomes more important to enable managers to meet personal and professional goals and reduces stress. Good time management skills allow an individual to spend time on things that matter. DEFINITION Time management is the use of tools, techniques, strategies and follow-up systems to control wasted time and to ensure that the time invested in activities leads towards achieving a desired, high priority goal. Time management refers to a range of skills, tools, and techniques used to manage time when accomplishing specific tasks, projects and goals. These include planning, allocating, setting goals, delegation, analysis of time spent, monitoring, organizing, scheduling, and prioritizing.
LEADERSHIP ROLES IN TIME MANAGEMENT 1. Is self aware regarding personal blocks and barriers to efficient time management as well as how ones own value system influences ones own use of time and the expectations of followers. 2. functions as a role model, supporter and resource person to subordinates in setting priorities 3. assists followers in working cooperatively to maximize time use 4. prevents and / or filters interruptions that prevent effective time management 5. role models flexibility in working cooperatively with other people whose primary time management style is different 6. Presents a calm and reassuring demeanor during periods of high unit activity. MANAGEMENT FUNCTIONS IN TIME MANAGEMENT 1. appropriately prioritize day-to-day planning to meet short-time and long time unit goals 2. builds time for planning into the work schedule
3. analyzes how time is managed on the unit level using job analysis and time and motion studies 4. eliminates environmental barriers to effective time management for unit staff 5. handles paperwork promptly and efficiently and maintains a neat work area 6. breaks down large tasks into smaller ones that can more easily be accomplished by unit members 7. utilizes appropriate technology to facilitate timely communication and documentation 8. discriminates between inadequate staffing and inefficient use of time when time resources are inadequate to complete assigned task TIME MANAGEMENT AND RELATED CONCEPT Time management has been considered as subsets of different concepts such as:
Project management: Time Management, can be considered as a project management subset, and is more commonly known as project planning and project scheduling. Time Management is also been identified as one of the core functions identified in project management. Attention management: Attention management relates to the management of cognitive resources, and in particular the time that humans allocate their mind (and organizations the minds of their employees) to conduct some activities. Personal knowledge management: Personal time management
CLASSIFICATION OF TIME MANAGEMENT TECHNIQUES primary secondary tertiary All level of prevention techniques has concepts in common. The unifying theme is that each activity undertaken should lead to goal attainment and that goal should be the number one priority at that time Level of technique Primary Purpose Designed to promote efficiency and productivity Focuses on goal achievement Uses right tool for planning and preparation Helps to refocus, to gain control and to use information appropriately Actions Organize and systematize things, tasks and people Basis time management skills Assemble a prioritized to do list based on goals daily Use of tools such as the Franklin planner Develop a personal time management plan
Secondary
Tertiary
STEPS IN TIME MANAGEMENT There are 5 basic steps to time management.
Analyzing present time use
Allow time for planning
Priority setting and procrastination
Complete the higher priority task/ goals whenever possible and finish one task before beginning another
Reprioritizing of goals based on the remaining tasks and on new information that may have been received
Step I: Analyzing present time use The first step toward improving time utilization is to determine hoe ones available time is spent. Applebaum and Rohrs, Drawbaugh recommended that each person keep a daily log, recording their activities at half hour intervals. When the record has been kept long enough to yield a representative sample of the persons job activities, she or he should identify the general categories of activity performed, such as planning, budgeting, scheduling,
supervising, decision making, evaluating and labor relations. The manager should categorize all logged activities to determine what percentage f total work time is spent in each type of activity. If the analysis reveals that excessive time was spent in one category and insufficient time was spent in an equally important category, the manager should correct the imbalance. Kozoll (1982) claims that personality characteristics exert a major influence on an individuals use of time and describe key characteristics of five personality types as follows 1. goal centered regularly sets goals, establish priorities, and measures progress towards goals 2. plan oriented develops detailed plans, rarely procrastinates, follow up to ensure that what was planned was carried out 3. completion focused defines what is needed to finish assignment and is persistent and self demanding in following through with activities 4. emphasis centered maintains a routine, makes decisions under pressure, calmly handles demands 5. Limits sensitive delegates easily, separates work from personal life, stays with in personal energy limits. Step II: Time Planning Daily planning is essential if the manager is to manage by efficiency rather than by crisis. The old adage fail to plan plan to fail is timeless. Managers may believe they are unproductive if they sit at their desk designing the plan of care for the day, rather than accomplishing a specific task. With out adequate planning, however the managers find getting started difficult and begin to manage by crisis. Planning take time; it requires the ability to think, analyze data, envision alternatives and make decisions. Setting aside time at the beginning of each day to plan the day allows the manager to spend time on high priority tasks. During this planning time, the manager should review short time, intermediate and long term goals and determine what progress will be made towards these goals. Lakein (1976) suggest that a person can improve time utilization by setting personal goals to be accomplished in three time periods: next 5 years, nest 6 months, and present day. Step III: Priority setting and procrastination Next step in the time management is prioritizing, which may well be the key to good time management. Priorities setting perhaps the most critical skill in good time management because all actions we take have some type of relative importance. Priority setting traps: Vacarro (2001) suggests there are five priority setting traps; 1. whatever hits first this traps occur when an individual simply respond to things as they happen rather than thinking first and then acting
2. path of least resistance the individual makes an erroneous assumption that it is always easier to do a task personally and fails to delegate appropriately
3. Squeaky wheel the individual falls prey to those who are most vocal about their urgent requisites. Compounding the trap is that the individual often feels a needs to respond to the time frame imposed by the squeaky wheel rather than his or her own. 4. Managing by default the individuals feels obligated to take on tasks that no one else has come forward to do. To keep this from happening, the individual must determine whether the undone job is truly his or her responsibility and whether it serves to accomplish his or her stated goals. 5. Waiting for inspiration individual wait until they become inspired to accomplish a task. Some necessary tasks will never be inspiring and the wise manager recognizes that the only thing that will complete these tasks is hard work and appropriate attention to the matter. Techniques for setting priorities ABC analysis A technique that has been used in business management for a long time is the categorization of large data into groups. These groups are often marked A, B, and C. Activities are ranked upon these general criteria:

A Tasks that are perceived as being urgent and important. B Tasks that are important but not urgent. C Tasks that are neither urgent nor important.
Each group is then rank-ordered in priority. To further refine priority, some individuals choose to then force-rank all "B" items as either "A" or "C". ABC analysis can incorporate more than three groups. ABC analysis is frequently combined with Pareto analysis. Pareto analysis This is the idea that 80% of tasks can be completed in 20% of the disposable time. The remaining 20% of tasks will take up 80% of the time. This principle is used to sort tasks into two parts. According to this form of Pareto analysis it is recommended that tasks that fall into the first category be assigned a higher priority. The 80-20-rule can also be applied to increase productivity: it is assumed that 80% of the productivity can be achieved by doing 20% of the tasks. If productivity is the aim of time management, then these tasks should be prioritized higher.
Fit Fit is the congruence of the requirements of a task (location, financial investment, time, etc.) with the available resources at the time. Often people are constrained by externally controlled schedules, locations, etc., and "fit" allows us to maximize our productivity given those constraints. For example, if one encounters a gap of 15 minutes in their schedule, it is typically more efficient to complete a task that would require 15 minutes, than to complete a task that can be done in 5 minutes, or to start a task that would take 4 weeks. This concept also applies to time of the day: free time at 7am is probably less usefully applied to the goal of learning the drums, and more productively a time to read a book. Lastly, fit can be applied to location: free time at home would be used differently from free time at work, in town, etc. POSEC method POSEC is an acronym for Prioritize by Organizing, Streamlining, Economizing and Contributing. The method dictates a template which emphasises an average individual's immediate sense of emotional and monetary security. It suggests that by attending to one's personal responsibilities first, an individual is better positioned to shoulder collective responsibilities. Inherent in the acronym is a hierarchy of self-realization which mirrors Abraham Maslow's "Hierarchy of needs". 1. PRIORITIZE-Your time and define your life by goals. 2. ORGANIZING-Things you have to accomplish regularly to be successful. (Family and Finances) 3. STREAMLINING-Things you may not like to do, but must do. (Work and Chores) 4. ECONOMIZING-Things you should do or may even like to do, but they're not pressingly urgent. (Pastimes and Socializing) 5. CONTRIBUTING-By paying attention to the few remaining things that make a difference. (Social Obligations) Categories of prioritization One simple means of prioritizing what needs to be accomplished is to divide all requests into three categories. A. highest priority (must be accomplished) - do now The do now request most commonly reflect a units day to day operational needs. These requests may include daily staffing needs, dealing with equipment shortages, meeting schedules, conducting hiring interviews and giving performance appraisal. Do now requests also may represent items that had been put off earlier In prioritizing the entire do now items, the manager may find preparing a written list helpful. This list is a plan not a product and the creations of the list are not a final goal. The list assists in coordinating daily operations. B. moderate priority (achievement desirable) - dont do
Dont do items probably reflect problems that will take care of themselves, are already outdated or are better accomplished by someone else. The manager either throws away the unnecessary information or passes it on to the appropriate person in a timely fashion. In either case the manager removes unneeded clutters from his or her work area. C. trivial importance (can be abandoned temporarily) do later Do later reflects trivial problems to those that do not have immediate deadlines; thus, they may be procrastinated. Procrastination - means to put off something until a future time, to postpone or to delay needlessly. Blunt and Pychyl (2005) suggest that procrastination is closely related to personality and terperament. They suggest that people tend to be either action oriented or state oriented (most likely to procrastinate) and that changing this orientation is very difficult. Marano (2006) procrastination does not mean lazy. Instead, it is an active mental process of diverting yourself from doing high priority things in the delusion that tomorrow will be better because you will know more, you will have more time or the sun will shine differently Bakunas (2001) states that procrastination is a major problem that can shrink productivity, undermine self esteem, and affect a career. It is also a difficult problem to sole because it rarely results from a single cause and involves a combination of dysfunctional attitudes, rationalization and resentment. Indeed, Bakunas maintains that the major cause of procrastination are performance anxiety, low frustration tolerance, resentment of working conditions, escapism, over preparation, overworking, poor working conditions, over commitment and rationalizing. The manager should selectively procrastinate; they should not avoid a task because it is overwhelming or unpleasant. Before setting do later items aside. The manager must be sure that large projects have been broken down into smaller projects and that a specific time line and plan for implementation are in place. The plan should include short time, intermediate and final deadlines.
Step IV: The third step entails completing the higher priority tasks when ever possible and finishing one task before accomplishing another Step V: The final step, the person must prioritize the tasks to be accomplished bases on new information received. Because this is a cyclic process, all five steps must be accomplished sequentially. TIME MANAGEMENT PRINCIPLES
Selection of staff selection of well qualified staff is critical for time saving because they require less supervisory time for development and corrective action. Identify time over which you have control o Set systems for routine tasks o Use technology o Make best use of the 80/20 rule Identify and use your energy cycle o High energy tasks scheduled during high-energy peaks o Save less intensive tasks for the low-energy periods Set goals and create daily plans and schedules o Leave some buffer room in your plans to accommodate unexpected changes o Prioritize the actions require to meet your goals or complete your plans Analyze your time usage o Keep a two-week time log at least once a year o Test your activities against the questions: Is it necessary? Is it appropriate? Is it efficient? o Eliminate the time-wasters in your schedule Personalize the system o Use the tools that work for you Delegation Personal organization and self discipline
TIME WASTERS Time is our most valuable resource and unless it is managed, nothing can be achieved. It is self management and requires no qualification or training. It is an art which is very easy to understand but difficult to follow. Keeping track of how one spends time is not time management, but is about making changes to the way to spend time. The application of carpenters rule of measure twice, cut once is necessary to be successful in life To effectively manage the time, it is necessary follow certain values and be disciplined in all activities. . Plan the work, write out goals and list the steps to be taken to accomplish the task. Some of the common time wasters are: Doing too much Inability to say no Procrastination Complaining Perfectionism Interruptions Disorganization Too much information
Feeling over whelmed and anxious about workload. Putting off tasks for tomorrow. Daydreaming or drifting off. Poor planning Socializing, idle conversation. Un-clear objectives and priorities Stress Non-confidence Jumping from one task to another leaving the first task unfinished. Frequently wasting time by playing cards/games, watching TV, etc. Lack of self-discipline
Doing too much Reasons - Doing too much at once, having three or four projects at same time, a member of more than one organizational committee, etc. Solution limit major commitments and then give each activity your full and undivided attention completing one task before starting another is the most efficient method of getting everything done Prioritization of goals and activities each day. Inability to say no If you are suffering from overload, you probably have gotten there by not being able to say no. Learning to not say yes to every request is difficult and in the process others may be displeased. If you do not say no, you may end up spending a great deal of time on projects in which you have no interest, projects that have no relationship to personal goals and priorities. Solution When someone asks you to do something, you need to stop and consider the request. Do you ever want to do the task? If not, then say no. However be honest with the requester if you simply do not have the time, say no as politely as possible. If you wish to do the task but simply do not have the time, consider delegation. If you wish to take on the task but at a later date, negotiate. Procrastination Engaging in procrastination or doing one thing when you should be doing something else, you give up time to complete your task and therefore limit the quality of the work you produce.
Procrastination is the avoidance of doing a task, which needs to be accomplished. This can lead to feelings of quilt, inadequacy, depression, and self-doubt. Procrastination has a high potential for painful consequences. Solution (techniques) Identify the reasons for procrastinating, then make the task your highest priority the next day Give yourself rewards for attacking the problem If the task is very large then the solution is to break the task down into manageable pieces and plan for rewards for accomplishing each of the smallor tasks Another technique is to select the least attractive element of the task to do first and the rest will seem easy. 10 ways of blasting procrastination 1. Affirmation: Do it every day and consistently. Keep telling yourself, "I like to do things NOW." Whenever you are thinking of pushing tasks away, tell yourself you like to do things now. 2. Daily Goals: Set a to do list and have a check box beside every item that you would like to do today. Avoid adding unnecessary things into the list to avoid the list to turn out as a 5000 words essay. Check off the items after you completed it. 3. Visualization: The world greatest athlete uses visualization to optimize their performance. We should use this tool to motivate ourselves and help to increase our productivity too. Visualize how you would feel and see after completing the task. See the image in your mind and make it as vibrant as possible. Examples like having a healthy and well toned body after you completed the exercise or having your book published and selling in the bookstores after you completed writing a book. 4. Set a Deadline: How many times have we procrastinate due to not having a deadline. We could drag and drag till nothing was accomplished. Setting a deadline will incorporate a sense of urgency for getting things done. 5. Countdown: After setting a dead line, counting down would helps to create a sense of urgency too. 6. Baby Steps: Break huge task into bite size nuggets. For example when you are writing an essay of 5000 words, you could instead write a paragraph or 2 instead of trying to complete the whole thing. 7. Peak Period: What is your peak period? When is the time you are the most productive? Take note of the time and allocate tasks that add the most value for you into that slot will help you to be more productive. You tend to do things when you are in your more productive time of the day.
8. Conducive environment: MSN messaging, facebook and countless of other applications and stuff that would distract you from doing your work. Either switch off the application (assuming you got the determination not to turn it back on), off the internet or get to a place where there is no Wi-Fi access to do your work. 9. Do Not Disturb!: Set a time where you are not suppose to be interrupted and do heavy task that you need to concentrate on it. Vice versa, set a time where interruptibility are allowed and do a lighter task in that period. 10. Committing time: Commit time to do a certain task. Do a task for a set amount of time before moving off your seat. Complaining Often the time nurses spend complaining about a task or a particular situation is greater than the time needed to solve the problem Solution If you find yourself complaining, stop and ask yourself what would be the ideal solution to the problem and then take the risk to act on it If the problem is another person, either take the time to talk with the person and get the problem out in the open or sit down and write a letter to the person discussing your point of view If the problem is a problem with in work place, take the time to think about the problem and generate some possible solutions. Then talk to your manager, but be prepared. By presenting solutions and just problems, your manager will see you as interested in contributing to the goals of the organization. Disorganization One of the most serious time wasters of all is disorganization. How many times have you had to spend 5 minutes trying to find something you have misplaced or misfiled? Solution Organization setting own goals, write a to do list, long term planning systems, schedules and blocks of time, filing systems, eliminating clutter, keeping everything in its place and doing similar tasks together.
Too much information The newest time waster to evolve is data proliferation. The technology with the work places forces to receive huge amounts of data and transform these data into useful information Solution- developing data / information receiving and sending skills can greatly reduce stress and improve efficiency and productivity.
RULES TO BE FOLLOWED IN TIME MANAGEMENT Butler & Hope (1996) nine rules Get Started - This is one of the all time classic time wasters. Often, as much time is wasted avoiding a project, as actually accomplishing the project. A survey showed that the main difference between good students and average students was the ability to start their homework quickly. Get into a routine - Mindless routines may curb your creativity, but when used properly, they can release time and energy. Choose a time to get certain task accomplished, such as answering email, working on a project, completing paper work; and then sticking to it every day. Use a day planning calendar. There are a variety of formats on the market. Find one that fits your needs. Do not say yes to too many things - Saying yes can lead to unexpected treasures, but the mistake we often make is to say yes to too many things. This causes us to live to the priorities of others, rather than according to our own. Every time you agree to do something else, something else will not get done. Learn how to say no. Do not commit yourself to unimportant activities, no matter how far ahead they are Even if a commitment is a year ahead, it is still a commitment. Often we agree to do something that is far ahead, when we would not normally do it if it was in the near future. No matter how far ahead it is, it will still take the same amount of your time. Divide large tasks - Large tasks should be broken up into a series of small tasks. By creating small manageable tasks, the entire task will eventually be accomplished. Also, by using a piecemeal approach, you will be able to fit it into your hectic schedule. Do not put unneeded effort into a project - There is a place for perfectionism, but for most activities, there comes a stage when there is not much to be gained from putting extra effort into it. Save perfectionism for the tasks that need it. Deal with it for once and for all - We often start a task, think about it, and then lay it aside. This gets repeated over and over. Either deal with the task right away or decide when to deal with it. Set start and stop times - When arranging start times, also arrange stop times. This will call for some estimating, but your estimates will improve with practice. This will allow you and others to better schedule activities. Also, challenge the theory, "Work expands to fill the allotted time." See if you can shave some time off your deadlines to make it more efficient. Plan your activities - Schedule a regular time to plan your activities. If time management is important to you, then allow the time to plan it wisely.
TIME MANAGEMENT STRATEGIES Planning Goal setting Setting priorities Setting limits Organization Dealing with information Taking breaks Dealing with interruptions Stream lining the work Planning All workers need to allow time for daily planning to appropriately manage time at work. Examples of the types of plans a charge nurse might make in day to day planning include staffing schedules, patient care assignments, coordination of lunch and work break schedules and interdisciplinary coordination of patient care.
Some staff nurses appear disorganized in their efforts to care for patients. Usually, this disorganization results from poor planning. Planning occurs first in the management process because the ability to be organized develops from good planning. During planning, there should be time to think about hoe plans will be translated into action. The palmer must pause and decide how people, activities and materials are going to be put together to carry out the objectives. Suggestions in planning nursing activities Gather all the supplies and equipment that will be needed before starting an activity. Group activities that are in the same location. Use time estimates e.g. If you know an intermittent IV will take 30 minutes to complete, then use that time estimate for planning some other activity that can be completed in that 30 minute window of time. Document all nursing interventions as soon as possible after an activity is completed. Always strive to end the workday on time.
Goal setting If determining long term goals is difficult, consider setting more short-term goals steps along the way to long term goals. Set the goals that are reasonable and achievable. Leave time to meet the goals. Set many short term goals to reach the long term goals, thus giving a frequent sense of goal achievement. Annual goals should become monthly goals, monthly goals become weekly goals, and weekly goals become daily goals. Give flexibility. If the last year selected path is no longer appropriate, change it. Write the goals on paper date the page and refer to it often to gives a progress report.
Setting priorities Once the goals are known, priorities are set, although they may shift throughout a given period in terms of goal attainment. For example, working on a budget may take precedence at certain times of the year, while new staff orientation is high priority at another time. Covey, Merrill and Merrill (1994) identified a particular strategy to assist in prioritization. They state that people generally focus on those things that are important and urgent.
Important Yes Yes No A B No C D
Urgent
Focus on items in cell A because they are both important and urgent and therefore command our attention. Making shift assessment ia an A task because it is both important to the work to be accomplished and frequently urgent because there is a time frame during which data about patients and qualifications of staff can be matched. Conversely If something is neither important, nor urgent (cell D), it may be considered a waste of time, at least in terms of personal goals. An example of a D activity might be reading the junk e-mail. Even if something is urgent but not important (cell C), it contributes minimally to productivity and goal achievement. An example of a C activity might be responding to a memo that has a specific time line but is important to goal attainment. The real key to setting priorities is to attend to the B tasks, those which are important, yet not urgent. Example reviewing the organizations strategic plan or participating on organizational committees Setting limits To set limits, it is necessary first to identify your objectives and arrange the actions needed to meet them in order of their priority. Time management exists on 2 levels. 1. Temporal focus on client care during the shift 2. Spatial - focus client care with in boundaries of working environment Setting limits include Saying no - negotiation Eliminating unnecessary work delegation Organization
A number of simple routines for organization can serve many minutes over a day and enhance your efficiency. This includes Lists one of the most useful organizers is the to do list. You can make this list either at the end of every day or at the beginning of each day before you do anything else. If you are a team leader, place the unique tasks of the day on the list team conference, telephone calls to families, discussion of a new project or in-service documentation on a new piece of equipment. Then arrange these things in order of their priority, starting with those that must be done on that day. Long term planning systems many people prefer computerized planning systems. A variety of calendar-creater programs have been developed. Many of these are found in internet or intranet of an institution. Personal digital assistants (PDAS) or handheld organizers have become quite popular. These devices allow both short time and long time scheduling. - PDAS permits storage of personal motes, reminders, contact data, internet access and other program files - Handheld devices permit synchronization with personal computers and internet-based calendars. Schedules and blocks of system assessment sheets, work sheets, floe sheets and critical pathways are all designed to help you plan client are and schedule your time effectively. Filing system filing system is helpful to keep track of important papers. Every professional needs to maintain copies of licenses, certifications and continuing education credits as well as current information about their specialty area. This saves time and energy. Using color folders often helpful. E.g. all continuing education credits in a blue folder, licensure in a yellow file etc.
Dealing with information The first step in managing information is to assess the source. Once you have identified the sources of your data, you have a better handle on how to deal with the information. Information receiving skills - By developing information receiving skills, you can quickly interpret the data and convert them to useful information, discarding that which is not needed. Information sending skills - Once you have mastered the receiving end of information, move on to information sending skills Select most appropriate mode of communication for your message from the technology available. Taking breaks Planning for periods breaks from work during the workday is an integral part of an individuals time and task management. Taking regularly scheduled beak from work is important, as beaks allow the worker to refresh both physically and mentally. 115 Padmashree college of nursing Bangalore -72
Dealing with interruptions You Chart somewhere other than in the place you will be most accessible Ask people to put their comments in writhing dont let them catch you on the run Let the office / unit secretary know the information you need immediately Conduct a conversation in the hall to help keep it short or in a separate room to take from being interrupted Be comfortable saying no When involved in a long procedure or home visit, ask someone else to cover your other responsibilities Break project into small, manageable pieces Get yourself organized Minimize interruptions e.g. allow voice mail to pick up the phone; shut the door Keep your manager informed of your goals Plan to accomplish high-priority or difficult tasks early in the day Develop a plan for the day, and stick to it Stream lining the work Many tasks cannot be eliminated or delegated, but they can be done more efficiently. There are many sayings in time management that reflect the principle of streamlining work. Work smarter, not harder is a favorite one that would appeal to nurses facing increasing demands on timing Examples Gather materials such as bed linens for your entire client at one time. As you go to each room, leave the linen so that it will be there when you need it. While giving head bath or providing other personal care, perform some of the aspects of the physical assessment Stream lining the work includes Keeping a time log it is an objective source of information. Once you see how large amount of your time are spent, you will be able to eliminate or reduce the time spent on non productive or minimally productive activities. Categorizing activities clustering certain activities helps eliminate the feeling of bouncing from one unrelated task to another. It also makes care giving more holistic. Finding the fastest way much time consuming tasks can be made more efficient through use of automation. E.g. Narcotic delivery systems that deliver the correct dose and electronically record the dose, the name of the client and name of the health care personnel removing the medications are being used in many institutions. Automating repetitive tasks developing techniques for repetitive tasks is similar to finding the fastest method, but it focuses on specific tasks that are repeated again and again, such as client teaching. The rhythm model for time management 116 Padmashree college of nursing Bangalore -72
Navuluri (2001) looked at time management in terms of a rhythm model PQRST pattern P- Prioritize Q Question R Recheck S Self reliance T Treat By prioritizing we are able to accomplish most important tasks first. Questioning permits us to look at events and tasks in terms of effectiveness, efficiency and efficacy. Rechecking unfinished tasks quickly helps us to efficiently manage our time. Self reliance allows knowing the difference between events that are within control and those that are not, as well as realizing the limitations. Treats are part of life. It is okay to take a break or time for ourselves. Prioritize Question Effectiveness Efficiency Efficacy List tasks in order of importance Remember that some tasks must occur at specific times where as others can occur at any time Emergencies take precedence Identify events controlled by you and events controlled by others Use critical thinking skills to assign priorities
Re-check Self reliance
Treat
Did you task produce the desired outcome? How can I accomplish the plan with the least expenditure of time? Is there a way to break this down into simpler tasks Do I have the skill and ability to obtain the desired effect? Mentally and physically re-check an unfinished or delegated task Identify those tasks that are within your control and those that are not. Use critical thinking skills and adoptability to revise priorities Go with the flow Treat yourself to a break when you can Treat yourself to time off Treat yourself to an educational experience: commit yourself to excellence Treat others courteously and with respect
TIME MANAGEMENT TIPS 1) Realize that time management is a myth. No matter how organized we are, there are always only 24 hours in a day. Time doesn't change. All we can actually manage is ourselves and what we do with the time that we have. 2) Find out where you're wasting time. Many of us are prey to time-wasters that steal time we could be using much more productively. What are your time-bandits? Do you spend too much time 'Net surfing, reading email, or making personal calls? Tracking Daily Activities explains how to track your activities so you can form a accurate picture of what you actually do, the first step to effective time management. 3) Create time management goals. Remember, the focus of time management is actually changing your behaviors, not changing time. A good place to start is by eliminating your personal time-wasters. For one week, for example, set a goal that you're not going to take personal phone calls while you're working. (See Set Specific Goals for help with goal setting.) 4) Implement a time management plan. Think of this as an extension of time management tip # 3. The objective is to change your behaviors over time to achieve whatever general goal you've set for yourself, such as increasing your productivity or decreasing your stress. So you need to not only set your specific goals, but track them over time to see whether or not you're accomplishing them. 5) Use time management tools. Whether it's a Day-Timer or a software program, the first step to physically managing your time is to know where it's going now and planning how you're going to spend your time in the future. A software program such as Outlook, for instance, lets you schedule events easily and can be set to remind you of events in advance, making your time management easier. 6) Prioritize ruthlessly. You should start each day with a time management session prioritizing the tasks for that day and setting your performance benchmark. If you have 20 tasks for a given day, how many of them do you truly need to accomplish? 7) Learn to delegate and/or outsource. No matter how small your business is, there's no need for you to be a one-person show. For effective time management, you need to let other people carry some of the load. Determining Your Personal ROI explains two ways to pinpoint which tasks you'd be better off delegating or outsourcing, while Decide To Delegate provides tips for actually getting on with the job of delegating. 8) Establish routines and stick to them as much as possible.
While crises will arise, you'll be much more productive if you can follow routines most of the time. 9) Get in the habit of setting time limits for tasks. For instance, reading and answering email can consume your whole day if you let it. Instead, set a limit of one hour a day for this task and stick to it. 10) Be sure your systems are organized. Are you wasting a lot of time looking for files on your computer? Take the time to organize a file management system. Is your filing system slowing you down? Redo it, so it's organized to the point that you can quickly lay your hands on what you need. You'll find more information about setting up filing systems and handling data efficiently in my Data Management library. 11) Don't waste time waiting. From client meetings to dentist appointments, it's impossible to avoid waiting for someone or something. But you don't need to just sit there and twiddle your thumbs. Always take something to do with you, such as a report you need to read, a checkbook that needs to be balanced, or just a blank pad of paper that you can use to plan your next marketing campaign. Technology makes it easy to work wherever you are; your PDA and/or cell phone will help you stay connected. ADVANTAGES OF TIME MANAGEMENT o gain time o motivates and initiates o reduces avoidance o promotes review o eliminates cramming o reduces anxiety o reduces stress o goal achievement PERSONAL TIME MANAGEMENT Personal management refers in part to self knowledge. Self awareness is a leadership skill. For people who are not certain of their own short to long term goals, time management in general poses difficulties. Personal Time Management is about controlling the use of your most valuable (and undervalued) resource which must be planned, monitored and regularly reviewed. Managing time is very difficult if a person is unsure of his or her priorities for time management, including personal short term, intermediate and long term goals. These goals give structure to what should be accomplished today, tomorrow and in the future. However goals alone are not enough; a concrete plan with time lines is needed. Plans outlined in manageable steps are clear, more realistic and attainable 119 Padmashree college of nursing Bangalore -72
Personal Time Management is a set of tools which allow to: eliminate wastage be prepared for meetings Refuse excessive workloads monitor project progress allocate resource (time) appropriate to a task's importance ensure that long term projects are not neglected plan each day efficiently plan each week effectively self-discipline Tips for personal time management 1. Concentrate on one thing at a time. Study difficult or boring subjects first while you are still fresh and get this "chore" out of the way to make the rest of the day easier for yourself. Be active in what you are doing at the time. 2. Be aware of your best time of the day. When do you study best? Daylight? Nighttime? Schedule study time during your best study hours for the classes that are hardest or you like the least. Experiment. Get up early, stay up late to see what works best for you. Remember to use your daylight hours and minutes and consider staying on campus between classes and finding a quiet place to study. 3. Use waiting time. Have short study tasks ready to do when you are waiting, such as between classes, while waiting for a friend, or standing in line somewhere. An example would be to carry 3 x 5 cards with you that contain facts, formulas, or definitions, which could be brought anywhere while you are waiting. Use time between classes to review class notes and to again use 3 x 5 cards. 4. Use a regular study area. Train your body so that you can focus attention more quickly. Use this area ONLY to study, such as the library or a study lounge, which has good lighting, low noise, and no distractions. Find a place where you can study everyday that has tables and chairs, is quiet, and has low traffic. 5. Study where you will be alert. Do not study where you sleep and avoid chairs and sofas. You need ENERGY, not relaxation. 6. Pay attention to your attention. Keep a note pad next to you while studying to jot down random thoughts that interfere with your studying. Get them out of your mind and onto a paper so that you can refocus on studying. If the task is really pressuring, do it, and then return to your studying. 7. Agree with living mates (roommates, parents, spouses, or kids) about study time. Have set times or a signal to indicate that you are studying and need to be left alone. Try using a "Do Not Disturb" sign on the door. 8. Get off the phone. Do not use the phone as an excuse to not study. Tell people when they call that you are studying and they should understand. If it is that important they will call back. If you must, unplug the phone, let the answer machine pick up, or go study somewhere else where there is not a phone. 9. Learn to say no. People understand that you need to study. 10. Plan your day each morning or the night before and set priorities for yourself. If you have morning calls, look up the numbers the night before and leave them by the 120 Padmashree college of nursing Bangalore -72
phone. Get the materials you will need together to complete your morning tasks. Pack your lunch and book bag. 11. Call ahead. Before walking all over campus to get a form or go to a meeting, find out what you need or directions to where you are going. 12. Do just one more thing. Before going to bed, try to do just one more thing to make the day more complete, and eliminate one task for the next day. 13. Notice how others misuse your time. If someone else, say a roommate, is misusing your time, then you have to do something about that, such as studying somewhere else, where your roommate can not misuse your time. 14. Be sure and set deadlines for yourself whenever possible and reward yourself when you get things done as you had planned, especially the important ones. 15. Make class time your best study time. Go to class prepared, and if you do not have enough time to read the whole assignment, at least look over it. Be sure to review notes from previous class. Listen attentively and paraphrase what the professor says in your own words. 16. Do NOT procrastinate. Do not let questions about material accumulate. Instead of trying to get it perfect - just do it. 17. Be realistic in your expectations of yourself. CONCLUSION A nurse manger can improve time use by identifying two or three highest priority work goals, analyzing time use to identify the common causes for time waste and using nursing time management devices such as a Gantt chart, PERT chart and delegating responsibilities. In addition the nurse manager should decline invitations to participate in activities that are worthy and interesting but will not advance his or her job performance or career goals. BIBLIOGRAPHY Test books 1. Dee Ann Gillies, Nursing Management a system approach, W.B. Saunders company, London, 3rd edition, 1982, P. No:- 200-209. 2. Marquis Huston, Leadership Role and Management Functions in Nursing, lippincott publication, New Delhi, 5th edition, P. No;- 191-206. 3. Tappen, Weiss and Whitehead, Essentials of nursing leadership and management, 3rd edition, F.A davis publication, Philadelphia, 2004, p.no:-137-48 4. Patronis Jones Rebecca A, Nursing leadership and management theories, process and practice, 1st edition, Jaypee brothers, Philadelphia, 2008, P.no:- 366-67. 5. Particia S Yoder Wise, Leading and managing in nursing, 2nd edition, Mosbys publication, New York, 1999, P. no:- 195-200. 6. Rebacca Samson, Leadership and management in nursing practice and education, 1 st edition, Jaypee publication, New Delhi, 2009, P.no:- 37-42. 121 Padmashree college of nursing Bangalore -72

Unit X Leadership Final

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MR.CHANNABASAPPA .K .

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Leaders hierarchical position

Factors affecting leadership effectiveness

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Permissive Free rein, Anarchic, Ultra liberal style of leadership

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Core functions of a leader

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The flow of the influence with three leadership styles

Democratic or Participative leader

Free Rein Leader

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5. GROUP DYNAMICS INTRODUCTION

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TYPES OF POWER 1. Legitimate power

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CONCEPTUAL SKILLS AND ATTRIBUTES:

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TYPES OF LOBBYING: Direct Grassroots

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