Marvin Jay C.

Salvador
Lecturer: Atty. Arlene Capili, Raymund Manago & Rafael Santiago

PROF AD, NURSING LEADERSHIP AND MANAGAMENT, RESEARCH

Leadership and Management Budget – systematic way of meeting with the expenses; focuses on revenues/income and
expenses/cost
Types of Budget
Management
1. Personnel: salary of full time employee (8 hours a day for 5 days a week) – prepared
- art of getting things done with and through people so that the goals of the ahead of time
organization can be achieved. 2. Operational: day-to-day expense – part time employee
3. Capital: expensive, long term use
Leadership
4. Petty cash: emergency, repairs – always available
- the use of one’s skills to influence others to perform to the best of their ability
Organizing
toward goal achievement.
- Establishing a formal structure that provides the coordination of resources to
Different influence tactics
accomplish objectives and determine position qualification and job description.
 Assertiveness – sending direct messages, standing up for own rights without stepping Purpose of organizational structure: promote work distribution
the rights of others. Elements of Organizational Structure:
 Ingratiation – making others feel good or look good before making a requests 1. Levels of Authority
 Rationality – use of reasoning 2. Lines of Communication
 Coalition – backing up a request together with co-members a. Solid – direct relationship
 Upward appeal – using the name of superior formally or informally o Unity of Command – one person who could give orders – immediate
 Blocking – threatening somebody to damage his opportunity for advancement or not superior
being friendly to another person until he grants the request o Scalar Chain/Chain of Command – follow hierarchical order – report to
 Exchange – reminding somebody of a previous favour or return of favour immediate superior; if complaints, address to the immediate superior
 Sanction – giving or preventing incentives, benefits or promotions of the one you are complaining
b. Broken – indirect relationship – coordinating relationship
Types of Leaders
3. Span of Control – number of workers that directly work to a superior/ the number of
1. Formal – people who hold a position in the organization workers that a superior handle
a. Top – monitor the entire organization (Chief Nurse, Nursing Director, Major Forms of Organizational Structure:
Assistant Chief Nurse) 1. Centralized Models – responsibility is assumed and confined only to one authority
b. Middle – coordinates with the top and low-level leaders (Supervisor, o Highly cost-effective
Coordinators, Department Head) o Makes management easier
c. First-level leaders – focuses on the operations (Head Nurses/Unit o As the organization becomes bigger and complex, the hierarchical
Managers) arrangement becomes cumbersome
2. Informal – people who do not hold any position but can motivate others to perform o Attention of manager becomes diluted due to his many responsibilities
(Senior Staff/Charge Nurse) o Arrangement does not readily adapt to change
o Obtaining quick decision is not easy
Styles of Leaders 2. Decentralized or Participating Approach – behavioural system whereby the large
1. Autocratic – leader-focused (during emergency and crisis situation) structures are broken down to small units and authority is delegated to those closer
2. Democratic – decision is based on the suggestion of the member (best used when you to the majority of workers.
need the compliance of the members) o Reflects the interest of the workers and have a voice in decision
3. Laisse-Faire – member-focused (members are matured enough); leader acts as a making
monitor; also happens when manager is new o Better interpersonal relationship
4. Bureaucratic – focuses more on rules and regulation o Communication departmentally and interdepartmentally
 Contigency Theory – leadership style may or may not be effective depending on the o Greater imagination and creativity
situation o Not cost-effective
o Communication breakdown
Authority o Problems with role communication can occur
- legitimate right to give command and to act on the interest of an organization; an Job Description – termed performance responsibility; spell out the precise job content including
officially sanctioned responsibility duties, activities to be performed, responsibilities and results expected from the varipus roles of the
agency – PREVENTS MALPRACTICE, USE FOR DELEGATION, USE FOR EVALUATION, USE FOR
Power
STAFFING
- ability to obtain, retain and motivate people and to organize informational and
Staffing
material resources to accomplish a task
Sources of Power: - Process of assigning competent people to fill the roles designed for the organizational
 Legitimate Power – people who holds a position structure through recruitment, selection and development of personnel.
 Reward Power – ability to give incentives and benefits Employment Procedure
 Coercive Power – ability to give fear and punishments 1. Recruitment – filling up of vacancies and selection of personnel
 Connection Power – people you know 2. Induction – employee becomes formal part of the organization
 Referent Power – charismas a. Included in the payroll – done contract signing
 Information Power – people who knows b. Submit necessary documents
 Expert Power – people with special skills and abilities 3. Orientation – employee familiar themselves to the organization
 Self Power – power that emanates from self due to maturity, experience or gender o First thing to know: organization; Most important: job description
Staffing Process Methods
Functions of Management  Conventional – manager can either do centralized or decentralized
 Cyclic – schedule repeats itself
Planning  Forty hours – 8 hours a day x 5 days, 2 days off
 Seven days – 10 hours a day for 7 days a week followed by 7 days off
- Know where you are and what you want to be Nursing Care System/Modalities of Nursing Care/ Patterns of Nursing Care
Types: - System that is used to deliver nursing care
1. Strategic – long term plan (3-5 years) and benefits the organization 1. Total Patient Care or Case Method
o Top-level leaders - Oldest, most common, assigned cases per nurse (1:1)
2. Operational – short term plan (changed annually) and benefits the operation - Private duty nursing, ideal in the ICU
o First-level leaders
2. Functional
SWOT Analysis
 Strengths – Internal advantages - Task-based; task are delegated
 Weakness – Internal disadvantages - E.g., BP monitoring, medication, hygiene
 Opportunity – External advantages 3. Team Nursing
 Threat – External disadvantages - Group of nurses assigned to a team of patients with a team leader
Planning Formula 4. Modular Nursing
o What action is necessary?
- Combination of team and primary nursing but there is geographical assignment
o Where will it take place?
of patient
o When will it take place?
5. Primary Nursing – ideal to the ward
o Who will do it?
o How will it be done? - 24-hour continuous coordinated comprehensive nursing care of 5-6 patients
Tools/Hierarchy of Planning from admission to discharge
 Vision: agency wants to achieved; futuristic - Reqt: primary nurse (creates NCP) + associate primary nurse (substitute when
 Mission: reason for existence primary nurse is off-duty/ can change NCP if there is sudden change of the
 Philosophy: statements of principles, values and beliefs status of the patient provided that he will immediately report to the primary
 Goal (general – FOCUS OF MANAGEMENT) and Objectives (specific): desired results nurse); 1 nurse per shift
 Policies: “what should we do” – affected is the entire organization 6. Case Management
o Implied – expected - Utilizing health care delivery system focus is long term treatment
o Express – written/ on paper
- Goal: delivery quality care, promote quality life, decrease fragmentation and
 Procedures: step-by-step process/instructions
contain costs
 Rules: Do’s and Don’ts – directed to the employees
- E.g., nursing home (art therapy)
Marvin Jay C. Salvador
Lecturer: Atty. Arlene Capili, Raymund Manago & Rafael Santiago

PROF AD, NURSING LEADERSHIP AND MANAGAMENT, RESEARCH

Directing/Delegation Controlling/Evaluating/Reviewing/Comparing/Checking

- Issuance of assignments, orders and instructions that permits the employees to - Seeing to it that what is planned is done
know what is expected of them so that they can contribute to the attainment of Basic Steps
the goals and objectives of the organization. 1. Develop standards (predetermined level of care) and criteria (characteristics used to
- Doing phase meet level of care) – basis for evaluation
Aspects a. Structure – facilities, equipment, materials and management system
1. Technical – tasks, procedures, materials and equipment b. Process – plans and procedures
o Show/Teach/Demonstrate/Supervise/Perform with the nurse c. Outcome – results
2. Interpersonal – includes attitude, behaviour and styles of direction given 2. Determine compliance to standards and criteria
o Verbalization of feelings a. Nursing Audit – patient focused
o Assertiveness as a style of direction i. Concurrent – evaluate as the care is given
Pointers of delegation ii. Retrospective – past; source of evaluation is patient
 Position of the staff – licensed or unlicensed chart
 Ward – san galing at san pupunta b. Performance Appraisal – staff focused
 Capabilities of the staff – depend in the position in the ward i. Informal – incidental performance appraisal
 Condition of the patient ii. Formal – systematically done based on the procedure,
5 Rights of Delegation usually ends up in review sessions
1. Right Task iii. Identify strengths and weaknesses
iv. Act to reinforce strengths and to take corrective actions
- Trabahong iuutos
on the weakness
- UAP: Routine vital signs, hygiene, feeding without swallowing problems, basic
life support, post-mortem care, ADL, ambulation, turning, elimination, I&O, Research
Obtaining specimens  Scientific Method – informal application of problem, identification, hypothesis
- License Vocational Nurse: Administering medications except intravenous, formulation, observation, analysis and conclusion
enteral tube feedings, ostomy care, inserting and removing foley catheters, oral  Research – more formal, systematic and intensive method of analysis for the purpose
suctioning, non-complex sterile procedure, plus UAP tasks of discovery and development of an organized body of knowledge.
- DON’TS! Types
o ADPE (except routine assessment)
1. Nursing Research – clinical problems
o Baseline/ admission assessment
o Health teaching/ Discharge Planning 2. Research in nursing – “issues”, broader study of people and the nursing profession
o Nursing judgement including historical, ethical and policy studies
3. Evidence-Based Practice – use of current best evidence in the care of patients and
o Beyond scope of practice
2. Right Circumstance delivery of health care services/ latest findings
- Stable: Delegate (for discharge) Importance
- Unstable: Do not delegate (admission)
- Professionalism
3. Right Person
- UAP
- Accountability

- LPN/LVN
- Social relevance of nursing
4. Right Direction - Research and decision making
Ultimate goal: Improve the practice of the profession: nursing practice/client care/patient care/
- Instruct the delegate first
healthcare/ nursing care
- Never assume that she knows what to do
5. Right Supervision Sources of Human Knowledge
- Monitor performance  Tradition
Communication  Authority
- exchange of messages hoping that it is being understood  Logical Reasoning
Elements of Communication  Experience and trial and error
o Message  Scientific method/Experiment
o Encoding Steps in the Process of Research
o Transmitting (channels of communication)/Mode of transmission
o Feedback/Action Conceptual
Barriers in Communication
 Physical Barriers – environmental, distance a. Formulating and delimiting the problem – brief, concise and specific
b. RRL – synthesis of previous studies
 Social-Psychologic Barriers – lack of trust
 Semantic – misinterpretation of signs and symbols o To get an idea or background of the study
Grapevine/chismis – beneficial because it gives the manager solve the problem immediately  Determine concept/issues/topics
Conflict  Identify variables/terms
 Conduct computer/library search
- misunderstanding between two persons, agency or organization
 Weed out irrelevant resources before printing
Resolution Strategies
 Organize resources from print out for retrieval
 Avoidance  Retrieve relevant sources
 Dominance and suppression  Copy articles
 Restriction/Power – manager will solve the problem  Conduct preliminary reading and weed out irrelevant sources
 Majority rule  Critically read each source
 Smoothing – unacceptable appears to be acceptable  Synthesize critical summaries of each article
 Compromise – meeting halfway c. Undertaking a clinical fieldwork
 Collaboration – working hand in hand in solving the problem d. Defining the framework (graphical representation of concepts and
o Brainstorming - #1 Rule: All ideas are welcome relationship between concepts: conceptual framework – relate topics
Approaches to a concept; theoretical framework – focus is theory) and develop
1. Win-lose – solved the problem at the expense of others = dominance and suppression conceptual definitions
2. Lose-win – solved the problem at own expense = restriction/power or smoothing e. Formulating Hypothesis
3. Lose-lose – both parties compromise
4. Win-win – both parties benefit = collaboration Design and Planning
Change Management a. Selecting a research design
- Any alteration in the status quo (present situation) b. Developing protocols for the intervention – used only for experimental
Stages of change c. Identifying the population to be studied
 Unfreezing – determine the need for change d. Designing the sampling plan
 Moving – change process e. Specifying the methods (tools/instruments) to measure the research
 Refreezing – implementation phase variables
Change Process f. Developing methods for safeguarding human/animal rights
o Perceive the need for change – determine the problem g. Finalizing and reviewing the research plan
o Initiate a group interaction – key (GROUP) to problem solving 3. Empirical
o Identify internal and external forces a. Collect data
o State the problem b. Prepare date for analysis
o Identify the constraints 4. Analytical
o List change strategies a. Analyzing the data
o Develop plan for implementation b. Interpreting the data
o Select or develop tools for evaluation 5. Disseminating
o Implement plan one step at a time a. Communicating the findings
o Evaluate over-all results b. Utilizing the findings in practice = Evidence-Based Practice
o If there is resistance, go back to 2 aspects of directing
Marvin Jay C. Salvador
Lecturer: Atty. Arlene Capili, Raymund Manago & Rafael Santiago

PROF AD, NURSING LEADERSHIP AND MANAGAMENT, RESEARCH

c. Sampling Plans
Research problem 1. Non Probability
Sources a. Convenience or accidental sampling
 Nursing literature b. Quota – get a proportion of population (limit)
 Ideas from external sources c. Purposive/Judgemental sampling – handpick by the research
 Theory d. Snowball sampling – networking or referral system
 Experience and clinical field work – richest in information 2. Probability
 Social issues a. Simple Random – everybody has a chance to become a sample
 Scientific research – least used b. Stratified – create a strata (characteristic) and divide the population
Criteria into homogenous group
 Significance of the study to people, society, profession c. Cluster – successive random sampling of unit – big group
 Availability of the subjects d. Systematic sampling – kth of least
 Limitation of subjects Slovin’s Formula = N/1+Ne2
 Time allotment and research ability Basic Rights of Research Subject
 Limitation of tools
 Interest of the researcher 1. Right not to be harmed
 Novelty/newness/freshness of idea a. Beneficence – to do
Major Types of Data Collection b. Non-maleficence – to prevent or to protect
2. Right to full disclosure – veracity
- Use of existing data
3. Right to privacy (moments, parts, property), anonymity (do not disclose the name)
- Self-reports – interview, questionnaire and confidentiality (do not disclose any information related to study)
 Widely used because of flexibility 4. Right to self-determination – autonomy
 Problem with validity and accuracy a. Subpoena duces tecum – bring documents that is within control
- Observation – can be participant or non-participant b. Subpoena ad testificandum – court order asking a person to testify
- Biophysiologic measures – use of equipment or gadgets c. Summons – notifying a person that a case is filed against him
 In vivo – directly on the subject Levels of Measurement
 In vitro – outside, bring to the laboratory
Phenomena Amenable to Observations  Nominal – name the category
 Characteristics and condition of the individual  Ordinal – ranking of events
 Activities and behaviour  Interval – ranking of events, zero is not absolute
 Ratio – zero is absolute
 Skill attainment and performance
 Verbal communication Descriptive Analysis
 Non-verbal communication
 Frequency distribution – use of table and graphs
Criteria to know effectivity of tool
 Measures of central tendency
1. Validity – degree to which an instrument measures what is supposed to be measured
o Mean - average
2. Reliability – repeatability/consistency yields the same result
o Median
3. Sensitivity – ability to detect fine differences
o Mode – frequently appears
Hypothesis  Measures of variability
o Simple rank
- Tentative prediction or explanation of the relation between variables o Range
Parts o Variance
 Independent Variables – cause; if there are 2 populations with different o Standard deviation
characteristic; all manipulation Do not prove hypothesis but only summarizes data
 Dependent Variables – effect; varies
 Relationship Inferential Statistics
 Population to which it applies – include all characteristics 1. ANOVA – analysis of variances, 3 or more set of population that is being compared to
Types of Research according to Motive 1 variable
2. Chi-square – 1 set of population with 2 or more variables focus in frequency
1. Basic/Pure Research – to gain new knowledge 3. T-tests
2. Applied Research – make new knowledge useful and practical a. Student T-test – 2 sets of population compared to 1 variable
Types of Research according to Levels of Investigation b. Paired T-test -1 set of population with dependent group or results (pre
and post)
 Level I – Exploratory – identifying variables; give opinion (quality, census) 4. Pearson r - 1 set of population with 2 or more variables focus in interval/ratio
 Level II – Descriptive – finding out whether the variables are associated are
associated/related Qualitative
o Descriptive – describe (facts and beliefs, study, analysis) - In-depth study of a phenomena (real world experience)
o Correlational – describe the relationship of variables to each other
Data: narrative
o Comparative – compare (similarities and difference) the variables to
Collection: interview
each other
Interpreted by the researcher with the participant
 Level III – Experimental – finding out the cause and effects of variables to each other No statistical treatment, hypothesis and theoretical framework
(there is manipulation)
Hypothesis – educated guess
Types of Research according to Approach/Design Theory – attempt to explain a phenomena
Types
 Non-experimental – without manipulation A. Phenomenological
o Historical – study of the past (issues)
o Survey – use of interviews and questionnaires to gather public opinion - Lived experiences of a person
o Case study – in-depth study of person or entities  Lived Experience
o Methodological – study of methods, tests and procedures  Intuition – kung ano sabi ng participant yun lang ang ilalagay; how it is interpreted by
o Analytical – further study of present issues the participant
 Experimental  Bracketing – emotional detachment
o True Experiment – strict control over the variables (randomization,  Ends: data saturation
manipulation and control) [Control: placebo – without comparison;  Data Collection: Semi-structured Interview (guide with follow-up question)
other – with comparison] When to discontinue data collection? There is no new information gathered over-time (data
o Quasi-Experimental – control overcomes variables (without saturation)
B. Ethnographical
Types of Research according to Approach/Design
- Studies culture/tribe
 Cross sectional study – one time research - Focus: Language, Beliefs/Tradition and Artifacts
 Longitudinal study – repetitive
 Retrospective – study of the past to explain the present - Longitudinal
 Prospective – study of the present to predict the future - End: Data Saturation
Sampling Designs - Data Collection: Immersion (living with the people); if not accessible – interview
with key informants
 Population – entire aggregation of cases that meet a designated set of criteria C. Grounded-Theory
 Eligibility Criteria – exact criteria by which it could be decided who will be included in
Threats
the population
 Accessible Population – aggregate of cases that is within the reach of the researcher 1. Internal validity – degree to which IV affects DV
 Target Population/Universe – the aggregate of cases about which the researcher a. Selection bias: To eliminate use randomization
would like to make generalization b. Maturation – caused by physiologic changes: To eliminate use control
 Sampling – process used to represent the population group
 Sample – representative the population (representativeness/representation) c. Instrumentation Change – epic fail in the instrument:
d. Testing Effect – knowledge of pretest affects the posttest
Marvin Jay C. Salvador
Lecturer: Atty. Arlene Capili, Raymund Manago & Rafael Santiago

PROF AD, NURSING LEADERSHIP AND MANAGAMENT, RESEARCH

2. External validity – the findings can be applicable to other settings Degree of Execution
a. Error of leniency – there is unjustifiable high score  Attempted – hindi natuloy pero may plano
b. Error of severity – unjustifiable low score  Frustrated – with plan and action but no result
c. Hawthorne Effect – knowledge of being observed; eliminate: double  Consummated – with plan, action and result
blind technique In rape, there is only attempted or consummated rape

Professional Adjustment and Ethics RA 9173

Philippine Nursing Act of 2002
Bioethical Principles - Previously known as RA 7164 (1991)
Highlights
1. Autonomy – self-determination (Priority: Document) R = Recognizes Special Certification Program
a. Paternalism – withhold the autonomy of patient for the benefit of A = Amend RA7169
patient 9 = Salary Grade 15 (32,000)
2. Veracity – truth telling 1 = Incentive and Benefits
a. Benevolent deception – withhold truth for the benefit of patient Free hospitalization for nurse and dependents
Free scholarship (hospital with school)
3. Beneficence Non-cash benefits
4. Non-maleficence 7 = 7 BON
a. Principle of Double Effect – good effect must overcome bad effect 3 = 3 months practicum and 1 month didactic (inactive nurses = RN who do not practice for 5 years)
5. Confidentiality
6. Justice – can only be applied in similar situation Board of Nursing
7. Fidelity – loyalty to profession Qualification
8. Advocacy – active support of an idea or cause 1. Natural-born Filipino Citizen
Negligence and Malpractice 2 doctrines:
Jus Sanguinis – by blood parents
Negligence – carelessness (omission or commission of duty) Jus soli – by soil
Elements 2. Member of PNA (Accredited Professional Organization
1. Existence of a duty 3. 10 years of continuous practice (provided last 5 years was in the Philippines)
2. Failure to meet the standard 4. RN, MAN/ MaEd/ Allied Health (other courses that have boards)
3. Foreseeability of the harm Majority should be RN, MAN
4. Injury 4. Not been convicted of any crime involving moral turpitude
Malpractice – professional negligence, stepping beyond one’s authority, improper or unskilful care Duties
of a patient  Conduct Licensure Examination
Incompetence – lack of skill  Issuance and Revocation of License
Doctrines of Negligence  Conduct hearing and investigation
 Monitor performance of nursing school
1. Respondeat Superior – “let the master answer for the acts of its subordinates ”
 Prescribe, adopt, promulgate rules and guidelines
- Command responsibility
2. Res Ipsa Loquitor – evidence speaks for itself Licensure and Examination
- Injury will not normally occur unless negligence happened
- Agency/Instrumentality is within the control of defendant/nurse 1. Qualifications for NLE
Defense of Negligence: assumption of risk - BSN Graduate
- Plaintiff/patient did not participates - Citizen of the Philippines
3. Force Majuere – irresistible, unforeseeable, inevitable act, sometimes foreseen but it - Good moral
cannot be prevented – Acts of God 2. Score and Ratings of NLE
Torts - NP1: CHN, NP2: OB/Pedia, NP3 and NP4: MS, NP5: Psych
Rating: Average 75% with no grade below 60 in any subject
- Civil wrong/ wrongful acts liable for damages If there is 60% - conditional passer (retake only subject with grade below 60 with 2 years with 75%
 Assault – imminent threat or above passing rate.
 Battery – unconsented touching After the boards – take an oath
 False Imprisonment Professional Licence
o Restraints Primary Purpose of license is to protect the health of individuals
 Illegal Detention – law is violated Validity: 3 years
o Non-payment of hospital bills License Renewal: Required CPD 15 units
 Breach of Confidentiality and Invasion of Privacy Revocation of License – temporary holding or privilege to practice; revocation should not exceed to
 Dafamation – destroying reputation 4 years
o Slander – private require witness
o Libel - public
Moral Turpitude/Criminal Crime

- Violation of revised penal codes

Punishment: Imprisonment
1. Murder – killing with intention
2. Homicide – killing without intention; collateral line (ex. Brother/sister, uncle)
3. Parricide – killing of father; killing on a direct line (ex. Mother, father, grandfather,
grandmother); ascendants and descendants
4. Abortion – termination of pregnancy before the age of viability (less than 20 weeks)
A. Infanticide – killing of an infant less than 3 days old
5. If 3 years old na = parricide
6. Rape – forceful, unconsented insertion of penis into any orifice of a female or another
male
7. Acquaintance/Date Rape – known attacker
Date Rape Drug: Benzodiazepine Flunitrizapem (Rohypnol)
8. Statutory Rape – sexual intercourse with minor (kahit pumayag yung minor, statutory
rape padin)
9. Sadistic Rape – multiple attacker; penetration of object GANGBANG
10. Incest Rape – sexual intercourse within the family member
11. Robbery – stealing with use of force
12. Theft –stealing without force
13. Simulation of Birth – filling of birth certification without natural occurrence;
punishable by PD 651
14. Adultery – sa asawa
15. Concubinage – sa kabit
16. Illegal Possession of Drugs – punishable by RA 9165
17. Substance Abuse – use of illegal drugs (marijuana) and illegal use of drugs (morphine,
benzodiazepine)
Accessibility of drugs – most important factor of substance abuse
People in a Crime
 Principal by Induction - Doer
 Principal by Direction - Mastermind
 Accomplice - Before and simultaneously
 Accessory - After the crime