Nursing Career

Fields of Nursing Practice: Institutional Community Health Education Independent Entrepreneur

Factors influencing Ng. Practice Economics Changing demands for nurses Consumer demands Family structure Sci and Tech Legislation – law Demography – population : area The Women’s MOVEMENT – nurses are

mostly females Collective Bargaining – labor unions Nursing Associations

Scaling of Nursing by ____(try to analyze why it is scored that way)Theory – 6Social Values – 4Education – 5Motivation – 9Commitment – 8Autonomy – 7Code of Ethics – 10Community – 9

Test of Professionalism is my service: relevant to society, of high quality, based on facts, in accordance to ethical; legal standards.

Professional Behaviors of Nurses: Assess, plans, implements, evaluates theory,

research & practice in nursing Accepts, promotes and manage

interdependence of theory, research, practice

Communicated, disseminates theoretical knowledge, practical knowledge and research findings to ng.community

Upholds the service orientation of ng. Preserves and promotes the professional org.

as major referent

3 elements of practice: responsibility, authority, accountability

Role – part one has to assume

Responsibility - duty

Right – due to a person

Provider of service

Provide safe competent care, inform client, remain competent

To adequate and qualified assistance as necessary, to reasonable and prudent conduct from clients

Employee Respect employer, fulfill obligations of contract service

To adequate working conditions, to compensation for services rendered

Citizen Protects rights of recipients of care

To respect by other of the nurse’s own rights and responsibilities,To physical safety

Nursing in the Organization

Types of Hospital: Public, Private (Profit e.g Abooitiz & Non-Profit e.g CDU), Military

Purpose of Hospitals: business, increase nurse job satisfaction, care and shelter for ill person

Philosophy – statement of beliefs based on the core values

Mission – a call to live out something meaningful, unit’s purpose

Vision – org’s vision of the future, aspires to be

Goal – specific aim that the unit wishes to attain within 1 year

Short term – days, weeks, months, 1 year Long term – within 3-5 years(or longer)

Types of Org Structure:

Matrix - integrates both product and functional structures into one overlapping structure. A person reports to 2 heads.

Flat – a few layers in reporting structure

Tall – many layers in change of command(Remember lines of authority)

(degree to which an organization has spread its lines of authority, power, and communication)

Decentralized – e.g Matrix Centralized – e.g Tall

Org. Culture- sum total of an organization’s beliefs, norms, values, philosophies and traditions

Subculture is a group that has shared experiences or like interest and values

Countercultures usually maintain beliefs and values that contradict those of the dominant culture. For example, nurses who abuse drugs might be a part of a counterculture.

If the subculture’s norms and tradition are in agreement with the organization’s, then consonance occurs, if not, dissonance occurs. (Fleeger, 1993)

TYPES OF CULTURES (Cooke and Lafferty, 1989)

1. Constructive or Positive – where the focus is on selfactualization, humanism, affiliation and achievement.

2. Passive or Defensive – where the focus is on approval, dependence, convention and avoidance.

3. Aggressive or Defensive – where the focus is on competition, perfectionism, power and opposition.

MANAGERS are considered to be a major factor in determining organizational culture. Management styles greatly impacts individual behavior. When a change in management occurs, the culture on the unit also changes.

TYPES OF CULTURE ACCORDING TO MANAGEMENT STYLE (Schnieder, 1994)

1. CONTROL – The authoritarian creates a culture of control. Workers are systematic, task-driven and conservative.

2. COLLABORATIVE – The manager who comes as a coach and team leader creates a collaborative culture that is democratic, collegial, supportive and trusting.

3. COMPETENCE – The visionary manager who challenges his or her workers to grow creates a culture of competence and the workers are task driven and efficient.

4. CULTIVATION – The manager who inspires and motivates creates a culture of cultivation

in which the workers are people-oriented and nurturing.

HCDS

HEALTH CARE SYSTEM - an organized plan of health services (Miller-Keane, 1987)

HEALTH CARE DELIVERY - rendering health care services to the people (Williams-Tungpalan, 1981).

HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981) - the network of health facilities and personnel which carries out the task of rendering health care to the people.

PHILIPPINE HEALTH CARE SYSTEM - is a complex set of organizations interacting to provide an array of health services (Dizon, 1977).

TWO-WAY REFERRAL SYSTEM (Niace, et. al. 8th edition 1995) - A two-way referral system need to be established between each level of health facility e.g. barangay health workers refer cases to the rural health team, who in turn refer more serious cases to either the district hospital, then to the provincial, regional or the whole health care system.

MULTISECTORAL APPROACH TO HEALTH (NLGNI, 8th edition, 1995)The level of health of a community is largely the result of a combination of factors.

1. Intersectoral Linkages- unify health efforts within the health organization itself and with other sectors concerned.

- Sectors most closely related to health include those concerned with:

a. Agriculturalb. Educationc. Public worksd. Local governmentse. Social Welfaref. Population Control

g. Private Sectors

2. Intrasectoral Linkages- Widely accepted pyramidal organization that provides levels of services starting with primary health and progressing to specialty care. Primary health care is the hub of the health system.

A PYRAMIDAL HEALTH STRUCTURE

Public Health Programs:

1. Family Healtha. Maternal Health Programb. Family Planning Programc. Child Health Programs (Newborns, Infants, and Children)d. Expanded Program on Immunizatione. Oral Health Programg. The Adolescent Health Programh. The Adult Meni. The Adult Womenj. The Old Personk. Philippine Reproductive Health

2. Non Communicable Disease Prevention and Controla. Integrated Community Based Non-

Communicable Disease Prevention and Control Program

b. Risk Assessment and Screening Proceduresc. Promoting Physical Activity and Exercise

d. Promoting a Smoke- Free Environmente. Promoting Stress Managementf. Mental Health Programsg. Renal Disease Control Program (REDCOP)h. Community- Based Rehabilitation Program

Transcultural Nursing Goal: Cultural Congruent Care6 Phenomena1) Communication2) Space3) Social Organization4) Time5) Environmental Control6) Biologic Variations

Transdisciplinary Nursing – provides new opputunities for staff & strengthens their communication and ability to wrok as a team

Differentiated Ng. Practice – Practice of structuring ng. roles on basis of education, experience and competence

2 Types of Diff. Practice:1. Education based2. Assessment Based – competency model

Components of Ng.1. Provision of care2. Communication3. Management care

Benner’s Stages of Clinical Competence:EXPERTPROFICIENTCOMPETENTADVANCED BEGINNERNOVICE

Ways of Org. Culture Changes: Diversification – expansion of org to new

arenas

Redesign 0 focus on the job Restructuring – coordination of work is

stressed Re-engineering – concerned with process

Leadership

Leadership is the activity of influencing to strive willingly for group objectives.

Purpose of Leadershipo The function of leadership is to guide people or

groups to accomplish common goals.

Sources of power1. Reward Power - The ability to reward others for complying

2. Coercive Power - The opposite of reward power

3. Legitimate Power - Based on an official position in the organization.

4. Referent Power - Comes from the followers’ identification with the leader.

5. Expert Power - People gain expert power through knowledge, skills, and information.

6. Information Power - Based on a person’s possession of information that is needed by others.

7. Connection Power - Based on a person’s relationship or affiliation with other people who are perceived as being powerful.

Types of leadership Formal ---- is practiced by the nurse who is appointed to an approved position and given the authority to act by the organization.

Informal ---- is exercised by the person who has no official or appointed authority to act but is able to persuade and influence others.

Theories of Leadership

1. Behaviorala. Autocratic / Authoritarian Leadership - leader

exhibits a consistent behavior pattern --- first determining all policies for group members and then detailing methods of goal attainment

b. Democratic Leadership - the leader maintains less control by encouraging the members to determine their own policies and giving them an overview of the task and explaining all the steps

c. Laissez-faire Leadership - leader gives the members complete freedom as resources for the work are provided but the leader’s participation limited only to answering questions when asked

d. Multicratic Leadership - a combination style that combines the bureaucrat, the mature autocrat, and the democrat to propose an effective range of behaviors

2. Contingency

a. Fiedler’s Theory

- Leadership is defined as an interpersonal relation in which power and influence are unevenly distributed that one person is able to direct and control the actions and behaviors of others to a greater extent than they direct and control his. - three variables that yield a favorable or unfavorable situation for the leader: leader-member relationships – the degree of acceptance of the leader by the group members and is classified as good or poor task structure – a routine or predictable task is said to be structured, while tasks requiring analysis of a variety of possibilities are said to be unstructured position power – refers to the leader’s place

within the organization and the amount of

authority given to the leader; it may be strong or weak

b. Situational Theory

- Leadership is defined as the process of influencing a group “in a particular situation, at a given point in time, in a specific set of circumstances” that stimulates the group to achieve objectives with satisfaction.

M1 Maturity Low. High directive. Low supportive behavior

Telling / Directing

M2 Medium Maturity with limited skillsBehavior: high directive, supportive

Selling/ Coaching

M3 Medium maturity but lacking self confidenceBehavior: low directive, high supportive

Participating/ Supporting

M4 High maturityBehavior: low directive and supportive

Delegating

d. Substitute for Leadership

- At times, competent leadership is not necessary and incompetent leadership may be counterbalanced by certain factors in the work situation

Characteristics of followers – such as presence of structured routine tasks, amount of feedback provided by a task, and presence of intrinsic satisfaction in work Characteristics of the tasks – clarity and routine

of activities Characteristics of the organization – such as

presence of a cohesive group, a formal or informal organization, a rigid adherence to the rules, and low position power

3. Contemporary

a. Charismatic Leadership

- Charisma is defined as a special power which some people have naturally which makes them able to influence other people and attract their attention and admiration.

b. Servant Leadership - describes leaders who choose first to serve others and then to be a leader, as opposed to those who are leaders first

c. Transformational Leadership - occurs when persons engage with others so that both leaders and followers raise each other to higher levels of motivation and ethical decision making

Intellectual Stimulation – The leader encourages followers to explore new ways of doing things and new opportunities to learn. Individualized Consideration – Transformational leadership also involves offering support and encouragement to individual followers. Inspirational Motivation – Transformational leaders have a clear vision that they are able to articulate to followers. These leaders are also able to help followers experience the same passion and motivation to fulfil these goals. Idealized Influence – The transformational leaders serves as a role model for followers. Because followers trust and respect the leader, they emulate the leader and internalize his or her ideals.

4. Motivational

a. Reinforcement

-also known as Operant Conditioning and Behavior Modification

positive reinforcement -administration of pleasant and rewarding consequence following a behaviornegative reinforcement-withdrawal of an unpleasant consequence once behavior is improved

b. Expectancy

- Motivation depends on individual’s mental expectations about their ability to perform tasks and receive desired rewards

Valence is the strength of a persons preference for something. It may be negative or positive from -1 to +2. If the person does not want something, there is a negative valence. If the person is indifferent, the valence is 0. A positive valence indicates a desire for something. Expectancy is the probability of getting something through specific actions. If a person believes that an action will result in an outcome, expectancy has a value of 1. If no probability is percieved, the axpectancy is 0. Expectancy is 0. Expectancy varies from one situation to another.- If someone has a high valence and a high expectancy, the motivation will be high. If there is a low valence and lo expectancy, the motivation will be low. If one is high and the other low, moderate motivation will result.

c. Equity

-Persons believe they are being treated with equity when the ratio of the efforts to rewards equal those of others.