Nursing Theories

NURSING THEORIES
I. NIGHTINGALE’S ENVIRONMENTAL THEORY Florence Nightingale, often considered as the first nurse theorist, defined nursing almost 150 years ago as “the act of utilizing the environment of the patient to assist him in his recovery” (Nightingale. 1860/1869). She links health with five environmental factors: a. Pure or fresh air b. Pure water c. Efficient drainage d. Cleanliness e. Light, especially direct sunlight Deficiencies in these 5 environmental factors produced lack of health or illness. These environmental factors attain significance when one considers that sanitation conditions of the hospitals of the mid-1800s were extremely poor and that women working in the hospitals were often unreliable, uneducated and incompetent to care for the ill. In addition to those factors, Nightingale also stressed the importance of keeping the client warm, maintaining a noise free environment and attending to the client’s diet in terms of assessing intake, timeliness of the food and its effect on the person. Nightingale set the stage for further work in the development of nursing theories. Her general concepts of ventilation, cleanliness, quiet, warmth and diet remain integral parts of nursing and health care today.

II. PEPLAU’S INTERPERSONAL RELATIONS MODEL Hildegard Peplau, a psychiatric nurse, introduced her interpersonal concepts in 1952. Central to Peplau’s the use of therapeutic relationship between the nurse and the client. Nurses enter into a personal relationship with an individual when a need is present. The nurse-client relationship evolves 4 phases: a. Orientation. During this phase, the client seeks help and the nurse assists the client to understand the problem and the extent of the need for help. b. Identification. During this phase, the client assumes a posture of dependence, interdependence or independence in relation to the nurse (relatedness). The nurse’s focus is to assure the person that the nurse understands the interpersonal meaning of the client’s situation.

c. Exploitation. In this phase, the client derives full value from what the nurse offers through the relationship. The client uses available services based on self-interest and needs. Power shifts from the nurse to the client. d. Resolution. In this final phase, old needs and goals are put aside and new ones adopted. Once older needs are resolved, newer and more mature ones emerge. Peplau's Six Nursing Roles illustrate the dynamic character roles typical to clinical nursing: 1. Stranger role: Receives the client the same way one meets a stranger in other life situations; provides an accepting climate that builds trust. 2. Resource role: Answers questions, interprets clinical treatment data, gives information. 3. Teaching role: Gives instructions and provides training; involves analysis and synthesis of the learner's experience. 4. Counseling role: Helps client understand and integrate the meaning of current life circumstances; provides guidance and encouragement to make changes. 5. Surrogate role: Helps client clarify domains of dependence, interdependence, and independence and acts on clients behalf as advocate. 6. Active leadership: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.

III. KING’S GOAL ATTAINMENT THEORY Imogene King’s theory of goal attainment (1891) was derived from her conceptual framework. King’s framework shows the relationship of operational systems (individuals), interpersonal systems (groups such as nurse-patient) and social systems (such as educational system, health care system). She selected 15 concepts from the nursing literature (self, role, perception, communication, interaction, transaction, growth and development, stress, time, personal space, organization, status, power, authority and decision making) as essential knowledge for use by nurses. Ten of the concepts in the framework were selected (self, role, perception, communication, interaction, transaction, growth and development, stress, time and personal space) as essential knowledge for use by nurses in concrete nursing situations. Within this theory, a transaction process model was designed. This process describes the nature of and standard for nurse-patient interactions that lead to goal attainment—that nurses purposefully interact and mutually set, explore and agree to means to achieve goals. Goal attainment represents outcomes. When this information is recorded in the patient record, nurses have data that represent evidence-based nursing practice. King’s theory offers insight into nurses’ interactions with individuals and groups within the environment. It highlights the importance of a client’s participation in decisions that influence care and focuses on both the process of nurse-client interaction and the

outcomes of care. King believes that her theory, used in evidence theory-based practice, blends the art and science of nursing (2006).
KING’S CONCEPTUAL FRAMEWORK OF NURSING: Dynamic interacting systems
Social Systems (Society)

Interpersonal Systems (Groups)

Personal Systems (Individual)

KING’S MODEL OF TRANSACTIONS
FEEDBACK PERCEPTION

JUDGMENT

NURSE
ACTION REACTION ACTION
INTERACTION TRANSACTION

CLIENT

JUDGMENT

PERCEPTION

FEEDBACK

IV. ROY’S ADAPTATION MODEL Sister Callista Roy (1997) defines adaptation as the process and outcome whereby the thinking and feeling person uses conscious awareness and choice to create human and environmental integration.” Roy’s work focuses on the increasing complexity of person and environment self-organization and on the relationship between and among persons, universe and what can be considered a supreme being or God. Her philosophical assumptions have been refines using major characteristics of “creation spirituality”—a view that “persons and the earth are one and that they are in God and of God. Roy focuses on the individual as a biopsychosocial adaptive system that employs a feedback cycle of input (stimuli), thoughput (control processes) and output (behaviors or adaptive responses). Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an ongoing purposive response. Adaptive responses contribute to health, which she defines as a process of being and becoming

integrated; ineffective or maladaptive responses do not contribute to health. Each person’s adaptation level is unique and constantly changing. The goal of Sister Callista Roy’s model is to enhance life processes through adaptation in four adaptive modes. Individuals respond to needs (stimuli) in one of the four modes: 1. The physiologic mode involves the body’s basic physiologic needs and ways of adaptiong with regard to fluid and electrolytes, activity and rest circulation and oxygen, nutrition and elimination, protection, the senses and neurologic and endocrine function. 2. The self-concept mode includes two components : the physical self, which involves sensation and body image, and the personal self, which involves self-ideal, self-consistency and the moral-ethical self. 3. The role function mode is determined by the need for social integrity and refers to the performance of duties based on given positions within society. 4. The interdependence mode involves one’s relations with significant others and support systems that provide help, affection and attention. V. NEUMAN’S SYSTEMS MODEL Betty Neuman, a community health nurse and clinical psychologist, developed a model based on the individual’s relationship to stress, the reaction to it and reconstitution factors that are dynamic in nature. Reconstitution is the state of adaptation to stressors. Neuman views the client as an open system consisting of a basic structure or central core of energy resources (Physiologic, psychologic, sociocultural, developmental and spiritual) surrounded by two concentric boundaries or rings referred to as lines of resistance. The lines of resistance represent internal factors that help the client defend against a stressor. Outside the lines of resistance are two lines of defense. The inner or normal line of defense, depicted as a solid line, represent’s the person’s state of equilibrium or the state of adaptation developed and maintained over time and considered normal for that person. The flexible line of defense, depicted as a broken line, is dynamic and can be rapidly altered over a short period of time. It is a protective buffer that prevents stressors from penetrating the normal line of defense. Certain variables (e.g. sleep deprivation) can create rapid changes in the flexible line of defense. Neuman categorizes stressors as intrapersonal stressors, those that occur within the individual; interpersonal stressors, those that occur between individuals and extrapersonal stressors, those that occur outside the person. The individual’s reaction to the stressor depends on the strength of the lines of defense. When the lines of defense fail, the resulting reaction depends on the strength of the lines of resistance. As part of the reaction, a person’s system can adapt to a stressor, an effect known as reconstitution. Nursing interventions focus on retaining or maintaining system stability. These interventions are carried out on the three preventive levels:

1. Primary prevention focuses on protecting the normal line of defense and strengthening the flexible line of defense. 2. Secondary prevention focuses on strengthening internal lines of resistance, reducing the reaction and increasing resistance factors. 3. Tertiary prevention focuses on readaptation and stability and protects reconstitution or return to wellness following treatment.

Management Theories 1.Mayo's Hawthorne Experiments

: organization development in terms of human relations and motivation theory. Flowing from the findings of these investigations he came to certain conclusions as follows:
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Work is a group activity. The social world of the adult is primarily patterned about work activity. The need for recognition, security and sense of belonging is more important in determining workers' morale and productivity than the physical conditions under which he works. A complaint is not necessarily an objective recital of facts; it is commonly a symptom manifesting disturbance of an individual's status position. The worker is a person whose attitudes and effectiveness are conditioned by social demands from both inside and outside the work plant. Informal groups within the work plant exercise strong social controls over the work habits and attitudes of the individual worker. The change from an established society in the home to an adaptive society in the work plant resulting from the use of new techniques tends continually to disrupt the social organization of a work plant and industry generally. Group collaboration does not occur by accident; it must be planned and developed. If group collaboration is achieved the human relations within a work plant may reach a cohesion which resists the disrupting effects of adaptive society.

2. C h e s t e r

Barnard

His importance lies in creating a new theory around organizational structures, focusing on the organization as communication system Key concepts: Importance of an Individual's behavior Felt other theorists had underestimated the variability of individual behavior and impact of this on organizational effectiveness. Compliance Concept of "zone of indifference" - orders must be perceived in neutral terms to be carried out without conscious questioning of authority. Incentives, can be used to expand zone, but material incentives alone limited in their ability to effect compliance - need also use status, prestige, personal power Communication Central concept - decision-making processes depend on communications, he described characteristics and focused on importance of communication in informal organization Other points Organizations made up of individual humans with individual motivations Every large organization includes smaller, less formal groupings whose goals need to be harnessed to those of the whole - this is managements responsibility Management efficiency vs. effectiveness Authority only exists in so far as the people are willing to accept it

3. Mc Gregor-Theory X and Theory Y Under Theory X, the four assumptions held by managers are: 1.Employees inherently dislike work and, whenever possible, will attempt to avoid it. 2.Since employees dislike work, they must be coerced, controlled, or threatened with punishment to achieve goals. 3.Employees will avoid responsibilities and seek formal direction whenever possible. 4.Most workers place security above all other factors associated with work and will display little ambition. In contrast to these negative views about the nature of human beings, McGregor listed the four positive assumptions that he called Theory Y: 1.Employees can view work as being as natural as rest or play. 2.People will exercise self-direction and self-control if they are committed to the objectives. 3.The average person can learn to accept, even seek responsibility. 4.The ability to make innovative decisions is widely dispersed throughout the population and is not necessarily the sole province of those in management positions. 4. Frederick Taylor and Scientific Management Taylor's 4 Principles of Scientific Management After years of various experiments to determine optimal work methods, Taylor proposed the following four principles of scientific management: 1. Replace rule-of-thumb work methods with methods based on a scientific study of the tasks. 2. Scientifically select, train, and develop each worker rather than passively leaving them to train themselves. 3. Cooperate with the workers to ensure that the scientifically developed methods are being followed. 4. Divide work nearly equally between managers and workers, so that the managers apply scientific management principles to planning the work and the workers actually perform the tasks. 5. FRANK GILBRETH (1868-1924) LILIAN GILBRETH (1878-1972) They develop to diagrams of processes and flow charts. They develop the "white list", that corresponds to the present systems of qualification of merits. They put emphasis in the written instructions to avoid bad understood and confusions They simplify the English alphabet, the keyboard of the typewriter and the spelling They initiate investigations on the fatigue and its impact in the productivity and the health. The interest of Gilbreth was the development of the person to its maximum potential by means of:

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the effective training the improvement in the work methods better labor atmospheres better tools healthful psychological attitude

6. Henry Gantt (1861 - 1919) - The Gantt Chart Henry Gantt's legacy to management profession is the following: • The Gantt chart: Accepted as a the most important project management tool until today. It provides a graphic mechanism of planning, controlling work and recording the progress of workers toward the task standard. The Chart also led to its modern variation - PERT (Program Evaluation and Review Technique). • Industrial Efficiency: Industrial efficiency can Only be produce by the application of scientific analysis to every aspect of work. and industrial management role is to improve the system by eliminating chance and accidents. • The Task And Bonus System: He linked the a manager bonus to how well he teaches his employees to perform better. • The social responsibility of business: He believed that the business had obligations to the welfare of society that it operates in. 7. Mary Parker Follett: prophet of management Follett's concept of leadership as the ability to develop and integrate group ideas, using "power with" rather than "power over" people, is very modern. She understood that the crude exercise of authority based on subordination is hurtful to human beings, and cannot be the basis of effective, motivational management control. The power of single individuals, Follett considered, could erode overall organizational and social achievement, and she advocated the replacement of personal power with the authority of task or function and with the "law of the situation" as revealed through group process consultation. Partnership and co-operation, she sought to persuade people, was of far more ultimate benefit to everyone than hierarchical control and competition. Follett viewed the group process as a form of collective control, with the interweaving experience of all who are performing a functional part in an activity feeding into decision-making. Thus, control is realized through the co-ordination of all functions rather than imposed from the outside. Follett's four fundamental principles of organization Follett identified four principles that she considered basic to effective management co-ordination: Coordination as the `Reciprocal Relating' of all factors in a situation--relating the factors in a situation. Coordination by direct contact--direct communication between all responsible people involved, whatever their hierarchical or departmental positions.

Coordination in the early stages--involving all the people directly concerned, right from the initial stages of designing a project or forming a policy. Coordination as a continuing process--keeping co-ordination going on a continuous basis, and recognizing that there is no such thing as unity, but only the continuous process of unifying. The context of evolutionary progress 8. Henri Fayol (1841-1925) Functions and Principles of Management Fayol's five functions are still relevant to discussion today about management roles and action.

1.

to forecast and plan - prevoyance examine the future and draw up plans of action 2. to organise build up the structure, material and human of the undertaking 3. to command maintain activity among the personnel 4. to co-ordinate bind together, unify and harmonise activity and effort 5. to control see that everything occurs in conformity with policy and practise Fayol 14 principles for organisational design and effective administration: 1.specialization/division of labour A principle of work allocation and specialisation in order to concentrate activities to enable specialisation of skills and understandings, more work focus and efficiency. 2. authority with corresponding responsibility If responsibilities are allocated then the post holder needs the requisite authority to carry these out including the right to require others in the area of responsibility to undertake duties. 3. discipline The generalisation about discipline is that discipline is essential for the smooth running of a business and without it - standards, consistency of action, adherence to rules and values - no enterprise could prosper. 4. unity of command The idea is that an employee should receive instructions from one superior only. 5. unity of direction The unity of command idea of having one head (chief executive, cabinet consensus) with agree purposes and objectives and one plan for a group of activities) is clear. 6. subordination of individual interest to the general interest Fayol's line was that one employee's interests or those of one group should not prevail over the organization as a whole. 7. remuneration of staff

The general principle is that levels of compensation should be "fair" and as far as possible afford satisfaction both to the staff and the firm (in terms of its cost structures and desire for profitability/surplus). 8. centralisation Centralisation for HF is essential to the organization and a natural consequence of organizing. This issue does not go away even where flatter, devolved organisations occur. Decentralisation - is frequently centralisaeddecentralisation !!! The modes of control over the actions and results of devolved organisations are still matters requiring considerable attention. 9. scalar chain/line of authority The scalar chain of command of reporting relationships from top executive to the ordinary shop operative or driver needs to be sensible, clear and understood. 10. order Basically an organisation "should" provide an orderly place for each individual member - who needs to see how their role fits into the organization and be confident, able to predict the organizations behavior towards them. 11.equity Equity, fairness and a sense of justice "should “pervade the organization - in principle and practice. 12. stability of tenure Time is needed for the employee to adapt to his/her work and perform it effectively. Stability of tenure promotes loyalty to the organization, its purposes and values. 13.initiative At all levels of the organisational structure, zeal, enthusiasm and energy are enabled by people having the scope for personal initiative. (Note: Tom Peters recommendations in respect of employee empowerment) 14. esprit de corps Here Fayol emphasises the need for building and maintaining of harmony among the work force , team work and sound interpersonal relationships. 9. Max Weber Weber described the ideal type bureaucracy in positive terms, considering it to be a more rational and efficient form of organization than the alternatives that preceded it, which he characterized as charismatic domination and traditional domination. According to his terminology, bureaucracy is part of legal domination. However, he also emphasized that bureaucracy becomes inefficient when a decision must be adopted to an individual case. A bureaucratic organization is governed by the following seven principles: 1. official business is conducted on a continuous basis 2. official business is conducted with strict accordance to the following rules: 1. the duty of each official to do certain types of work is delimited in terms of impersonal criteria

3. 4. 5. 6. 7.

2. the official is given the authority necessary to carry out his assigned functions 3. the means of coercion at his disposal are strictly limited and conditions of their use strictly defined every official's responsibilities and authority are part of a vertical hierarchy of authority, with respective rights of supervision and appeal officials do not own the resources necessary for the performance of their assigned functions but are accountable for their use of these resources official and private business and income are strictly separated offices cannot be appropriated by their incumbents (inherited, sold, etc.) official business is conducted on the basis of written documents

Management Styles SCIENTIFIC MANAGEMENT. In the late 19th century, management decisions were often arbitrary and workers often worked at an intentionally slow pace. There was little in the way of systematic management and workers and management were often in conflict. Scientific management was introduced in an attempt to create a mental revolution in the workplace. It can be defined as the systematic study of work methods in order to improve efficiency. Frederick W. Taylor was its main proponent. Other major contributors were Frank Gilbreth, Lillian Gilbreth, and Henry Gantt. Scientific management has several major principles. First, it calls for the application of the scientific method to work in order to determine the best method for accomplishing each task. Second, scientific management suggests that workers should be scientifically selected based on their qualifications and trained to perform their jobs in the optimal manner. Third, scientific management advocates genuine cooperation between workers and management based on mutual self-interest. Finally, scientific management suggests that management should take complete responsibility for planning the work and that workers' primary responsibility should be implementing management's plans. Other important characteristics of scientific management include the scientific development of difficult but fair performance standards and the implementation of a pay-for-performance incentive plan based on work standards. Scientific management had a tremendous influence on management practice in the early twentieth century. Although it does not represent a complete theory of management, it has contributed to the study of management and organizations in many areas, including human resource management and industrial engineering. Many of the tenets of scientific management are still valid today. ADMINISTRATIVE MANAGEMENT. Administrative management focuses on the management process and principles of management. In contrast to scientific management, which deals largely with jobs and work at the individual level of analysis, administrative management provides a more general theory of management. Henri Fayol is the major contributor to this school of management thought.

Fayol was a management practitioner who brought his experience to bear on the subject of management functions and principles. He argued that management was a universal process consisting of functions, which he termed planning, organizing, commanding, coordinating, and controlling. Fayol believed that all managers performed these functions and that the functions distinguished management as a separate discipline of study apart from accounting, finance, and production. Fayol also presented fourteen principles of management, which included maxims related to the division of work, authority and responsibility, unity of command and direction, centralization, subordinate initiative, and team spirit. Although administrative management has been criticized as being rigid and inflexible and the validity of the functional approach to management has been questioned, this school of thought still influences management theory and practice. The functional approach to management is still the dominant way of organizing management knowledge, and many of Fayol's principles of management, when applied with the flexibility that he advocated, are still considered relevant. BUREAUCRATIC MANAGEMENT. Bureaucratic management focuses on the ideal form of organization. Max Weber was the major contributor to bureaucratic management. Based on observation, Weber concluded that many early organizations were inefficiently managed, with decisions based on personal relationships and loyalty. He proposed that a form of organization, called a bureaucracy, characterized by division of labor, hierarchy, formalized rules, impersonality, and the selection and promotion of employees based on ability, would lead to more efficient management. Weber also contended that managers' authority in an organization should be based not on tradition or charisma but on the position held by managers in the organizational hierarchy. Bureaucracy has come to stand for inflexibility and waste, but Weber did not advocate or favor the excesses found in many bureaucratic organizations today. Weber's ideas formed the basis for modern organization theory and are still descriptive of some organizations. Pinoy Management Styles FRANCO Management Styles 1. Management by Kayod - A manager is a realist and a hard worker. He acts fast, is autocratic and a “segurista”. - He does first things first, has a talent and is known for the “kayod ng kayod” attitude. - Knows how to utilize his resources and cuts his problems down to manageable sizes and can out rightly decide. 2. Management by Libro - The manager is an idealist, with technical jargon and all sophisticated tools of management.

- He is a “pala-isip”, “mahilig”, “may sistema”, thinks carefully before deciding, “matigas and ulo”, mataas ang paningin” and seeks quality results. 3. Management by Lusot - The manager is an opportunist who resorts to short cuts, working with the least hardships and sweats. - He is “galawgaw”,” walang konsyensya”, “mahilig sa ayusan”, “ayaw ng sakit ng ulo”, “kung walang atik, walang gawa”, “mahilig sa lagay”. 4. Management by Suyod - The manager is the reconciler who makes it all possible to make both sides meet to achieve a common goal. - He is the one who restores harmony, one who settles differences among members, a mediator, go-between and intercessor. - He is the person who is “ayaw ng gulo”, “ pinakikinggan ang bawat anggulo”, “nagdedesisyon ayon sa kapakanan ng lahat”. ANDRES Leadership Styles 1. Management by Pakiramdam ( Feelings) - The manager works according to what he feels is desired by the management. - He is rule-oriented, follows exactly what the management wants him to do, no more, no less. - He has a strong personal loyalty to the management. - He is a sheer follower dependent and has no decision of his own. 2. Management by Takutan or Sindakan (Threatening or Inflicting Fear) -The manager sees to it that his subordinates, colleagues and everybody fears him. - He is secretive, aloof and uncommunicative. - He coerces, uses threats and punishment, is hostile and arrogant. - He is very dictative and a “slave-driver”. - His motto is “Do as I told” or “ Marunong ka pa sa akin?’ 3. Management by Kulit - The manager is communicative in all respects, follows up detail and sees to it that all takes are well-monitored and programmed with persons responsible and accommodating for a particular job. - He cannot keep himself out and interferes in everything which is under his command, demanding religious attention to one’s job.

4. Management by Patsamba-tsamba (Guesswork) - The manager works without direction and procedure. - The manager is there because he happens to be there by chance. - His system is the “kapa-kapa” system wherein he uses the trial and error method in all the work that is to be done.

MANAGERIAL GRID ( Blake-Mouton)
The Managerial Grid is based on two behavioral dimensions: 1. Concern for People – This is the degree to which a leader considers the needs of team members, their interests, and areas of personal development when deciding how best to accomplish a task 2. Concern for Production – This is the degree to which a leader emphasizes concrete objectives, organizational efficiency and high productivity when deciding how best to accomplish a task. Using the axis to plot leadership ‘concerns for production’ versus ‘concerns for people’, Blake and Mouton defined the following five leadership styles:

FIVE MAJOR STYLES of MANAGEMENT: 1. Impoverished Leadership / Laissez Faire– Low Production/Low People This leader is mostly ineffective. He/she has neither a high regard for creating systems for getting the job done, nor for creating a work environment that is

satisfying and motivating. The result is a place of disorganization, dissatisfaction and disharmony 2. Country Club Leadership – High People/Low Production This style of leader is most concerned about the needs and feelings of members of his/her team. These people operate under the assumption that as long as team members are happy and secure then they will work hard. What tends to result is a work environment that is very relaxed and fun but where production suffers due to lack of direction and control 3.Task or Authoritarian Management./Produce or Perish Leadership – High Production/Low People Also known as Authoritarian or Compliance Leaders, people in this category believe that employees are simply a means to an end. Employee needs are always secondary to the need for efficient and productive workplaces. This type of leader is very autocratic, has strict work rules, policies, and procedures, and views punishment as the most effective means to motivate employees. 4. Middle-of-the-Road Leadership – Medium Production/Medium People This style seems to be a balance of the two competing concerns. It may at first appear to be an ideal compromise. Therein lies the problem, though: When you compromise, you necessarily give away a bit of each concern so that neither production nor people needs are fully met. Leaders who use this style settle for average results and often believe that this is the most anyone can expect. 5. Team Leadership – High Production/High People According to the Blake Mouton model, this is the pinnacle of managerial style. These leaders stress production needs and the needs of the people equally highly. The premise here is that employees are involved in understanding organizational purpose and determining production needs. When employees are committed to, and have a stake in the organization’s success, their needs and production needs coincide. This creates a team environment based on trust and respect, which leads to high satisfaction and motivation and, as a result, high production.

Leadership Theory and Practice
Leadership -"the ability of an individual to influence, motivate, and enable others to contribute toward the effectiveness and success of the organizations of which they are members." - is the ability of an individual to set rules for others and lead from the front. Power -ability to act or produce an effect -possession of control, authority, or influence over others Nature of Power:

1. Power revolves around the issue of the constraining and/or enabling nature of power. Thus, power can be seen as various forms of constraint on human action, but also as that which makes action possible, although in a limited scope. 2. Power has the unilateral ability (real or perceived) or potential to bring about significant change, usually in people’s lives, through the actions of oneself or of others. Authority -implies the granting of power for a specific purpose within specified limits. -the right and power which an officer has in the exercise of a public function to compel obedience to his lawful commands. Nature of Authority: 1. Delegated authority can be executed only by the person to whom it is given, for the confidence being personal, cannot be assigned to a stranger. 2. An authority given to two cannot be executed by one. And an authority given to three jointly and separately, is not, in general, well executed by two. These rules apply to on authority of a private nature, which must be executed by all to whom it is given; and not to a power of a public nature, which may be executed by all to whom majority. 3. An authority is to be so construed as to include all necessary or usual means of executing it with effect and when the agent acts, avowedly as such, within his authority, he is not personally responsible.

The Five Points of Power
A person has the potential for influencing five points of power over another (French & Raven, 1959): 1. Legitimate Power - The power a person receives as a result of his or her position in the formal hierarchy of an organization. Legitimate power is applied to negotiations in a variety of ways. People with a lot of legitimate power could use their authority to 'instruct' other parties to adhere to certain procedures. Depending on the authority level of the individual, the other negotiators could follow whatever is decided by completely relying on the abilities of the individual in authority.

2. Reward Power - Reward power is used to support legitimate power. When someone is rewarded or might receive a potential reward such as through recognition, a good job assignment, a pay rise, or additional resources to complete a job, the employee may respond in kind by carrying through with orders, requests and directions, Compliance is achieved based on the ability to distribute rewards that others view as valuable. Types: a. Verbal rewards i. extreme politeness ii. compliments iii. praise' for past behavior. b. Non-verbal rewards i. Giving individuals in the other party more space at the table; ii. Nodding of the head to signal your acceptance and that you approve; iii. Eye contact to indicate attention; and iv. By using open and non-aggressive gestures to designate acceptance and respect. 3. Coercive Power - the opposite of reward power. It is the ability of the power holder to remove something from a person or to punish them for not conforming with a request. It is the power that is based on fear. This results from the expectation of a negative reward if wishes are not obeyed. A person with coercive power can make things difficult for people. These are the persons that one wants to avoid getting angry. Employees working under coercive managers are unlikely to be committed, and more likely to resist the manager. 4. Expert Power - Any individual person who has an expertise that is highly valued possesses expert power. Experts have power even though their status might be regarded as being low. A person may have expert knowledge about technical, administrative, or personal matters. The harder it becomes to replace an expert; the higher becomes the degree of expert power that they possess. 5. Referent Power - is occasionally called personal power. Influence is based on possession by an individual or desirable resources or personal traits. It is premised on the target's attraction to the power holder - liking, perceived similarity, admiration, desire to be close to or friendly with the power holder. This attraction may due to physical attractiveness, dress, mannerisms, lifestyle or position, but can also include friendliness, congeniality, honesty, integrity and so on.

6. Informational power - is a variation of legitimate power stemming from the ability to control the availability and accuracy of information. This depends on the giving or withholding of information or having knowledge that others do not have.

Two Classes of Leaders
1. Informal Leader -means taking charge of a group without being formally appointed such a role. -refers to someone who has no formal position of authority over people but who becomes a group’s leader informally. Such a person might not even be acknowledged explicitly by the group as their leader. It might be quite subconscious and only observable by an outsider who might notice that the group is regularly doing what the informal leader is suggesting. 2. Formal leader-occupying positions of authority (i.e., a supervisory position) and the sole claim to leadership. A formal position gives a leader the following power: a. Formal authority leads to legitimacy, acceptance (zone of acceptance, indifference) b. Control over rewards and punishments, resources c. Control over information. Centrality in the network, central location d. Control over the physical environment / conditions, organization and job design, technology, social structure.

Theories of Leadership:
1. “Great Man” Theory: Great Man theories assume that the capacity for leadership is inherent – that great leaders are born, not made. These theories often portray great leaders as heroic, mythic, and destined to rise to leadership when needed. The term “Great Man” was used because, at the time, leadership was thought of primarily as a male quality, especially in terms of military leadership. 2. Trait Theory: Similar in some ways to “Great Man” theories, trait theory assumes that people inherit certain qualities and traits that make them better suited to leadership. Trait theories often identify particular personality or behavioral characteristics shared by leaders. But if particular traits are key features of leadership, how do we explain people who possess those qualities but are not leaders? This question is one of the difficulties in using trait theories to explain leadership. 3. Contingency Theory: Contingency theories of leadership focus on particular variables related to the environment that might determine which particular style of leadership is best suited for the situation. According to this theory, no leadership style is best in all situations. Success depends upon a number of variables, including the leadership

style, qualities of the followers, and aspects of the situation. In this model leadership is effective when the leader’s style is appropriate to the situation, as determined by three principal factors: 1. Leader-member relations: The nature of the interpersonal relationship between leader and follower, expressed in terms of good through poor, with qualifying modifiers attached as necessary. It is obvious that the leader’s personality and the personalities of subordinates play important roles in this variable. 2. Task structure: The nature of the subordinate’s task, described as structured or unstructured, associated with the amount of creative freedom allowed the subordinate to accomplish the task, and how the task is defined. 3. Position power: The degree to which the position itself enables the leader to get the group members to comply with and accept his or her direction and leadership

4. Situational Theory: Situational theories propose that leaders choose the best course of action based upon situational variable. Different styles of leadership may be more appropriate for certain types of decision-making. 5. Charismatic Theory Charismatic Leadership is one of the more recent theories on leadership. Although not many studies have been done so far to test them, these theories suggest certain different and interesting ways of looking at leadership. Charisma is a special characteristic of some leaders. People usually feel personally attracted to a charismatic leader. And the attraction can lead to a powerful leadership. Phenomena that can be observed in charisma include: 1. The followers trust the correctness of the leader's believes; 2. The followers feel affection to the leader and obey the leader willingly; The followers feel an emotional involvement in the mission they are led to do. 5. Behavioral Theory: Behavioral theories of leadership are based upon the belief that great leaders are made, not born. Rooted in behaviorism, this leadership theory focuses on the actions of leaders, not on mental qualities or internal states. According to this theory, people can learn to become leaders through teaching and observation. Types of Behavioral theory: 1. Autocratic- Use of Authority by the manager. 2. Democratic- the leader allows certain areas of freedom for the subordinates.

Management Process
Both of the above interpretations acknowledge the major functions of planning, organizing, leading and coordinating activities -- they put different emphasis and suggest different natures of activities in the following four major functions. They still agree that what managers do is the following:

1. Planning
including identifying goals, objectives, methods, resources needed to carry out methods, responsibilities and dates for completion of tasks. Examples of planning are strategic planning, business planning, project planning, staffing planning, advertising and promotions planning, etc.

Guidelines to Ensure Successful Planning and Implementation
A common failure in many kinds of planning is that the plan is never really implemented. Instead, all focus is on writing a plan document. Too often, the plan sits collecting dust on a shelf. Therefore, most of the following guidelines help to ensure that the planning process is carried out completely and is implemented completely -or, deviations from the intended plan are recognized and managed accordingly.

1. Involve the Right People in the Planning Process
Going back to the reference to systems, it's critical that all parts of the system continue to exchange feedback in order to function effectively. This is true no matter what type of system. When planning, get input from everyone who will responsible to carry out parts of the plan, along with representative from groups who will be effected by the plan. Of course, people also should be involved if they will be responsible to review and authorize the plan.

2. Write Down the Planning Information and Communicate it Widely
New managers, in particular, often forget that others don't know what these managers know. Even if managers do communicate their intentions and plans verbally, chances are great that others won't completely hear or understand what the manager wants done. Also, as plans change, it's extremely difficult to remember who is supposed to be doing what and according to which version of the plan. Key stakeholders (employees, management, board members, funders, investor, customers, clients, etc.) may request copies of various types of plans. Therefore, it's critical to write plans down and communicate them widely.

3. Goals and Objectives Should Be SMARTER
SMARTER is an acronym, that is, a word composed by joining letters from different words in a phrase or set of words. In this case, a SMARTER goal or objective is:

Specific: For example, it's difficult to know what someone should be doing if they are to pursue the goal to "work harder". It's easier to recognize "Write a paper". Measurable: It's difficult to know what the scope of "Writing a paper" really is. It's easier to appreciate that effort if the goal is "Write a 30-page paper". Acceptable: If I'm to take responsibility for pursuit of a goal, the goal should be acceptable to me. For example, I'm not likely to follow the directions of someone telling me to write a 30-page paper when I also have to five other papers to write. However, if you involve me in setting the goal so I can change my other commitments or modify the goal, I'm much more likely to accept pursuit of the goal as well. Realistic: Even if I do accept responsibility to pursue a goal that is specific and measurable, the goal won't be useful to me or others if, for example, the goal is to "Write a 30-page paper in the next 10 seconds". Time frame: It may mean more to others if I commit to a realistic goal to "Write a 30-page paper in one week". However, it'll mean more to others (particularly if they are planning to help me or guide me to reach the goal) if I specify that I will write one page a day for 30 days, rather than including the possibility that I will write all 30 pages in last day of the 30-day period. Extending: The goal should stretch the performer's capabilities. For example, I might be more interested in writing a 30-page paper if the topic of the paper or the way that I write it will extend my capabilities. Rewarding: I'm more inclined to write the paper if the paper will contribute to an effort in such a way that I might be rewarded for my effort.

4. Build in Accountability (Regularly Review Who's Doing What and By When?)
Plans should specify who is responsible for achieving each result, including goals and objectives. Dates should be set for completion of each result, as well. Responsible parties should regularly review status of the plan. Be sure to have someone of authority "sign off" on the plan, including putting their signature on the plan to indicate they agree with and support its contents. Include responsibilities in policies, procedures, job descriptions, performance review processes, etc.

5. Note Deviations from the Plan and Replan Accordingly
It's OK to deviate from the plan. The plan is not a set of rules. It's an overall guideline. As important as following the plan is noticing deviations and adjusting the plan accordingly.

6. Evaluate Planning Process and the Plan
During the planning process, regularly collect feedback from participants. Do they agree with the planning process? If not, what don't they like and how could it be done better? In large, ongoing planning processes (such as strategic planning, business planning, project planning, etc.), it's critical to collect this kind of feedback regularly.

During regular reviews of implementation of the plan, assess if goals are being achieved or not. If not, were goals realistic? Do responsible parties have the resources necessary to achieve the goals and objectives? Should goals be changed? Should more priority be placed on achieving the goals? What needs to be done? Finally, take 10 minutes to write down how the planning process could have been done better. File it away and read it the next time you conduct the planning process.

7. Recurring Planning Process is at Least as Important as Plan Document
Far too often, primary emphasis is placed on the plan document. This is extremely unfortunate because the real treasure of planning is the planning process itself. During planning, planners learn a great deal from ongoing analysis, reflection, discussion, debates and dialogue around issues and goals in the system. Perhaps there is no better example of misplaced priorities in planning than in business ethics. Far too often, people put emphasis on written codes of ethics and codes of conduct. While these documents certainly are important, at least as important is conducting ongoing communications around these documents. The ongoing communications are what sensitize people to understanding and following the values and behaviors suggested in the codes.

8. Nature of the Process Should Be Compatible to Nature of Planners
A prominent example of this type of potential problem is when planners don't prefer the "top down" or "bottom up", "linear" type of planning (for example, going from general to specific along the process of an environmental scan, SWOT analysis, mission/vision/values, issues and goals, strategies, objectives, timelines, etc.) There are other ways to conduct planning.

9. Critical -- But Frequently Missing Step -- Acknowledgement and Celebration of Results
It's easy for planners to become tired and even cynical about the planning process. One of the reasons for this problem is very likely that far too often,

emphasis is placed on achieving the results. Once the desired results are achieved, new ones are quickly established. The process can seem like having to solve one problem after another, with no real end in sight. Yet when one really thinks about it, it's a major accomplishment to carefully analyze a situation, involve others in a plan to do something about it, work together to carry out the plan and actually see some results. So acknowledge this -- celebrate your accomplishment

2. Organizing resources
to achieve the goals in an optimum fashion. Examples are organizing new departments, human resources, office and file systems, re-organizing businesses, etc.

3. Leading
Including to set direction for the organization, groups and individuals and also influence people to follow that direction. Examples are establishing strategic direction (vision, values, mission and / or goals) and championing methods of organizational performance management to pursue that direction.

4. Controlling, or Coordinating
This occurs with the organization's systems, processes and structures to effectively and efficiently reach goals and objectives. This includes ongoing collection of feedback, and monitoring and adjustment of systems, processes and structures accordingly. Examples include use of financial controls, policies and procedures, performance management processes, measures to avoid risks etc.

Another common view is that "management" is getting things done through others. Yet another view, quite apart from the traditional view, asserts that the job of management is to support employee's efforts to be fully productive members of the organizations and citizens of the community. To most employees, the term "management" probably means the group of people (executives and other managers) who are primarily responsible for making decisions in the organization. In a nonprofit, the term "management" might refer to all or any of the activities of the board, executive director and/or program directors.

Evidence-based Nursing Practice: solves problems encountered by nurses by carrying out four steps:

a. Clearly identify the issue or problem based on accurate analysis of current nursing knowledge and practice. b. Search the literature for relevant research by: 1. Literature review: Scholarly analysis of a body of research about a specific issue or topic. 2. Integrative literature review: Integration of a body of research findings (including theory, statistics) which concludes by addressing issues for future research. 3. Systematic literature review: Comprehensive, unbiased analysis of research findings on a specific topic which uses a strict scientific design to select and assess various related scientific studies. c. Evaluate the research evidence using established criteria regarding scientific merit by: 1. Meta-analysis: Merged statistical results from a number of related studies which combines various research studies with the goal of discovering consistencies and differences between studies. 2. Clinical Decision-making: drawing conclusions based on EBN, clinical expertise, patient preference, and other factors such as cost-benefit analysis, availability of alternatives, etc.

d. Choose interventions and justify the selection with the most valid evidence by: 1. Research Utilization: Transfers research findings to nursing practice: Carried out by individual nurses, groups of nurses working together to solve problems, by interdisciplinary teams, and by institutions and organizations seeking to make systemwide improvements in care outcomes

Overview
Evidenced-based nursing/evidence-based practice (EBN/EBP) is a nursing process that entails reviewing and instilling the most reliable and updated research in patient care. The goal of EBN is to provide the highest quality and most cost efficient nursing care possible. EBN is a process founded on the collection, interpretation, and integration of valid, important, and applicable patient-reported, clinician-observed, and research-derived evidence. The best available evidence, moderated by patient circumstances and preferences, is applied to improve the quality of clinical judgments." Some define EBN as "the synthesis and use of scientific findings from randomized clinical trials only." Others see it as "the use of information from case reports and expert opinion" [1] . EBN must use the best research evidence with clinical expertise and patient values. Nurses want to use EBN to improve the quality of care and create new and exciting questions to be addressed

through the research. EBN is not easily achieved and requires a conscious effort to practice and participate. In order to practice evidence based nursing one must understand the concept of research, know how to accurately evaluate research and decide which research is measurably valid and reliable.

EBP Meets Nursing
"Registered Nurses are expected to access, appraise, and incorporate research evidence into their professional judgment and decision-making as well as to consider preferences and values of their patient population." Associate degree graduates will demonstrate an awareness of the value or relevance of research in nursing. Registered nurses help identify problem areas in nursing practice within an established structured format, assist in data-collection activities, and , in conjunction with the professional nurse, appropriately use research findings in practice (Geri LoBiondo-Wood, Judith Haber pg.9) Thus, incorporating EBP into their nursing careers. "When enough research evidence is available, it is recommended that the evidence base for practice be based on the research." EBP is a growing trend in nursing. As more research is done in a specific area, the research evidence can be used to update and refine guidelines. "As we are exposed to new scientific knowledge, we need to use integrative review of literature, formulation of a new theory, or generate new hypotheses. Use of knowledge in this way is referred to as cognitive application" 1 . It is not to be overlooked however, that the nursing approach to evidence based practice may differ from the standard medical approach. This is typically due to nurses' commitment to providing holistic care; treating and working with patients rather than working on them. The difficulties associated with EBP in nursing is due to the wide range of meanings and uses associated with the term and the failure to clarify them in the context of a nursing discussion. "The science of nursing is based on a critical thinking framework, known as the nursing process, composed of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. These steps serve as the foundation of clinical decision-making and are used to provide evidence- based practice." [2] Because EBP originated in medicine, the assumptions associated with it may or may not apply to nursing and must be identified and addressed. Specifically, the assumptions equate practice decisions with medical interventions and evidence with quantitative research. Is the definition of EBP--along with these underlying assumptions--congruent with nursing practice? Prior to adopting EBP in nursing, clinicians must determine what constitutes evidence and what an effective nursing intervention is. It is important to distinguish how these concepts of evidence and intervention differ when applied in fields other than medicine. Any discussion of the application of EBP within nursing must be accompanied by a clarification of these terms and consideration of how they fit into the nursing discipline. [3] According to Sackett et al', evidence-based practice is the "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." Gibbs- takes this idea further, stating, "Placing the client's benefits first, evidence-based practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence."[4]

Challenges of EBN for Nurses
Professional nurses are constantly challenged to be aware of new information to provide the highest quality of patient care (Barnsteiner and Prevost, 2002; IOM, 2001). Nurses are challenged to expand their "comfort zone" by offering creative approaches to old and new health problems and designing new and innovative programs. Nursing research provides a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet these shifting challenges and maintain our societal relevance. The best available evidence--moderated by patient circumstances and preferences--is applied to improve the quality of clinical judgements and facilitate cost-effective health care (Sackett, Straus, Richardson, Rosenberg, and Haynes, 2000) In order to be the best possible patient advocate, a nurse must be willing to continually evaluate and change his or her practice methods. Health care is constantly changing. New information on how to provide better care for patients is discovered every day; and old practices are being improved. Now, health care practices are being implemented after research is done to prove their effectiveness. Accurate research provides health care workers with the evidence needed to change their practice. However, not all research is valid. Many studies are biased or have low external and internal validity. These studies cannot be trusted because nurses cannot be sure if the intervention is really beneficial. Therefore, these new methods should not be put into practice. That is how research, theory, and practice all come together. Nurses must realize how important research is in patient care. He or she must then learn to become a wise interpreter and evaluator of research, and continually evaluate current research to provide the highest quality patient care.