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NURSING CARE OF THE FAMILYNURSING CARE OF THE FAMILY
The Process…
THE FAMILY NCPTHE FAMILY NCP
The nursing process is a systematic, scientific, dynamic, ongoing interpersonal process in which nurses and clients are viewed as a system with each affecting the other and both being affected by the factors within the behavior
Series of actions that lead toward a particular result/goal resulting in optimal health care for clients
Guidelines for Family Health Guidelines for Family Health AssessmentAssessmentFocus on the family as a total unitAsk goal directed questionsCollect data over timeCombine quantitative and qualitative
dataExercise professional judgment
Data Gathering Methods and ToolsData Gathering Methods and Tools
ObservationPhysical ExaminationInterviewRecords ReviewLaboratory/Diagnostic Tests
Graphic Assessment ToolsGraphic Assessment ToolsEco Map◦Diagram of connections between the family
and the other systems in its ecological environment
Genogram◦Displays family patterns and relationship
Social Network Support Map
Family Case LoadFamily Case Load the no. and kind of families a nurse
handles at any given time variable for cases are added or dropped
based on the need for nursing care and supervision
Types of FamiliesTypes of Families
NuclearExtendedThree generationalDyadSingle- Parent Step- ParentBlended or reconstitutedSingle adult living aloneCohabiting/ Living –in
Stages of Family Life CycleStages of Family Life CycleNewly married coupleChildbearingPreschool age SchoolageTeenageLaunchingMiddle-aged ( empty nest –retirement)Period from retirement to Death of both
spouses
HEALTH TASKS OF THE FAMILYHEALTH TASKS OF THE FAMILY(Freeman, 1981)(Freeman, 1981)Recognizing interruptions of health or
developmentSeeking health careManaging health and non-health crisesProviding nursing care to the sick, disabled and
dependent member of the familyMaintaining a home environment conducive to
good health and personal developmentMaintaining a reciprocal relationship with the
community and health institutions
Family Nursing ProblemFamily Nursing ProblemArises when the family cannot effectively
perform its health tasks
Nurse’s Roles in Family Health Nurse’s Roles in Family Health Nursing Nursing
HEALTH MONITORPROVIDER OF CARE TO A SICK FAMILY MEMBERCOORDINATOR OF FAMILY SERVICESFACILITATORTEACHERCOUNSELOR
INITIAL DATA BASE FOR FAMILY INITIAL DATA BASE FOR FAMILY NURSING PRACTICENURSING PRACTICE
Family structure, Characteristics, and Dynamics
1. Members of the household and relationship to the head of the family
2. Demographic data – age, sex, civil status, position in the family
3. Place of residence of each member – whether living with the family or elsewhere
4. Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended
5. Dominant family members in terms of decision-making, especially in matters of health care
6. General family relationship/dynamics – presence of any readily observable conflict between members; characteristics communication patterns among members
Socio-economic and Cultural Characteristics1. Income and Expenses
◦ Occupation, place of work and income of each working members
◦ Adequacy to meet basic necessities ◦ Who makes decisions about money and
how it is spent2. Educational attainment of each other 3. Ethnic background and religious affiliation
4. Significant Others – role(s) they play in family’s life
5. Relationship of the family to larger community – Nature and extent of participation of the family in community activities
Home and Environment1. Housing
◦ Adequacy of living space◦ Sleeping arrangement ◦ Presence of breeding or resting sites of vectors of
diseases◦ Presence of accidents hazards◦ Food storage and cooking facilities ◦ Water supply – source, ownership, portability◦ Toilet facility – type, ownership, sanitary condition◦ Drainage system – type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum, etc.
3. Social and health facilities available4. Communication and transportation
facilities available
Health Status of each Family Member1. Medical and nursing history indicating current or past
significant illnesses or beliefs and practices conducive to health illness
2. Nutritional assessment ◦ Anthropometric data: Measures of nutritional
status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio
◦ Dietary history specifying quality and quantity of food/nutrient intake per day
◦ Eating/ feeding habits/ practices
3. Developmental assessments of infants, toddlers, and preschoolers – e.g., Metro Manila
4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse
5. Physical assessment indicating presence of illness state/s
6. Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings
Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention.
Examples include:1. Immunization status of family members2. Healthy lifestyle practices. Specify.3. Adequacy of:
◦ rest and sleep◦ exercise◦ use of protective measures- e.g. adequate
footwear in parasite-infested areas;◦ relaxation and other stress management
activities4. Use of promotive-preventive health services
Data AnalysisData AnalysisSorting data
Classifying/grouping data
Relating them to each other
Determining patterns or relationships among the data
Comparing data and patterns with norms or standards of society on health, family functioning and assumption of health task
Interpreting results of comparisons
Making inferences
Drawing conclusions
A TYPOLOGY OF NURSING A TYPOLOGY OF NURSING PROBLEMS IN FAMILY PROBLEMS IN FAMILY NURSING PRACTICENURSING PRACTICE
FIRST-LEVEL ASSESSMENTI. Presence of Wellness Condition – stated as Potential
or Readiness- a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on client’s performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client’s current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance.
Examples of these are the following:1. Potential for Enhanced Capability for:
Healthy lifestyle – e.g. nutrition/diet, exercise/ activity
Health Maintenance Parenting Breastfeeding Spiritual Well-being – process of a client’s
unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/GOD (NANDA 2001)
Others,
2. Readiness for Enhanced Capability for:
Healthy Lifestyle Health Maintenance Parenting Breastfeeding Spiritual Well-being Others,
I. Presence of Health Threats – conditions that are conducive to disease, accident or failure top realize one’s health potential.
Examples of these are the following:1. Family history of hereditary condition,
e.g. diabetes2. Threat of cross infection from a
communicable disease case
3. Family size beyond what family resources can adequately provide
4. Accidental hazards Broken stairs Sharp objects, poison, and medicines
improperly kept Fire hazards
5. Faulty nutritional habits or feeding practices.
Inadequate food intake both in quality & quantity
Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding practices
6. Stress-provoking factors – Strained marital relationship Strained parent-sibling relationship Interpersonal conflicts between family
members Care-giving burden
7. Poor Home Condition Inadequate living space Lack of food storage facilities Polluted water supply Presence of breeding sites of vectors of disease Improper garbage Unsanitary waste disposal Improper drainage system Poor ventilation Noise pollution Air pollution
8. Unsanitary food handling and preparation9. Unhealthful lifestyles and personal habits-
• Alcohol drinking • Cigarette smoking• Inadequate footwear• Eating raw meat• Poor personal hygiene• Self-medication• Sexual promiscuity• Engaging in dangerous sports• Inadequate rest• Lack of inadequate exercise• Lack of relaxation activities• Non-use of self protection measures
10. Inherent personal characteristics – e.g. poor impulse control
11. Health history which induce the occurrence of a health deficit, e.g. previous history of difficult labor
12. Inappropriate role assumption – e.g. child assuming mother's role, father not assuming his role
13. Lack of immunization/ inadequate immunization status specially of children
14. Family disunity – Self-oriented behavior of member(s) Unresolved conflicts of member(s) Intolerable disagreement Other
15. Other
III. Presence of Health Deficits – instances of failure in health maintenance.
Examples include:1. Illness states, regardless of whether it is
diagnosed or by medical practitioner2. Failure to thrive/ develop according to
normal rate3. Disability – whether congenital or arising
from illness; temporary
IV. Presence of stress Points/ Foreseeable Crisis Situations – anticipated periods of unusual demand of the individual or family in terms of family resources.
Examples of these include:1. Marriage 9. Menopause 2. Pregnancy 10. Loss of job3. Parenthood 11. Hospitalization of a 4. Additional member family member5. Abortion 12. Death of a
manner6. Entrance at school 13. Resettlement in a 7. Adolescence new community8. Divorce 14. illegitimacy
Second Level AssessmentSecond Level AssessmentFocus on determining family’s capacity to perform the
health tasksStatements on family health nursing problem:a. Inability to recognize the presence of the condition or
problemb. Inability to make decisions with respect to taking
appropriate health actionc. Inability to provide adequate nursing care to the sick,
disabled , dependent or vulnerable member of the family
d. Inability to provide a home environment conducive to health maintenance or personal development
e. Failure to utilize community resources for health care
Nursing diagnosesNursing diagnoses
1. Defining the Health Problem (first level assessment) THREAT, DEFICIT, FORESEEABLE CRISIS
2. Defining the Nursing Problems (second level assessment)◦ To facilitate the process of defining family
nursing problems, a classification system is used: Typology of Nursing Problems in Health Care
Cues/Data Family Nursing Problem
G8P7 (7007), 37 years old at 21 weeks AOG, BP of 140/100 with slight bipedal edema
Mother says “Wala naman akong balak magpacheck up kasi 7 na anak ko, lahat naman normal.”
Health center is 5 km from their home
A. Presence of Health Deficit, Preeclampsia
1. Inability to recognize presence of problem due to lack of knowledge
2. Failure to utilize community resources for health care due to:
a. physical inaccessibility of health center
Cues/Data Family Nursing Problem
Rina, 1 year old weighs 6 kgs, , looks pale, lethargic and apathetic
Mother says “ Ganyan talaga timbang nyan kasi premature pinanganak.”
Family income is P240 per day
B. Malnutrition as a health deficit
1. Inability to recognize the presence of malnutrition due to lack of knowledge
2. Inability to provide adequate nursing care to the malnourished member due to
a. Lack of knowledge
b. inadequate resources
Cues/Data Family Nursing Problem
Nine members with an income of P240 per day, 3 children are studying
Mother says “Biyaya sa pamilya ang anak, mas maraming anak mas masaya.”
“Ayaw ng asawa ko gumamit ng kahit ano kasi baka magkasakit ako ng kanser.”
C. Presence of Health threat, Family size beyond what family resources can provide
1. Inability to make decisions with respect to taking appropriate health action due to lack of knowledge as to alternative courses of action open to the family
Cues/Data Family Nursing Problem
All of the children are not immunized
Mother says “Para saan ba ang bakuna, lalo lang magkakasakit ang anak ko dahil nilalagnat pagnaturukan.”
“Ayaw ng asawa ko din pabakunahan, kaysa magaway kami di ko na lang pinabakunahan ang mga bata.”
D.Presence of health threat Inadequate immunization status of children
1. Inability to recognize the presence of problem due to wrong attitude or philosophy in life
2. Inability to make decisions with respect to health actions due to conflicting opinions among family members
“Mataray naman yung nurse sa center, laging nanghihingi ng donation.”
3. Failure to utilize community resources due to previous unpleasant experience with health worker
PlanningPlanningDeveloping a Family Nursing Care Plan
Family Care Plan: Nature and Family Care Plan: Nature and CharacteristicsCharacteristicsDefinition: the family care plan is the
blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools
CharacteristicsCharacteristicsThe nursing care plan focuses on actions
which are designed to solve or minimize existing problems
The nursing care plan is product of a deliberate systematic process.
The NCP relates to the future
The NCP is based upon identified health and nursing problems
The NCP is a means to an end, not an end in itself
Nursing care planning is a continuous process, not a one-shot deal
Qualities of a NCPQualities of a NCPIt should be based on clear, explicit
definition of the problems
A good plan is realistic
Prepared jointly with the family/community
The NCP is most useful in written form
Importance of NCPImportance of NCP
Individualize care to clientsHelps in setting priorities by providing
information about the family as well as the nature of the problem
Promotes systematic communication among those involved in the health care effort
Facilitates continuity of careFacilitates coordination of care
Steps in Developing a Family NCPSteps in Developing a Family NCP
Prioritize problems
Set goals and objectives
Plan interventions
Plan for evaluating care
Prioritizing Health ProblemsPrioritizing Health ProblemsUses the Scale for Ranking Family Health
Problems According to PrioritiesCriteria:◦Nature of problem presented – categorize
into threat, deficit, foreseeable crisis◦Modifiability of the problem – refers to the
probability of success in minimizing, alleviating or totally eradicating the problem through intervention
Criteria:◦Preventive Potential – refers to the nature
and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration
◦Salience – refers to the family’s perception and evaluation of the problem in terms of seriousness and urgency of attention needed
Factors affecting the nature of the Factors affecting the nature of the problem presentedproblem presentedGreater weight assigned to health deficit
because immediate intervention is required
Foreseeable crisis is given least weight
Factors in determining ModifiabilityFactors in determining Modifiability
Current knowledge, technology and interventions to manage the problem
Resources of the family – physical, financial, manpower
Resources of the nurse –knowledge, skills and time
Resources of the community – facilities and community organization or support
Factors considered in Preventive Factors considered in Preventive PotentialPotentialGravity or severity of the problemDuration of the problemCurrent ManagementExposure of any high risk group
Factors considered in SalienceFactors considered in SalienceThe nurse evaluates the family's
perception of the problemAs a general rule, the family’s concern
and felt needs require priority attention
Criteria Computation Actual
score
Justification
1. Nature of the score x weight
Problem highest score
2. Modifiability of score x weight
Problem highest score
3. Preventive score x weight
Potential highest score
4. Salience of score x weight
Problem highest score
Total Score
Inadequate immunizationInadequate immunizationCriteria Computation Actual
ScoreJustification
Nature
Modifiability
PP
Salience
2/3x1
2/2x2
3/3x1
0/2x1
2/3
2
1
0
The problem is a health deficit
The resources and interventions needed are available to the family
Communicable diseases are prevented with the proper and compete immunization
The family does not recognize the existence of the problem
TOTAL 3 2/3
After ranking, The Prioritized Health Problems are:1. Inadequate immunization 3 2/32. Possible complicated pregnancy 3 3. Malnutrition as a health deficit 24. Family size beyond family resources 2
List Problems ranked according to priorities presented
Given available resources, the health problems are to be addressed in the family nursing care plan
Formulation of Goals and ObjectivesFormulation of Goals and Objectives
Goals are broad statements of outcome
Objectives are specific, short term achievements expected to result in goal accomplishment
Objectives (components)Objectives (components)
Content ComponentComposed of a verb and its objectModifiers adjectives and adverbs that qualify the
verbTime for achievementTime frame for objectives
ObjectivesObjectives
Short TermFormulated for problems which require
immediate attentionMedium TermLong Term Require several nurse-family encounters
and investment of more resources
Barriers to joint goal settingBarriers to joint goal setting1. Failure on the part of the family to see
the problem2. Family is too busy3. Problem not serious enough4. Family refuses to do anything due to
◦ Fear of consequences◦ Respect for tradition◦ Failure to perceive benefits
5. Failure to develop a working relationship
Health Problem: Inadequate immunization status
Goal: Client will be adequately protected against communicable diseases
Objectives: All the children will be brought to the health
center for immunization every monthAfter 1 year, all the children will be given complete immunization appropriate for age.
Selection of Appropriate Selection of Appropriate InterventionIntervention Explore with the family all choices and
possibilities Develop and enhance cognition, volition
and emotions Focus on interventions to help the
family perform the health tasks:1. help the family recognize the problem
2. Guide the family on how to decide on Appropriate actions to take
3. Develop the family’s ability and commitment to provide nursing care to its members
4. Enhance the capability of the family to provide a home environment conducive to health maintenance and personal development
5. Facilitate the family’s capability to utilize community resources for health care
6. Catalyze motivation change through motivation and support
Health Problem
Family Nursing Problem
Goal of Care Objectives of Care
Intervention Measures
Resources Required
Evaluation
InterventionInterventionNursing Intervention = actions or measures taken by the nurse to achieve certain predetermined objectives of care
Characteristics of Nursing InterventionsCharacteristics of Nursing Interventions
1. Action is based on identified health and nursing problems
2. Actions is aimed at meeting the objectives formulated
3. Action is within the current or prevailing scope of nursing practice as defined by the law
General Types of Nursing InterventionGeneral Types of Nursing Intervention
1. Anticipatory Intervention Measure ◦ Actions taken before
the occurrence of disease or modifying the risk factors
◦ Health Promotive Measures
◦ Preventive Measures◦ Diagnostic Measures
2. Compensatory Intervention Measure◦ Effectively cope with an
undesirable health situation
◦ Curative Measures◦ Rehabilitative Measures◦ Supportive Measures
Types of Nursing Interventions in CHN Types of Nursing Interventions in CHN PracticePractice1. Administration of Medical Treatments
◦ Performed by the nurse based on doctors orders
◦ Based delegated expanded roles/function of nurse
2. Direct Nursing Care◦Hands on performance of assistive actions
related to the performance of activities of daily living Comfort measures Mobility and exercise Prevention of illness Rehabilitation First aid and emergency actions
3. Indirect Nursing Care◦Performed by a person under the guidance
and supervision of the nurse
4. Observational Measures◦ Inspecting, checking, examining and
monitoring the physical and psychosocial conditions of the client
5. Anticipatory Guidance◦Nursing actions aimed to meet a future need
or prevent a problem which the client may or may not express or realize
6. Health Teaching/Education◦Aims/Objectives
To enhance or broaden a client’s information knowledge base about health related matters
To form or change specific attitudes To develop or enhance specific skills and abilities To change personal habits, behavior patterns or
lifestyle
General Principles/Guidelines◦Start from where the learner is◦Use language which the learner will
understand◦Encourage active learning and maximum
participation◦Use appropriate teaching methods and
teaching materials◦Follow up and evaluate
7. Counseling◦Directed at health problems with strong
emotional components◦ Involves a closer more intimate relationship
between the nurse (counselor) and the client◦Requires a deep trusting relationship
8. Motivation, support and development of support system◦Enables the client to feel confident, secure
and in control of the situation◦Encouraging positive feelings and reducing
negative ones
9. Environmental manipulation, modifications or improvement
10. Referral11. Advocacy – speaking for, interceding,
seeking for support on behalf of the client12. Community Organization and
Development
Tools in Implementation of PlanTools in Implementation of Plan
Communication, Collaboration, Contracting, Education, Leadership, Planned change
CommunicationCommunicationConstruct shared realitiesCreate shared meaningsIndividuals engage in an exchange that is
both understood and meaningful
Functions of CommunicationFunctions of CommunicationProvides information Motivates by clarifying information so
that consensus is reached and the people involved can move forward with commitment
Facilitates expression of feelings Promotes closer working relationshipsControls behavior by providing clear
expectations and boundaries
Communication processCommunication process1. Message=Expression of the purpose of
communication2. Sender=Person conveying the message3. Receiver= person message is directed4. Encoding= senders conversion of the message into
symbolic form5. Channel= medium through which the sender conveys
the message6. Decoding=translation of message by the receiver7. Feedback loop=indicates that the message has been
received
Communication barriersCommunication barriersSelective perceptionLanguage barrierFiltering informationEmotional influence
Core communication skillsCore communication skillsSending skills◦ Verbal
Keep message honest and uncomplicated Use as few words as possible Ask for reactions
◦Nonverbal Gestures Body movements Eye contact Tone of voice silence
Core communication skillsCore communication skills
Interpersonal skills◦ Showing respect◦ Emphatizing◦ Developing trust
Receiving skills◦ Active listening/reflective
listening◦ paraphrasing
Collaboration in Community Health Collaboration in Community Health NursingNursingPurposeful interaction between nurses,
clients , other professionals and community members
Characteristics of collaborationCharacteristics of collaborationShared goalsMutual participationMaximize use of resourcesClear responsibilitiesSet boundaries
Contracting in Community Health Contracting in Community Health NursingNursingNegotiating a working agreement
between tow or more parties in which they come to a shared understanding and mutually consent to the purposes and terms of the transaction
Difference between legal contracts and nurse-client contract◦Flexible◦Changing◦Based on mutual trust and understanding
Characteristics of contractingCharacteristics of contractingPartnership and mutualityCommitmentFormatnegotiation
Process of ContractingProcess of Contracting
1. Exploration of needs: Assessment of clients health needs by clients, nurse and other relevant persons
2. Establishment of goals: Discussion and agreement between contracting members on goals and objectives
3. Exploration of resources : Defining what each member has to offer and can expect from the others; identifying appropriate resources and agencies
4. Development of a plan : Identifying methods, activities and a time line for achieving the stated goals
5. Division of responsibilities : Negotiating the activities for which each member will be responsible
6. Agreement on time frame : Setting the limits for the contract in terms of length of time or number of meetings
7. Evaluation : Periodic and final assessment of progress towards goals occurring at agreed on intervals
8. Renegotiation/Termination : Agreement to modify, renegotiate or terminate the contract
Health Promotion through Health Promotion through EducationEducationTeaching – specialized communication
process in which desired behavior changes are achieved
Learning – process of assimilating new information that promotes a permanent change in behavior
Domains of LearningDomains of LearningCognitiveAffectivePsychomotor
Cognitive DomainCognitive DomainInvolves the mind and thinking processLevels of cognitive learning
Level Client Behavior Nurse Behavior
Knowledge Recalls/knows Provides information
Comprehension Understands Explains information
Application Uses learning Suggest how to use learning
Analysis Examines /explains Demonstrates and encourages analysis
Synthesis Integrates with other learning, generates new ideas
Promotes client formulation of own plan
Evaluation Judges the usefulness of new material
Facilitates evaluation
Affective domainAffective domainInvolves emotions and feelingsDeals with changes in interest, attitudes
and valuesLevels of learning
Level Client Behavior Nurse Behavior
Receptive Listens, pays attention
Directs clients attention
Responsive Participates, reacts Encourages client involvement
Valuing Accepts, appreciates, commits
Respects clients rights to decide
Internal consistency Organizes values to fit together
Brings clients into contact with role modes
Adoption Incorporates new values into lifestyle
Positively reinforces healthy behavior
Psychomotor domainPsychomotor domainIncludes visible, demonstrable
performance skills that require neuromuscular coordination
Examples:◦Teaching infant bathing, temperature taking,
breast self examination
Conditions for psychomotor learning◦Learner must be capable of the skill◦Learner must have a sensory image of how to
perform the skill◦Learner must practice the skill
Teaching ProcessTeaching Process
1. Interaction2. Assessment and diagnosis3. Setting goals and objectives4. Planning5. Teaching6. Evaluation
Principles for the Teaching ProcessPrinciples for the Teaching ProcessAdapt teaching to client’s level of
readinessDetermine clients perceptions about the
subject matter before and during the teaching
Create an environment that is conducive to learning
Involve clients throughout the learning process
Make subject matter relevant to clients interest and use
Ensure client satisfaction during the teaching-learning process
Provide opportunities to apply material taught
Teaching Methods and MaterialsTeaching Methods and MaterialsLectureDiscussionDemonstrationRole playingTeaching materials
LeadershipLeadershipProcess in which one person influences
the activities of another person or group of persons toward accomplishment of a goal
Major characteristics of leadershipMajor characteristics of leadershipPurposefulInterpersonalInfluential
Leadership TheoriesLeadership TheoriesTrait Theory/Great Man Theory◦Based on Aristotle's belief that “Only a few
people are born with the traits necessary to be great leaders”
◦Traits that distinguishes leaders from non leadersDesire to lead Self confidenceAmbition and energy Honesty and IntegrityIntelligence Relevant knowledge
Leadership TheoriesLeadership Theories
Behavioral Theory◦ Proposed that
leaders behavior rather than personality traits would determine the effectiveness of leadership
◦ Leadership behavior grid
High emphasis on people
Low emphasis on tasks
High emphasis on people
High emphasis on task
Low emphasis on people
Low emphasis on tasks
Low emphasis on people
High emphasis on tasks
Leadership TheoriesLeadership TheoriesContingency Theory◦Describes leadership in terms of the leader’s
ability to adapt to a situation◦Leadership style should be adapted to
follower’s level of maturity, immaturity, ability to assume responsibility
Leadership TheoriesLeadership Theories Charismatic Theory States that leadership occurs because of a magnetic and
inspirational personality and behavior Charismatic leader:
1. emerge during a crisis2. advocates a vision that differs from the status quo3. accurately assess the situation4. communicate self confidence5. use personal power6. make self sacrifices7. Use unconventional strategies
Followers of a charismatic leader1. Trust in the leader’s beliefs2. Have similar beliefs3. Exhibit affection for, obedience to and
unquestioning acceptance for their leader4. Believe that they can contribute to the
mission advocated by the leader
Leadership functionsLeadership functionsCreative functionInitiating functionRisk taking functionIntegrative functionInstrumental function
Leadership StylesLeadership StylesAutocratic leadership◦Authoritarian◦Leaders use their power to influence their
followers◦Leader makes decision alone, gives orders,
expects others to follow without question
Leadership StylesLeadership StylesParticipative Leadership◦Democratic◦Leaders involve followers in the decision
making process
Leadership StylesLeadership StylesAutonomous leadership◦Facilitative◦Encourages members to select and carry out
their own activities and to function independently
Leadership StylesLeadership StylesTransactional leadership◦Focused more on roles, tasks and
accomplishing goals
Leadership StylesLeadership StylesTransformational leadership◦Emphasizing inspiring motivation and
commitment in followers
Planned changePlanned changeStages of change◦Unfreezing = need/problem causes
disequilibrium◦Changing = people examine, accept and try
the innovation◦Refreezing = change is established as an
accepted and permanent part of the system
Characteristics of planned changeCharacteristics of planned changePurposeful and intentionalBy design and not by defaultAims at improvementAccomplished through an agent
Planned Change ProcessPlanned Change Process1. Assess symptoms2. Diagnose need3. Analyze alternative solutions4. Select a change5. Plan the change 6. Implement7. Evaluate the change8. Stabilize the change
Principles for Effective Positive ChangePrinciples for Effective Positive Change
Principle of participationPrinciple to resistance to changePrinciple of proper timingPrinciple of interdependencePrinciple of flexibilityPrinciple of self understanding
Evaluating Nursing CareEvaluating Nursing CareEvaluation involves the analysis of the
appropriateness, adequacy, effectiveness and efficiency of care provided
Types of EvaluationTypes of Evaluation
1. Quantitative Evaluation2. Qualitative Evaluation
Effectiveness – measures the degree of attainment of objectivesEfficiency – measures the cost in terms of resourcesAppropriateness – measures the ability to resolve the existing problemAdequacy – measures whether all necessary and appropriate activities were performedImpact – overall effect on the clients health and wellnessProgress – comparison of actual and planned activities
