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HUMAN BEHAVIOUR IN HEALTH CARE ORGANIZATIONS

Human Behaviour in Health Care Organizations

Christine R. Guirnela

Floressa Jean R. Cabatania

Julie M. Yap

Kathryn Joy T. Gustilo`

Krejmer R. Magalona

Leslie Mae P.Adalin

Mary June T. Carinal

Suzette P. Espallardo

Maribel R. Tecson

Northern Negros College of Science and Technology

Authors Note

This paper is prepared for Human Behaviour in Health Organizations taught by

Andrea Marie A. Boherom RMT,RN,MN

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Leadership Theories

The Trait Theory

The trait theory of leadership (which was popular in the 1940s and 1950s), attached

leadership ability to specific traits. This theory of leadership attempted to state that if someone

had true leadership traits they could lead regardless of the situation. The trait theory focused on

what a person is and not on what they could accomplish. The following are assumptions of the

trait theory:

People are born with inherited traits.

Some traits are particularly suited to leadership.

People who make good leaders have the right (or sufficient) combination of traits.

The trait theory postulates the following as important leadership traits:

Physical attractiveness (neat, well groomed, tall, healthy, usually male).

Social and personal characteristics that are inherent to leaders (well bred, intelligent,

educated, and well mannered).

Adaptable to situations /Alert to social environment

Ambitious and achievement-orientated

Assertive/Cooperative/Decisive/Dependable/Persistent

Dominant (desire to influence others)

Energetic (high activity level)/Self-confident/Tolerant of stress

Willing to assume responsibility

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The Behavioral Theory

Overall dissatisfaction with the trait theory lead to a new theory of leadership (1950s and

1960s) that focused more on the actual behavior of the leader. The behavior theory focuses

more on what a leader does rather then what a person is. The three leadership styles that

emerged from this new belief were the Autocratic, Democratic and Laissez-Faire styles of

leadership. It was originally thought that a persons personality lead them to fall into an either or

behavioral pattern, but today mastering all of these behaviors and applying the appropriate

behavior to the appropriate situation is thought to be a better approach. The following quiz will

help to individualize and define these behaviors:

Contingency Theories of Leadership

Managers and leaders in any organization are expected to influence the actions of their

employees through several channels. Some of these include communicating with staff members,

stimulating subordinates to work hard and ensuring that all the resources within the company are

allocated well. These expectations can either be met successfully or unsuccessfully. Numerous

researchers felt the need to come up with theories that govern successful leadership. One of these

theories is known as the contingency theory.

Tannenbaum and Schmidts Leadership Continuum Theory

In 1957, Robert Tannenbaum and Richard Schmidt developed a leadership continuum

with relationship orientation characterized by high employee freedom on one extreme and task

oriented behavior characterized by high use of leader authority at the other extreme. According
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to this model, as a leader became more relationship oriented, he became less task oriented.

Tannenbaum and Schmidt, proposed that leadership behaviour varies along a continuum

and that as leaders move away from the autocratic extreme the amount of follower participation

and involvement in decision taking increases.

They identified three forces that led to the leader's action: the forces in the situation, the

forces in the follower and also forces in the leader. They proposed a more detailed approach to

defining leadership styles. Their model shows the spectrum of possible styles along a continuum

linking autocratic leaders, who tell their staff what to do at one extreme, with those who delegate

authority for decision-making to subordinates, at the other. The two extremes represent the ideas

characterized by Theory X and Theory Y managers. Managers may move along this continuum

as external factors alter and situations change. This is shown in figure 1 below.
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Figure 1 Tannenbaum and Schmidt's leadership model

It may seem as if the ideal is a position somewhere between the two extremes, but the

truth is that the nature of decision-making an effective leader displays can swing constantly

between them.

Fiedler Contingency Theory

Fred E. Fiedlers contingency theory of leadership effectiveness concentrated on the

relationship between leadership and organizational performance. This is one of the earliest

situation-contingent leadership theories given by Fiedler. According to him, if an organization

attempts to achieve group effectiveness through leadership, then there is a need to assess the

leader according to an underlying trait, assess the situation faced by the leader, and construct a

proper match between the two.

In order to assess the attitudes of the leader, Fiedler developed the least preferred co-

worker (LPC) scale in which the leaders are asked about the person with whom they least like to

work. The scale is a questionnaire consisting of 16 items used to reflect a leaders underlying

disposition toward others. The items in the LPC scale are pleasant / unpleasant, friendly /

unfriendly, rejecting / accepting, unenthusiastic / enthusiastic, tense / relaxed, cold / warm,

helpful / frustrating, cooperative / uncooperative, supportive / hostile, quarrelsome / harmonious,

efficient / inefficient, gloomy / cheerful, distant / close, boring / interesting, self-assured /

hesitant, open / guarded. Each item in the scale is given a single ranking of between one and

eight points, with eight points indicating the most favorable rating.
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Unfriendly
Friendly 8 7 6 5 4 3 2 1

Fiedler states that leaders with high LPC scores are relationship-oriented and the ones

with low scores are task-oriented. The high LPC score leaders derived most satisfaction from

interpersonal relationships and therefore evaluate their least preferred co-workers in fairly

favorable terms. These leaders think about the task accomplishment only after the relationship

need is well satisfied. On the other hand, the low LPC score leaders derived satisfaction from

performance of the task and attainment of objectives and only after tasks have been

accomplished, these leaders work on establishing good social and interpersonal relationships.

According to Fiedler, a leaders behavior is dependent upon the favorability of the

leadership situation. Three factors work together to determine how favorable a situation is to a

leader. These are:

Leader-member relations - The degree to which the leaders is trusted and liked by the

group members, and the willingness of the group members to follow the leaders

guidance

Task structure - The degree to which the groups task has been described as structured or

unstructured, has been clearly defined and the extent to which it can be carried out by

detailed instructions

Position power - The power of the leader by virtue of the organizational position and the

degree to which the leader can exercise authority on group members in order to comply

with and accept his direction and leadership.

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With the help of these three variables, eight combinations of group-task situations were

constructed by Fiedler. These combinations were used to identify the style of the leader.

Figure 1: Correlation between leaders LPC scores and group effectiveness

The leaders effectiveness is determined by the interaction of the leaders style of

behavior and the favorableness of the situational characteristics. The most favorable situation is

when leader-member relations are good, the task is highly structured, and the leader has a strong

position power.
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Research on the contingency model has shown that task-oriented leaders are more

effective in highly favorable (1, 2, 3) and highly unfavorable situation (7, 8), whereas

relationship-oriented leaders are more effective in situations of intermediate favorableness (4, 5,

6).

Fiedler also suggested that leaders may act differently in different situations.

Relationship-oriented leaders generally display task-oriented behaviors under highly favorable

situations and display relationship-oriented behaviors under unfavorable intermediate favorable

situations. Similarly, task-oriented leaders frequently display task-oriented in unfavorable or

intermediate favorable situations but display relationship-oriented behaviors in favorable

situations.

Blake and Moutons Managerial Grid Theory

Robert Blake and Jane Mouton (1960s) proposed a graphic portrayal of leadership styles

through a managerial grid (sometimes called leadership grid). The grid depicted two dimensions

of leader behavior, concern for people (accommodating peoples needs and giving them priority)

on y-axis and concern for production (keeping tight schedules) on x-axis, with each dimension

ranging from low (1) to high (9), thus creating 81 different positions in which the leaders style

may fall. (See figure 1).

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The five resulting leadership styles are as follows:

1. Impoverished Management (1, 1): Managers with this approach are low on both the

dimensions and exercise minimum effort to get the work done from subordinates. The

leader has low concern for employee satisfaction and work deadlines and as a result

disharmony and disorganization prevail within the organization. The leaders are termed

ineffective wherein their action is merely aimed at preserving job and seniority.

2. Task management (9, 1): Also called dictatorial or perish style. Here leaders are more

concerned about production and have less concern for people. The style is based on

theory X of McGregor. The employees needs are not taken care of and they are simply a

means to an end. The leader believes that efficiency can result only through proper
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organization of work systems and through elimination of people wherever possible. Such

a style can definitely increase the output of organization in short run but due to the strict

policies and procedures, high labour turnover is inevitable.

3. Middle-of-the-Road (5, 5): This is basically a compromising style wherein the leader tries

to maintain a balance between goals of company and the needs of people. The leader does

not push the boundaries of achievement resulting in average performance for

organization. Here neither employee nor production needs are fully met.

4. Country Club (1, 9): This is a collegial style characterized by low task and high people

orientation where the leader gives thoughtful attention to the needs of people thus

providing them with a friendly and comfortable environment. The leader feels that such a

treatment with employees will lead to self-motivation and will find people working hard

on their own. However, a low focus on tasks can hamper production and lead to

questionable results.

5. Team Management (9, 9): Characterized by high people and task focus, the style is based

on the theory Y of McGregor and has been termed as most effective style according to

Blake and Mouton. The leader feels that empowerment, commitment, trust, and respect

are the key elements in creating a team atmosphere which will automatically result in

high employee satisfaction and production.

Hersey Blanchard Situational Leadership Theory

According to this model, the leader has to match the leadership style according to the

readiness of subordinates which moves in stage and has a cycle. Therefore, this theory is also

known as the life-cycle theory of leadership.

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The theory, developed by Paul Hersey and Kenneth Blanchard, is based on the readiness

level of the people the leader is attempting to influence. Readiness is the extent to which

followers have the ability and willingness to accomplish a specific task. Ability is the knowledge,

experience, and skill that an individual possesses to do the job and is called job readiness.

Willingness is the motivation and commitment required to accomplish a given task. The style of

leadership depends on the level of readiness of the followers.

The readiness(R) is divided into a continuum of four levels which are:

R1 - low follower readiness - refers to low ability and low willingness of followers i.e. those

who are unable and insecure

R2 - low to moderate follower readiness - refers to low ability and high willingness of

followers i.e. those who are unable but confident

R3 - moderate to high follower readiness - refers to high ability and low willingness of

followers i.e. those who are able but insecure

R4 - high follower readiness - refers to high ability and high willingness of followers i.e.

those who are both able and confident

The direction is provided by the leader at the lower levels of readiness. Therefore, the

decisions are leader directed. On the other hand, the direction is provided by the followers at the

higher levels of readiness. Therefore, the decisions in this case are follower directed. When the

followers move from low levels to high levels of readiness, the combinations of task and

relationship behaviors appropriate to the situation begin to change.

For each of the four levels of readiness, the leadership style used may be a combination of

task and relationship behavior.

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Task behavior: Extent to which the leader spells out the duties and responsibilities of a

follower which includes providing them direction, setting goals, and defining roles for

them. Usually a one-way communication exists which is meant to provide the direction to

the followers.

Relationship behavior: Extent to which the leader listens to the followers, and provides

encouragement to them. Here, a two-way communication exists between the leader and

the follower.

By combining the task and the relationship behavior, we arrive at the following four different

styles of leadership which correspond with the different levels of readiness as shown in the Figure 1.

S1 - Telling: This style is most appropriate for low follower readiness (R1). It emphasizes

high task behavior and limited relationship behavior.

S2 - Selling: This style is most appropriate for low to moderate follower readiness (R2). It

emphasizes high amounts of both task and relationship behavior.

S3 - Participating: This style is most appropriate for moderate to high follower readiness (R3).

It emphasizes high amount of relationship behavior but low amount of task behavior.
S4 - Delegating: This style is most appropriate for high follower readiness (R4). It emphasizes

low levels of both task and relationship behavior.

Houses Path-Goal Theory

The theory was developed by Robert House and has its roots in the expectancy theory of

motivation. The theory is based on the premise that an employees perception of expectancies

between his effort and performance is greatly affected by a leaders behavior. The leaders help

group members in attaining rewards by clarifying the paths to goals and removing obstacles to

performance. They do so by providing the information, support, and other resources which are
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required by employees to complete the task.

Houses theory advocates servant leadership. As per servant leadership theory,

leadership is not viewed as a position of power. Rather, leaders act as coaches and facilitators to

their subordinates. According to Houses path-goal theory, a leaders effectiveness depends on

several employee and environmental contingent factors and certain leadership styles. All these are

explained in the figure 1 below:

Figure 1: Path-Goal Leadership Theory
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The four leadership styles are:

Directive: Here the leader provides guidelines, lets subordinates know what is expected

of them, sets performance standards for them, and controls behavior when performance

standards are not met. He makes judicious use of rewards and disciplinary action. The

style is the same as task-oriented one.

Supportive: The leader is friendly towards subordinates and displays personal concern for

their needs, welfare, and well-being. This style is the same as people-oriented leadership.

Participative: The leader believes in group decision-making and shares information with

subordinates. He consults his subordinates on important decisions related to work, task

goals, and paths to resolve goals.

Achievement-oriented: The leader sets challenging goals and encourages employees to

reach their peak performance. The leader believes that employees are responsible enough

to accomplish challenging goals. This is the same as goal-setting theory.

The theory states that each of these styles will be effective in some situations but not in

others. It further states that the relationship between a leaders style and effectiveness is

dependent on the following variables:

Employee characteristics: These include factors such as employees needs, locus of

control, experience, perceived ability, satisfaction, willingness to leave the organization,

and anxiety. For example, if followers are high inability, a directive style of leadership

may be unnecessary; instead a supportive approach may be preferable.

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Characteristics of work environment: These include factors such as task structure and

team dynamics that are outside the control of the employee. For example, for employees

performing simple and routine tasks, a supportive style is much effective than a directive

one. Similarly, the participative style works much better for non-routine tasks than

routine ones.

The theory has been subjected to empirical testing in several studies and has received

considerable research support. This theory consistently reminds the leaders that their main role as

a leader is to assist the subordinates in defining their goals and then to assist them in

accomplishing those goals in the most efficient and effective manner. This theory gives a guide

map to the leaders about how to increase subordinates satisfaction and performance level.

Leader-Member Exchange (LMX) Theory

Leader-Member Exchange Theory, also called LMX or Vertical Dyad Linkage Theory,

describes how leaders in groups maintain their position through a series of tacit exchange

agreements with their members.

In particular, leaders often have a special relationship with an inner circle of trusted

lieutenants, assistants and advisors, to whom they give high levels of responsibility, decision

influence, and access to resources. This in-group pay for their position. They work harder, are

more committed to task objectives, and share more administrative duties. They are also expected

to be fully committed and loyal to their leader. The out-group, on the other hand, are given low

levels of choice or influence.

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This also puts constraints upon the leader. They have to nurture the relationship with their

inner circle whilst balancing giving them power with ensuring they do not have enough to strike

out on their own.

These relationships, if they are going to happen, start very soon after a person joins the

group and follow three stages.

Role taking. The member joins the team and the leader assesses their abilities and

talents. Based on this, the leader may offer them opportunities to demonstrate their

capabilities. Another key factor in this stage is the discovery by both parties of how

the other likes to be respected.

Role making. In the second phase, the leader and member take part in an

unstructured and informal negotiation whereby a role is created for the member and

the often-tacit promise of benefit and power in return for dedication and loyalty takes

place.Trust-building is very important in this stage, and any felt betrayal, especially

by the leader, can result in the member being relegated to the out-group.

This negotiation includes relationship factors as well as pure work-related ones, and a

member who is similar to the leader in various ways is more likely to succeed. This perhaps

explains why mixed gender relationships regularly are less successful than same-gender ones (it

also affects the seeking of respect in the first stage). The same effect also applies to cultural and

racial differences.

Routinization. In this phase, a pattern of ongoing social exchange between the leader

and the member becomes established. Successful members are thus similar in many
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ways to the leader (which perhaps explains why many senior teams are all white,

male, middle-class and middle-aged). They work hard at building and sustaining trust

and respect.

To help this, they are empathetic, patient, reasonable, sensitive, and are good at seeing the

viewpoint of other people (especially the leader). Aggression, sarcasm and an egocentric view

are keys to the out-group wash-room.

The overall quality of the LMX relationship varies with several factors. Curiously, it is

better when the challenge of the job is extremely high or extremely low. The size of the group,

financial resource availability and the overall workload are also important.

The principle works upwards as well. The leader also gains power by being a member of

their manager's inner circle, which then can then share on downwards. People at the bottom of an

organization with unusual power may get it from an unbroken chain of circles up to the

hierarchy.

When you join a team, work hard to also join the inner circle. Take on more than your

share of administrative and other tasks. Demonstrate unswerving loyalty. See your leader's point

of view. Be reasonable and supportive in your challenges to them, and pick your moments

carefully.

As a leader, pick your inner circle with care. Reward them for their loyalty and hard

work, whilst being careful about maintaining commitment of other people.

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If you want to be an 'ordinary' member of a team, play your part carefully. There will be

others with more power. If you want to lead an equal team, beware of those who curry favor.

Contemporary Leadership Theories

Hudson, K. (n.d.) traditionally defined leadership as an interpersonal influence directed

toward the achievement of a goal or goals. When broken down there are three key principles to

this traditional definition which are:

Interpersonal meaning dealing with more than one person (thus a leader works with a

group of people).

Influence the power to affect others.

Goals the end that one strives to attain.

This traditional definition of leadership can be re-worded to simply state a leader influences

more than one person towards a goal.

On the other hand, a more contemporary definition, Leadership is a dynamic relationship

(based on mutual influence and common purpose) between leaders and collaborators which leads

both parties to higher levels of motivation and moral development as they evoke real change.

When this definition is broken down there are also three key principles which are:

Relationship the connection between people.

Mutual sharing something in common.

Collaborators working together.

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This more contemporary definition of leadership can be re-worded to simply state the leader

is influenced by the collaborators while they work together to achieve real change.

The Autocratic Leadership

The Autocratic leader is someone who usually needs to dominate others. The autocratic

approach is often a unilateral one and they are most likely attempting to achieve a single goal or

objective. This approach to leadership generally results in passive resistance from team-members

and in order to get things done, requires continual pressure and direction from the leader.

Generally an authoritarian approach is not a good way to get the best performance from the team.

The Autocratic approach is sometimes confused with the yelling and demeaning approach that an

abusive leader would resort to.

There is however some instances where an autocratic style of leadership may not only be

necessary but actually the most appropriate style of leadership for a given situation. These

situations are ones that call for urgent or quick action. Because most people are familiar with

autocratic leadership, they have less trouble adapting to this style. In stressful situations (such as

an impromptu survey), staff may prefer an autocratic approach.

The Democratic Leadership

The Democratic leader uses a team approach to make decisions. Although the Democratic

leader makes the final decision; they will usually involve one or more team members in the

decision making process. A good Democratic leader is one who encourages staff participation, is

empowering and supportive, and is careful not to lose site of the fact that he/she is still ultimately

responsible for the final outcome. The Democratic leader is happy to see staff members
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collaborate and is willing to accept that outcomes may turn out different then originally planned

(it is all about the process).

One draw back to the Democratic leadership style is that the leader is sometimes viewed as

someone who cannot make a decision on his/her own. Though most team members will have

respect for this type of leader; not everyone will view them as a "true" leader. Another draw back

to this leadership style is that many discussions, emails and meetings are usually required before

a decision that has group consensus is made (this can be time consuming).

The Laissez-Faire Leadership

The Laissez-Faire leader exercises very little control over his/her staff members. This type

of leadership essentially leaves all of the decision making to those who will be affected most.

The Laissez-Faire leadership style works very well when dealing with staff members who are

committed, motivated and able to analyze a situation properly. Once the Laissez-Faire leader has

established that staff members are high functioning; it is often best for this leader to step back

and let staff members get busy with the task at hand. This type of leadership also allows for

delegation of tasks that empowers staff members to achieve their goals.

A good use of Laissez-Faire leadership would be identifying a problem and allowing

staff to come up with and implement a solution. When staff develops anything on their own,

there is a much greater chance that they will be accountable for the change or improvement

Characteristics of the Working Environment within the Health Care Organizations

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A positive workplace attitude can generally tend to boost staff morale and can lead to

advantages such as higher productivity, increase sense of loyalty to organization and lower staff

turnovers. Because the perfect workplace does not exist, there are common issues and

challenges that workers may face .

Workplace Challenges

The healthcare industry is as dynamic as it gets. The only constant is change. Healthcare

leaders are confronted with many situations that must be contended with as they lead their

organizations. Some can be considered barriers that, if not dealt with properly, will stymie the

leaders capability. Certain other areas are challenges that must be addressed if the leader is to be

successful. A few of the more critical ones in todays healthcare world are presented

Healthcare is involved, directly or indirectly, with the provision of health services to

individuals. These services can occur in a variety of work settings, including hospitals, clinics,

dental offices, out-patient surgery centers, birthing centers, emergency medical care, home

healthcare, and nursing homes. Healthcare workers face a number of serious safety and health

hazards. They include bloodborne pathogens and biological hazards, potential chemical and drug

exposures, waste anesthetic gas exposures, respiratory hazards, ergonomic hazards from lifting

and repetitive tasks, laser hazards, workplace violence, hazards associated with laboratories, and

radioactive material and x-ray hazards. Some of the potential chemical exposures include

formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde,

and paracetic acid used for sterilization; and numerous other chemicals used in healthcare

laboratories.
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Workplace violence (WPV) is a recognized issue in the healthcare industry. WPV is any

act or threat of physical violence, harassment, intimidation, or other threatening disruptive

behavior that occurs at the work site. It can affect and involve workers, clients, customers and

visitors. WPV ranges from threats and verbal abuse to physical assaults and even homicide. In

2010, the Bureau of Labor Statistics (BLS) data reported healthcare and social assistance

workers were the victims of approximately 11,370 assaults by persons; a greater than 13%

increase over the number of such assaults reported in 2009. Almost 19% (i.e., 2,130) of these

assaults occurred in nursing and residential care facilities alone. Unfortunately, many more

incidents probably go unreported.

Gossip in the workplace is one of the most common and annoying problems in the

workplace. It's understandable to be interested in co-workers' lives; with many workweeks

stretching beyond 40 hours, workers may see their colleagues more than just about anyone else.

When gossip rages about sensitive issues, such as a co-worker's failing marriage or a

possible workplace romance, however, it can become destructive and create a great deal of

negativity. They can be especially disruptive to the workplace and cause misunderstandings..To

help calm gossip, employees should keep any overheard conversations or confidential

admissions of other workers private and stay out of conversations.

Workplace Discrimination refers to a situation in which you are treated unfairly because

of who you are and what you stand for.

Bullying includes the following things like practical jokes, being criticized or insulted ,

rumours being spread about you, being overloaded with work.

Workplace Issues
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Diversity issues are important in early 21st century workplaces. Ethnicity, race, economic

background, religion, gender and age are all critical components of a company's environment.

Diversity in an organization can create tensions, but it can also foster creative cooperation among

people from a variety of backgrounds, education, and experience. These differences can benefit a

company greatly, or they can tear it apart at the seams. Managers and leaders must be cognizant

of the effects of diversity and also be willing to promote a team environment.

Each individual brings a unique cultural background comprised of ethnicity, race and

religion. A person's ethnic heritage influences his belief system, traditions, and relationships with

others. Similarly, someone's color can affect how he interacts with employees based on his

environment growing up. For instance, an African American man will generally have a different

perspective from an Asian young woman.

Economic background also plays a role in the varying viewpoints of two individuals.

Being raised in a rich community versus a neighborhood in which the residents are always

struggling can definitely affect an individual's outlook on life. Managers should be aware of

these possibilities and treat all employees equally, regardless of their cultural background.

Further, religion may have a huge impact on an organization's diversity, as religious holidays can

affect an employee's involvement in certain activities within the company such as holiday parties

or after hours events.

The age-old comparison between women and men can be applied to the issue of diversity

within the workplace. According to the Bureau of Labor Statistics, women make up 46.6 percent

of the United States workforce as of February 2013. Women and men are genetically, physically

and emotionally different. Thus, men and women bring a different perspective to the company,

which can be very beneficial for organizations in creating a comprehensive view of all projects
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and decisions. Managers should encourage team building exercises in all departments, joining

diverse groups of people to collaborate for the good of the organization.

Within the 2013 workforce, several generations are working within the same industry,

and often, as employees of one organization. The baby boomers (those born between 1946 and

1964) do not understand their co-workers of Generation X (those born in the 1960s and 1970s)

and especially the Millennials (or Generation Y, born after 1980). The priorities and view of

work of each generation has been influenced by the circumstances surrounding their childhood

and professional lives. According to Lauren Rikleen in an interview with Dan Schawbel of

Forbes magazine, "Millennials are about the size of the baby boomers, and the generation in

between the 2 Gen X is significantly smaller.

As boomers approach retirement, there are simply not enough Gen Xers to fill the

leadership gap. It is necessary to the sustainability of the workplace to develop future talent and

train tomorrows leaders. Tomorrows leaders happen to be Millennials." With this in mind, it is

crucial that managers train the leaders of tomorrow to work cooperatively with individuals from

all different backgrounds culturally, economically, religiously, as well as taking into

consideration the generational gap and the gender differences in the workforce.

Theories and Models Related to Stress and Conflict

For the last five decades the term stress has enjoyed increasing popularity in the

behavioral and health sciences. It first was used in physics in order to analyze the problem of

how man-made structures must be designed to carry ]heavy loadsand resist deformation by

external focus. In this analysis, stress referred to external pressure or force applied to a structure,

while strain denoted the resulting internal distortion of the object (for the term's history, cf.
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Hinkle 1974, Mason 1975a, 1975c). In the transition from physics to the behavioral sciences, the

usage of the term stress changed. In most approaches it now designates bodily processes created

by circumstances that place physical or psychological demands on an individual (Selye 1976).

The external forces that impinge on the body are called stressors (McGrath 1982).

Selyes General Adaptation Syndrome

The popularity of the stress concept in science and mass media stems largely from the

work of the endocrinologist Hans Selye. He is credited with identifying the body's reaction to

stress with a syndrome he called the general adaptation syndrome, which has three phases

(Alarm, Resistance and Exhaustion) as evidenced by the level of stress hormones. During the

alarm phase, when the body is first aroused, the hypothalamus sends signals to the pituitary

gland. This endocrine gland in turn secretes adrenocorticotrophic hormone (ACTH), which

travels via the bloodstream to the cortex (outer layer) of the adrenal glands,

where corticosteroids are released. The hypothalamus also activates the adrenal medulla, the

central part of the adrenal gland, which causes adrenaline (epinephrine) to be released and the

activation of the sympathetic nervous system. After maintaining high levels of the hormones for

a long time, the body loses its ability to do so and exhausts its resources. Selye is credited with

identifying the fact that the incidence of certain types of diseases(stressrelated diseases, such as

some types of coronary disorders) increases during this stage of exhausted body resources and

that a second stressor introduced during the resistance phase or the exhaustion phase further

increases that incidence.

Evidence demonstrates that prolonged stress also affects the ability of the immune system

to function adequately and can affect the release of other neurotransmitters such as serotonin.
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Stress may also affect the release of endorphins, chemicals similar in structure to morphine and

other opiate drugs used in the modulation of pain.

Although Selye's work influenced a whole generation of stress researchers, marked

weaknesses in his theory soon became obvious. First of all, Selye's conception of stress as a

reaction to a multitude of different events had the fatal consequence that the stress concept

became the melting pot for all kinds of approaches. Thus, by becoming a synonym for diverse

terms such as, for example, anxiety, threat, conflict, or emotional arousal, the concept of stress

was in danger of losing its scientific value (cf. Engel 1985). Besides this general reservation,

specific critical issues have been raised. One criticism was directed at the theory's core

assumption of a nonspecific causation of the GAS. Mason ( 1971, 1975b) pointed out that the

stressors observed as effective by Selye carried a common emotional meaning: they were novel,

strange, and unfamiliar to the animal. Thus, the animal's state could be described in terms of

helplessness, uncertainty, and lack of control. Consequently, the hormonal GAS responses

followed the (specific) emotional impact of such influences rather than the influences as such. In

accordance with this assumption, Mason ( 1975b) demonstrated that in experiments where

uncertainty had been eliminated no GAS was observed. This criticism lead to a second, more

profound argument: unlike the physiological stress investigated by Selye, the stress experienced

by humans is almost always the result of a cognitive mediation (cf. Arnold 1960, Janis 1958,

Lazarus 1966, 1974). Selye, however, fails to specify those mechanisms that may explain the

cognitive transformation of `objective' noxious events into the subjective experience of being

distressed. In addition, Selye does not take into account coping mechanisms as important

mediators of the stressoutcome relationship. Both topics are central to psychological stress

theories as, for example, elaborated by the Lazarus group.

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A derivative of the systemic approach is the research on critical life events. An example is

the influential hypothesis of Holmes and Rahe ( 1967), based on Selye's work, that changes in

habits, rather than the threat or meaning of critical events, is involved in the genesis of disease.

The authors assumed that critical life events, regardless of their specific (e.g., positive or

negative) quality, stimulate change that produces challenge to the organism. Most of this

research, however, has not been theoretically driven and exhibited little empirical support for this

hypothesis (for a critical evaluation, see Thoits 1983).

Lazarus Theory

Lazarus ( 1991) developed a comprehensive emotion theory that also includes a stress

theory (cf. Lazarus 1993). This theory distinguishes two basic forms of appraisal, primary and

secondary appraisal (see also Lazarus 1966). These forms rely on different sources of

information. Primary appraisal concerns whether something of relevance to the individual's well

being occurs,whereas secondary appraisal concerns coping options. Within primary appraisal,

three components are distinguished: goal relevance describes the extent to which an encounter

refers to issues about which the person cares. Goal congruencedefines the extent to whichan

episode proceeds in accordance with personal goals. Type of ego- involvement designates

aspects of personal commitment such as self- esteem, moral values, ego-ideal, or ego-identity.

Likewise, three secondary appraisal components are distinguished: blame or credit results from

an individual's appraisal of who is responsible for a certain event. By coping potential Lazarus

means a person's evaluation of the prospects for generating certain behavioral or cognitive

operations that will positively influence a personally relevant encounter. Future expectations

refer to the appraisal of the further course of an encounter with respect to goal congruence or

incongruence. Specific patterns of primary and secondary appraisal lead to different kinds of
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stress. Three types are distinguished: harm, threat, and challenge (Lazarus and Folkman 1984).

Harm refers to the (psychological) damage or loss that has already happened. Threat is the

anticipation of harm that may be imminent. Challenge results from demands that a person feels

confident about mastering. These different kinds of psychological stress are embedded in specific

types of emotional reactions, thus illustrating the close conjunction of the fields of stress and

emotions.

Lazarus ( 1991) distinguishes 15 basic emotions. Nine of these are negative (anger, fright,

anxiety, guilt, shame, sadness, envy, jealousy, and disgust), whereas four are positive (happiness,

pride, relief, and love). (Two more emotions, hope and compassion, have a mixed valence.) At a

molecular level of analysis, the anxiety reaction, for example, is based on the following pattern

of primary and secondary appraisals: there must be some goal relevance to the encounter.

Furthermore, goal incongruence is high, i.e., personal goals are thwarted. Finally, ego-

involvement concentrates on the protection of personal meaning or ego- identity against

existential threats. At a more molar level, specific appraisal patterns related to stress or distinct

emotional reactions are described as core relational themes. The theme of anxiety, for example, is

the confrontation with uncertainty and existential threat. The core relational theme of relief,

however, is `a distressing goal-incongruent condition that has changed for the better or gone

away' (Lazarus 1991).

Roys Adapataion Model

Sister Callista Roy developed Adaptation Model, which comprises the four domain

concepts of person, health, environment, and nursing; it also involves a six-step nursing process.

Andrews & Roy (1991) state that the person can be a representation of an individual or a group
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of individuals. Roy's model sees the person as "a biopsychosocial being in constant interaction

with a changing environment" (Rambo, 1984). The person is an open, adaptive system who uses

coping skills to deal with stressors. Roy sees the environment as "all conditions, circumstances

and influences that surround and affect the development and behaviour of the person" (Andrews

& Roy, 1991). Roy describes stressors as stimuli and uses the term residual stimuli to describe

those stressors whose influence on the person is not clear (Andrews & Roy). Originally, Roy

wrote that health and illness are on a continuum with many different states or degrees possible

(Rambo, 1984). More recently, she states that health is the process of being and becoming an

integrated and whole person (Andrews & Roy). Roy's goal for nursing is "the promotion of

adaptation in each of the four modes, thereby contributing to the person's health, quality of life

and dying with dignity" (Andrews & Roy). These four modes are physiological, self-concept,

role function and interdependence.

Cannons Flight or Fight Response

The flight or fight response, also called the "acute stress response" was first described by

Walter Cannon in the 1920s as a theory that animals react to threats with a general discharge of

the sympathetic nervous system. The response was later recognized as the first stage of a general

adaptation syndrome that regulates stress responses among vertebrates and other organisms. The

onset of a stress response is associated with specific physiological actions in the sympathetic

nervous system, primarily caused by release of adrenaline and norepinephrine from the medulla

of the adrenal glands. The release is triggered by acetylcholine released from preganglionic

sympathetic nerves. These catecholamine hormones facilitate immediate physical reactions by

triggering increases in heart rate and breathing, constricting blood vessels and tightening
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muscles. An abundance of catecholamines at neuroreceptor sites facilitates reliance on

spontaneous or intuitive behaviors often related to combat or escape. Normally, when a person is

in a serene, unstimulated state, the "firing" of neurons in the locus ceruleus is minimal. A novel

stimulus, once perceived, is relayed from the sensory cortex of the brain through the thalamus to

the brain stem. That route of signaling increases the rate of noradrenergic activity in the locus

ceruleus, and the person becomes alert and attentive to the environment. If a stimulus is

perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the

sympathetic division of the autonomic nervous system (Thase & Howland, 1995). The activation

of the sympathetic nervous system leads to the release of norepinephrine from nerve endings

acting on the heart, blood vessels, respiratory centers, and other sites. The ensuing physiological

changes constitute a major part of the acute stress response. The other major player in the acute

stress response is the hypothalamic-pituitary-adrenal axis.

Holmes and Rahes Life Events Theory

In 1967, psychiatrists Thomas Holmes and Richard Rahe decided to study whether or not

stress contributes to illness. They surveyed more than 5,000 medical patients and asked them to

say whether they had experience any of a series of 43 life events in the previous two years. Each

event, called a Life Change Unit (LCU), had a different "weight" for stress. The more events the

patient added up, the higher the score. The higher the score, and the larger the weight of each

event, the more likely the patient was to become ill.

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Conflict Theory

Conflict theory emphasizes the role of coercion and power in producing social order. This

perspective is derived from the works of Karl Marx, who saw society as fragmented into groups

that compete for social and economic resources. Social order is maintained by domination, with

power in the hands of those with the greatest political, economic, and social resources. When

consensus exists, it is attributable to people being united around common interests, often in

opposition to other groups.

According to conflict theory, inequality exists because those in control of a

disproportionate share of societys resources actively defend their advantages. The masses are

not bound to society by their shared values, but by coercion at the hands of those in power. This

perspective emphasizes social control, not consensus and conformity. Groups and individuals

advance their own interests, struggling over control of societal resources. Those with the most

resources exercise power over others with inequality and power struggles resulting. There is

great attention paid to class, race, and gender in this perspective because they are seen as the

grounds of the most pertinent and enduring struggles in society.

Whereas most other sociological theories focus on the positive aspects of society, conflict

perspective focuses on the negative, conflicted, and ever-changing nature of society. Unlike

functionalists who defend the status quo, avoid social change, and believe people cooperate to

effect social order, conflict theorists challenge the status quo, encourage social change (even

when this means social revolution), and believe rich and powerful people force social order on

the poor and the weak. Conflict theorists, for example, may interpret an elite board of regents
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raising tuition to pay for esoteric new programs that raise the prestige of a local college as self-

serving rather than as beneficial for students.

Whereas American sociologists in the 1940s and 1950s generally ignored the conflict

perspective in favor of the functionalist, the tumultuous 1960s saw American sociologists gain

considerable interest in conflict theory. They also expanded Marx's idea that the key conflict in

society was strictly economic. Today, conflict theorists find social conflict between any groups in

which the potential for inequality exists: racial, gender, religious, political, economic, and so on.

Conflict theorists note that unequal groups usually have conflicting values and agendas, causing

them to compete against one another. This constant competition between groups forms the basis

for the ever-changing nature of society. Critics of the conflict perspective point to its overly

negative view of society. The theory ultimately attributes humanitarian efforts, altruism,

democracy, civil rights, and other positive aspects of society to capitalistic designs to control the

masses, not to inherent interests in preserving society and social order.

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References

Angeli, E., Wagner, J., Lawrick, E., Moore, K., Anderson, M., Soderlund, L., & Brizee, A.

(2010, May 5). General format. Retrieved from

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Bryman, A. Collimson, D., Grint, K., Jackson, G. (2011),

H. W. Krohnea 2002 Stress and Coping Theories Johannes Gutenberg-Universitt Mainz Ger

many retrieved from http://userpage.fu-berlin.de/schuez/folien/Krohne_Stress.pdf

Hager, P. (2004) Lifelong learning in the workplace? Challenges and issues, Journal of

Workplace Learning, Leadership: Theory and Practice Sixth Edition

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1114222274?ean=9780275988029

http://www.ehow.com/about_6303375_modern-leadership-theories.html

https://en.wikipedia.org/wiki/Conflict_theories

https://en.wikipedia.org/wiki/contingency_leadership_theory

https://en.wikipedia.org/wiki/Hans_Selye

https://en.wikipedia.org/wiki/Richard_Lazarus

Hudson, K.. Contemporary Leadership Styles. Retrieved from

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http://www.iseek.org/jobs/workplace-challenges.html
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McGrat, J E, (1982). Methodological problems in research on stress. In H W Krohne and L Laux

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Northouse , P. G. (2013) The Handbook of Leadership, London, UK :Sage.

Virginia Hill Rice retrieved from http://www.sagepub.com/upm-data/44175_2.pdfn.

wikipedia.org/wiki/Holmes_and_Rahe_stress_scale