Course Code NCM 119

Course Title Nursing Leadership and Management

Number of Units Lecture - 4 units; RLE – 3 units
Number of Contact Hours Lecture - 72 hours; RLE - 162 hours
Pre-requisite/s NCM 116, NCM 117
Instructor NCM 119 TEAM; DR. HAZEL N. VILLAGRACIA
Textbook Required :
Marquis & Huston. (2017). Leadership roles and management
functions in nursing : theory and application. Description:
Ninth edition. Philadelphia : Wolters Kluwer Health. LCCN
2016046163. ISBN 9781496349798
Marriner, A. (2009). Guide to Nursing Management and
Leadership (8th Ed.) The C.V. Mosby Company. St. Louise.
Essential :
Jones, P. (2007). Nursing leadership and management :
theories, processes, and practice. Copyright © F. A. Davis
Company. ISBN-13: 978-0-8036-1362-1
Thomas, P. (2016). Management and Leadership for Nurse
Administrators. Burlington, Massachusetts . Jones & Bartlett
Learning
Stanley, D. (2016). Clinical Leadership in Nursing and
Healthcare: values into Action. Hoboken, NJ. Wiley-Blackwell
Venzon, L. (2010). Professional Nursing in the Philippines. C &
E Publishing
Weiss S. & Tappen, R. (2015). Essentials of Nursing Leadership
and Management. 6th ed. Copyright © F. A. Davis Company
1915 Arch Street. Philadelphia, PA 19103.
www.fadavis.com. 2014945714.
Whitehead, D., Weiss S., Tappen, R. (2010). Essentials of
nursing leadership and management. 5th ed. Copyright © F. A.
Davis Company. ISBN 978-0-8036-2208-1
Other Resource Material/s : Electronic Journal of Nursing Management
https://onlinelibrary.wiley.com/journal/13652834
Journal of Nursing Scholarship
https://sigmapubs.onlinelibrary.wiley.com/journal/15475069
Journal of Holistic Nursing
https://journals.sagepub.com/home/jhn
Teaching and Learning in Nursing

Page 1 of 33
 https://www.journals.elsevier.com/teaching-and-learning-in-
nursing
International Council of Nurses
https://www.icn.ch/
American Nurses Association
https://www.nursingworld.org/
Professional Regulations Commission (PRC)
www.prc.gov.ph
https://www.facebook.com/professionalregulationcommission
Department of Health Philippines
https://doh.gov.ph/
Selected Youtube Videos and Journals in Nursing Leadership
and Management
Specific Course Information
A. Level of Demonstrated
Competency
B. Course Application of concepts, principles, theories and methods of
Description management and leadership, as well as, the ethico-moral, legal
and professional responsibilities of a nurse. The students are
expected to perform beginning professional management and
leadership skills, and apply sound ethico-moral and legal
decision-making in the hospital and community-based settings.
Students arelikewise expected to comply to the professional
standards of nursing practice.
C. Co-requisite/s NCM 118
D. Course Required
Classification
Required/Elective/Selected
Elective

Page 2 of 33
 MODULE 1.9.1 COLLABORATON / COORDINATION
True Collaboration (https://www.aacn.org/nursing-excellence/healthy-work-
environments/true-collaboration)
A team that works together succeeds together. Collaboration among nurses and staff ensures
more efficient, effective patient care and a more supportive environment where team
members can develop in their practice.
Standard Definition
Nurses must be relentless in pursuing and fostering true collaboration.
Critical Elements
For Organizations
1. The health care organization provides team members with support for and access to
interprofessional education and coaching that develop collaboration skills.
2. The health care organization creates, uses, and evaluates processes that define each
team member’s accountability for collaboration and how unwillingness to collaborate
will be addressed.
3. The health care organization creates, uses, and evaluates operational structures that
ensure the decision-making authority of nurses is acknowledged and incorporated into
the norm.
4. The health care organization ensures unrestricted access to structured forums, such as
ethics committees, and makes available the time and resources needed to resolve
disputes among all critical participants, including patients, families, and the health care
team.

Page 3 of 33
For Individuals
1. Every team member embraces true collaboration as an ongoing process and invests in
its development to ensure a sustained culture of collaboration.
2. Every team member contributes to the achievement of common goals by giving power
and respect to each person’s voice, integrating individual differences, resolving
competing interests, and safeguarding the essential contribution each makes in order to
achieve optimal outcomes.
3. Every team member acts with a high level of personal integrity and holds others
accountable for doing the same.
4. Team members master skilled communication, an essential element of true
collaboration.
5. Each team member demonstrates competence appropriate to his or her role and
responsibilities.
6. Nurse and physician leaders are equal partners in modeling and fostering true
Collaboration.

Why Collaboration Is Often Ineffective? (Agency for Healthcare Research and Quality’s 2008
manual, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Michelle
O’Daniel, MHA, MSG, and Alan H. Rosenstein, M.D., MBA )
1. Personal values and expectations
2. Personality differences
3. Hierarchy
4. Disruptive behavior
5. Culture and ethnicity
6. Generational differences
7. Gender
8. Historical interprofessional and intraprofessional rivalries
9. Differences in language and jargon
10. Differences in schedules and professional routines
11. Varying levels of preparation, qualifications and status
12. Differences in requirements, regulations and norms of professional education
13. Fears of diluted professional identity
14. Differences in accountability, payment and rewards
15. Concerns regarding clinical responsibility
16. Complexity of care

Page 4 of 33
Six Ways to Improve Collaboration on Nursing Teams: The goal is to overcome obstacles
1. Look in the mirror.
2. Create a safe space to share information.
3. Handle conflict with care.
4. Belong to the right team.
5. Communicate effectively.
6. Be a leader.

Checklist for Successful Teamwork

How well does your unit or team collaborate? The Agency for Healthcare Research and
Quality’s 2008 manual, Patient Safety and Quality: An Evidence-Based Handbook for Nurses,
offers the following key features of effective teams:
1. Open communication
2. Nonpunitive environment
3. Clear direction
4. Clear and known roles and tasks for team members
5. Respectful atmosphere
6. Shared responsibility for team success
7. Appropriate balance of member participation for the task at hand
8. Acknowledgement and processing of conflict
9. Clear specifications regarding authority and accountability
10. Clear and known decision-making procedures
11. Regular and routine communication and information sharing
12. Enabling environment, including access to needed resources
13. Mechanism to evaluate outcomes and adjust accordingly
Why Is Care Coordination Important?
Care coordination is identified by the Institute of Medicine as a key strategy that has the
potential to improve the effectiveness, safety, and efficiency of the American health care
system. Well-designed, targeted care coordination that is delivered to the right people can
improve outcomes for everyone: patients, providers, and payers.

3Ps: Patient, Providers, Payers

Page 5 of 33
Redesigning a health care system in order to better coordinate patients' care is important for
the following reasons:
1. Current health care systems are often disjointed, and processes vary among and
between primary care sites and specialty sites.
2. Patients are often unclear about why they are being referred from primary care to a
specialist, how to make appointments, and what to do after seeing a specialist.
3. Specialists do not consistently receive clear reasons for the referral or adequate
information on tests that have already been done. Primary care physicians do not often
receive information about what happened in a referral visit.
4. Referral staff deal with many different processes and lost information, which means
that care is less efficient.

MODULE 1.9.2. DECISION MAKING, CHANGE PROCESS, CONFLICT MANAGEMENT

Decision making - is one of the major tasks of planning.
➢ In each of the components of the management process decisions are made and
alternative courses of action are chosen at critical points.
➢ Managers engage in decision making, whether consciously or unconsciously, throughout
every day of their lives, either at work or out of work settings
➢ can be regarded as an outcome of mental processes leading tothe selection of a course
of action among several alternatives. The output fromthe decision can be an action or
an opinion.
➢ Decision making is the subject that has attracted a lot of attentions in the management
literature. It can be studied from different perspectives or angles.
➢ From a psychological perspective, decisionmaking is examined in the context of a set of
needs, preferences an individual has and values he/she seeks. For example different
individuals have different needs,preferences and values in life.
➢ Individual needs, preferences and values are important inputs to the decision making
process. They will affect the way the decision is made.

Decision making processes, tools and theories

A Manager needs to make decision.
Selecting which project should be invested,choosing which shares should be bought
are examples of decisions which themanager need to make. Every decision making
process produces a final choice.

Decision-making process
➢ A systematic cognitive process in which there must be an identification of alternatives

Decision or Decision taking

➢ Alternative Judgment selected from two or more alternatives.

Page 6 of 33
Decision making situation
➢ The situation in which decisions are made. It may be personal, clinical, or organizational.

Personal decision making

➢ is a familiar part of everyday life.

Clinical decision making

➢ relates to quality of care and competency issues.

Organizational decision making

➢ is choosing options directed toward the resolution of organizational problems and the
achievement of organizational goals.

Problem Solving
Problem
➢ A present unsatisfactory state that needs to be changed to a desired state as soon as
possible.
or
➢ Some deviation from the expected standard which prevent the achievement of
objectives.

Problem Solving
➢ Is a process whereby a dilemma is identified and corrected.
or
➢ Is the process of taking corrective action in order to meet objectives.

What is Difference between problem solving & decision making

Page 7 of 33
Characteristics of effective decision making process
1. Conducted in a systematic, comprehensive way of thinking.
2. The consequences of the implemented decision are determined.
3. Results in positive outcomes and fewer negative consequences.
4. Based on a "Goal-oriented" analysis of the situation, its problems, and their alternative
solutions.

Steps : Problem Solving And Decision Making Process

1. Identify the problem
2. Develop alternatives
3. Weigh or evaluate Alternatives
4. Choose and implement the best alternative
5. Evaluate the decision (results)

Page 8 of 33
Decision Making and Problem Solving Process:

Decision Making Process

1. Identify the problem

➢ In defining a problem it is important to consider not just the problem itself but the
underlying causes.
➢ Example: the problem may be an increased medication errors in the unit;
➢ Causes: untrained nurses have been assigned to the unit, pharmacist may have been
doing a poor job, or drugs materials expired ...
➢ Causes of a problem must be understood before the problem can be corrected.

2. Develop alternatives
➢ A problem can usually be solved in any of a number of ways.
➢ The choices that the decision maker has to decide on alternatives; the number of
alternatives generated is limited by:
The amount of time available for the taking decision
Importance of the decision itself

3. Weigh or evaluate Alternatives

➢ Advantages and disadvantages can be found in every possible solution, one alternative
may be clearly superior, but it may also have some weak points. There are a number of
ways to evaluate alternatives:
When choosing alternative for solving problem: the manager should determine:
a- Listing the pros and cons of each and importance of these relating to each alternative.
b-Determine the expected pay off associated with each alternative (cost, benefits and
effectiveness).
c- Using Thomas Saaty's Analytical Hierarchy Matrix

Page 9 of 33
 Thomas Saaty's Analytical Hierarchy Matrix

Weigh or evaluate Alternatives

• alternatives in columns and rows as depicted in the matrix above. Starting with
Alternative A, go across columns in the matrix and rate each alternative against all the
others.
• When the alternative under consideration has more value than the others,
• Then give the more valuable alternative a score of 1.
• When the alternative has less value than the others.
• Then give the less valuable alternative a score of 0.

4-Choose and implement the best alternative

➢ The ability to select the best course of action from several possible alternatives often
separates successful managers from less successful ones, the alternative offering the
highest promise of attaining the objective, taking into consideration the overall
situation, should be selected.

5-Evaluate the decision:

➢ Evaluation requires an objective assessment of how the decision has solved the
problem, the implementation of a decision does not complete the decision making
process, but there is constant revaluation of and feed back to every step of decision
making, the outcome, whether good or bad, provides information that can contribute to
future decisions.
➢ i.e. evaluation step should be consider as recycling or stating the a new decision making
process

Page 10 of 33
 ➢ Managers' responsibility not only to make correct decisions but also to ensure that
those decisions are implemented properly, so the decision has no value except through
its implementation.

How to improve decision making process?

1. Educate people so they know how to make appropriate decision.
2. Seeking support of top management for decision making at the lowest possible level,
(e.g decentralization).
3. Successful manager stay informed about decision being made at different levels of the
organization after appropriately delegating these responsibilities.
4. The managers should deal only with these decisions requiring their level of expertise
(non routine decisions), support implementation of decisions, and credit the decision
maker.

Decision-making Techniques
1. Brainstorming
The idea-generating technique wherein a number of persons present alternatives
without regard to questions of feasibility or practicality.
Through this technique, individuals are encouraged to identify a wide range of ideas.
Usually, one individual is assigned to record the ideas on a chalkboard.
Brainstorming may be used at any stage of the decision- making process, but it is most
effective at the beginning, once a problem has been stated.
Brainstorming is most effective for simple, well-defined problems.
It encourages enthusiasm and competitiveness among group members in generating
ideas.
It also prevents group members from feeling hopeless about the range of possibilities in
a given situation.
2. Fishbone diagram (causes and effect)
Is drawn after a brainstorming session, the central problem is visualized as the head of
the fish, with the skeleton divided into branches showing contributing causes of
different parts of the problem.

Page 11 of 33
 E ui ent Infor a on syste

en inf ma n
availa le

navaila le Delay la .
Results for
e ergency
De .
Insu cient Pa ent u sin sta

s ecimens
m e e a a n

Procedures Peo le i v lume A ility t d a

elay in ducin
f t e sam le
e uisi n

Cause E ect

Fish one diagra E a le

Change Process
Managing change is essential to the survival of every staff nurse, manager, teacher and
administrator in health care .
Nurses must learn about change and be able to lead, manage, and participate in the
process of change.
Because change is the process of making something different from what it was -even
when it is planned- it often produces anxiety and fear, it can be threatening and a
source of conflict but change is necessary for growth.

Change
a phenomenon that occurs
continuously in all living systems
An alteration in the status quo .

Types of change IOPU

1. Imperceptible (invisible)
➢ Unable to be noticed because of smallness or slightness.
➢ some change are imperceptible such as changes occur in human body as new cells
replace older ones on the skin surface.
2. Obvious
➢ It can be easily seed and recognized.
➢ Such as in wound healing the process of cellular replacement becomes more obvious

Page 12 of 33
3. Planned change
➢ is intentional, thought out, deliberate process and include mutual goal setting with
equal power distribution among participants. (E .g: change assignment system next
month )
➢ It is easier to manage, and positively use planned change, so the nurses must
understand the process of planned change to become skilfull in managing the change
process.

4. Unplanned change HCDS

1- Haphazard change - random with no advance preparation (e .g : arrange staff due to
absenteeism)
2- Coercive change- non mutual goal sitting, unbalanced power (e. g : person is told to do
something)
3- Developmental change (promotion) - tend to be sequential, with one phase orderly
leading into another.
➢ occurs through the natural development of people, groups, or organizations. (e. g :
change staff to senior staff to the head nurse)
4- Spontaneous or natural change - occurs in response to natural, uncontrollable external
events outside the system being affected. (e .g :increase number of sickle cell patient in winter
season )

1. The person's knowledge:

➢ A change in knowledge is the result of successful learning, which can be accomplished
through the teaching –learning process.
2. The person's skill:
➢ It may result from increased knowledge or from an improvement in skill acquired during
teaching-learning process.

Page 13 of 33
 ➢ It may follow a change in attitude or change in expectations whether self or other
imposed.
➢ It may be a result of normal growth and development process.
3. The person's attitude:
➢ It may result from a change in knowledge when previous beliefs are found to be false or
incomplete.
➢ Also, result from a conscious effort to alter an attitude through value clarification or
various types of therapy.
➢ Attitude change must occur in lower the level of tension and allow the person to
experience congruence between attitude and action.

Change agent or manager

The change manager or agent : Is the person who initiates the change process and sees it
through to completion .
This person generates ideas, introduces the innovation , develops a positive climate
for planned change by identifying potential sources of resistance , developing
strategies to overcome them , and marshalling (gathering (forces for acceptance of
the change .
Is the person who initiates the change process and sees it through to completion .

External change agent

Is called "consultant" which comes from out side the organization in order to assist the group
during the change process.
Advantages:
The person can be completely objective about the situation
There is no bias to the members within the group.
Disadvantage:
Needs time to assess the target because they didn't know each other
The target may not offer complete cooperation and trust because the agent comes to the
situation as a stranger , until participants gain trust and confidence in this person’s ability .

Page 14 of 33
Example:
➢ As a Nursing manager there were acute shortage of nursing staff in the hospital which
was not covering the total number of patient and lead to overload of the work on the
nurses, and more absent done . So we need to planned to find solution (unfreezing).
➢ The hospital and nursing administration decided 12 hrs duty instead of 8hrs duty many
will be more effective and increased the coverage.
➢ Meeting and communications were made to all nurses about this change, new memo
sent to nurses , then started to implement (move to new level).
➢ This system of duty started for sometime , they found that 12hrs duty more effective to
the system, and they adopted to that (refreezing).

Page 15 of 33
Lewin also proposed a force-field analysis framework for change.

1. He described driving and restraining forces.

2. Driving forces move people in the direction desired by the change agent.
3. In contrast, restraining hinder the change cycle.
4. It is important to identify the driving and restraining forces, which may be people (who
oppose (against, resist) or support), time, financial constraints, knowledge, habits, or
traditions.

Page 16 of 33
Page 17 of 33
Page 18 of 33
Communication channels: message are sent from source (change manager ) through channel
to participants in the process. Clear communication influence whether the innovation or
change will be accepted.
Timing: consider if participants are tired, upset, or angry, even a good idea at wrong time is
generally greeted with little enthusiasm.

Categories of adopters: individual responses to change form a continuum from innovators

eager participators to rejecters.

B. Handling resistance to change

https://onlinelibrary.wiley.com/doi/10.1111/nuf.12479
https://pubmed.ncbi.nlm.nih.gov/32578229/

Page 19 of 33
Strategies for making change
1. Change in organization can occur at three different levels
2. Changing the individuals working in the organization .
3. Changing the organizational structure & system.

4. Changing the interpersonal style of the organization .

➢ Strategies used for making change have common characteristics (requirement for
successful change)

a. Vision of what the change will look like .

b. An organizational culture in which people value and trust one another .
c. Communication system that is clear , concise and frequent and that uses appropriate
mechanisms .
d. Involvement of the right people .

Managing change

➢ Before change can take place , members of organization must become dissatisfied
(unfreezing )with how things are going .

➢ The person managing the change must have a vision of where the process needs to go
and the best options for getting there .

➢ People must be engaged in the change process and commit to both the process and the
direction in which the change is going coalitions (union) must be formed to support
change .

Steps for managing organizational change

Step 1 : define the change goals .
Step 2 : make sure change goals are congruent with the organization’s strategic plan .
Step 3 : decide who will lead the change.
Step 4 : obtain commitment from key stakeholders who come from all levels of the organization
Step 5 : identify specific measurable objectives that provide a description of the effects of the
change.
Step 6 : establish work groups to address objectives
Step 7 : use a patient care focus to involve individuals from all levels of the organization .
Step 8 : build on past efforts to avoid “ reinventing the wheel” draw upon the past work of
group members .
Step 9 : educate work groups to the “ interactive planning” process .
Step 10 : develop a comprehensive, ongoing communication plan.

Page 20 of 33
Principles of change
➢ Dissatisfaction with existing situation
➢ Change must be useful
➢ Change must be planned
➢ Change must be supported from top management
➢ Change must be communicated
➢ Affected persons must be involved in goal setting
➢ Benefits of change must be stressed
➢ Change must be gradually

Change in accord with the value and deal of organizational members

a. Timing of change is important
b. Resistance to change must be anticipated
c. Participants’ security and authority are not too threatened
d. Plan of change is kept open for revision
e. Plan is adopted by consensus

To understand how people respond to change and why they might resist , it is useful to cite
several characteristics of people :

Psychological resistance:
➢ When individual feels threatening, he become motivational aroused and begin to use
psychological defense mechanism in order to explain or defend his view points.
➢ Frequently, when people unable to explain the reasoning behind their view points, they
are psychological resisting.
➢ Psychological resistance also occur when individual have low tolerance to change.
➢ Emotional responses to changes can be categorized as anxiety, mistrust or loose.

How to handle resistance to change

Using power and energy by using the following strategies:
- analyze organizational chart to know formal and informal lines of authority.
- identify the stakeholders & their interest.
- build coalition of support.
- identify how will support the ideas and most persuaded easily.
- mention what benefits and costs be to them.
➢ Do not try to change too much or too fast.
➢ Use exercises to reduce resistance, if resistance continue :
- may be the change not workable and need modification.
- or the change is fine-tuned sufficiently, but change must proceed now and resistance must
be overcome.
➢ The manager participate in change process depends on whether from inside or outside.

Page 21 of 33
PEGS MICE

➢ success of planned change depends not only on the steps used, but also on how clearly
and in what manner the ideas are explained to the involved parties.
➢ there is a systematic process for diffusing new ideas that can be used by change
managers to move the process forward.

Page 22 of 33
Diffusion of New Ideas
1. Innovation: participant evaluate innovation according to:
Relative advantage is measured in economic terms, it is judged by
➢ social factors and general satisfaction with idea.
➢ Compatibility the degree of congruence between innovation and past experiences and
needs of participants.
➢ Complexity difficulty that participants understanding and using the innovation.
➢ Trialability is the degree to which new idea can pre tested.
➢ Observability it easier for individual to see the results of innovation, so more adoption
will be.

2- Communication channels: message are sent from source (change manager ) through
channel to participants in the process.
Clear communication influence whether the innovation or change will be accepted

3- Timing: consider if participants are tired, upset, or angry, even a good idea at wrong time is
generally greeted with little enthusiasm.

4- Categories of adopters: individual responses to change form a continuum from innovators

eager participators to rejecters.

3- Manipulation: It is frequently involves distorting information or using it in a selective fashion

causing that individual view the change as less costly or more beneficial than it actually is, this
approach can be used by change agent to increase the likelihood of change to be accepted.
➢ This approach tends to be time and cost efficient and generally quicker than
participation.
➢ The major difficulty associated with the use of manipulation is that it may be detected
by the individuals being manipulated and if this occurs or recognized after change
process is complete, the individuals are likely to respond negatively, create distrust
which generally added to the difficulty of future change effort

4-Education
➢ As a change technique, education is the process of providing individuals with
information needed to help them see the needs for the change. It is particularly valuable
in situations where resistance is due to incomplete or inaccurate information about
change.

5- External agent (normative educative strategy)

➢ By giving them an example of the same external change process as a positive result was
obtained and explains how each person benefits as a result of the change.
➢ Use the group to socialize others and influence individuals.
➢ Or by use an external person , with high specialty, who is able to explain, educate and
give employees a complete view with all information about the change process

Page 23 of 33
8-Gradual introduction:
➢ Introducing change gradually will reduce resistance this may involve:
➢ Making a series of minor changes.
➢ Demonstrating the feasibility of change in one segment of the organization before
introducing it to the whole organization.

How to deal with unplanned change?

The following steps will enable managers to respond constructively to unexpected or

unplanned change:

1- Do not panic:

Remain calm no matter what happens

Deal realistically with your own feelings and attitudes
Remember that decisions made during periods of high stress are more likely to be
ineffective
Keep your reactions under control by staying in the “thinking” arena.

Page 24 of 33
2- Analyze the situation:

Define the problems brought about by the change

Discover why the change is occurring
Assess the potential effects of the change
Consider the Restraining and the driving forces, as well as the effects on employees
Work with the best information you have available at the time.
Analysis can take place over a period of a few minutes or many hours

3- Reprioritize:
Determining what needs to be done will help you to cope with the unexpected change
Add these tasks to the “Priority list” and order it according to importance
Share your plans or analysis of the situation with all staff members
Solicit feedback
N.B. Remember: you lead by example. When staff members see you coping with
unexpected changes calmly and effectively, they will do the same

4- Match resources with priorities:

The most important rule to remember here is “Do the best you can with what you’ve
got”
Resources, both human and material, are always limited
The successful manager meets as many priorities as possible with the resources
available.

5- Evaluate continuously
The evaluation step is even more important when the change is unplanned Evaluations
at frequent intervals allow the manager to identify and support groups and individuals
as they progress through the change process
Frequent evaluations also help the manager to monitor the situation’s dynamics and
anticipate other possible changes.

CONFLICT MANAGEMENT
Conflict
❖ the “ consequence of a real or perceived differences in mutually exclusive goals, values,
ideas, attitudes, beliefs, feelings, or actions” . (Sullivan &Decker)
❖ Conflict may be defined as a struggle or contest(competition) between people with
opposing needs, ideas, beliefs, values or goals.)
Conflict Dimensions
Conflict may be viewed as occurring along cognitive (perception), emotional (feeling),
and behavioral (action) dimensions.

Page 25 of 33
 This three-dimensional perspective can help us understand the complexities of conflict
and why a conflict sometimes seems to proceed in contradictory directions.
1. Conflict as Perception
❖ Conflict is a belief or understanding that one's own needs, interests, wants, or values are
incompatible with someone else's.
2. Conflict as Feeling
❖ Conflict also involves an emotional reaction to a situation or interaction
❖ These emotions might be felt fear, sadness, bitterness, anger, or hopelessness, or some
mix of these.
❖ If we experience these feelings in regard to another person or situation, we feel that we
are in conflict-and therefore we are actually in a conflict.
3. Conflict as Action:
❖ Conflict also consists of the actions that we take to express our feelings, articulate our
perceptions and get our needs met in a way that has the potential for interfering with
someone else's ability to get his or her needs met. It may be an exercise of power. It
may be violent. It may be destructive.

Types of conflict IIO

1. Intrapersonal
❖ Occurs within the individual
Example: Nurse leader can experience internal conflict about to stay in current position or
move to higher level which is more stress and less flexible hours.
2. Interpersonal
❖ Occurs between people, groups, or work team.
❖ May involve disagreement about values or philosophy.
❖ Often due to differing or incompatible personalities or work styles.
Example: Conflict between two staff about needs to updating computer system , one prefer to
update and other one refuse to change.
3. Organizational
❖ Occurs within organization
❖ Result of scarce resources, cultural differences, or change in infrastructure.
❖ Often reflect departmental differences in values and philosophies.

Page 26 of 33
Characteristics of Conflict
1. Tension
2. Mistrust
3. Poor Communication
4. Intense Emotions
5. Unclear Goals
6. Confusion over Roles
7. Tends to polarize involved persons/groups
8. Not harmful nor destructive (instead, our reaction to conflict that can be harmful or
destructive).
Conflict Structure:
1. Structurally based, conflict is either vertical or horizontal.
2. Vertical conflict
❖ Differences between managers and staff associates, related to inadequate
communication, opposing interest, lack of shares perceptions and attitudes.
❖ In this type of conflict, manager start to control staff behaviors and resistance, often
use power through bureaucratic roles.
3. Horizontal conflict
❖ It is line-staff conflict, commonly a struggle among domains related activity, expertise,
and authority , or strife.
❖ this type of conflict affects on trust, cooperation, communication and interaction
structures.
Effects of conflict
Distrust
Increased stress
Abusive behavior
Reduced collaboration
Loss of Morale
Missing of Deadlines
Reduced Productivity
High Employee Turnover

Page 27 of 33
Conflict Management Strategies

AACCC

Avoiding
This is perhaps the most common techniques that people use.
Not paying attention to the conflict and not taking any action to resolve it.

Page 28 of 33
 When people avoid conflict, they ignore it.
Prevent overreact to situation
But it prevent change and innovation.
Accommodation
Also called smoothing or cooperating, it used when a person ignores his or her own
feelings about an issue to agree (accommodate ) the other side.
Allow to move to the important issue but may be become less willing to cooperate in
future due to ignoring feelings
Competing
One side wins the conflict and other side loses . Because the winner forces loser to
accept his or her perspective on the conflict.
Or using formal authority or other power that he/she possess to satisfy he/she concerns
without regard to the concerns of the party that you are in conflict with.
But it increase anger on the side of loser
Compromising
Attempting to resolve a conflict by identifying a solution that is partially satisfactory to
both parties, but completely satisfactory to neither.
Effective for interpersonal conflict
Everybody win something
But Losing and wining is unfair
Collaborating
Both side in conflict work to develop the outcome that best for both sides
Emphasis on problem solving, to meet both goal but may require significant resource
like time.
Need committed to success
Require problem solving, critical thinking and creating skills.
Rules for effective conflict resolution
Protect each part’s self-respect
Do not blame the problem on the participants
Allow all parties in the conflict to completely discuss their perspective of the problem.
Set ground rules before discussion started
Encourage full expression
Encourage active listening
Encourage frequent feedback
Help participants develop alternative solutions
Follow up the agreed action and provide feedback.
Page 29 of 33
-----------------------------------------------------------------------------------------------------------------------------
EXERCISES: ASYNCHRONOUS
Journal Sharing/Critiquing
Read the original article on Conflict Resolution Strategies
JOURNAL ARTICLES
1. https://www.aacn.org/nursing-excellence/healthy-work-
environments/true-collaboration
2. https://www.workingnurse.com/articles/Six-Ways-to-Improve-
Collaboration-on-Nursing-Teams/
3. https://www.aonl.org/role-nurse-leader-care-coordination-and-transition-
management-across-health-care-continuum
https://doi.org/10.1002/nop2.753
4. https://www.tandfonline.com/doi/full/10.1080/13561820.2017.1400150
5. https://doi.org/10.3912/OJIN.Vol20No03ManOS
DOI: 10.3912/OJIN.Vol20No03ManOS
6. https://www.sciedupress.com/journal/index.php/jnep/article/view/8238
DOI: https://doi.org/10.5430/jnep.v6n5p91
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369768/pdf/ijerph-17-
04896.pdf
8. https://journals.lww.com/nursingmanagement/fulltext/2012/02000/keepin
g_the_peace__conflict_management_strategies.13.aspx

Watch the video presentation.

Problem Solving for Nurses
https://www.youtube.com/watch?v=IAOPad3Vhy8
Decision Making And Problem Solving
https://www.youtube.com/watch?v=I60klVGrLVA
Decision Making in Healthcare - Part 1
https://www.youtube.com/watch?v=5tjM-S8asnY
Decision making in Nursing
https://www.youtube.com/watch?v=5Z3pliTis7w
The NURSE strategy for responding to emotional concerns
https://www.youtube.com/watch?v=c5l4LFy1OSo

Choosing your Marketing Strategy: SFA Matrix of Johnsons & Scholes explained
https://www.youtube.com/watch?v=dXt-KhSpw9Y

Page 30 of 33
 Fishbone / Ishikawa / Cause and effect diagram
https://www.youtube.com/watch?v=ACR1g5jhOYI

Cause and Effect | Cause effect | Cause and Effect Diagram -Cause and Effect
Analysis-cause & effect
https://www.youtube.com/watch?v=pezYndsY7TM

Root Cause Analysis

https://www.youtube.com/watch?v=TKv4Mw7qQbI

Lewin's Unfreeze, Change and Refreeze Model - Simplest explanation ever

https://www.youtube.com/watch?v=B2J-Y1ThvU8

SFF Matrix: Suitability, Feasibility & Flexibility

SFF Matrix: Suitability, Feasibility & Flexibility

Rate each alternative on scale of 1 - 3 for its

Suitability: refers to the alternative itself, whether it is ethical or practical. Is it appropriate in
scale or importance? An adequate response? Too extreme?
Feasibility: refers to how many resources will be needed to solve the problem (i.e. Is it
affordable? (Reasonable) How likely will it solve the problem?
Flexibility: refers to your ability to respond to unintended consequences, or openness to new
possibilities? The alternative itself and whether you can control outcomes once you begin.

Total a score for each alternative, compare, prioritize your alternatives...

Page 31 of 33
What is the SFA Matrix?
The SFA matrix was developed by Gerry Johnson and Kevan Scholes and is a tool to analyse
strategic possibilities. (https://www.toolshero.com/marketing/sfa-matrix/)

The acronym SFA stands for:

1. Suitability: this is the extent to which the strategic opportunity is suitable for the
company.
➢ Within the perspective of suitability, it is checked whether the option being considered
is suitable for the goal that must be achieved.
➢ For example, in practice this may mean that an analysis is carried out to investigate
whether a particular product is suitable for the market in which the company operates.
➢ When the organisation enters a new market, or has intentions to do so, the use of the
SFA matrix is ideally suited to determine whether the strategic choice can be
substantiated. Questions that can be asked within this criteria are:
➢ Are opportunities and strengths taken advantage of?
➢ Have the threats and weaknesses been mapped and considered?
➢ What desired effect does the option have?

2. Feasibility: this is the extent to which the strategic option is feasible. This involves
looking at strengths and weaknesses that arise from an internal analysis.
➢ Within the perspective of suitability, it is checked whether the option being considered
is suitable for the goal that must be achieved.
➢ For example, in practice this may mean that an analysis is carried out to investigate
whether a particular product is suitable for the market in which the company operates.
➢ When the organisation enters a new market, or has intentions to do so, the use of the
SFA matrix is ideally suited to determine whether the strategic choice can be
substantiated. Questions that can be asked within this criteria are:
➢ Are opportunities and strengths taken advantage of?
➢ Have the threats and weaknesses been mapped and considered?
➢ What desired effect does the option have?

3. Acceptability: the acceptability of a strategic choice arises by examining at two criteria:

financial aspects and the extent to which the choice fits in with stakeholders.
➢ Within the perspective of suitability, it is checked whether the option being considered
is suitable for the goal that must be achieved.
➢ For example, in practice this may mean that an analysis is carried out to investigate
whether a particular product is suitable for the market in which the company operates.
➢ When the organisation enters a new market, or has intentions to do so, the use of the
SFA matrix is ideally suited to determine whether the strategic choice can be
substantiated. Questions that can be asked within this criteria are:
➢ Are opportunities and strengths taken advantage of?
➢ Have the threats and weaknesses been mapped and considered?

Page 32 of 33
 ➢ What desired effect does the option have?

How should the SFA matrix be completed?

a. Since some factors will weigh more heavily in deciding whether the strategic option is
suitable for an organisation, it is important that the matrix is carefully prepared.

b. Different questions are asked for each approach angle, to which different maximum
values are linked. A rating is then assigned per question. The average scores of the
criteria are then compared to each other. The higher the score, the higher the chances.

c. The weighting and valuation of a question can be determined in different ways.

Different priorities apply for each organisation and some criteria will weigh more
heavily.

d. To determine this, analyses are needed to justify the choice. It is also a good idea to take
the opinion of experts into account during difficult decisions. Determining weights in
this way is qualitative.

e. The weightings can also be quantified. This often happens with quantifiable information
such as results from financial analyses.

https://www.toolshero.com/marketing/sfa-matrix/
Johnson, G., & Scholes, K. (1993). Exploring corporate strategy. New York: Prentice Hall.
Thompson, A. A., & Strickland, A. J. (2001). Strategic management: Concepts and cases.
Boston, Mass: McGraw-Hill/Irvin
Johnson, G., Whittington, R., Scholes, K., Angwin, D. and Regner, P. (2010). Exploring
Strategy. 10th ed. Pearson.

Page 33 of 33