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Correlates to Decision-Making among Nurse Managers.

ABSTRACT

There is a need to make collaborative decision in the preparation of the nursing program. Strader (1987) pointed that in the nursing profession democratic and participative mode of decision-making is essential. This study is anchored on Vroom Yetton Normative Model in decision-making. The study aimed to determine the correlates to the decision-making styles among nurse middle managers. The correlates are the diversity factors such as : code of ethics, emotional intelligence, leadership styles and socio-influence. Descriptive research design particularly the correlational technique was used. Standardized questionnaire was used in gathering data. Code of Ethics on Nurses and Practice was assessed highest and lowest was on Nurses and the Profession. Nurse Managers dominantly practice delegating and gave priority concern on their personal and cultural needs. Significant difference was observed on nurses and practice and nurses and co-workers. Decision-making style was dominant on group consensus. The delegating leadership skills and socio-cultural influence were strong correlates to decision-making styles in all dimensions. In conclusion, managers' dominant leadership skills in delegating led them to formulate decisions through consultations and group consensus.

Keywords: Correlates, decision-making, nurse middle managers, diversity factors

INTRODUCTION

There is a need to make rational and collaborative decision in the preparation and implementation of the nursing curricular program. Theory Z has been adapted by Strader (1987) that Theory Z gives a significant element on collective decision making. Strader pointed that in the nursing profession a democratic and participative mode of decision-making is an essential element. Moreover, in nursing management, problems are dealt in a participative manner to encourage nurses to identify and resolve problems faced by the health care organization.

Today, nurse managers face day to day decision making approaches in their respective workplaces, in establishing the alternatives to arrive at the final choice or decision in the implementation of the teaching and learning activities of the students. Nuzzo and Lancaster (2004) investigated shared decision-making in nursing education. Findings revealed that shared decision-making is an effective management strategy shared by the faculty, students, and administration. This study guides the nurse managers in understanding the significance of their presence and supervision in attending to the needs of their clinical instructors necessary in the decision making situations for an effective learning outcomes of the students.

In an organization, middle managers will have to make critical decisions, and every employee should also understand that everyone's diversity is valued. In this study, the correlates are the diversity factors that include the code of ethics for nurses, leadership skills, emotional intelligence and socio-cultural influences. It is noted that there are several influencing factors affecting the diversity of an organization. As an organization moves up to the continuum of diversity implementation, diversity in styles, communication, and problem solving gains greater acceptance. Valuing diversity mind-set includes valuing that diversity benefits all and is good for individuals as well as the company (Tomey, 2004).

The study is anchored on the Vroom and Yetton Normative Model (as discussed by Tomey, 2004) this model addresses decision making as a social process and emphasize how managers do rather than should behave in their normative model. This model categorizes decision-making styles as autocratic, consultative and group consensus. In this study, the researcher aims to investigate the correlates or the diversity factors which are hypothesized as predictors to the decision making styles among the nurse middle managers in Southern Philippines.

FRAMEWORK

The study was anchored on Tomey's (2004) concepts of nursing management and leadership. In the 21st century and beyond, there is a need of an organization to manage diversity.

The independent variables of the study comprised the diversity factors in terms of code of ethics for nurses, leadership skills, emotional intelligence and socio cultural influence. On the other hand, the dependent variables are the decision-making styles of the nurse middle managers based on Vroom and Yetton Normative Model. The study was anchored on the Vroom and Yetton Normative Model (as discussed by Tomey, 2004) this model addresses decision making as a social process and emphasize how managers do rather than should behave in their normative model. This model categorizes decision-making styles as autocratic, consultative and group consensus.

According to Genrich SJ, the use of the Vroom-Yetton-Jago Leadership model may help leaders gain the skill needed to appropriately delegate decision making to groups. Vroom and Yetton focus on three classes of outcomes that influence the ultimate effectiveness of decisions: 1) the quality of the decision 2) acceptance of the decision of the subordinates, and 3) the available time-needed to make the decision. The Philippine Code of Ethics for Registered Nurses mentioned that the nursing profession has four fundamental responsibilities, namely: to promote health, prevent illness, restore health and alleviate suffering. The profession has standards of ethical conduct on the following: nurses and people, nurses and practice, nurses and profession, nurses and coworkers. In making decisions in the nurses' workplace, the ethical aspects should be considered.

However, Hersey and Blanchard (2008) formulated four (4) leadership styles which are applicable in any organizational settings. First, the directing/telling leaders define the roles and tasks of the followers and supervise them closely. Second, the coaching/selling leaders still define roles and tasks, but seek ideas and suggestions from the followers. Third, the supporting/participating leaders possess day-to-day decisions, such as task allocation and processes, to the followers. Fourth, delegating leaders are still involved in decisions and problem-solving, but control is with the followers. The follower decides when and how the leader will be involved. Of these, there is no style that is considered optimal or desired for all leaders to possess. Effective leaders need to be flexible, and must adapt themselves according to the situations while autocratic leaders tend to be directive, strong control and critical. The autocratic leaders make decisions that are not in the best interest of the group. They give themselves a higher status than the group members which reduces open communications and trust. They tend to get good quantity and quality of output but little autonomy, creativity, or self-motivation. This can be appropriate for an emergency situations when leader knows what to do, but does not develop people. Consultative leaders maintain less control, ask questions and make suggestions rather than issue orders; and get the group involved in planning, problem solving, and decision making. The participation tends to increase motivation and creativity. It works when people have the knowledge, skills and work together over time. It can be cumbersome, too. Meanwhile, in the group consensus the leaders share a problem with the subordinates as a group.

Shared decision-making is also an effective management strategy that may have positive implications for nurse educators. Use of shared decision-making recognizes that decisions made for the overall good of the organization. The study hypothesizes that a significant relationship is established between diversity factors and decision-making styles of the respondents.

OBJECTIVES OF THE STUDY

The study sought to determine the correlates to the decision making among the middle managers in selected nursing schools in Southern Philippines. It aims to answer the following objectives: 1) to determine to what extent do nurse middle managers practice the following diversity factors as assessed by themselves and the clinical instructors in terms of code of ethics for nurses; leadership skills; and socio-cultural influences; 2) to determine significant difference on the extent to which the nurse middle managers practice the diversity factors as assessed by themselves and the clinical instructors; 3) to determine to what extent do the nurse middle managers exercise the Vroom-Yetton decision making styles as assessed by themselves and clinical instructors; 4) to determine if there is a significant difference in the Vroom--Yetton decision making styles of the nurse middle managers as assessed by themselves and the clinical instructors; and 5) to identify the diversity factors that have significant correlates to the decision-making styles of the nurse middle managers.

METHODOLOGY

The descriptive correlational research design was used in the study. This design is appropriate because it attempted to establish the relationship between the diversity factors and the decision-making styles of the nurse middle managers. The respondents of the study were a select group of nurse middle managers and clinical instructors from the selected public state universities, private sectarian and non-sectarian colleges and universities in Southern Philippines. The purposive sampling technique was used and a quota of five nurse middle managers were chosen as respondents in each school selected which included fifty-two (52) clinical instructors. The criteria of selection for the clinical instructors were: a) they are tenured/regular faculty members; and b) at least with a rank of Senior Instructor. On the other hand, the 30 nurse middle managers should be at least with one year of experience in the position and married.

A set of standardized questionnaire was used in gathering the data. The following data were gathered: 1) extent of practice of the Code of Ethics for Nurses adapted from the International Code of Ethics for Nurses and PRC Board Resolution No. 220, Series of 2004. The parameters were nurses and people, nurses and practice, nurses and the profession, nurses and co-workers, and nurses, society and environment. 2) Leadership skills adapted from Hersey and Blanchard (1998). The indicators were directing/ telling; coaching/ selling; supporting/ participation; and delegating. 3) socio-cultural influences with items patterned from Kluckhon (1996). 4) decision-making styles of the nurse middle managers patterned from Vroom and Yetton's Normative Model. Decision-making styles were gauged in terms of autocratic, consultative, and group force. A reliability test was conducted to ten clinical instructors of LDCU which resulted to .934 Cronbach Alpha Reliability Coefficients which indicated that the questionnaire is highly reliable. A total of eighty-two (82) respondents were chosen which composed of 30 nurse middle managers and 52 clinical instructors.

The researcher asked permission to conduct the study from the respective President of the selected nursing schools through a formal letter endorsed by the Dean of the School of Graduate Studies and the Dissertation Adviser. After permission was granted, the researcher requested the Deans to give her time to administer the questionnaire to the respondents. A discussion with the respondents was done to explain to them the purpose of the study and most importantly to ensure them of the confidentiality of their responses.

RESULTS AND DISCUSSION

Table 1 reveals that the extent of the nurse middle managers' practice of the Code of Ethics for Nurses as assessed by themselves and the clinical instructors was highest on the indicators of nurses and practice closely followed by the indicators of nurses and co-workers. On nurses and practice, the high ratings of the nurse middle managers as well as the high rating of the clinical instructors consistently established that the salient practice on the Code of Ethics for Nurses is towards nursing practice. The most salient indicator was accepting personal responsibility and accountability for nursing practice and for maintaining competence for continual learning, taken jointly from the ratings of the two groups of respondents.

Meanwhile, the dominant manifestation of nurses and co-workers was sustaining a cooperative relation with co-workers in nursing and other fields, taken from the average of the nurse middle managers' self-rating and the clinical instructors' assessment. These findings indicated that cooperative relation is important considering the varied tasks of nurses. It is expected that the nurse middle managers spearhead the cooperative understanding of the nurses as a team rather than a competitive orientation. This implied that the nurse middle managers were able to show cooperation and teamwork although they work interdependently; nevertheless they function as interrelated parts of the whole nursing unit under their supervision. On the other hand, the lowest indicator of the Code of Ethics for Nurses was nurses and the profession. Two indicators obtained the highest rating (although rated moderately). These were assuming the major role in determining and implementing acceptable standards of clinical nursing practices, management, research, and education and voluntary participation/membership in professional organization. The findings implied that the nurse middle managers tried their best capability to act as a role model for the standards of nursing practice, administration, education, and research.

The lowest extent to which the nurse middle managers practiced nurses and the profession was being active in developing a care of research-based professional knowledge. In fact, the nurse middle managers rated themselves lowest on this indicator, as well as the clinical instructors' ratings. The finding indicated that the nurse middle managers still need an in-depth involvement in research activities.

As shown in Table 2 in terms of the extent of leadership skills of the nurse middle managers, the highest assessment given by the nurse middle managers and the clinical instructors which established that delegating leadership skills was the dominant practice of the nurse middle managers. The highest item was on recognizing the members' talents, skills, and contributions to the unit's productivity and managing their own assigned responsibility with minimal supervision. The data pointed out that the nurse middle managers possess an open mind and give much emphasis and recognition of the clinical instructors' contribution the productivity of the work unit. On the other hand, the lowest rated item jointly taken from the nurse middle manager's and clinical instructors' was on giving directions to the delegated responsibilities, selects the appropriate person, and intervene when the members' activities deviate from role expectations and task allocation. This situation implies that the nurse middle managers only give directions and intervenes rarely.

Data further revealed that among the various dimensions of leadership skills, the lowest assessed aspects were on directing or telling. Rated highest by both groups of respondents was setting the guidelines of the members' expected activities. This indicated that the nurse middle managers ensured their best that the members or clinical instructors are properly oriented on the guidelines to be followed regarding their assigned tasks.

The lowest assessed indicator of directing/telling leadership skills was monitoring the members' performance closely but with infrequent feedback from the CIs assessment and the self-rating of the nurse middle managers. This implied that the supervisory task of monitoring the CIs performance was not so intensively done. Perhaps, the nurse middle managers could be so loaded academically that monitoring is not done regularly.

Table 3 reveals that the extent of socio-cultural influence, the nurse middle managers' self-rating combined with the CIs ratings, verbally described as moderate extent. Both groups of respondents consistently gave the highest rating to the activity on starting and concluding meeting with a prayer closely followed by refraining from religious and cultural discrimination and inculcating cultural values in the performance of tasks and functions. The findings indicated that the nurse middle managers emphasized the importance of an opening prayer before the meeting starts or any activity. This is done for spiritual enlightenment and blessings.

The lowest assessed item on socio-cultural influence was giving priority to personal activities as the cultural needs and activities prevail. The lowest ratings of the CIs concorded with that of the nurse middle managers. This meant that the nurse middle managers only give personal priorities when it is really an urgent need and ask excuses for non-attendance of any work activities.

Table 4 presents the extent of emotional intelligence of the nurse middle managers. The combined ratings of the nurse middle managers and the clinical instructors resulted to the variable mean as follows: self-awareness; self/management/self-regulation; motivation; empathy; and social skills.

Among the various indicators of emotional intelligence, self-management/self-regulation garnered the highest extent as assessed by the nurse middle managers and clinical instructors. Meanwhile, the lowest extent of emotional intelligence appeared to be the indicators of self-awareness as rated by the nurse middle managers themselves and clinical instructors. However, the nurse managers were able to manifest emotional awareness to the highest extent while the lowest indicator of self-awareness was accurate self-assessment. Self-awareness will heightened sensitivity that will act as a clarifier of nurses' problems, their responses to immediate superior, and the superior's responses to them.

As shown on Table 5, to draw out the difference of means test (t-test) results on the diversity factors as practiced by the nurse middle managers as assessed by themselves and the clinical instructors significant differences were observed on the assessments of the two groups of respondents on nurses and practice (p = .025) and nurses and co-workers (p = .014). It can be gleaned that the clinical instructors' assessments were higher than their middle managers on nurses and practice and nurses and co-workers. These proved that the nurse middle managers exercised to a high extent the Code of Ethics for nurses on nurses and practice and nurses and co-workers as assessed by the clinical instructors.

These findings indicate that nurses assume total responsibility and accountability in providing quality nursing education and health care services to the stakeholders. In terms of leadership skills, no significant differences were observed between the ratings of the nurse middle managers and clinical instructors. The p value exceeded the alpha level of .05. The same non-significant differences existed on the socio-cultural influence. The p value of these variables did not reach statistical significance at .05. Hence, the null hypothesis was not rejected. The implication of these findings is that on the dimension of leadership skills, delegating persisted to be the dominant leadership skills of the nurse middle managers and the directing/telling consistently appeared as the weakest leadership skills regardless of the assessments made by the two groups of respondents.

Table 6 reveals that the highest rated style was group consensus on decision--making styles of the nurse middle managers based on Vroom and Yetton Normative Model with the mean value of 3.47.The lowest parameter as rated by the nurse middle managers and the clinical instructors was on autocratic decision-making style. With autocratic style as the lowest mean is a good indication that decisions made are presented to the group members for a consultation. It can be gleaned that nurse middle managers practiced combination of decision--making styles in terms of group consensus, consultative, and autocratic. Such situations make it imperative that situational differences consequently led to a choice of a combination of the three decision-making styles based on Vroom and Yetton Normative Model.

The computed T-value for autocratic decision-making style; consultative decision--making style; and group consensus were insignificant because the p-value of these three decision--making styles exceeded the level of significance at 0.05. Hence, the null hypothesis was not rejected. It can be stated that there is no significant difference in the assessments of the nurse middle managers and the clinical instructors on the decision making styles of the former.

The dominant decision making style made by the nurse middle managers is of group consensus followed by consultative with autocratic style as the least practiced. It is also important to stress that effective decisions require the existence of quality based on facts; acceptance of the decision by the subordinates, and the time element.

The regression analysis on the extent of practice of the Code of Ethics for Nurses as correlates to decision-making styles of the nurse middle managers. It can be gleaned that the most significant correlate to group consensus decision-making style was nurses and co-workers. This was supported by the T value of 2.59 at .012 probability. Therefore, the null hypothesis for this correlate was rejected. However, no significant correlates were established for autocratic and consultative decision-making styles. It can be discerned that the group consensus decision-making style is enhanced if the nurse middle managers exercise to a high extent a cooperative relation with co-workers in nursing and other fields. The importance of cooperation and cohesiveness to be spearheaded by the nurse middle manager has a significant bearing on his/her decision-making which is group consensus. It is also imperative for the nurse middle managers to take into cognizant emphasis the Code of Ethics for nurses specifically, nurses and co-workers without jeopardizing the other components such as: nurses and people, nurses and practice, nurses and profession, and nurses, society, and environment. This is so because, taken as a whole, that the R-S value indicate that 37% of the variance in group focus decision-making style is due to the high extent of practice of the Code of Ethics for nurses by the nurse middle managers.

Summing the coefficient of determination for all three variable / correlates in the regression model, it appeared that 52% (R-S mean) of the nurse middle managers' delegating leadership skill was established as a significant correlates of decisionmaking skills. This significant correlation was supported by the average T-value of 3.97 on delegating leadership skills. Thus, the null hypothesis was rejected in this case. It appeared then that the nurse middle managers were able to manifest all varied types of decision-making styles if they are more likely to practice delegating leadership skill.

Data further showed that supporting/participative leadership skill was shown as a significant correlates to autocratic decision-making style. This was supported by the T value of 2.28 at .025 probability. It can be inferred that when the nurse middle managers ensured that every subordinate is involved in the acceptance of their roles and tasks; they were more willing to support one another. As a result, the nurse middle manager maintains strong control over the people under their supervision.

Socio-cultural influence appeared as significant correlates to all types of decisionmaking styles. The T values are all significant as their probability levels of .000 are absolutely less than .05. This led to the rejection of the null hypothesis. The combined R-SQ value of 35.73 indicated that 36% of the decision-making styles of the nurse middle managers are due to socio-cultural influence. Stark (2007) believed on socio-cultural influence on personality which was termed cultural determinism. This means that the person's world view is determined by cultural forces. Through the process of social and cultural socialization, people acquire the values, customs, and beliefs of one's culture and oftentimes affect rational thinking and reasoning. The nurse middle managers' decision-making styles are highly predicted by their socio-cultural orientations. Their choice in making decisions which could be autocratic, consultative or group consensus reflects the cultural orientation to which they were socialized.

Self-management /self-regulation appeared as a significant correlate to autocratic decision-making style. In addition, social skills appeared a significantly correlated to consultative decision-making style and group focus decision-making style Hence, the null hypothesis was rejected for this variable. On the other hand, those who have a high extent of social skills are more likely to adopt consultative and group focus decision-making styles. The nurse middle managers who manifested a higher concern on social relationships are the ones who adopt decision-making styles which are group oriented and consultative rather than autocratic. This is so because self-regulated nurse middle managers take responsibility and accountability of their decisions. Both consultative and group consensus appeared significantly correlated to the decision--making styles.

CONCLUSIONS

The following conclusions were formulated based on the significant findings: The dominant leadership skills of the nurse middle managers is consistently a delegating approach and logically, the delegating leadership approach is the most significant correlate to decision-making. Consequently, it also leads the nurse middle managers to formulate decisions by being autocratic, consultative and group consensus to a moderate extent. Group consensus as the dominant decision-making style is predicted to a large extent by the manifestation of the observance of the Code of Ethics on nurses and co-workers. Socio-cultural influence appears as a significant correlation to decision-making styles proves that one's cultural norms and beliefs are reflected on how one exercises his/her managerial capability as one predictor to the decision-making skills of the nurse middle managers. The middle managers who are more likely to adapt an autocratic decision-making style are the ones who display supportive/participative leadership skills while social skills were correlates to consultative and group consensus. Moreover, situational differences consequently led to a choice of a combination of the three decision-making styles based on Vroom and Yetton Normative Model decision--making process. It is concluded that the nurse middle managers exercised responsibility and accountability in making decisions in facilitating, coordinating and supervising clinical instructors and students in varied health care settings through a combination of three decision--making styles of Vroom and Yetton Normative Model in the implementation of the nursing program and management of safe quality nursing care.

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MARIA CHONA V. PALOMARES

ORCID No. 0000-0002-5377-0469

magvpalomares@yahoo.com.ph

Liceo de Cagayan University Cagayan de Oro City, Philippines
Table 1. Extent of Practice of the Code of Ethics for Nurses

Variable                                     Nurse Middle  Clinical
                                             Managers      Instructors
                                             Mean  SD      Mean  SD

A. Nurses and People
1. Promote an environment in which the       3.46  0.507   3.66  0.516
human rights,values, customs and spiritual
beliefs of people are requested.
2. Ensure that personal information is held  3.46  0.637   3.66  0.478
in confidence and use judgment in sharing
this information.
3. Share with others the responsibility for  3.36  0.731   3.51  0.541
initiating and supporting actions to meet
the health and social needs of the public,
in particular those of vulnerable
populations.
4. Provide professional responsibility to    3.64  0.559   3.72  0.454
people requiring nursing care.
Total                                        3.48  0.608   3.64  0.497

B. Nurses and Practice
1. Accept personal responsibility and        3.61  0.629   3.79  0.494
accountability for nursing practice, and
for maintaining competence by continual
learning.
2. Maintain a standard of personal health    3.32  0.548   3.68  0.471
such that the ability to provide care is
not compromised.
3. Use judgment regarding individual         3.46  0.693   3.68  0.471
competence when accepting and delegating
responsibility.
4. Maintain standards of personal            3.43  0.690   3.74  0.445
conduct which reflect well on theprofession
and enhance public confidence.
Total                                        3.46  0.640   3.73  0.466

C. Nurses and the Profession
1. Assume the major role in determining      3.39  0.567   3.58  0.534
and implementing acceptable standards of
clinical nursing practice, management,
research and education.
2. Active in developing a care of            3.18  0.670   3.04  0.759
research-based professional knowledge.
3. Participate in creating and maintaining   3.32  0.670   3.42  0.663
equitable social and economic working
conditions.
4. Ensure voluntary                          3.43  0.634   3.53  0.607
participation/membership in
professional organization.
Total                                        3.33  0.635   3.39  0.640

D. Nurses and Coworkers
1. Sustain a cooperative relation with       3.46  0.637   3.79  0.409
coworkers in nursing and other fields.
2. Take appropriate action to safeguard      3.36  0.621   3.64  0.522
individuals when their care is endangered
by a coworker or any other person.
Total                                        3.41  0.629   3.72  0.465

E. Nurses, Society and Environment
1. Commit to the preservation of life        3.71  0.535   3.87  0.319
and respect for human rights.
2 Promote a healthy environment              3.61  0.497   3.75  0.434
3. Establish linkages with the public        3.25  0.585   3.40  0.630
in promoting local and national
efforts to meet health and social needs
of the people.
4. Establish linkages with the public in     3.10  0.567   3.32  0.672
promoting international efforts to meet
health and social needs of the people.
Total                                        3.42  0.546   3.59  0.513

Variable                                     Overall   Verbal
                                             Mean      Description


A. Nurses and People
1. Promote an environment in which the       3.56     High Extent
human rights,values, customs and spiritual
beliefs of people are requested.
2. Ensure that personal information is held  3.56     High Extent
in confidence and use judgment in sharing
this information.
3. Share with others the responsibility for  3.44     Moderate
initiating and supporting actions to meet             Extent
the health and social needs of the public,
in particular those of vulnerable
populations.
4. Provide professional responsibility to    3.68     High Extent
people requiring nursing care.
Total                                        3.56     High Extent

B. Nurses and Practice
1. Accept personal responsibility and        3.70     High Extent
accountability for nursing practice, and
for maintaining competence by continual
learning.
2. Maintain a standard of personal health    3.50     High Extent
such that the ability to provide care is
not compromised.
3. Use judgment regarding individual         3.50     High Extent
competence when accepting and delegating
responsibility.
4. Maintain standards of personal            3.59     High Extent
conduct which reflect well on theprofession
and enhance public confidence.
Total                                        3.59     High Extent

C. Nurses and the Profession
1. Assume the major role in determining      3.48     Moderate
and implementing acceptable standards of              Extent
clinical nursing practice, management,
research and education.
2. Active in developing a care of            3.11     Moderate
research-based professional knowledge.                Extent
3. Participate in creating and maintaining   3.37     Moderate
equitable social and economic working                 Extent
conditions.
4. Ensure voluntary                          3.48     Moderate
participation/membership in                           Extent
professional organization.
Total                                        3.36     Moderate
                                                      Extent
D. Nurses and Coworkers
1. Sustain a cooperative relation with       3.63     High Extent
coworkers in nursing and other fields.
2. Take appropriate action to safeguard      3.50     High Extent
individuals when their care is endangered
by a coworker or any other person.
Total                                        3.57     High Extent

E. Nurses, Society and Environment
1. Commit to the preservation of life        3.70     High Extent
and respect for human rights.
2 Promote a healthy environment              3.68     High Extent
3. Establish linkages with the public        3.33     Moderate
in promoting local and national                       Extent
efforts to meet health and social needs
of the people.
4. Establish linkages with the public in     3.21     Moderate
promoting international efforts to meet               Extent
health and social needs of the people.
Total                                        3.50     High Extent

Table 2. Extent of Leadership Skills among the nurse-respondents

Variable                                      Nurse Middl  Clinical
                                              Managers     Instructors
                                              Mean  SD     Mean  SD

A. Directing/Telling
1. Clarifies the roles and task of the        3.36  0.678  3.57  0.537
members to avoid duplication.
2. Give members the guidelines of their       3.39  0.685  3.58  0.569
expected activities
3. Supervise the members closely but with     3.07  0.539  3.34  0.677
infrequent feedback.
4. Formulate alternative courses of action    3.21  0.686  3.40  0.599
and announces them to be members.
Total                                         3.26  0.647  3.47  0.595

B. Coaching/Selling
1. Still define the members' roles and tasks  3.93  0.567  3.45  0.574
but seek ideas, opinions, and suggestions
from them.
2. Still give the members the guidelines of   3.39  0.629  3.53  0.540
their expected activities but ask their
comments and suggestions for improvement
revision of the guidelines.
3. Supervise the members closely and frankly  3.25  0.701  3.43  0.572
tell them if things go wrong in their
activities.
4. Motivate members to formulate courses of   3.25  0.701  3.45  0.574
action as a team with unity of direction and
goal setting.
Total                                         3.46  0.649  3.47  0.565

C. Supporting/Participation
1. See to it that everyone is involved in     3.46  0.637  3.57  0.537
the acceptance of their roles and tasks.
2. Accept constructive feedback for work      3.46  0.744  3.68  0.471
improvement.
3. Conduct regular meetings for a             3.32  0.670  3.38  0.627
collective solution of issues problems in
the department.
4. Facilitate and take part in any            3.39  0.629  3.49  0.541
activities of the department but control is
with the members.
Total                                         3.41  0.670  3.53  0.544

D. Delegating
1. Assign responsibility to members--what     3.39  0.629  3.60  0.531
specific tasks should be done, when, where
and by whom.
2 Communicate properly in writing documents   3.42  0.690  3.53  0.575
the delegated assignment willing to accept
feedback an address concerns.
3. Recognize the members' talents, skills,    3.57  0.634  3.57  0.537
and contributions to the units'
productivity and manage their own assigned
responsibilities with minimal supervision
4. Give direction on the responsibilities     3.36  0.621  3.45  0.637
delegated, selects the appropriate person,
and intervene when the members' activities
deviate from the role expectations and task
allocation.
Total                                         3.44  0.643  3.54  0.57


Variable                                      Overall  Verbal
                                              Mean     Description


A. Directing/Telling
1. Clarifies the roles and task of the        3.47     Moderate
members to avoid duplication.                          Extent
2. Give members the guidelines of their       3.49     Moderate
expected activities                                    Extent
3. Supervise the members closely but with     3.21     Moderate
infrequent feedback.                                   Extent
4. Formulate alternative courses of action    3.31     Moderate
and announces them to be members.                      Extent
Total                                         3.37     Moderate
                                                       Extent
B. Coaching/Selling
1. Still define the members' roles and tasks  3.69     High
but seek ideas, opinions, and suggestions              Extent
from them.
2. Still give the members the guidelines of   3.46     Moderate
their expected activities but ask their                Extent
comments and suggestions for improvement
revision of the guidelines.
3. Supervise the members closely and frankly  3.34     Moderate
tell them if things go wrong in their                  Extent
activities.
4. Motivate members to formulate courses of   3.35     Moderate
action as a team with unity of direction and           Extent
goal setting.
Total                                         3.46     Moderate
                                                       Extent
C. Supporting/Participation
1. See to it that everyone is involved in     3.52     High Extent
the acceptance of their roles and tasks.
2. Accept constructive feedback for work      3.57     High Extent
improvement.
3. Conduct regular meetings for a             3.35     Moderate
collective solution of issues problems in              Extent
the department.
4. Facilitate and take part in any            3.44     Moderate
activities of the department but control is            Extent
with the members.
Total                                         3.47     Moderate
                                                       Extent
D. Delegating
1. Assign responsibility to members--what     3.50     High Extent
specific tasks should be done, when, where
and by whom.
2 Communicate properly in writing documents   3.48     Moderate
the delegated assignment willing to accept             Extent
feedback an address concerns.
3. Recognize the members' talents, skills,    3.57     High Extent
and contributions to the units'
productivity and manage their own assigned
responsibilities with minimal supervision
4. Give direction on the responsibilities     3.41     Moderate
delegated, selects the appropriate person,             Extent
and intervene when the members' activities
deviate from the role expectations and task
allocation.
Total                                         3.49     Moderate
                                                       Extent

Table 3. Extent of Socio-Cultural Influence

Variable                            Nurse Middle  Clinical     Overall
                                    Managers      Instructors  Mean
                                    Mean  SD      Mean  SD

1. Show transparency in             3.39  0.737   3.62  0.527  3.51
one's own cultural orientation
(preferred food: mode of dressing:
religious restrictions: etc.)
2. Express frankly that cultural    3.36  0.559   3.43  0.693  3.40
beliefs and values are in conflict
with scheduled activities of the
department.
3. Express some disagreements       3.18  0.475   3.45  0.574  3.32
when changes introduced activities
to be done are threats restricted
by the immediate needs of the
families.
4. Provide strict compliance to     3.32  0.475   3.45  0.539  3.39
time orientation or being "on
time" or not on time as prescribed
by cultural definition of time and
punctuality.
5. Give priority to personal        3.04  0.744   3.32  0.580  3.18
activities as the cultural needs
and activities prevail.
6. Start and conclude               3.64  0.488   3.55  0.574  3.60
meetings with a prayer.
7. Provides spiritual counseling    3.25  0.585   3.36  0.623  3.31
to members.
8. Refrain from religious           3.50  0.638   3.57  0.604  3.54
and cultural discrimination.
9. Inculcate cultural values        3.54  0.507   3.51  0.575  3.53
in the performance of tasks and
functions.
10 Ask excuses/apology for          3.39  0.737   3.58  0.534  3.49
non-attendance of  important or
any work activities.
Total                               3.36  0.594   3.48  0.582  3.43

Variable                            Verbal
                                    Description


1. Show transparency in             High Extent
one's own cultural orientation
(preferred food: mode of dressing:
religious restrictions: etc.)
2. Express frankly that cultural    Moderate
beliefs and values are in conflict  Extent
with scheduled activities of the
department.
3. Express some disagreements       Moderate
when changes introduced activities  Extent
to be done are threats restricted
by the immediate needs of the
families.
4. Provide strict compliance to     Moderate
time orientation or being "on       Extent
time" or not on time as prescribed
by cultural definition of time and
punctuality.
5. Give priority to personal        Moderate
activities as the cultural needs    Extent
and activities prevail.
6. Start and conclude               High Extent
meetings with a prayer.
7. Provides spiritual counseling    Moderate
to members.                         Extent
8. Refrain from religious           High Extent
and cultural discrimination.
9. Inculcate cultural values        High Extent
in the performance of tasks and
functions.
10 Ask excuses/apology for          Moderate
non-attendance of  important or     Extent
any work activities.
Total                               Moderate

Table 4. Extent of Emotional Intelligence

Variable                             Nurse Middle  Clinical     Overall
                                     managers      Instructors  Mean
                                     Mean  SD      Mean  SD

A. Self-Awareness
1. Emotional Awareness (Being able   3.61  0.497   3.62  0.562  3.62
to recognize one's own feelings as
it happens).
2. Accurate self-assessment          3.11  0.567   3.38  0.627  3.25

3. Self-Confidence                   3.46  0.507   3.42  0.633  3.44

Total                                3.39  0.523   3.47  0.607  3.44

B. Self-Management/Self-Regulation   3.39  0.567   3.47  0.575  3.43
1. Self-Control (Being able to
keep disruptive emotions temper'
and impulses)
2. Trustworthiness(Maintain          3.57  0.573   3.75  0.476  3.66
standards of honesty and integrity)
3. Conscientious (Take               3.68  0.548   3.68  0.580  3.68
responsibility for one's
performance)
4. Adaptability (Handle change       3.36  0.621   3.62  0.595  3.49
effectively)
5. Innovation (Comfortable with      3.39  0.685   3.57  0.572  3.48
new ideas and approaches)
Total                                3.48  0.598   3.62  0.559  3.55

C. Motivation
1. Facilitate achievement drive to   3.39  0.497   3.64  0.558  3.52
meet standard of excellence
2. Facilitate commitment on the      3.36  0.488   3.62  0.527  3.49
alignment of goals with the group
or organization.
3. Facilitate initiate to act on     3.36  0.559   3.58  0.569  3.47
opportunities.
4. Facilitate optimism (persistence  3.43  0.504   3.51  0.575  3.47
to reach goals despite setbacks)
Total                                3.39  0.512   3.59  0.557  3.49

D. Empathy
1. Understand others by being aware  3.36  0.678   3.68  0.471  3.52
of their needs, perspectives,
feelings, and concerns.
2. Show actions gestures to let      3.32  0.670   3.62  0.562  3.47
others know that he/she feel their
feelings emotions problems
3. Determine and sensing the         3.46  0.637   3.47  0.607  3.47
developmental needs of others.
4. Show a committed and involved     3.46  0.576   3.62  0.527  3.54
service orientation
Total                                3.40  0.640   3.60  0.541  3.50

E. Social Skills
1. Being able to influence or        3.39  0.567   3.51  0.575  3.45
induce desirable responses of
others by using effective diplomacy
to persuade
2. Being able to communicate         3.43  0.634   3.58  0.569  3.51
effectively by listening openly to
others and send convincing
messages.
3. Being able to inspire and guide   3.43  0.573   3.52  0.668  3.48
groups individuals.
4. Being able to collaborate and     3.46  0.576   3.62  0.489  3.54
cooperate with others toward a
shared goal.
5. Being able to create group        3.46  0.576   3.51  0.608  3.49
synergy in pursuing collective
goals.
Total                                3.43  0.592   3.54  0.591  3.49

Variable                             Verbal
                                     Description


A. Self-Awareness
1. Emotional Awareness (Being able   High Extent
to recognize one's own feelings as
it happens).
2. Accurate self-assessment          Moderate
                                     Extent
3. Self-Confidence                   Moderate
                                     Extent
Total                                Moderate
                                     Extent
B. Self-Management/Self-Regulation   Moderate
1. Self-Control (Being able to       Extent
keep disruptive emotions temper'
and impulses)
2. Trustworthiness(Maintain          High Extent
standards of honesty and integrity)
3. Conscientious (Take               High Extent
responsibility for one's
performance)
4. Adaptability (Handle change       Moderate
effectively)                         Extent
5. Innovation (Comfortable with      Moderate
new ideas and approaches)            extent
Total                                High Extent

C. Motivation
1. Facilitate achievement drive to   High Extent
meet standard of excellence
2. Facilitate commitment on the      Moderate
alignment of goals with the group    Extent
or organization.
3. Facilitate initiate to act on     Moderate
opportunities.                       Extent
4. Facilitate optimism (persistence  Moderate
to reach goals despite setbacks)     Extent
Total                                Moderate
                                     Extent
D. Empathy
1. Understand others by being aware  High Extent
of their needs, perspectives,
feelings, and concerns.
2. Show actions gestures to let      Moderate
others know that he/she feel their   Extent
feelings emotions problems
3. Determine and sensing the         Moderate
developmental needs of others.       Extent
4. Show a committed and involved     High Extent
service orientation
Total                                High Extent

E. Social Skills
1. Being able to influence or        Moderate
induce desirable responses of        Extent
others by using effective diplomacy
to persuade
2. Being able to communicate         High Extent
effectively by listening openly to
others and send convincing
messages.
3. Being able to inspire and guide   Moderate
groups individuals.                  Extent
4. Being able to collaborate and     High Extent
cooperate with others toward a
shared goal.
5. Being able to create group        Moderate
synergy in pursuing collective       Extent
goals.                               Moderate
Total                                Extent

Table 5. Difference of Means Test (T-test) on the Diversity Factors as
Practiced by the Nurse Middle Managers as assessed by themselves and
the Clinical Instructors

Code of Ethics         Mean          Qualitative      T-Value  DF
                                     Description

Nurses and People      Chair   3.50  High Extent      -1.35    43
                       CI:     3.63  High Extent
                       Chair:  3.47  Moderate Extent
Nurses and Practice    CI:     3.73  High Extent      -2.32    40
                       Chair:  3.30  Moderate Extent
Nurses and Profession  CI:     3.39  Moderate Extent  -0.75    54
                       Chair:  3.41  Moderate Extent
Nurses and Coworkers   CI:     3.71  High Extent      -2.55    43
Nurses. Society, and   Chair:  3.40  Moderate Extent  -1.94    54
Environment            CI:     3 59  High Extent
Leadership
Directing/Telling      Chair:  3.26  Moderate Extent  -1.68    51
                       CI:     3.47  Moderate Extent
Coaching/Selling       Chair:  3.31  Moderate Extent  -1.24    49
                       CI:     3.46  Moderate Extent
Supporting/            Chair:  339   Moderate Extent  -1.07    44
Participation          CI:     3.52  High Extent
Delegating             Chair:  3.44  Moderate Extent  -0.72    51
                       Chair:  3.36  Moderate Extent
Socio-Cultural         CI:     3.48  Moderate Extent  -1.36    59
Influence
Emotional
Intelligence
Self-Awareness         Chair:  3.40  Moderate Extent  -0.64    65
                       CI:     3.47  Moderate Extent
Self-Management/Self   Chair:  3.48  Moderate Extent  -1.16    52
Regulation             CI:     3.62  High Extent
Motivation             Chair:  3.38  Moderate Extent  -1.96    62
                       CI:     3.59  High Extent
Empathy                Chair:  3.40  Moderate Extent  -1.56    47
                       CI:     3.60  High Extent
Social Skills          Chair:  3.43  Moderate Extent  -0.91    58
                       CI:     3.54  High Extent

Code of Ethics         P-Value  Interpretation

Nurses and People      0.183    Not Significant
Nurses and Practice    0.025    Significant
Nurses and Profession  0.458    Not Significant
Nurses and Coworkers   0.014    Significant
Nurses, Society, and   0.056    Not Significant
Environment
Leadership

Directing/Telling      0.099    Not Significant
Coaching/Selling       0.219    Not Significant
Supporting/            0.291    Not Significant
Participation
Delegating             0.476    Not Significant

Socio-Cultural         0.178    Not Significant
Influence

Emotional
Intelligence
Self-Awareness         0 522    Not Significant
Self-Management/Self   0.250    Not Significant
Regulation
Motivation             0.056    Not Significant
Empathy                0.126    Not Significant
Social Skills          0.368    Not Significant


Table 6. Decision-Making Styles of the Nurse Middle Managers Based
on Vroom and Yetton Normative Model

Variable                            Nurse Middle  Clinical     Overall
                                    Managers      Instructors  Mean
                                    Mean  SD      Mean  SD

A. Autocratic
1 Make decisions using information  3.36  0.559   3.45  0.539  3.41
available at that time
2. Obtain necessary information
from the subordinates, and then     3.25  0.752   3.53  0.575  3.39
make the decisions.
3. Establish goals through orders   3.21  0.612   3.47  0.607  3.34
(both written and verbal)
4. Formulate decisions alone most   2.75  0.887   2.85  0.907  2.80
of the time which ignore the group
processes of consultations and an
open communication.
5. Inform the subordinates about    3.00  0.720   3.28  0.727  3.14
the decisions reached and impose
strict acceptance and obedience
from them.

Total                               3.11  0.706   3.32  0.669  3.22


B. Consultative
1. Share the problem with relevant  3.14  0.651   3.40  0 531  3.27
subordinates as a group but
decisions may not reflect the
subordinates' influence.
2. Consult some group members,      3.00  0.861   3.36  0.623  3.18
getting their ideas and
suggestions without bringing
together as a group.
3. Consult the subordinates as a    3.32  0.612   3.45  0.637  3.39
group, collectively obtaining
their ideas and suggestions.
4. Make suggestions for the group   3.50  0.509   3.53  0.575  3.52
to plan activities.
5. Seek group's comment critics on  3.39  0.662   3.57  0.500  3.48
the final decisions.

Total                               3.27  0.652   3.4   0.573  3.37


C. Croup Consensus
1. Share a problem with the         3.36  0.559   3.57  0.572  3.47
subordinates as a group.
2. Generate and evaluate            3.39  0.497   3.45  0.574  3.42
alternative with the group as a
whole and attempt to reach
agreement consensus on a solution.
3. Accept andimplement any          3.46  0.507   3.51  0.575  3.49
decisions solution that has the
support of the entire group.
4. Recognize the group's choice of  3.46  0.56    3.58  0.497  3.52
solution among the given
alternatives.
5. Accept the group's               3.46  0.637   3.60  0.493  3.53
comments/feedback on the "pros"
and "cons" of the decisions.

Total                               3.43  0.555   3.54  0.542  3.47

Variable                            Verbal
                                    Description


A. Autocratic
1 Make decisions using information  Moderate
available at that time              Extent
2. Obtain necessary information
from the subordinates, and then     Moderate
make the decisions.                 Extent
3. Establish goals through orders   Moderate
(both written and verbal)           Extent
4. Formulate decisions alone most   Moderate
of the time which ignore the group  Extent
processes of consultations and an
open communication.
5. Inform the subordinates about    Moderate
the decisions reached and impose    Extent
strict acceptance and obedience
from them.

Total                               Moderate
                                    Extent

B. Consultative
1. Share the problem with relevant  Moderate
subordinates as a group but         Extent
decisions may not reflect the
subordinates' influence.
2. Consult some group members,      Moderate
getting their ideas and             Extent
suggestions without bringing
together as a group.
3. Consult the subordinates as a    Moderate
group, collectively obtaining       Extent
their ideas and suggestions.
4. Make suggestions for the group   High Extent
to plan activities.
5. Seek group's comment critics on  Moderate
the final decisions.                Extent

Total                               Moderate
                                    Extent

C. Croup Consensus
1. Share a problem with the         Moderate
subordinates as a group.            Extent
2. Generate and evaluate            Moderate
alternative with the group as a     Extent
whole and attempt to reach
agreement consensus on a solution.
3. Accept andimplement any          Moderate
decisions solution that has the     Extent
support of the entire group.
4. Recognize the group's choice of  High Extent
solution among the given
alternatives.
5. Accept the group's               High Extent
comments/feedback on the "pros"
and "cons" of the decisions.
                                    Moderate
Total                               Extent
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Author:Palomares, Maria Chona V.
Publication:Asian Journal of Health
Article Type:Report
Date:Jan 1, 2014
Words:8419
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