Leadership has been described as the “process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task”.[1] A definition more inclusive of followers comes from Alan Keith of Genentech who said "Leadership is ultimately about creating a way for people to contribute to making something extraordinary happen."[2]
According to Jules Masserman, United States psychoanalyst and professor of the Chicago University, Leaders must fulfill three functions~~ The Leader must provide for the well-being of the lead. The leader or would be leader must provide a social organization in which people feel relatively secure and that this leader must provide his people with one set of beliefs.
Leadership is one of the most salient aspects of the organizational context. However, defining leadership has been challenging. The following sections discuss several important aspects of leadership including a description of what leadership is and a description of several popular theories and styles of leadership. This page also dives into topics such as the role of emotions and vision, as well leadership effectiveness and performance. Finally, this page discusses leadership in different contexts, how it may differ from related concepts (i.e., management), and some critiques that have been raised about leadership.
Contents
[hide]
• 1 Theories of leadership
o 1.1 Trait theory
1.1.1 Criticism to trait theory
o 1.2 Behavioral and style theories
o 1.3 Situational and contingency theories
o 1.4 Functional theory
o 1.5 Transactional and transformational theories
o 1.6 Leadership and emotions
• 2 Leadership performance
• 3 Contexts of leadership
o 3.1 Leadership in organizations
o 3.2 Leadership versus management
o 3.3 Leadership by a group
o 3.4 Leadership among primates
• 4 Historical views on leadership
• 5 Action Orientated Team Leadership Skills
• 6 Titles emphasizing authority
• 7 Criticism of the concept of leadership
• 8 See also
• 9 References
• 10 External links
[edit] Theories of leadership
Students of leadership have produced theories involving traits [3], situational interaction, function, behavior, power, vision and values [4], charisma, and intelligence among others.
[edit] Trait theory
Trait theory tries to describe the types of behavior and personality tendencies associated with effective leadership. This is probably the first academic theory of leadership. Thomas Carlyle (1841) can be considered one of the pioneers of the trait theory, using such approach to identify the talents, skills and physical characteristics of men who arose to power. [5] Ronald Heifetz (1994) traces the trait theory approach back to the nineteenth-century tradition of associating the history of society to the history of great men.[6] Famous quote by Napoleon Bonaparte states that a leader is a dealer in hope.
Proponents of the trait approach usually list leadership qualities, assuming certain traits or characteristics will tend to lead to effective leadership. Shelley Kirkpatrick and Edwin A. Locke (1991) exemplify the trait theory. They argue that "key leader traits include: drive (a broad term which includes achievement, motivation, ambition, energy, tenacity, and initiative), leadership motivation (the desire to lead but not to seek power as an end in itself), honesty, integrity, self-confidence (which is associated with emotional stability), cognitive ability, and knowledge of the business. According to their research, "there is less clear evidence for traits such as charisma, creativity and flexibility".[3]
[edit] Criticism to trait theory
Although trait theory has an intuitive appeal, difficulties may arise in proving its tenets, and opponents frequently challenge this approach. The "strongest" versions of trait theory see these "leadership characteristics" as innate, and accordingly labels some people as "born leaders" due to their psychological makeup. On this reading of the theory, leadership development involves identifying and measuring leadership qualities, screening potential leaders from non-leaders, then training those with potential.[citation needed]
[edit] Behavioral and style theories
Main article: Managerial grid model
In response to the criticism of the trait approach, theorists began to research leadership as a set of behaviors, evaluating the behavior of 'successful' leaders, determining a behavior taxonomy and identifying broad leadership styles.[7] David McClelland, for example, saw leadership skills, not so much as a set of traits, but as a pattern of motives. He claimed that successful leaders will tend to have a high need for power, a low need for affiliation, and a high level of what he called activity inhibition (one might call it self-control).[citation needed]
A graphical representation of the managerial grid model
Kurt Lewin, Ronald Lipitt, and Ralph White developed in 1939 the seminal work on the influence of leadership styles and performance. The researchers evaluated the performance of groups of eleven-year-old boys under different types of work climate. In each, the leader exercised his influence regarding the type of group decision making, praise and criticism (feedback), and the management of the group tasks (project management) according to three styles: (1) authoritarian, (2) democratic and (3) laissez-faire.[8] Authoritarian climates were characterized by leaders who make decisions alone, demand strict compliance to his orders, and dictate each step taken; future steps were uncertain to a large degree. The leader is not necessarily hostile but is aloof from participation in work and commonly offers personal praise and criticism for the work done. Democratic climates were characterized by collective decision processes, assisted by the leader. Before accomplishing tasks, perspectives are gained from group discussion and technical advice from a leader. Members are given choices and collectively decide the division of labor. Praise and criticism in such an environment are objective, fact minded and given by a group member without necessarily having participated extensively in the actual work. Laissez faire climates gave freedom to the group for policy determination without any participation from the leader. The leader remains uninvolved in work decisions unless asked, does not participate in the division of labor, and very infrequently gives praise. [8] The results seemed to confirm that the democratic climate was preferred.[9]
The managerial grid model is also based on a behavioral theory. The model was developed by Robert Blake and Jane Mouton in 1964 and suggests five different leadership styles, based on the leaders' concern for people and their concern for goal achievement.[10]
[edit] Situational and contingency theories
Main articles: Fiedler contingency model, Vroom-Yetton decision model, Path-goal theory, and Hersey-Blanchard situational theory
Situational theory also appeared as a reaction to the trait theory of leadership. Social scientists argued that history was more than the result of intervention of great men as Carlyle suggested. Herbert Spencer (1884) said that the times produce the person and not the other way around.[11] This theory assumes that different situations call for different characteristics; according to this group of theories, no single optimal psychographic profile of a leader exists. According to the theory, "what an individual actually does when acting as a leader is in large part dependent upon characteristics of the situation in which he functions."[12]
Some theorists started to synthesize the trait and situational approaches. Building upon the research of Lewin et al., academics began to normatize the descriptive models of leadership climates, defining three leadership styles and identifying in which situations each style works better. The authoritarian leadership style, for example, is approved in periods of crisis but fails to win the "hearts and minds" of their followers in the day-to-day management; the democratic leadership style is more adequate in situations that require consensus building; finally, the laissez faire leadership style is appreciated by the degree of freedom it provides, but as the leader does not "take charge", he can be perceived as a failure in protracted or thorny organizational problems.[13] Thus, theorists defined the style of leadership as contingent to the situation, which is sometimes classified as contingency theory. Four contingency leadership theories appear more prominently in the recent years: Fiedler contingency model, Vroom-Yetton decision model, the path-goal theory, and the Hersey-Blanchard situational theory.
The Fiedler contingency model bases the leader’s effectiveness on what Fred Fiedler called situational contingency. This results from the interaction of leadership style and situational favorableness (later called "situational control"). The theory defined two types of leader: those who tend to accomplish the task by developing good-relationships with the group (relationship-oriented), and those who have as their prime concern carrying out the task itself (task-oriented).[14] According to Fiedler, there is no ideal leader. Both task-oriented and relationship-oriented leaders can be effective if their leadership orientation fits the situation. When there is a good leader-member relation, a highly structured task, and high leader position power, the situation is considered a "favorable situation". Fiedler found that task-oriented leaders are more effective in extremely favourable or unfavourable situations, whereas relationship-oriented leaders perform best in situations with intermediate favourability.
Victor Vroom, in collaboration with Phillip Yetton (1973)[15] and later with Arthur Jago (1988),[16] developed a taxonomy for describing leadership situations, taxonomy that was used in a normative decision model where leadership styles where connected to situational variables, defining which approach was more suitable to which situation.[17] This approach was novel because it supported the idea that the same manager could rely on different group decision making approaches depending on the attributes of each situation. This model was later referred as situational contingency theory.[18]
The path-goal theory of leadership was developed by Robert House (1971) and was based on the expectancy theory of Victor Vroom.[19] According to House, the essence of the theory is "the meta proposition that leaders, to be effective, engage in behaviors that complement subordinates' environments and abilities in a manner that compensates for deficiencies and is instrumental to subordinate satisfaction and individual and work unit performance.[20] The theory identifies four leader behaviors, achievement-oriented, directive, participative, and supportive, that are contingent to the environment factors and follower characteristics. In contrast to the Fiedler contingency model, the path-goal model states that the four leadership behaviors are fluid, and that leaders can adopt any of the four depending on what the situation demands. The path-goal model can be classified both as a contingency theory, as it depends on the circumstances, but also as a transactional leadership theory, as the theory emphasizes the reciprocity behavior between the leader and the followers.
The situational leadership model proposed by Hersey and Blanchard suggests four leadership-styles and four levels of follower-development. For effectiveness, the model posits that the leadership-style must match the appropriate level of followership-development. In this model, leadership behavior becomes a function not only of the characteristics of the leader, but of the characteristics of followers as well.[21]
[edit] Functional theory
Main article: Functional leadership model
Functional leadership theory (Hackman & Walton, 1986; McGrath, 1962) is a particularly useful theory for addressing specific leader behaviors expected to contribute to organizational or unit effectiveness. This theory argues that the leader’s main job is to see that whatever is necessary to group needs is taken care of; thus, a leader can be said to have done their job well when they have contributed to group effectiveness and cohesion (Fleishman et al., 1991; Hackman & Wageman, 2005; Hackman & Walton, 1986). While functional leadership theory has most often been applied to team leadership (Zaccaro, Rittman, & Marks, 2001), it has also been effectively applied to broader organizational leadership as well (Zaccaro, 2001). In summarizing literature on functional leadership (see Kozlowski et al. (1996), Zaccaro et al. (2001), Hackman and Walton (1986), Hackman & Wageman (2005), Morgeson (2005)), Klein, Zeigert, Knight, and Xiao (2006) observed five broad functions a leader perform when promoting organisation's effectiveness. These functions include: (1) environmental monitoring, (2) organizing subordinate activities, (3) teaching and coaching subordinates, (4) motivating others, and (5) intervening actively in the group’s work.
A variety of leadership behaviors are expected to facilitate these functions. In initial work identifying leader behavior, Fleishman (Fleishman, 1953) observed that subordinates perceived their supervisors’ behavior in terms of two broad categories referred to as consideration and initiating structure. Consideration includes behavior involved in fostering effective relationships. Examples of such behavior would include showing concern for a subordinate or acting in a supportive manner towards others. Initiating structure involves the actions of the leader focused specifically on task accomplishment. This could include role clarification, setting performance standards, and holding subordinates accountable to those standards.
[edit] Transactional and transformational theories
Main articles: Transactional leadership and Transformational leadership
The transactional leader (Burns, 1978)[22] is given power to perform certain tasks and reward or punish for the team’s performance. It gives the opportunity to the manager to lead the group and the group agrees to follow his lead to accomplish a predetermined goal in exchange for something else. Power is given to the leader to evaluate, correct and train subordinates when productivity is not up to the desired level and reward effectiveness when expected outcome is reached.
The transformational leader (Burns, 2008)[22] motivates its team to be effective and efficient. Communication is the base for goal achievement focusing the group on the final desired outcome or goal attainment. This leader is highly visible and uses chain of command to get the job done. Transformational leaders focus on the big picture, needing to be surrounded by people who take care of the details. The leader is always looking for ideas that move the organization to reach the company’s vision.
[edit] Leadership and emotions
Leadership can be perceived as a particularly emotion-laden process, with emotions entwined with the social influence process[23]. In an organization, the leaders’ mood has some effects on his group. These effects can be described in 3 levels[24]:
1. The mood of individual group members. Group members with leaders in a positive mood experience more positive mood than do group members with leaders in a negative mood.The leaders transmit their moods to other group members through the mechanism of emotional contagion[24].Mood contagion may be one of the psychological mechanisms by which charismatic leaders influence followers[25].
2. The affective tone of the group. Group affective tone represents the consistent or homogeneous affective reactions within a group. Group affective tone is an aggregate of the moods of the individual members of the group and refers to mood at the group level of analysis. Groups with leaders in a positive mood have a more positive affective tone than do groups with leaders in a negative mood [24].
3. Group processes like coordination, effort expenditure, and task strategy.Public expressions of mood impact how group members think and act. When people experience and express mood, they send signals to others. Leaders signal their goals, intentions, and attitudes through their expressions of moods. For example, expressions of positive moods by leaders signal that leaders deem progress toward goals to be good.The group members respond to those signals cognitively and behaviorally in ways that are reflected in the group processes [24].
In research about client service it was found that expressions of positive mood by the leader improve the performance of the group, although in other sectors there were another findings[26].
Beyond the leader’s mood, his behavior is a source for employee positive and negative emotions at work. The leader creates situations and events that lead to emotional response. Certain leader behaviors displayed during interactions with their employees are the sources of these affective events. Leaders shape workplace affective events. Examples – feedback giving, allocating tasks, resource distribution. Since employee behavior and productivity are directly affected by their emotional states, it is imperative to consider employee emotional responses to organizational leaders[27]. Emotional intelligence, the ability to understand and manage moods and emotions in the self and others, contributes to effective leadership in organizations[26]. Leadership is about being responsible.
[edit] Leadership performance
Main article: Leadership Performance
In the past, some researchers have argued that the actual influence of leaders on organizational outcomes is overrated and romanticized as a result of biased attributions about leaders (Meindl & Ehrlich, 1987). Despite these assertions however, it is largely recognized and accepted by practitioners and researchers that leadership is important, and research supports the notion that leaders do contribute to key organizational outcomes (Day & Lord, 1988; Kaiser, Hogan, & Craig, 2008). In order to facilitate successful performance it is important to understand and accurately measure leadership performance.
Job performance generally refers to behavior that is expected to contribute to organizational success (Campbell, 1990). Campbell identified a number of specific types of performance dimensions; leadership was one of the dimensions that he identified. There is no consistent, overall definition of leadership performance (Yukl, 2006). Many distinct conceptualizations are often lumped together under the umbrella of leadership performance, including outcomes such as leader effectiveness, leader advancement, and leader emergence (Kaiser et al., 2008). For instance, leadership performance may be used to refer to the career success of the individual leader, performance of the group or organization, or even leader emergence. Each of these measures can be considered conceptually distinct. While these aspects may be related, they are different outcomes and their inclusion should depend on the applied/research focus.
[edit] Contexts of leadership
[edit] Leadership in organizations
An organization that is established as an instrument or means for achieving defined objectives has been referred to as a formal organization. Its design specifies how goals are subdivided and reflected in subdivisions of the organization. Divisions, departments, sections, positions, jobs, and tasks make up this work structure. Thus, the formal organization is expected to behave impersonally in regard to relationships with clients or with its members. According to Weber's definition, entry and subsequent advancement is by merit or seniority. Each employee receives a salary and enjoys a degree of tenure that safeguards him from the arbitrary influence of superiors or of powerful clients. The higher his position in the hierarchy, the greater his presumed expertise in adjudicating problems that may arise in the course of the work carried out at lower levels of the organization. It is this bureaucratic structure that forms the basis for the appointment of heads or chiefs of administrative subdivisions in the organization and endows them with the authority attached to their position. [28]
In contrast to the appointed head or chief of an administrative unit, a leader emerges within the context of the informal organization that underlies the formal structure. The informal organization expresses the personal objectives and goals of the individual membership. Their objectives and goals may or may not coincide with those of the formal organization. The informal organization represents an extension of the social structures that generally characterize human life — the spontaneous emergence of groups and organizations as ends in themselves.
In prehistoric times, man was preoccupied with his personal security, maintenance, protection, and survival. Now man spends a major portion of his waking hours working for organizations. His need to identify with a community that provides security, protection, maintenance, and a feeling of belonging continues unchanged from prehistoric times. This need is met by the informal organization and its emergent, or unofficial, leaders.[29]
Leaders emerge from within the structure of the informal organization. Their personal qualities, the demands of the situation, or a combination of these and other factors attract followers who accept their leadership within one or several overlay structures. Instead of the authority of position held by an appointed head or chief, the emergent leader wields influence or power. Influence is the ability of a person to gain co-operation from others by means of persuasion or control over rewards. Power is a stronger form of influence because it reflects a person's ability to enforce action through the control of a means of punishment.[29]
A leader is a person who influences a group of people towards a specific result. It is not dependent on title or formal authority. (elevos, paraphrased from Leaders, Bennis, and Leadership Presence, Halpern & Lubar). Leaders are recognized by their capacity for caring for others, clear communication, and a commitment to persist. [30] An individual who is appointed to a managerial position has the right to command and enforce obedience by virtue of the authority of his position. However, he must possess adequate personal attributes to match his authority, because authority is only potentially available to him. In the absence of sufficient personal competence, a manager may be confronted by an emergent leader who can challenge his role in the organization and reduce it to that of a figurehead. However, only authority of position has the backing of formal sanctions. It follows that whoever wields personal influence and power can legitimize this only by gaining a formal position in the hierarchy, with commensurate authority.[29] Leadership can be defined as one's ability to get others to willingly follow. Every organization needs leaders at every level.[31]
[edit] Leadership versus management
Over the years the terms management and leadership have been so closely related that individuals in general think of them as synonymous. However, this is not the case even considering that good managers have leadership skills and vice-versa. With this concept in mind, leadership can be viewed as:
• centralized or decentralized
• broad or focused
• decision-oriented or morale-centred
• intrinsic or derived from some authority
Any of the bipolar labels traditionally ascribed to management style could also apply to leadership style. Hersey and Blanchard use this approach: they claim that management merely consists of leadership applied to business situations; or in other words management forms a subset of the broader leadership process. They say: "Leadership occurs any time one attempts to influence the behavior of an individual or group, regardless of the reason. Management is a kind of leadership in which the achievement of organizational goals is paramount." And according to Warren Bennis and Dan Goldsmith, A good manager does things right. A leader does the right things."[32]
However, a clear distinction between management and leadership may nevertheless prove useful. This would allow for a reciprocal relationship between leadership and management, implying that an effective manager should possess leadership skills, and an effective leader should demonstrate management skills. One clear distinction could provide the following definition:
• Management involves power by position.
• Leadership involves power by influence.
Abraham Zaleznik (1977), for example, delineated differences between leadership and management. He saw leaders as inspiring visionaries concerned about substance while managers he views as planners who have concerns with process. Warren Bennis (1989) further explicated a dichotomy between managers and leaders. He drew twelve distinctions between the two groups:
• Managers administer; leaders innovate.
• Managers ask how and when; leaders ask what and why.
• Managers focus on systems; leaders focus on people.
• Managers do things right; leaders do the right things.
• Managers maintain; leaders develop.
• Managers rely on control; leaders inspire trust.
• Managers have short-term perspective; leaders have long-term perspective.
• Managers accept the status-quo; leaders challenge the status-quo.
• Managers have an eye on the bottom line; leaders have an eye on the horizon.
• Managers imitate; leaders originate.
• Managers emulate the classic good soldier; leaders are their own person.
• Managers copy; leaders show originality.
Paul Birch (1999) also sees a distinction between leadership and management. He observed that, as a broad generalization, managers concerned themselves with tasks while leaders concerned themselves with people. Birch does not suggest that leaders do not focus on "the task." Indeed, the things that characterise a great leader include the fact that they achieve. Effective leaders create and sustain competitive advantage through the attainment of cost leadership, revenue leadership, time leadership, and market value leadership. Managers typically follow and realize a leader's vision. The difference lies in the leader realising that the achievement of the task comes about through the goodwill and support of others (influence), while the manager may not.
This goodwill and support originates in the leader seeing people as people, not as another resource for deployment in support of "the task". The manager often has the role of organizing resources to get something done. People form one of these resources, and many of the worst managers treat people as just another interchangeable item. A leader has the role of causing others to follow a path he/she has laid out or a vision he/she has articulated in order to achieve a task. Often, people see the task as subordinate to the vision. For instance, an organization might have the overall task of generating profit, but a good leader may see profit as a by-product that flows from whatever aspect of their vision differentiates their company from the competition.
Leadership does not only manifest itself as purely a business phenomenon. Many people can think of an inspiring leader they have encountered who has nothing whatever to do with business: a politician, an officer in the armed forces, a Scout or Guide leader, a teacher, etc. Similarly, management does not occur only as a purely business phenomenon. Again, we can think of examples of people that we have met who fill the management niche in non-business organisationsNon-business organizations should find it easier to articulate a non-money-driven inspiring vision that will support true leadership. However, often this does not occur.
Patricia Pitcher (1994) has challenged the bifurcation into leaders and managers. She used a factor analysis (in marketing) technique on data collected over 8 years, and concluded that three types of leaders exist, each with very different psychological profiles: Artists (imaginative, inspiring, visionary, entrepreneurial, intuitive, daring, and emotional), Craftsmen (well-balanced, steady, reasonable, sensible, predictable, and trustworthy), Technocrats (cerebral, detail-oriented, fastidious, uncompromising, and hard-headed). She speculates that no one profile offers a preferred leadership style. She claims that if we want to build, we should find an "artist leader" if we want to solidify our position, we should find a "craftsman leader" and if we have an ugly job that needs to get done like downsizing, we should find a "technocratic leader". Pitcher also observed that a balanced leader exhibiting all three sets of traits occurs extremely rarely: she found none in her study.
Bruce Lynn postulates a differentiation between 'Leadership' and ‘Management’ based on perspectives to risk. Specifically,"A Leader optimises upside opportunity; a Manager minimises downside risk." He argues that successful executives need to apply both disciplines in a balance appropriate to the enterprise and its context. Leadership without Management yields steps forward, but as many if not more steps backwards. Management without Leadership avoids any step backwards, but doesn’t move forward.
Leadership Styles Overview
When developing your leadership skills, one must soon confront an important practical question, "What leadership styles work best for me and my organization?" To answer this question, it's best to understand that there are many from which to choose and as part of your leadership development effort, you should consider developing as many leadership styles as possible.
Three Classic Leadership Styles
One dimension of has to do with control and one's perception of how much control one should give to people. The laissez faire style implies low control, the autocratic style high control and the participative lies somewhere in between.
The Laissez Faire Leadership Style
The style is largely a "hands off" view that tends to minimize the amount of direction and face time required. Works well if you have highly trained and highly motivated direct reports.
The Autocratic Leadership Style
The style has its advocates, but it is falling out of favor in many countries. Some people have argued that the style is popular with today's CEO's, who have much in common with feudal lords in Medieval Europe.
The Participative Leadership Style
It's hard to order and demand someone to be creative, perform as a team, solve complex problems, improve quality, and provide outstanding customer service. The style presents a happy medium between over controlling (micromanaging) and not being engaged and tends to be seen in organizations that must innovate to prosper.
Determining the Best Leadership Style
Situational Leadership. In the 1950s, management theorists from Ohio State University and the University of Michigan published a series of studies to determine whether leaders should be more task or relationship (people) oriented. The importance of the research cannot be over estimated since leaders tend to have a dominant style; a leadership style they use in a wide variety of situations.
Surprisingly, the research discovered that there is no one best style: leaders must adjust their leadership style to the situation as well as to the people being led.
The Emergent Leadership Style
Contrary to the belief of many, groups do not automatically accept a new "boss" as leader. We see a number of ineffective managers who didn't know the behaviors to use when one taking over a new group.
The Transactional Leadership Style
The approach emphasizes getting things done within the umbrella of the status quo; almost in opposition to the goals of the transformational leadership. It's considered to be a "by the book" approach in which the person works within the rules. As such, it's commonly seen in large, bureaucratic organizations.
The Transformational Leadership Style
The primary focus of this leadership style is to make change happen in:
• Our Self,
• Others,
• Groups, and
• Organizations
Charisma is a special leadership style commonly associated with transformational leadership. While extremely powerful, it is extremely hard to teach.
Visionary Leadership, The leadership style focuses on how the leader defines the future for followers and moves them toward it.
From the short review above, one can see that there are many different aspects to being a great leader; a role requiring one to play many different leadership styles to be successful.
Transformational Leadership Principles
Presenter: Murray Johannsen
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Other leadership styles include:
Strategic Leadership is practiced by the military services such as the US Army, US Air Force, and many large corporations. It stresses the competitive nature of running an organization and being able to out fox and out wit the competition.
Team Leadership. A few years ago, a large corporation decided that supervisors were no longer needed and those in charge were suddenly made "team leaders." Today, companies have gotten smarter about teams, but it still takes leadership to transition a group into a team.
Facilitative Leadership. This is a special style that anyone who runs a meeting can employ. Rather than being directive, one uses a number of indirect communication patterns to help the group reach consensus.
Leadership Influence Styles. Here one looks at the behaviors associated how one exercises influence. For example, does the person mostly punish? Do they know how to reward?
Cross-Cultural Leadership. Not all individuals can adapt to the leadership styles expected in a different culture; whether that culture is organizational or national.
Coaching. A great coach is definitely a leader who also possess a unique gift--the ability to teach and train.
Level 5 Leadership. This term was coined by Jim Collins in his book Good to Great: Why Some Company’s Make the Leap and Other Don’t. As Collins says in his book, "We were surprised, shocked really, to discover the types of leadership required for turning a good company into a great one."
Servant Leadership. Some leaders have put the needs of their followers first. For example, the motto of the Los Angeles Police Department, "To Protect and Serve." reflects this philosophy of service. One
Seven Qualities of a Good Leader
By Barbara White
How often have you heard the comment, “He or she is a born leader?” There are certain characteristics found in some people that seem to naturally put them in a position where they’re looked up to as a leader.
Whether in fact a person is born a leader or develops skills and abilities to become a leader is open for debate. There are some clear characteristics that are found in good leaders. These qualities can be developed or may be naturally part of their personality. Let us explore them further.
Seven Personal Qualities Found In A Good Leader:
1. A good leader has an exemplary character. It is of utmost importance that a leader is trustworthy to lead others. A leader needs to be trusted and be known to live their life with honestly and integrity. A good leader “walks the talk” and in doing so earns the right to have responsibility for others. True authority is born from respect for the good character and trustworthiness of the person who leads.
2. A good leader is enthusiastic about their work or cause and also about their role as leader. People will respond more openly to a person of passion and dedication. Leaders need to be able to be a source of inspiration, and be a motivator towards the required action or cause. Although the responsibilities and roles of a leader may be different, the leader needs to be seen to be part of the team working towards the goal. This kind of leader will not be afraid to roll up their sleeves and get dirty.
3. A good leader is confident. In order to lead and set direction a leader needs to appear confident as a person and in the leadership role. Such a person inspires confidence in others and draws out the trust and best efforts of the team to complete the task well. A leader who conveys confidence towards the proposed objective inspires the best effort from team members.
4. A leader also needs to function in an orderly and purposeful manner in situations of uncertainty. People look to the leader during times of uncertainty and unfamiliarity and find reassurance and security when the leader portrays confidence and a positive demeanor.
5. Good leaders are tolerant of ambiguity and remain calm, composed and steadfast to the main purpose. Storms, emotions, and crises come and go and a good leader takes these as part of the journey and keeps a cool head.
6. A good leader as well as keeping the main goal in focus is able to think analytically. Not only does a good leader view a situation as a whole, but is able to break it down into sub parts for closer inspection. Not only is the goal in view but a good leader can break it down into manageable steps and make progress towards it.
7. A good leader is committed to excellence. Second best does not lead to success. The good leader not only maintains high standards, but also is proactive in raising the bar in order to achieve excellence in all areas.
These seven personal characteristics are foundational to good leadership. Some characteristics may be more naturally present in the personality of a leader. However, each of these characteristics can also be developed and strengthened. A good leader whether they naturally possess these qualities or not, will be diligent to consistently develop and strengthen them in their leadership role.
suspects these leaders are rare in business.
THE CHARACTERISTICS *
- OF A GOOD LEADER! -
• Challenges me to do my best.
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• Sets a good example.
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• Explains the reasons
for instructions & procedures.
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• Helps me polish my thoughts
before I present them to others.
________________________________________
• Is objective about things.
________________________________________
• Lets me make my own decisions.
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• Cares about me & how I'm doing.
________________________________________
• Does not seek the limelight.
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• Won't let me give up.
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• Gives personal guidance & direction,
especially when I'm learning something new.
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• Is empathetic & understanding.
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• Is firm but fair.
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• Keeps a results orientation.
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• Makes me work out
most of my own problems or tough situations,
but supports me.
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• Lets me know where I stand.
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• Listens exceptionally well.
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• Doesn't put words in my mouth.
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• Is easy to talk with.
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• Keeps the promises s/he makes.
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• Keeps me focused on the goals ahead.
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• Works as hard or harder than anyone else.
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• Is humble.
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• Is proud of those managers s/he has developed.
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• Gives credit where credit is due.
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• Never says "I told you so."
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• Corrects my performance in private.
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• Never flaunts authority.
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• Is always straight-forward.
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• Gives at least a second chance.
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• Maintains an open door policy.
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• Uses language that is easy to understand.
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• Lets bygones be bygones.
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• Inspires loyalty.
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• Really wants to hear my ideas
& acts on them.
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• Lets me set my own deadlines.
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• Celebrates successes.
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• Is open & honest.
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• Doesn't hide bad news.
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• Gives me enough time
to prepare for discussion.
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• Is enthusiastic.
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• Follows through.
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• Is patient.
________________________________________
• Wants me to "stretch" my skills.
________________________________________
• Gives me his/her full attention
during discussions,
& won't be distracted.
________________________________________
• Has a sense of humor.
________________________________________
• Handles disagreements privately.
________________________________________
• Reassures me.
________________________________________
• Makes me feel confident.
________________________________________
• Tells me the "whole story."
________________________________________
• Says "we" instead of "I".
________________________________________
• Makes hard work worth it.
________________________________________
• Can communicate annoyance
without running wild.
________________________________________
• Is courageous.
________________________________________
• Insists on training.
________________________________________
• Is a stabilizing influence in a crisis.
________________________________________
• Gets everyone involved.
________________________________________
• Wants me to be successful.
________________________________________
• Is optimistic.
________________________________________
• Operates well under pressure,
or in a rapidly changing environment.
________________________________________
• Has a reputation for competence
with his/her own peers.
________________________________________
• Has a good understanding of the job.
________________________________________
• Is tough & tender.
________________________________________
• Believes we can do it.
________________________________________
• Sets attainable milestones.
________________________________________
• Communicates philosophy & values.
________________________________________
• Is perceptive;
doesn't believe that everything
needs to be spelled out.
________________________________________
• Has a strong sense of urgency.
________________________________________
• Preserves the individuality
of his/her team members.
________________________________________
• Thinks & operates at a level
above that expected.
________________________________________
• Wants to make the organization
the best in the industry.
________________________________________
• Is willing to act on intuition;
believes feelings are facts.
________________________________________
• Empowers us.
________________________________________
• Is there when we need her/him.
________________________________________
• Enjoys his/her job.
________________________________________
• Likes to spend time with us.
Sunday, June 21, 2009
Tuesday, June 16, 2009
Point to Remeber in the Operating Room
DRESS CODE - SURGICAL ATTIRE
1. All persons who enter the semirestricted and restricted areas of the surgical suite should be in hospital laundered surgical attire intended for use only within the surgical suite at UTMB.
2. All possible head and facial hair, including sideburns and neckline, should be covered when in the surgical suite.
3. All persons entering an operating room or centerwell area should wear a mask.
4. All personnel entering the suite should have all jewelry confined or removed. Watches and plain wedding bands are acceptable. Earrings must be covered by the scrub cap.
5. Nail polish and artificial nails should not be worn within the suite.
6. Protective barriers (gloves, masks, protective eyewear, and face shields) are provided by the hospital and should be utilized to reduce the risk of exposure to potentially infective agents.
7. Shoes should be dedicated to the OR and shoe covers are not required. If shoe covers are necessary, the wearer should remove them before leaving the operating room to avoid tracking blood and debris through the department.
SURGICAL HAND SCRUB
1. A five (5) minute anatomical timed scrub will be used for all surgical hand scrubs.
2. Fingernails must be free of polish/enamel and of medium length. No jewelry is permitted on the hands and arms while performing as a member of the surgical team.
3. **Remember to put your mask on prior to starting you scrub.**
4. Wash hands and arms with solution to 2 inches above the elbow.
5. Clean fingernails with file. Take sterile brush in right hand. Wet brush with water and soap. Scrub fingernails of left hand.
6. Start scrubbing fingers of left hand, one at a time, treating each finger as four-sided; palm, knuckles, and back of hand. Repeat with right hand.
7. Scrub right wrist and continue up arm to 2 inches above elbow. Repeat with left arm. Discard brush. Rinse both hands and arms under running water keeping hands above level of elbow so that water runs off the elbows and not the hands.
1. All persons who enter the semirestricted and restricted areas of the surgical suite should be in hospital laundered surgical attire intended for use only within the surgical suite at UTMB.
2. All possible head and facial hair, including sideburns and neckline, should be covered when in the surgical suite.
3. All persons entering an operating room or centerwell area should wear a mask.
4. All personnel entering the suite should have all jewelry confined or removed. Watches and plain wedding bands are acceptable. Earrings must be covered by the scrub cap.
5. Nail polish and artificial nails should not be worn within the suite.
6. Protective barriers (gloves, masks, protective eyewear, and face shields) are provided by the hospital and should be utilized to reduce the risk of exposure to potentially infective agents.
7. Shoes should be dedicated to the OR and shoe covers are not required. If shoe covers are necessary, the wearer should remove them before leaving the operating room to avoid tracking blood and debris through the department.
SURGICAL HAND SCRUB
1. A five (5) minute anatomical timed scrub will be used for all surgical hand scrubs.
2. Fingernails must be free of polish/enamel and of medium length. No jewelry is permitted on the hands and arms while performing as a member of the surgical team.
3. **Remember to put your mask on prior to starting you scrub.**
4. Wash hands and arms with solution to 2 inches above the elbow.
5. Clean fingernails with file. Take sterile brush in right hand. Wet brush with water and soap. Scrub fingernails of left hand.
6. Start scrubbing fingers of left hand, one at a time, treating each finger as four-sided; palm, knuckles, and back of hand. Repeat with right hand.
7. Scrub right wrist and continue up arm to 2 inches above elbow. Repeat with left arm. Discard brush. Rinse both hands and arms under running water keeping hands above level of elbow so that water runs off the elbows and not the hands.
Points to Remember about Aseptic Technique
Principles of Aseptic Technique Reflects One's Surgical Conscience.
1. The patient is the center of the sterile field.
2. Only sterile items are used within the sterile field.
A. Examples of items used.
B. How do we know they are sterile? (Wrapping, label, storage)
3. Sterile persons are gowned and gloved.
A. Keep hands at waist level and in sight at all times.
B. Keep hands away from the face.
C. Never fold hands under arms.
D. Gowns are considered sterile in front from chest to level of sterile field, and the sleeves from above the elbow to cuffs. Gloves are sterile.
E. Sit only if sitting for entire procedure.
4. Tables are sterile only at table level.
A. Anything over the edge is considered unsterile, such as a suture or the table drape.
B. Use non-perforating device to secure tubing and cords to prevent them from sliding to the floor.
5. Sterile persons touch only sterile items or areas; unsterile persons touch only unsterile items or areas.
A. Sterile team members maintain contact with sterile field by wearing gloves and gowns.
B. Supplies are brought to sterile team members by the circulator, who opens wrappers on sterile packages. The circulator ensures a sterile transfer to the sterile field. Only sterile items touch sterile surfaces.
6. Unsterile persons avoid reaching over sterile field; sterile persons avoid leaning over unsterile area.
A. Scrub person sets basins to be filled at edge of table to fill them.
B. Circulator pours with lip only over basin edge.
C. Scrub person drapes an unsterile table toward self first to avoid leaning over an unsterile area. Cuff drapes over gloved hands.
D. Scrub person stands back from the unsterile table when draping it to avoid leaning over an unsterile area.
7. Edges of anything that encloses sterile contents are considered unsterile.
A. When opening sterile packages, open away from you first. Secure flaps so they do not dangle.
B. The wrapper is considered sterile to within one inch of the wrapper.
C. In peel-open packages, the edges where glued, are not considered sterile.
8. Sterile field is created as close as possible to time of use.
A. Covering sterile tables is not recommended.
9. Sterile areas are continuously kept in view.
A. Sterility cannot be ensured without direct observation. An unguarded sterile field should be considered contaminated.
10. Sterile persons keep well within sterile area.
A. Sterile persons pass each other back to back or front to front.
B. Sterile person faces a sterile area to pass it.
C. Sterile persons stay within the sterile field. They do not walk around or go outside the room.
D. Movement is kept to a minimum to avoid contamination of sterile items or persons.
11. Unsterile persons avoid sterile areas.
A. Unsterile persons maintain a distance of at least 1 foot from the sterile field.
B. Unsterile persons face and observe a sterile area when passing it to be sure they do not touch it.
C. Unsterile persons never walk between two sterile fields.
D. Circulator restricts to a minimum all activity near the sterile field.
12. Destruction of integrity of microbial barriers results in contamination.
A. Strike through is the soaking through of barrier from sterile to non-sterile or vice versa.
B. Sterility is event related.
13. Microorganisms must be kept to irreducible minimum.
A. Perfect asepsis is an idea. All microorganisms cannot be eliminated. Skin cannot be sterilized. Air is contaminated by droplets.
1. The patient is the center of the sterile field.
2. Only sterile items are used within the sterile field.
A. Examples of items used.
B. How do we know they are sterile? (Wrapping, label, storage)
3. Sterile persons are gowned and gloved.
A. Keep hands at waist level and in sight at all times.
B. Keep hands away from the face.
C. Never fold hands under arms.
D. Gowns are considered sterile in front from chest to level of sterile field, and the sleeves from above the elbow to cuffs. Gloves are sterile.
E. Sit only if sitting for entire procedure.
4. Tables are sterile only at table level.
A. Anything over the edge is considered unsterile, such as a suture or the table drape.
B. Use non-perforating device to secure tubing and cords to prevent them from sliding to the floor.
5. Sterile persons touch only sterile items or areas; unsterile persons touch only unsterile items or areas.
A. Sterile team members maintain contact with sterile field by wearing gloves and gowns.
B. Supplies are brought to sterile team members by the circulator, who opens wrappers on sterile packages. The circulator ensures a sterile transfer to the sterile field. Only sterile items touch sterile surfaces.
6. Unsterile persons avoid reaching over sterile field; sterile persons avoid leaning over unsterile area.
A. Scrub person sets basins to be filled at edge of table to fill them.
B. Circulator pours with lip only over basin edge.
C. Scrub person drapes an unsterile table toward self first to avoid leaning over an unsterile area. Cuff drapes over gloved hands.
D. Scrub person stands back from the unsterile table when draping it to avoid leaning over an unsterile area.
7. Edges of anything that encloses sterile contents are considered unsterile.
A. When opening sterile packages, open away from you first. Secure flaps so they do not dangle.
B. The wrapper is considered sterile to within one inch of the wrapper.
C. In peel-open packages, the edges where glued, are not considered sterile.
8. Sterile field is created as close as possible to time of use.
A. Covering sterile tables is not recommended.
9. Sterile areas are continuously kept in view.
A. Sterility cannot be ensured without direct observation. An unguarded sterile field should be considered contaminated.
10. Sterile persons keep well within sterile area.
A. Sterile persons pass each other back to back or front to front.
B. Sterile person faces a sterile area to pass it.
C. Sterile persons stay within the sterile field. They do not walk around or go outside the room.
D. Movement is kept to a minimum to avoid contamination of sterile items or persons.
11. Unsterile persons avoid sterile areas.
A. Unsterile persons maintain a distance of at least 1 foot from the sterile field.
B. Unsterile persons face and observe a sterile area when passing it to be sure they do not touch it.
C. Unsterile persons never walk between two sterile fields.
D. Circulator restricts to a minimum all activity near the sterile field.
12. Destruction of integrity of microbial barriers results in contamination.
A. Strike through is the soaking through of barrier from sterile to non-sterile or vice versa.
B. Sterility is event related.
13. Microorganisms must be kept to irreducible minimum.
A. Perfect asepsis is an idea. All microorganisms cannot be eliminated. Skin cannot be sterilized. Air is contaminated by droplets.
Characteristics of Surgical Scrubbing
Characteristics of a Surgical Scrub
Performance characteristics for a surgical scrub agent generally fall into four categories:
1. Antimicrobial Action--an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms. This agent would have to work rapidly. An agent that does not work rapidly may not provide adequate bacterial reduction before being rinsed off.
2. Persistent Activity--an agent offering persistent activity keeps the bacterial count low under the gloves. It is not unusual for a surgery to last in excess of two hours. Studies have shown the rate of glove failures (non-visible holes) increases with the duration of surgery.4 In addition, studies show bacteria grow faster under gloved than ungloved hands.5,6,7
3. Safety--the ideal agent would be non-irritating and non-sensitizing. It must have no appreciable ocular or ototoxicity, be safe for use on the body, and not be damaging to the skin or environment.
4. Acceptance--probably most important to achieving compliance in using a new product is its acceptance by the healthcare worker. A product that has ideal antimicrobial action and an excellent safety profile is of little value to good infection control if the user population fails to support its use. Although each is important in its own right, all four characteristics should be present for a complete package.
Surgical scrub agents come in many forms. Not all forms meet all characteristics.
1. Liquid or foam soaps. These are the most common products for surgical scrubs and are used in conjunction with water and dry scrub brushes or sponges. The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor, or PCMX (parachlorometaxylenol). These agents are very drying and with repeated scrubbing with the scrub brush can cause skin damage.
2. Impregnated scrub brushes/sponges. Scrub brushes/sponges are preloaded with CHG, iodophor, or PCMX and are water-aided products.
3. Brush-free surgical scrub. These products use an antimicrobial agent and water but no scrub brush.
Conclusion
No matter what agent is used, or which scrub technique you practice, there is only one goal: infection prevention. Effective surgical scrubs are one of the most powerful strategies of infection prevention in the OR. Glove usage gives a false sense of security against bacteria. Gloves provide an ideal environment for bacterial growth, moisture and warmth, which makes good hand-scrub techniques and aseptic gowning and gloving an important part of the total infection prevention platform. It is important for healthcare management to help the personnel understand the cause/effect cycle of surgical scrubs as they relate to infection prevention.
Performance characteristics for a surgical scrub agent generally fall into four categories:
1. Antimicrobial Action--an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms. This agent would have to work rapidly. An agent that does not work rapidly may not provide adequate bacterial reduction before being rinsed off.
2. Persistent Activity--an agent offering persistent activity keeps the bacterial count low under the gloves. It is not unusual for a surgery to last in excess of two hours. Studies have shown the rate of glove failures (non-visible holes) increases with the duration of surgery.4 In addition, studies show bacteria grow faster under gloved than ungloved hands.5,6,7
3. Safety--the ideal agent would be non-irritating and non-sensitizing. It must have no appreciable ocular or ototoxicity, be safe for use on the body, and not be damaging to the skin or environment.
4. Acceptance--probably most important to achieving compliance in using a new product is its acceptance by the healthcare worker. A product that has ideal antimicrobial action and an excellent safety profile is of little value to good infection control if the user population fails to support its use. Although each is important in its own right, all four characteristics should be present for a complete package.
Surgical scrub agents come in many forms. Not all forms meet all characteristics.
1. Liquid or foam soaps. These are the most common products for surgical scrubs and are used in conjunction with water and dry scrub brushes or sponges. The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor, or PCMX (parachlorometaxylenol). These agents are very drying and with repeated scrubbing with the scrub brush can cause skin damage.
2. Impregnated scrub brushes/sponges. Scrub brushes/sponges are preloaded with CHG, iodophor, or PCMX and are water-aided products.
3. Brush-free surgical scrub. These products use an antimicrobial agent and water but no scrub brush.
Conclusion
No matter what agent is used, or which scrub technique you practice, there is only one goal: infection prevention. Effective surgical scrubs are one of the most powerful strategies of infection prevention in the OR. Glove usage gives a false sense of security against bacteria. Gloves provide an ideal environment for bacterial growth, moisture and warmth, which makes good hand-scrub techniques and aseptic gowning and gloving an important part of the total infection prevention platform. It is important for healthcare management to help the personnel understand the cause/effect cycle of surgical scrubs as they relate to infection prevention.
Surgical Scrub Technique
How To Perform Surgical Hand Scrubs
By Deborah Gardner, LPN, OPAC, and Ellen Anderson-Manz, RN, BSN
Human hands are the most important tools for caring. Hands feel, diagnose, cure, prod, and provoke as they are placed upon each patient who is hoping for answers, understanding, and healing remedies. The hands can also be a portal and transmitter of infection. While handwashing may be the simplest way to control infection, it is often not practiced where warranted.
Surgical site infections greatly contribute to nosocomial infections. Some of the risk factors for nosocomial infections include the behavior of OR personnel regarding decontamination practices, hand hygiene/antisepsis, and compliance with universal precautions. Most surgical professionals agree on the importance of good surgical hand-washing practices in infection prevention. Hand transmission is a critical factor in the spread of bacteria, pathogens, viruses that cause disease, and nosocomial infections in general.
The purpose of surgical hand scrub is to:
* Remove debris and transient microorganisms from the nails, hands, and forearms
* Reduce the resident microbial count to a minimum, and
* Inhibit rapid rebound growth of microorganisms.1
Surgical Scrub Techniques
All sterile team members should perform the hand and arm scrub before entering the surgical suite. The basic principle of the scrub is to wash the hands thoroughly, and then to wash from a clean area (the hand) to a less clean area (the arm). A systematic approach to the scrub is an efficient way to ensure proper technique.
There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol.
The procedure for the timed five minute scrub consists of:
* Remove all jewelry (rings, watches, bracelets).
* Wash hands and arms with anitmicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash with for the recommended amount of time. However, because cold water prevents soap from lathering properly, soil and germs may not be washed away.
* Clean subungual areas with a nail file.
* Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two minutes.
* Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
* Wash each side of the arm to three inches above the elbow for one minute.
* Repeat the process on the other hand and arm, keeping hands above elbows at all times. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been contaminated.
* Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
* Proceed to the operating room suite holding hands above elbows.2
* If the hands and arms are grossly soiled, the scrub time should be lengthened. However, vigorous scrubbing that causes the skin to become abraded should be avoided.
* At all times during the scrub procedure care should be taken not to splash water onto surgical attire.2
* Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique. You are now ready to don your gown and sterile gloves.
When gowning oneself, grasp the gown firmly and bring it away from the table. It has already been folded so that the outside faces away. Holding the gown at the shoulders, allow it to unfold gently. Do not shake the gown.
Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do not allow hands to slide outside the gown cuff. The circulator will assist by pulling the gown up over the shoulders and tying it.
To glove, lay the glove palm down over the cuff of the gown. The fingers of the glove face toward you. Working through the gown sleeve, grasp the cuff of the glove and bring it over the open cuff of the sleeve. Unroll the glove cuff so that it covers the sleeve cuff. Proceed with the opposite hand, using the same technique. Never allow the bare hand to contact the gown cuff edge or outside of glove.
The scrubbed technologist or nurse gowns the surgeon after he or she has performed the hand and arm scrub. After handing the surgeon a towel for drying, the technologist or nurse allows the gown to unfold gently, making sure that there is enough room to prevent contamination by nonsterile equipment. To glove another person, the rules of asepsis must be observed. One person's sterile hands should not touch the nonsterile surface of the person being gloved.
* Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them so that a wide opening is created. Keep thumbs under the cuff.
* The surgeon will thrust his or her hand into the glove. Do not release the glove yet.
* Gently release the cuff (do not allow the cuff to snap sharply) while unrolling it over the wrist. Proceed with the left glove, using the same technique.
Formal guidelines and recommended practices for hand washing have been published by professional organizations (e.g., Association for Professionals in Infection Control (APIC), Association of periOperative Registered Nurses, Inc. (AORN). AORN recommends the use of a traditional standardized anatomical timed scrub or counted stroke method for surgical hand scrub and encourages institutions to follow the scrub agent manufacturer's written recommendations when establishing policies and procedures for scrub times. On this basis, for example, the typical scrub procedure for a PVPI-containing product based on manufacturer's labeling would require the use of a scrub brush and two applications of five minutes each, whereas the typical procedure for a CHG-based product would require a three-minute scrub followed by a three-minute wash. In actual practice, however, variations in surgical hand scrubbing times may be of shorter duration than manufacturer's recommendations for a number of reasons:
* Staff time constraints.
* Desire to reduce poor hand health.
* Acceptance of data from other sources suggesting those scrub times shorter than those recommended by manufactures are adequate.3
Hand condition is emerging as an increasingly important factor in personnel compliance and infection control. Frequent surgical scrubbing can cause dermatitis of the hands and arms. Most antimicrobial agents are drying to the skin, especially when coupled with a scrub brush.
By Deborah Gardner, LPN, OPAC, and Ellen Anderson-Manz, RN, BSN
Human hands are the most important tools for caring. Hands feel, diagnose, cure, prod, and provoke as they are placed upon each patient who is hoping for answers, understanding, and healing remedies. The hands can also be a portal and transmitter of infection. While handwashing may be the simplest way to control infection, it is often not practiced where warranted.
Surgical site infections greatly contribute to nosocomial infections. Some of the risk factors for nosocomial infections include the behavior of OR personnel regarding decontamination practices, hand hygiene/antisepsis, and compliance with universal precautions. Most surgical professionals agree on the importance of good surgical hand-washing practices in infection prevention. Hand transmission is a critical factor in the spread of bacteria, pathogens, viruses that cause disease, and nosocomial infections in general.
The purpose of surgical hand scrub is to:
* Remove debris and transient microorganisms from the nails, hands, and forearms
* Reduce the resident microbial count to a minimum, and
* Inhibit rapid rebound growth of microorganisms.1
Surgical Scrub Techniques
All sterile team members should perform the hand and arm scrub before entering the surgical suite. The basic principle of the scrub is to wash the hands thoroughly, and then to wash from a clean area (the hand) to a less clean area (the arm). A systematic approach to the scrub is an efficient way to ensure proper technique.
There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol.
The procedure for the timed five minute scrub consists of:
* Remove all jewelry (rings, watches, bracelets).
* Wash hands and arms with anitmicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash with for the recommended amount of time. However, because cold water prevents soap from lathering properly, soil and germs may not be washed away.
* Clean subungual areas with a nail file.
* Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two minutes.
* Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
* Wash each side of the arm to three inches above the elbow for one minute.
* Repeat the process on the other hand and arm, keeping hands above elbows at all times. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been contaminated.
* Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
* Proceed to the operating room suite holding hands above elbows.2
* If the hands and arms are grossly soiled, the scrub time should be lengthened. However, vigorous scrubbing that causes the skin to become abraded should be avoided.
* At all times during the scrub procedure care should be taken not to splash water onto surgical attire.2
* Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique. You are now ready to don your gown and sterile gloves.
When gowning oneself, grasp the gown firmly and bring it away from the table. It has already been folded so that the outside faces away. Holding the gown at the shoulders, allow it to unfold gently. Do not shake the gown.
Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do not allow hands to slide outside the gown cuff. The circulator will assist by pulling the gown up over the shoulders and tying it.
To glove, lay the glove palm down over the cuff of the gown. The fingers of the glove face toward you. Working through the gown sleeve, grasp the cuff of the glove and bring it over the open cuff of the sleeve. Unroll the glove cuff so that it covers the sleeve cuff. Proceed with the opposite hand, using the same technique. Never allow the bare hand to contact the gown cuff edge or outside of glove.
The scrubbed technologist or nurse gowns the surgeon after he or she has performed the hand and arm scrub. After handing the surgeon a towel for drying, the technologist or nurse allows the gown to unfold gently, making sure that there is enough room to prevent contamination by nonsterile equipment. To glove another person, the rules of asepsis must be observed. One person's sterile hands should not touch the nonsterile surface of the person being gloved.
* Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them so that a wide opening is created. Keep thumbs under the cuff.
* The surgeon will thrust his or her hand into the glove. Do not release the glove yet.
* Gently release the cuff (do not allow the cuff to snap sharply) while unrolling it over the wrist. Proceed with the left glove, using the same technique.
Formal guidelines and recommended practices for hand washing have been published by professional organizations (e.g., Association for Professionals in Infection Control (APIC), Association of periOperative Registered Nurses, Inc. (AORN). AORN recommends the use of a traditional standardized anatomical timed scrub or counted stroke method for surgical hand scrub and encourages institutions to follow the scrub agent manufacturer's written recommendations when establishing policies and procedures for scrub times. On this basis, for example, the typical scrub procedure for a PVPI-containing product based on manufacturer's labeling would require the use of a scrub brush and two applications of five minutes each, whereas the typical procedure for a CHG-based product would require a three-minute scrub followed by a three-minute wash. In actual practice, however, variations in surgical hand scrubbing times may be of shorter duration than manufacturer's recommendations for a number of reasons:
* Staff time constraints.
* Desire to reduce poor hand health.
* Acceptance of data from other sources suggesting those scrub times shorter than those recommended by manufactures are adequate.3
Hand condition is emerging as an increasingly important factor in personnel compliance and infection control. Frequent surgical scrubbing can cause dermatitis of the hands and arms. Most antimicrobial agents are drying to the skin, especially when coupled with a scrub brush.
Monday, June 15, 2009
Stages of Labor
Stages of Labor
There are three stages of labor. The first stage occurs from the time true labor begins until the cervix is completely dilated and effaced. During the second stage the baby is delivered. The third stage follows the birth of the baby through the birth of the placenta.
* First Stage
* Second Stage
* Third Stage
* Labor and Delivery Checklist
First Stage
The first stage of labor is the longest. There are three phases within the first stage;
* Early or latent phase
* Active phase
* Transition phase
At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first child, this stage usually lasts 12 to 16 hours. For women having second or subsequent children, the first stage lasts around 6-7 hours.
Early Labor
During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first phase is the longest, averaging around 8 hours. Your contractions may be irregular, progressing to rhythmic and methodical. The pain felt at this early stage may be similar to menstrual pain: aching, fullness, cramping and backache. You will still be able to walk. Walking is usually more comfortable than sitting. Most women spend these hours at home, or they may be checked at the hospital and sent home until labor becomes more active. You may feel eager, excited and social. It is important that you conserve your energy for the work of labor.
Active Labor
Active labor is marked by regular contractions that become longer, stronger and closer together over time. Most providers recommend that you go to the hospital when your contractions are five minutes apart, lasting more then 60 seconds for at least an hour. Measure your contractions from the start of one contraction to the beginning of the next.
Your physician will want to know:
* How far apart are the contractions?
* How long they are lasting, and how intense?
* Are you using breathing techniques to manage the pain?
* Has your "bag of water" broken? Your provider will want to know the time this occurred, and any color or odor.
* Has there been any discharge, such as a bloody show?
If you have had previous deliveries, the active phase of labor can proceed more quickly. Your physician may want to be contacted sooner.
When you are in active labor, you will be concentrating on the task at hand, and will not feel like doing anything else. Your labor partner's support is important at this phase. Contractions are growing stronger, longer and closer together. Contractions will be about 3-4 minutes apart, lasting 40 to 60 seconds. You may have a tightening feeling in your pubic area and increasing pressure in your back. If you have learned breathing techniques, begin using them now, if you haven't already. Pain medication is often given at this stage. If you have chosen to have an epidural anesthetic, it is usually given at this stage. Please see pain management for more information.
Transition
Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30 minutes to two hours. The cervix is opening the last few centimeters, from 7 to 10 centimeters. The pain may be intense, as the cervix stretches and the baby descends into the birth canal. All of your energy is concentrated on doing the work of labor. Try to remain calm and focused as your uterus works. At the end of transition, you may feel a strong urge to push the baby out. The baby is ready to be born.
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Second Stage
During the second stage the baby is born. This stage of labor lasts anywhere from one contraction to up to two hours. The baby's head stretches your vagina and perineum (the skin between the vagina and rectum). This may cause a burning sensation. Some women may feel as if they are having a bowel movement, and feel the urge to push, or bear down. The labor nurse or physician will tell you when it is time to push. It is important that you not push until instructed. Pushing too early will cause the cervix to become edematous, or swollen. "Crowning" occurs as the widest part of the head appears at the vaginal opening. In the next few pushes, the baby is born. Mucous and amniotic fluid will be removed from the baby's mouth and nose with a bulb syringe. The baby will take its first breath, and may begin to cry. Immediately after birth, the baby is still connected to the placenta by the umbilical cord. The cord is clamped and cut.
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Third Stage
The third stage begins with the birth of the baby and ends with the delivery of the placenta. It is the shortest stage, lasting from 5 to 15 minutes. Your contractions may stop for awhile, then resume to deliver the placenta. You will be observed closely for the next few hours to make certain that your uterus is contracting and bleeding is not excessive. The nurse will massage your uterus, or your lower abdomen to check that the uterus is contracting. Take this time to rest and get acquainted with your new baby.
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Labor and Delivery Checklist
1. Prior to labor, discuss the following issues with your physician or nurse practitioner:
* What do I do if I think I am in labor?
* What pain management options are available?
* When is an episiotomy necessary?
* What are some reasons you might perform a cesarean delivery?
2. If you have not done so, take a hospital tour so you are familiar with the place where you will give birth.
3. Arrange for help to care for you and the baby after birth, if you can.
4. Shop and prepare food for the first weeks when you are home with the baby, and collect take-out menus.
5. Review Preparing for Baby checklist.
6. Make sure you always have gas in the car.
7. Pack your bags. See what to pack for the labor room.
There are three stages of labor. The first stage occurs from the time true labor begins until the cervix is completely dilated and effaced. During the second stage the baby is delivered. The third stage follows the birth of the baby through the birth of the placenta.
* First Stage
* Second Stage
* Third Stage
* Labor and Delivery Checklist
First Stage
The first stage of labor is the longest. There are three phases within the first stage;
* Early or latent phase
* Active phase
* Transition phase
At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first child, this stage usually lasts 12 to 16 hours. For women having second or subsequent children, the first stage lasts around 6-7 hours.
Early Labor
During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first phase is the longest, averaging around 8 hours. Your contractions may be irregular, progressing to rhythmic and methodical. The pain felt at this early stage may be similar to menstrual pain: aching, fullness, cramping and backache. You will still be able to walk. Walking is usually more comfortable than sitting. Most women spend these hours at home, or they may be checked at the hospital and sent home until labor becomes more active. You may feel eager, excited and social. It is important that you conserve your energy for the work of labor.
Active Labor
Active labor is marked by regular contractions that become longer, stronger and closer together over time. Most providers recommend that you go to the hospital when your contractions are five minutes apart, lasting more then 60 seconds for at least an hour. Measure your contractions from the start of one contraction to the beginning of the next.
Your physician will want to know:
* How far apart are the contractions?
* How long they are lasting, and how intense?
* Are you using breathing techniques to manage the pain?
* Has your "bag of water" broken? Your provider will want to know the time this occurred, and any color or odor.
* Has there been any discharge, such as a bloody show?
If you have had previous deliveries, the active phase of labor can proceed more quickly. Your physician may want to be contacted sooner.
When you are in active labor, you will be concentrating on the task at hand, and will not feel like doing anything else. Your labor partner's support is important at this phase. Contractions are growing stronger, longer and closer together. Contractions will be about 3-4 minutes apart, lasting 40 to 60 seconds. You may have a tightening feeling in your pubic area and increasing pressure in your back. If you have learned breathing techniques, begin using them now, if you haven't already. Pain medication is often given at this stage. If you have chosen to have an epidural anesthetic, it is usually given at this stage. Please see pain management for more information.
Transition
Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30 minutes to two hours. The cervix is opening the last few centimeters, from 7 to 10 centimeters. The pain may be intense, as the cervix stretches and the baby descends into the birth canal. All of your energy is concentrated on doing the work of labor. Try to remain calm and focused as your uterus works. At the end of transition, you may feel a strong urge to push the baby out. The baby is ready to be born.
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Second Stage
During the second stage the baby is born. This stage of labor lasts anywhere from one contraction to up to two hours. The baby's head stretches your vagina and perineum (the skin between the vagina and rectum). This may cause a burning sensation. Some women may feel as if they are having a bowel movement, and feel the urge to push, or bear down. The labor nurse or physician will tell you when it is time to push. It is important that you not push until instructed. Pushing too early will cause the cervix to become edematous, or swollen. "Crowning" occurs as the widest part of the head appears at the vaginal opening. In the next few pushes, the baby is born. Mucous and amniotic fluid will be removed from the baby's mouth and nose with a bulb syringe. The baby will take its first breath, and may begin to cry. Immediately after birth, the baby is still connected to the placenta by the umbilical cord. The cord is clamped and cut.
Back to top
Third Stage
The third stage begins with the birth of the baby and ends with the delivery of the placenta. It is the shortest stage, lasting from 5 to 15 minutes. Your contractions may stop for awhile, then resume to deliver the placenta. You will be observed closely for the next few hours to make certain that your uterus is contracting and bleeding is not excessive. The nurse will massage your uterus, or your lower abdomen to check that the uterus is contracting. Take this time to rest and get acquainted with your new baby.
Back to top
Labor and Delivery Checklist
1. Prior to labor, discuss the following issues with your physician or nurse practitioner:
* What do I do if I think I am in labor?
* What pain management options are available?
* When is an episiotomy necessary?
* What are some reasons you might perform a cesarean delivery?
2. If you have not done so, take a hospital tour so you are familiar with the place where you will give birth.
3. Arrange for help to care for you and the baby after birth, if you can.
4. Shop and prepare food for the first weeks when you are home with the baby, and collect take-out menus.
5. Review Preparing for Baby checklist.
6. Make sure you always have gas in the car.
7. Pack your bags. See what to pack for the labor room.
Parts and its Function
Uterus
The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes.
The uterus is a pear-shaped muscular organ. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. If the egg does not embed in the wall of the uterus, a woman gets her period and the egg is flushed away.
Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus.
On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy.
Ovaries
The ovaries are the place inside the female body where ova or eggs are produced. The process by which the ovum is released is called ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle.
After ovulation, the ovum is captured by the oviduct, after traveling down the oviduct to the uterus, occasionally being fertilized on its way by an incoming sperm, leading to pregnancy and the eventual birth of a new human being.
The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.
The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes.
The uterus is a pear-shaped muscular organ. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. If the egg does not embed in the wall of the uterus, a woman gets her period and the egg is flushed away.
Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus.
On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy.
Ovaries
The ovaries are the place inside the female body where ova or eggs are produced. The process by which the ovum is released is called ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle.
After ovulation, the ovum is captured by the oviduct, after traveling down the oviduct to the uterus, occasionally being fertilized on its way by an incoming sperm, leading to pregnancy and the eventual birth of a new human being.
The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.
Parts and Its Function
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female mammals, or to the cloaca in female birds and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the oviduct.
The vagina is the place where semen from the male is deposited into the female's body at the climax of sexual intercourse, commonly known as ejaculation. Around the vagina, pubic hair protects the vagina from infection and is a sign of puberty.
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible; the remainder lies above the vagina beyond view.
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female mammals, or to the cloaca in female birds and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the oviduct.
The vagina is the place where semen from the male is deposited into the female's body at the climax of sexual intercourse, commonly known as ejaculation. Around the vagina, pubic hair protects the vagina from infection and is a sign of puberty.
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible; the remainder lies above the vagina beyond view.
Female Reproductive System
The female reproductive system contains two main parts: the uterus, which hosts the developing fetus, produces vaginal and uterine secretions, and passes the male's sperm through to the fallopian tubes; and the ovaries, which produce the female's egg cells. These parts are internal; the vagina meets the external organs at the vulva, which includes the labia, clitoris and urethra. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the Fallopian tubes. At certain intervals, the ovaries release an ovum, which passes through the Fallopian tube into the uterus.
If, in this transit, it meets with sperm, the sperm penetrate and merge with the egg, fertilizing it. The fertilization usually occurs in the oviducts, but can happen in the uterus itself. The zygote then implants itself in the wall of the uterus, where it begins the processes of embryogenesis and morphogenesis. When developed enough to survive outside the womb, the cervix dilates and contractions of the uterus propel the fetus through the birth canal, which is the vagina.
The ova are larger than sperm and are generally all created by birth. Approximately every month, a process of oogenesis matures one ovum to be sent down the Fallopian tube attached to its ovary in anticipation of fertilization. If not fertilized, this egg is flushed out of the system through menstruation.
Donning and Removing Sterile Gloves
Donning Techniques - Sterile Gloves
There are two techniques for donning sterile gloves, "Closed Donning" and "Open Donning". Regardless of which one you use, it is vital that all surface powder be removed from powdered gloves after donning. This can be done with either sterile water from a pour rinse, or a sterile wipe.
Closed Donning
1. Peel open the outer pack from the corners. The inner pack is sterile. Gripping it through your gown, open it to display the gloves.
2. With your gown covering your fingers, use your right hand to remove the left glove. Hold your left hand palm up, fingers straight. Lay the glove on your left wrist, and grip the cuff with your left thumb.
3. Place your right thumb inside the top cuff edge. Make a fist with your right hand and stretch the glove over your left fingertips.
4. Keeping your left fingers straight, pull down the glove.
5. Repeat the above procedure to don the other glove, that is: use your gloved left hand to lay the right glove on your right wrist. Slide your left thumb inside the top of the cuff, make a fist, and stretch the cuff over your right fingertips. Pull down the sleeve and glove together.
Open Donning
1. Pick up the cuff of the right glove with your left hand. Slide your right hand into the glove until you have a snug fit over the thumb joint and knuckles. Your bare left hand should only touch the folded cuff - the rest of the glove remains sterile.
2. Slide your right fingertips into the folded cuff of the left glove. Pull out the glove and fit your right hand into it.
3. Unfold the cuffs down over your gown sleeves. Make sure your gloved fingertips do not touch your bare forearms or wrists.
Glove Removal
The key to removing both sterile and non-sterile gloves is"Dirty to Dirty - Clean to Clean",
that is, contaminated surfaces only touch other contaminated surfaces: your bare hand, which is clean, touches only clean areas inside the other glove.
1. Take hold of the first glove at the wrist.
2. Fold it over and peel it back, turning it inside out as it goes. Once the glove is off, hold it with your gloved hand.
3. To remove the other glove, place your bare fingers inside the cuff without touching the glove exterior. Peel the glove off from the inside, turning it inside out as it goes. Use it to envelope the other glove.
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