CHAPTER I THE PROBLEM AND ITS BACKGROUND

Introduction Nurses lead and manage nursing care for patients, families, aggregates, and communities in a variety of settings, ranging from ambulatory to community to inpatient. Nurses also lead and manage care across the health-care continuum, including primary health promotion and prevention; secondary skilled, long term, and rehabilitative; and tertiary: emergent, urgent, and acute care. Strategies are drawn from both leadership and management theories. Management, one of the responsibilities of leadership, is a five-step process that comprises planning, organizing, directing, coordinating, and controlling (Garrison, Morgan, and Johnson, 2008). Management is the process of working in and through others to achieve organizational objectives in a changing environment. It is the process of obtaining and organizing resources, building up dual structure (skill and people) and of achieving objective through people a set of interactive process through which the utilization of resources result in the accomplishment of organizational objectives. The managerial grid model (1957) is a behavioral management model developed by Robert R. Blake and Jane Mouton. This model originally identified five different leadership styles based on the concern for people and the concern for production. The optimal leadership style in this model is based on Theory Y. WHO (World Health Organization) defines hospital as an integral part of social and medical organization, the function is which to provide for the population that it

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serves, complete health care, both curative and preventive and whose outpatient services reach out to the family in its home and environment. RA 7164 focused on three changes in the effort to improve the peoples health from hospital or institutional care, emphasis shifted to community health delivery from emphasis on physical care, efforts are now directed toward holistic approach to the care of individuals, families and communities from being mere recipients of care, patients, individuals, families and communities are now active participants in healthcare. Furthermore, the Philippines Nursing Law of 2002, RA 9173 still emphasizes these concerns of Filipino nurses. The nurses must learn and adjust to complex interrelationships and among service units, departments, professional disciplines, community agencies and administration. It is for them to know their place and their specific role in the organizational hierarchy and leads to find at varying levels that they have to manage people, their clients or patients, their resources and their time. There is increasing attention to nursing workforce issues such as recruitment, retention, turnover, workplace health and safety issues and their impact on quality patient care. A number of these problems have been linked to poor morale. While there has been a lack of consensus on the determinants of morale, it is clear that the outcomes of poor morale not only add considerable cost to the organization but also impact negatively on patient care. Staff morale is a workforce phenomenon that confronts every organization at some time. The understanding of morale is important because it can have tangible and wide-ranging effects and outcomes for an organization. Morale is not a simple concept and the outcomes associated with high or low morale may impact upon staff turnover,

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attainment of organizational or personal goals, the ability to adopt new practices, learning new skills and the delivery of good customer service. As early as the 1940s morale was being viewed as an important workplace issue. At the time, it was suggested that when any person holds a position of responsibility in a business, the word "morale" comes to have real meaning and refers to something that has great importance, even if that something remains vague and illusive. At times the feelings of poor morale are difficult to articulate by those that are affected by it. While there are a number of thematic variations on the definition of morale, for the purposes of this review, positive morale is seen as an attitude of confidence in the mind of the individual where they identify with a group, accept group goals and work towards achieving them collectively. The fact that there has been no unifying definition of morale goes some way to explaining the reasons why definitive empirical studies on the phenomenon have been somewhat sporadic. The researcher, who was currently taking up Masters of Arts in Nursing, chose this topic to have in-depth knowledge on how management styles of hospital nurse managers play an important role in staff nurses morale. Due to the complexity of todays healthcare setting, it is crucial that hospital nurse managers create a work environment that supports a committed and confident staff of nurses in hospital setting.

Theoretical Framework Dr Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences. She further explains that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of

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practical knowledge (know how) through research and the characterization and understanding of the "know how" of clinical experience. The Proficient phase is where nurses perceives and understands situations as whole parts. Have more holistic understanding improves decision-making and learns from experiences what to expect in certain situations and how to modify plans

Conceptual Framework Ever-changing organizational arrangements within the healthcare setting mean that hospital clinical leaders face additional challenges in managing the human relations aspect of the enterprise (Prybil, 2003). Hospital clinical leaders have always had to know how to motivate their managers by creating performance management systems that change unproductive behaviors, but the strategies for doing so while imperative, have become more complex in contemporary healthcare settings where the urgency for retention is profound (Laschinger & Sabiston, 2000). Given the weight of the evidence in favor of empowering hospital staff, hospital clinical leaders must exhibit leadership styles that nurture collaborative high performance nurse management teams (Tzeng & Ketefian, 2002).

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Conceptual Paradigm INPUT PROCESS OUTPUT

Management style based on Blake and Mouton Managerial Grid Leadership Assessment Assessment and Analysis of Survey Questionnaire and Interview Effects of Management Style to Morale of Nurses Proposed Program to enhance the Management Style and Its Effect to the Morale of Nurses

Figure 1 Effects of Management Style on the Morale of the Nurses

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The study used the IPO (input-process-output) to present the paradigm of the study entitled Effects of Management Style on the Morale of the Nurses in selected hospitals in Batangas Province. The input includes the management style based on Blake and Mouton Managerial Grid Leadership Assessment; and the effect of management style on the morale of nurses. The process includes the assessment and analysis of survey questionnaire and interview. The output of the study will be the propose program to enhance the management style and its effect to the morale of the nurses. Statement of the Problem This study aims to determine the effects of management style on the morale of nurses. It specifically will determine the following: 1. What are the management styles exhibited by the nurse managers based on Blake and Mouton Managerial Grid Leadership Assessment Questionnaire?
2. What are the management styles exhibited by the nurse managers as perceived by

staff nurse based on Blake and Mouton Managerial Grid Leadership Assessment Questionnaire?
3. What is the effect of management style to the morale of the nurses? 4. Is there a significant difference between the management styles of nurse managers as

perceived by the two groups of respondents? 5. Based on the result, what program may be proposed to enhance the management style and its effect to the morale of the nurses.

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Hypothesis H01: There is no significant difference between the management styles of nurse managers as perceived by the two groups of respondents.

Significance of the Study This study will be beneficial to the following: For nurse managers and staff nurses, the outcome of this research will be beneficial to the respondents as this will serve as a guide for them to be able to know the effect of management style on the morale of nurses. For nursing research, the result of this investigation will enhance the concepts of management style and its effect on the morale of the nurses. For the Graduate School of Nursing, they will know the which management style is most effective and practiced by nurse managers and how it affects the morale of nurses in hospital setting,. For the readers, the findings of this research may be used as a tool to serve as a guide or basis regarding management style and its effect on morale of nurses and will provide them additional information and to be aware of the most appropriate management style.. Scope and Limitation of the Study This study highlighted how the hospital clinical management style affected their subordinate hospital staff nurses morale. Also the demographic profile is limited to the questionnaire where it will determine the age, gender, civil status, highest educational attainment and length of clinical experience.

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The management style will cover the managerial grid model (1957) which is a behavioral management model developed by Robert R. Blake and Jane Mouton. This model originally identified five different leadership styles based on the concern for people and the concern for production. Definition of Terms In order to fully understand this study, the researcher used the conceptual as well as the operational definitions of the following: Country Club Leadership. In this study, this refers to managers who have great concerns for people and little concern for production. They try to avoid conflicts and concentrate on being well liked. To them, task is less important than good interpersonal relations. Impoverished Leadership. Often refereed to as laissez-faire leadership. Leaders in this position have little concern for people or productivity, avoid taking sides, and stay out of conflicts. Management Style. In this study, it refers to the style of management of nurse managers and the foundation of its theory is that management should have concern for both human relations and completion of work tasks. Middle-of-the-Road Leadership. Adequate organization performance is possible through balancing the necessity to get out the work with maintaining morale of people at a satisfactory level. Morale. In this study, this refers to the way a person or staff nurses responds or reacts to work and organizational stimuli has a strong bearing on their subsequent perception of morale within the workplace.

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Produce or Perish Leadership. Efficiency of operation results from arranging conditions of work in such a way that human elements interfere to a minimum degree. Team Leadership. This style of leadership is considered to be ideal. Such managers have great concern for both people and production. They work to motivate employees to reach their highest level of accomplishments. They are flexible and responsive to change. Nurse Manager. A licensed registered nurse either a Head nurse or Nurse supervisor who served as respondents of the study. Nursing Practice. The actions of the nurse in whatever role the nurse fulfills, including direct patient care provider, educator, administrator, researcher, policy developer or other. (Burkhardt & Nathaniel, 2002) Standards of Nursing Practice. These are written documents outlining minimum expectations for nursing care and practices.

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CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES

This part presents the review of related literature derived from different books, articles and journals. Related studies foreign and locally are also presented here which were derived from thesis and dissertations.

Related Literature Management is a body of knowledge existing as a PROCESS, as an ART, and as a SCIENCE. Management as a PROCESS is a series of systematic, sequential or instances of overlapping steps directed toward the achievement of organization goals and objectives with features of time dimension reflecting the dynamic nature of management; recognition that one major task of management is the integration of the efforts of group or organization; and inclusion of the phrase purposeful group, - includes not only goal definition and objectives but also includes assumption that organizational managers must work together in the direction of their purpose. Management as a SCIENCE is where achievement is required through the scientific method which employs an empirical measurement of data, causal links among phenomena, logical organization of internal structure, conclusions validated through experimentation. And management as an ART is getting one done through people; problems are adaptive to individual styles based on creativity, judgment, intuition and experience instead of the usual systemic methods of science.

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The nurses approach to leadership and management reflects the dynamic state of nursing practice and health care. Leadership has evolved from theories of the past, which pronounced that only great and noble men could be leaders, to more current theories that look at leadership as a learned process or a changing role depending on the situation. Management has evolved from competing managerial activities in a hierarchical, bureaucratic organization to complexity theory involving both the physical and social sciences (Jones, 2007). The Managerial Grid by Robert Black and Jane Mouton is based on two behavioral dimensions:

Concern for People This is the degree to which a leader considers the needs of team members, their interests, and areas of personal development when deciding how best to accomplish a task.

Concern for Production This is the degree to which a leader emphasizes concrete objectives, organizational efficiency and high productivity when deciding how best to accomplish a task.

Using the axis to plot leadership concerns for production versus concerns for people, Blake and Mouton defined the following five leadership styles: Country Club Leadership High People/Low Production. This style of leader is most concerned about the needs and feelings of members of his/her team. These people operate under the assumption that as long as team members are happy and secure then they will work hard. What tends to result is a work environment that is very relaxed and fun but where production suffers due to lack of direction and control.

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Produce or Perish Leadership High Production/Low People. Also known as Authoritarian or Compliance Leaders, people in this category believe that employees are simply a means to an end. Employee needs are always secondary to the need for efficient and productive workplaces. This type of leader is very autocratic, has strict work rules, policies, and procedures, and views punishment as the most effective means to motivate employees. Impoverished Leadership Low Production/Low People. This leader is mostly ineffective. He/she has neither a high regard for creating systems for getting the job done, nor for creating a work environment that is satisfying and motivating. The result is a place of disorganization, dissatisfaction and disharmony. Middle-of-the-Road Leadership Medium Production/Medium People. This style seems to be a balance of the two competing concerns. It may at first appear to be an ideal compromise. Therein lies the problem, though: When you compromise, you necessarily give away a bit of each concern so that neither production nor people needs are fully met. Leaders who use this style settle for average performance and often believe that this is the most anyone can expect. Team Leadership High Production/High People. According to the Blake Mouton model, this is the pinnacle of managerial style. These leaders stress production needs and the needs of the people equally highly. The premise here is that employees are involved in understanding organizational purpose and determining production needs. When employees are committed to, and have a stake in the organizations success, their needs and production needs coincide. This creates a team environment based on trust and respect, which leads to high satisfaction and motivation and, as a result, high production.

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The model is represented as a grid with concern for production as the [x-axis]] and concern for people as the Y-axis; each axis ranges from 1 (Low) to 9 (High). The resulting leadership styles are as follows:

The indifferent (previously called impoverished) style (1,1) : evade and elude. In this style, managers have low concern for both people and production. Managers use this style to preserve job and job seniority, protecting themselves by avoiding getting into trouble. The main concern for the manager is not to be held responsible for any mistakes, which results in less innovative decisions.

The accommodating (previously, country club) style: yield and comply. This style has a high concern for people and a low concern for production. Managers using this style pay much attention to the security and comfort of the employees, in hopes that this will increase performance. The resulting atmosphere is usually friendly, but not necessarily very productive.

The dictatorial (previously, produce or perish) style (9,1): control and dominate. With a high concern for production, and a low concern for people, managers using this style find employee needs unimportant; they provide their employees with money and expect performance in return. Managers using this style also pressure their employees through rules and punishments to achieve the company goals. This dictatorial style is based on Theory X of Douglas McGregor, and is commonly applied by companies on the edge of real or perceived failure. This style is often used in cases of crisis management.

The status quo (previously, middle-of-the-road) style: balance and compromise. Managers using this style try to balance between company goals and workers'

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needs. By giving some concern to both people and production, managers who use this style hope to achieve suitable performance but doing so gives away a bit of each concern so that neither production nor people needs are met.

The sound (previously, team style): contribute and commit. In this style, high concern is paid both to people and production. As suggested by the propositions of Theory Y, managers choosing to use this style encourage teamwork and commitment among employees. This method relies heavily on making employees feel themselves to be constructive parts of the company.

The opportunistic style: exploit and manipulate. Individuals using this style, which was added to the grid theory before 1999, do not have a fixed location on the grid. They adopt whichever behaviour offers the greatest personal benefit.

The paternalistic style: prescribe and guide. This style was added to the grid theory before 1999. In The Power to Change, it was redefined to alternate between the (1,9) and (9,1) locations on the grid. Managers using this style praise and support, but discourage challenges to their thinking.

Morale The Merriam-Webster Collegiate Dictionary defines morale as the mental and emotional condition (as of enthusiasm, confidence, or loyalty) of an individual or group with regard to the function or tasks at hand. In their article examining the importance of employee-management relationship closeness, McKnight, Ahmad, and Schroeder (2001) define morale, in the context of the workplace, as the degree to which an employee feels good about his or her work and work environment. The authors say morale serves as a

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broad term that encompasses smaller concepts including intrinsic motivation, job satisfaction, experienced work meaningfulness, organizational commitment, and pride in ones work (467). Lubans (2000) writes, Morale matters because low morale affects process. In libraries the process usually involves clients and staff. Because of our strong service tradition, with many points of service, [librarians] are especially vulnerable to the impact of low morale. Effectively dealing with people and their productivity is a huge part of the responsibility assigned to all nurse managers, and staff nurses often find their morale affected by the management style of their supervisors. It is important for managers to realize that a one-size-fits-all approach to management is inadequate for the simple reason that people are different. Different personalities respond to different management styles; getting to know individual employees will help a manager determine how best to use various management controls to motivate different employees and boost their morale. This notion centers on the issue of communication. A close employee-management relationship opens the door for trust and familiarity between managers and their employees. Fear is not a good motivator over the long term. While many nurse managers will point to a time when a good scare moved a lackluster employee into action, the effect was usually short lived. If fear becomes the overriding emotion in the company's culture, morale will fall to very low levels. Instead of innovation and creativity, employees will turn their attention to holding onto their jobs. In times of layoffs, fear of further cutbacks, and rumours of department and plant closures, leads to lower productivity. This staff response should be expected and not arrive with a shock to management.

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The problem for a nurse manager faced with the need to let go a number of staff nurse is how to carry it out without irreparable morale damage. The key is to initiate and nurture a culture of open and honest management. An ethical hospital will not hide behind platitudes and vague denials that layoffs may be taking place. The secret will get out through that informal communications channel known as the office grapevine. The problem with the grapevine is the information may be entirely inaccurate. Staffers will expect the worst, causing a steep decline in productivity and mood. Open discussion is a better course of action. If there are impending layoffs, make all of the cuts at once. Don't do it in steps or phases. Even if the latest round of layoffs is the final one, employees will still fear that more employees will be let go sooner or later. The possibility that it may be them tends to create fear that lowers production dramatically. A worker keeping their head down isn't doing much useful work. Bite the bullet and get the pain taken care of all at once. When the layoffs are completed, call all of the staff together and tell them the truth. Explain why people were let go and what the plans are for the future. Be sure to spell out that the remaining workers are part of the permanent team. Leave no room for doubt. Let no new possible downsizing rumours enter the informal chat around the water cooler or lunch room. Once you give your word as an ethical business person, stick to it. If the layoffs are not over, complete the job, and then call the company wide informational meeting. No one likes layoffs, but they are better done quickly. Demonstrate to the remaining staffers that you are an open and honest company. They will reward you with

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higher productivity and new ideas for products and services. The need for any morale building beatings will never be required in an open and ethical organization. Humility is also a virtue and a crucial one in responding to errors. By being humble, one has the capability for candidness to admit ones own imperfection. Through humility we know our personal limitations. Humility is defined as the awareness of and being at ease with ones imperfections (Crigger, 2004). By recognizing our own fallibility, we have a more sympathetic attitude toward others and more readiness to forgive ourselves and others. Consequently, the ethical response to making a mistake begins with being humble enough to honestly disclose the error. This is supported by Kants moral theory of the categorical imperative against lying (Kant, 1996). This imperative states Act only on the maximum through which you can, at the same time, will that it become a universal law of values. According to Kant, anything less than full disclosure of the error would deny the patient his moral dignity. Trust between the patient and the nurse necessitates this open communication. Nurses are obligated to steer clear of intentional deception (e.g. stating that the injury occurred because of other believable causes). If it was fast forward to today, authors tend to see the virtue of moral courage as driven by principle (Kidder, 2005; Lachman, 2007). When courage supports our values and maintains core principles, we lean to using the term moral courage. Moral courage is about facing mental or social challenges that could wreck your reputation and emotional well-being, your adherence to conscience, and/or your self-esteem. The risks in acts of moral courage are humiliation, ridicule, unemployment and loss of social standing. The morally courageous person often goes against the grain, acting contrary to the accepted

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norm. Simply put, moral courage is the courage to be moral which means adhering to the five core moral values of honesty, respect, responsibility, fairness, and compassion (Kidder, 2005, p.10). Moral courage, like physical courage, requires the individual to overcome fear and stand up for his or her core values. It is the willingness to speak out and do what is right in the face of forces that would lead a person to act some other way (Lachman, 2007). Both Kidder and Lachman agree with Aristotle, moral courage is measured in action. It requires a conscious reasoning of the risks and a willingness to act regardless of the risks. We have the ethical responsibility to determine what is needed for patient safety and to implement the training, mechanisms and strategies necessary (Sharpe, 2003).

Related Studies Foreign Studies In the study of Wagner (2000) the delivery of health care by a coordinated team of individuals has always been assumed to be a good thing. Patients reap the benefits of more eyes and ears, the insights of different bodies of knowledge, and a wider range of skills. Thus team care has generally been embraced by most as a criterion for high quality care. Despite its appeal, team care, especially in the primary care setting, remains a source of confusion and some skepticism. Which disciplines are essential on the team? What do the team members other than the doctor do to support patient care? With the ageing of the population and the advances in the treatment of chronic diseases, teamwork in the context of chronic diseases needs to be re-examined.

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In the study of Druss et al (2009) that poor quality of healthcare contributes to impaired health and excess mortality in individuals with severe mental disorders. The authors tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings. A total of 407 subjects with severe mental illness at an urban community mental health center were randomly assigned to either the medical care management intervention or usual care. For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education, and support in overcoming systemlevel fragmentation and barriers to primary medical care. At a 12-month follow-up evaluation, the intervention group received an average of 58.7% of recommended preventive services compared with a rate of 21.8% in the usual care group. They also received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% versus 27.7%) and were more likely to have a primary care provider (71.2% versus 51.9%). The intervention group showed significant improvement on the SF-36 mental component summary (8.0% [versus a 1.1% decline in the usual care group]) and a nonsignificant improvement on the SF-36 physical component summary. Among subjects with available laboratory data, scores on the Framingham Cardiovascular Risk Index were significantly better in the intervention group (6.9%) than the usual care group (9.8%). Medical care management was associated with significant improvements in the quality and outcomes of primary care. These findings suggest that care management is a promising approach for improving medical care for patients treated in community mental health settings.

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According to the study of Page (2009) behavior, whether internalizing or externalizing, constitutes a primary challenge in any inpatient setting. In many cases, behavior may interfere with progress during inpatient treatment, resulting in the need for a behavioral strategy for those concerns. A multidisciplinary team approach is often necessary to fully identify and remediate interfering difficulties. Functional behavioral assessment (FBA) is a team-based technique that offers a positive option to these types of difficulties. This article provides a rationale for and delineates the use of FBA as a strategy for assessment and treatment for a complex care patient. Two uncontrolled case studies (pediatric rehabilitation and cancer) are used to illustrate the use of FBA in the tertiary hospital setting. Both cases demonstrated improvements in behavior with limited resources (time and training) needed to implement behavioral plans. Additional casecontrolled research is needed to demonstrate the feasibility and utility of FBA as a strategy for multidisciplinary treatment planning and intervention. In the study of Bosch et al (2009), health care is increasingly provided by teams of health professionals rather than by individual doctors. For decision makers, it is imperative to identify the critical elements for effective teams to transform health care workplaces into effective team-based environments. The authors reviewed the research literature published between 1990 and February 2008. The available research indicated that teams with enhanced clinical expertise improved professional performance and had mixed effects on patient outcomes. Teams with improved coordination had some positive effects on patient outcomes and limited effects on costs and resource utilization. The combination of enhanced expertise and coordination only showed some limited effect on patient outcomes. The authors conclude that enhancement of the clinical expertise is a

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potentially effective component of improving the impact of patient care teams. The added value of coordination functions remained unclear. Overall, current studies provide little insight into the underlying mechanisms of teamwork. In the study of Day (2006), his literature clearly demonstrates that workplace relationships between nurses can have a major impact on morale. The literature specifically examines the importance of social and group interaction and its effect on the concept of morale and suggests the stability of the group's cohesion depends upon morale. These findings provide a basis for the positive regard for social interaction and its role in teamwork and group goal achievement. For example, in one quantitative study (n = 221) exploring nursing turnover, one of the important variables was found to be kinship relationships. The effect of the group and the social relationships that form among nurses is crucial in how nurses view their workplaces in terms of achievement and teamwork. Working relationships extended beyond those developed within a "craft" group, with nurses showing improved morale when professional relationships with physicians were viewed as positive. The results showed that when supportive professional relationships with medical staff were present nurses reported that their work was more meaningful and satisfying, their professional knowledge and skills were utilized, and they thought less often of quitting. Additionally, the study suggested that absenteeism and turnover were significantly reduced as a result of a strong sense of community and work-group relationships fostered by the nurse manager.

Local Studies

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The research of Truong (2007) attempted to do a descriptive case study and qualitative analysis of the factors of personality, culture, and environment that contributed to the success of seven top female lay presidents of seven colleges and universities in Metro Manila. An interview guide, was used to ask president and two administrators in each school and documentation. Findings 1. Personality factors. Four common factors that contributed to the seven respondents success: relevant professional training; knowledge, competencies, and task-related and people-related skills; excellent personal traits, moral values, and positive attitudes and extension work experiences. Other personality factors of some respondents are family relations, professional involvement, alumnae relations, and the strong ambition for the success of institution. 2. Cultural factors. Most of the respondents have strong school culture with clear vision, effective mission and core values as the coherent direction for school members to follow as displayed in their family ties, loyalty to institutions, and developed patriotism.. Other cultural factors of some respondents focus on the field of women or direct service for the poor and have inculcated culture in the curriculum and Asian Studies subjects. One respondent has been promoting indigenous Filipino culture and languages through longterm plans. Another respondent has received an award from UNESCO. 3. Institutional environment. Most of the respondents were supported by their Board of Governance, by loyal, competent school members, good performance of students, and fair resources. All of them have effective leadership styles provided intrinsic and extrinsic xi motivations to make them highly satisfied with their jobs. One respondent practices transformation leadership, and develops spirituality. Seven respondents create healthy learning environments with staff development program, and budget support. One respondent, is to

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allow her faculty to teach at other schools in order to explore and learn more new things. Majority of the respondents overcame the difficulties of changing old patterns, financial problems, faculty pirated to attain success by their excellent personal examples, by the cooperation of their people, and sharing burden with others, providing scholarships to students, revising the curriculum, developing new programs, improving facilities, physical plant, and getting support from alumnae, and international organizations. 4. External environment: Most of them overcame difficulties by updating knowledge of management, using information technology, adapting the need of the global market, getting consultants from experts, support from other educational institutions, networking, and alumnae; acting on the challenges by available resources, improving teaching and learning. Two respondents are very successful because they responded to the need of the global market for nurses. One respondent has survived through regular financial support from international funding agencies. Value formation and development of traditional culture were addressed by some respondents. 5. Indicators of success.. All of the respondents have attained the recognition for the quality of education from various accrediting agencies; successful students performances show in passing board exams; and good evaluation for professional growth. Most of them revised and re-aligned curriculum offerings. promoted the values and attitudes of students, created good image and status with green, clean and safe environment, modernized physical plant, up-to-date facilities and Organization Development. xii Conclusion 1. There are the commonalities of seven respondents success: personality factors include relevant professional training; knowledge, competencies and task-related and people related skills; excellent personal traits, moral values, and positive attitudes and extension work experiences. The

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differences of success in personality level depend on their relationship to their institutions and the expertise of some respondents. 2. There are also similarities in cultural factors with clear vision, effective mission and core values as the coherent direction with family ties, loyalty to institutions, and patriotism. The exceptions of success in cultural factors depend on the nature of some institutions and their vision and philosophy. 3. The successful respondents have support from their Board of Governance and the cooperation of their loyal, competent employees, good performance of students, and good resources under their effective leadership. 4. For the success in external environment, seven respondents commonly face the rapid changes in the era of globalization by updating their knowledge, using Information Technology and getting support from networks and alumni. In addition, two respondents were successful because of responding the global market of nurses. Recommendations 1. Sharing experiences and expertise from successful executives to other educational executives and students of Educational Leadership and Management 2. Similar researches for top female executives in other geographical areas and for male executives to find out how different male and female educational leaders in leading the institutions. According to the study of Delos Reyes (2007), the role of the nurse supervisor is very important, because of his/her ability to influence the atmosphere within the clinical nursing supervision group. His study aimed to present and interpret nurse supervisors' different ethical decision-making styles. This study utilized hermeneutic interpretation of three studies on nurse supervisors' different ethical decision-making styles. It was found out that the significance of the nurse supervisor's ethical decision-making style is reflected in the awareness of their responsibility for creating a relationship with the

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supervisee. The supervisors focus on ensuring safety, integrating theoretical knowledge and clinical practice, willingness and preparedness to supervise on the substance of nursing, sharing the supervisees' feelings and challenging them, reflecting on the content of clinical nursing supervision as well as promoting justice and integrity in clinical nursing supervision. The interpretation highlights the importance of the nurse supervisor's style for the outcome of clinical nursing supervision, as they are role models for the supervisees. There is a need for further research to explore the advantages and disadvantages of nurse supervisors' different ethical decision-making styles, especially in relation to the influence of clinical nursing supervision on the quality of care and various support systems.

Synthesis Many empirical studies are carried out to explore the issue on clinical nursing manage as a factor which influences the nurses morale. The focus of this research is to associate the management style of nurse managers as perceived by nurse managers and staff nurses. The present study is designed to investigate the and its effect to the morale of the staff nurses. The researcher also found it easy to conduct the selected hospitals in Batangas Province because it is where she spent most of his time.

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CHAPTER III METHODS AND PROCEDURES OF THE STUDY This part presented the methods used in the study. It contained the different techniques, methods and procedures, employed in gathering the needed data such as research design, subject of the study, instrument, procedures and data analysis.

Research Design The study will utilize descriptive-comparative design. The descriptive method defines the present phenomena. This is the most appropriate method on inquiry about the present status and condition of a particular phenomenon. Concepts and procedures of general description, analysis and classification are discussed and illustrated in considerable detail (Polit and Beck, 2008). This study will determine the effect of management style to the morale of nurses in selected hospitals in Batangas Province.

Sampling Design and Sample The study will use quota sampling to attain the total number of respondents and will have two sets of respondents; the nurse managers and staff nurses of selected hospitals in Batangas Province.

Research Instrument The study will adapt the Blake and Mouton Mangerial Grid Leadership Assessment Questionnaire. The first part of the questionnaire will include the demographic profile of the respondents in terms of age, gender, civil status, length of

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clinical experience. The second part will be the managerial grid leadership assessment questionnaire. The third part will include the effects of management style to the morale of nurses.

Data Gathering Procedure After some readings of related studies and literature, the researcher planed and framed the topic problem for this research. The researcher started to formulate his questionnaire to be used in this study. A letter of request will be submitted to the dean of graduate school of St. Jude asking permission to conduct the study. After approval of topic, the researcher will proceed in gathering data by interviews and survey among the recipients.

Statistical Treatment of Data

To answer the demographic profile of the respondents, frequency, percentage and ranking were used.
a.

Percentage. This is the numerical analysis to describe or compare the magnitudes of the given data. It could be defined as part per hundred part of the total sampling population.

FORMULA: P=

f
x 100 N

Where: P = Percentage

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F N
b.

= Frequency = Total Number of Respondents

Frequency. It is the actual number of the respondents to a specific question or item in the questionnaire. It also referred to the number of tally marks for each category or item.

c.

Ranking. This is used to determine the order or decreasing or increasing magnitude of variables. The largest frequency is ranked 1, the second 2, and so on down to the last rank. (Tan, 2006, p. 185)

2.

To measure the management style and effects to morale of nurses, mean scores will be used.
a.

Weighted Mean. A method which is used to interpret data from responses provided. This response is interpreted according to point scale that was used to determine the weighted mean response on the terms provided in the questionnaire.

FORMULA: wf WM = N Where: WM wf = Weighted mean = sum of the product of the frequency and their corresponding weights. N = Total Number of Respondents.

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To test the significant difference between the two groups of respondents, T-Test will be used.

a.

T-Test. A nonparametric alternative to the two sample t-test which is based solely on the order in which the observations from the two samples fall. To interpret the results, the following was used

Option 5 4 3 2 1

Range 4.50 5.00 3.50 4.49 2.50 3.49 1.50 2.49 1.00 1.49

Interpretation Highly Affected Affected Moderately Affected Not Affected Highly Not Affected

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