Chapter 7 Communicating With Others and Working With the Interprofessional Team (Leadership)
1. Jane is a new nurse manager who will be holding her first staff meeting tomorrow. She has learned that the staff members have not been following important patient care policies. What is the most important communication skill that she should use at the meeting? 1. Talking to the staff 2. Laughing with them 3. Listening 4. Crying
Answer: 3 Rationales: 1. Although answer 1—talking to the staff —is important, the best answer is 3. 2. Th is is incorrect. Laughing with staff can confuse the audience and cause them to misconstrue the seriousness of the message from Manager Jane. 3. Listening to staff is the most critical communication skill because it helps the manager understand the situation and the staff's rationale for their actions. It also demonstrates empathy and openness, which can lead to agreement on better adherence to the policies. 4. This is incorrect. Demonstrating emotions such as crying can confuse the audience and cause them to misconstrue the seriousness of the message from Manager Jane.
10. Who is responsible for accepting, transcribing, and implementing physician orders? 1. Unit clerk 2. Medical intern or resident 3. Professional nurse 4. Medical assistant
Answer: 3 Rationales: 1. Unit secretaries may enter orders into a patient record; however, it is the responsibility of the professional nurse to accept or sign off on the order before it is implemented. 2. Medical students may write orders; however, they must first be signed off by the faculty physician before being accepted by the professional nurse, who can then ensure they are implemented. 3. The professional nurse is responsible for accepting, transcribing, and implementing health-care provider orders. 4. Medical assistants may not accept or implement physician or healthcare provider orders without being accepted by a professional nurse.
9. ISBARR provides a framework for communicating critical client information. ISBARR is an acronym for: 1. Identify, Study, Background, Assess, Recognize, Readback 2. Issue, Situation, Better, Advise, Refer with Recommendations 3. Introduce, Situation, Background, Assess, Recommend, Readback 4. None of the above
Answer: 3 Rationales: The ISBARR is an acronym for a concise review of the client with other team members to ensure timely intervention and feedback. It includes introducing the patient, the current situation, any pertinent background that could be contributing to the situation, a clinical assessment with recommendations, and finally, a readback of the instructions or orders to ensure accuracy.
5. Implicit bias affects our understanding in an unconscious manner. A person's ability to recognize these biases can improve communication with patients and colleagues alike. Which of the following statements is true about implicit bias? 1. Implicit bias forms during a lifetime. 2. Implicit bias can influence clinical decision-making and treatment. 3. Implicit bias contributes to an individual's social behavior. 4. All of the above
Answer: 4 Rationales: 1. Implicit bias is formed during a lifetime because it is formed based on an individual's culture, which shapes attitudes, beliefs, and actions. 2. Implicit bias is automatic and subconscious during our interactions with others and can influence our clinical decision making and even treatment. 3. Implicit bias contributes to social behavior because it is derived from an individual's cultural norms. 4. All of the above
3. Bedside shift report is one of the things that Jane reviews at the staff meeting. She stresses the way she would prefer the report to start. Which of these would be the least important to share with the oncoming nurse? 1. Telling the oncoming nurse what happened on the unit during the shift 2. Introducing the client and his or her diagnosis to the oncoming nurse 3. Sharing the nurse ' s personal opinion of the client 4. Reviewing new medication orders and the medication administration record (MAR)
Answer: 2 Rationales: 1, 4. Although answers 1 and 4 should be included in the bedside shift report, they are not the best answer. 2. Introducing the client and his diagnosis ensures that the sender and receiver of the communication are familiar with the client and share pertinent care needs, nursing interventions, and client progress with goals of care. 3. This is incorrect. Personal opinions may prejudice the oncoming nurse's view of the patient, which could compromise care.
4. TJC attributes 80% of all medical errors to: 1. Poor hygiene and hand washing 2. Poor hand-off communication 3. Poor work environment 4. Lack of care
Answer: 2 Rationales: 2. Ineffective hand-off communication or miscommunication between caregivers during the transfer of care is estimated to contribute to 80% of serious medical errors. Poor hand-offs can lead to delays in treatment, inappropriate treatment, and prolonged hospital stays. Answers 1, 3, and 4 contribute to medical error but not to the same degree as ineffective hand-off communication.
7. Social media is commonly used to update friends and groups on things we have going on in our lives. Health-care organizations routinely use social media to promote medical facts, services, and recognitions. What is important for nurses to remember when deciding to post something work related on a social media site? 1. Nurses should never post protected health information on a social media site. 2. Stories with good outcomes can be posted to your media page. 3. Stories and photos can always be shared if the patient ' s name or face is not visible. 4. Posting stories on personal time is OK because the nurse is not working.
Answer: 1 Rationales: 1. Protected health information (PHI) must be protected and never shared without expressed written permission. A patient's privacy and confidentiality are paramount. 2. Nurses and other health professionals should never post stories about patients or work on social media sites. People familiar with you may easily put 2 and 2 together and surmise the situation and patient involved, which could be a breach in patient privacy. Th is could be grounds for disciplinary action. 3. Photos of patients or work areas should not be shared on social media. Although innocent, a photo may include an assignment board or other information that could inadvertently display PHI. 4. Th e time of social media posting is irrelevant; the issue is the confidentiality and privacy of the patients and the staff caring for them.
6. The EMR has many advantages compared with paper charting. It helps track data through time and can help monitor things such as preventative care in primary care practices. Jane is the office nurse in a local practice. She is meeting a new patient for the very first time who informs her that he was recently hospitalized. Jane pulls up the patient's EMR and sees no information regarding his recent hospital stay. How could this have happened? 1. The patient's discharge was so recent that it is not available yet. 2. EMRs are usually practice or hospital-specific, so the patient's information would not be accessible to Jane. 3. The patient was hospitalized out of state. 4. The patient has not signed the necessary consents to give Jane access.
Answer: 2 Rationales: 1. The emergency medical responder (EMR) is readily available at the hospital where the patient was treated. Only electronic health records (EHRs) contain a comprehensive accounting of health encounters regardless of location. 2. EMRs are usually hospital or practice-specific, so Jane would not have access to the patient's hospital EMR. Recent changes in technology and the creation of health information exchanges are making EMR information available to hospital and practice affiliates. 3. EHRs can capture patient information from anywhere within a health information exchange. 4. General consents for treatment and release of information are part of primary care practice and hospital paperwork.
8. You are working on the trauma unit today, and your new patient with a femur fracture complains of leg pain and seems a little diaphoretic and short of breath. You assess the patient and prepare to contact the surgeon. In preparation for contacting the physician, you: 1. Immediately page the MD; it could be a pulmonary embolism, and time is of the essence. You will give him the particulars when the MD arrives. 2. Wait for the MD to round on his patient because it should be within the next hour or so. 3. Medicate the patient for pain and plan to contact the MD when he rounds. 4. Jot down notes about the situation as it is presented to you, review the patient's history, focus your assessment, and determine what you need for the patient.
Answer: 4 Rationales: 1. Paging the MD to the bedside without any information may cause the MD to just add visiting the patient to his list rather than conveying the urgency of the patient ' s change in condition. 2. Placing a STAT page to the MD may get the MD there quickly; however, without the necessary information about the patient, the MD may think that you overreacted and dismiss the severity of the clinical change. 3. Rather than bother the MD, you medicate the patient for pain and continue to observe the patient. 4. Describing the situation, background, assessment, and recommendations (SBAR) is best. Reporting on situational change is designed to provide concise, pertinent, and factual information to members of the health-care team. This approach to a sudden change in patient condition allows you to communicate information, your concerns, and the need for action.
2. As Jane speaks with the team, she learns why the staff members have had difficulty following policies. Which of these would be considered barriers to effective communication? 1. Th e charge nurse is unavailable to help the nurses when they have questions about policies. 2. Some staff are afraid to ask particular charge nurses for help for fear of retribution. 3. Th e use of acronyms is confusing to staff members who are new to the unit. 4. All of the above
Answer: 4 Rationales: 1. Physical barriers—such as the absence of the charge nurse to answer questions— could prevent the staff from following policies. 2. Emotional barriers—such as a nurse's fear of retribution from a colleague—can cause nurses to seek out answers, which can delay care or compromise safety. 3. Semantic barriers—such as acronyms or nicknames—can confuse or mislead staff unfamiliar with their meaning. 4. All of the above
