Leadership Chapter 7 +

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?

listening

4. TJC attributes 80% of all medial errors to:

poor hand-off communication

Although there are many advantages to the use of electronic medical records (EMRs), disadvantages do exist. Which of the following is a disadvantage to the use of EMRs? A. Patient confidentiality B. Portability C. Identification of patients in need of screenings D. Quality of care evaluation

ANS: B Page: 104 A. This is incorrect. Security safeguards are in place to protect patient confidentiality. B. This is correct. Moving data from an EMR to a location other than the provider's practice or the health-care facility can be difficult and may require physical printing of the information. C. This is incorrect. The ease of quickly identifying patients in need of screenings is a benefit. D. This is incorrect. The ability to evaluate the quality of care is a benefit.

A new nurse is reviewing social media use. Which of the following tips should be followed? A. Social media is a personal choice with a different set of standards. B. Do not make remarks about patients, even if they are not identified. C. Ask permission from patients before taking pictures or videos at work. D. Connecting with patients on social media for follow-up can be beneficial.

ANS: B Page: 106 A. This is incorrect. Professional standards are the same with social media as any other circumstances. B. This is correct. Disparaging remarks about patients, employers, or coworkers should not be made on social media, even if they are not identified. C. This is incorrect. Do not take videos or pictures of any patients on any personal devices. D. This is incorrect. Professional boundaries should be maintained even online. Online contact with patients blurs professional boundaries.

During shift change, the day shift nurse reports to the night shift nurse that the patient has no known drug allergies and the last potassium came back low. Which of the following best describes the part of the I PASS the BATON tool used in this scenario? A. Patient B. Situation C. Actions D. Safety concerns

ANS: D Page: 110 A. This is incorrect. Patient communication includes patient name, identifiers, age, gender, and location. B. This is incorrect. Situation communication includes current status, code status, level of concern, recent changes, and response to treatment. C. This is incorrect. Action communication includes discussing what has been done and why. D. This is correct. Safety communication includes critical laboratory values, allergies, socioeconomic factors, and risk assessment.

A new RN on an interdisciplinary team is working at becoming a good team player. Which of the following qualities is best for an effective team player? A. Communicate positively. B. Share information that is needed by the others. C. Participate when there is something to be added. D. Actively work to solve problems.

ANS: D Page: 112 A. This is incorrect. Effective team players communicate constructively. B. This is incorrect. Effective team players share information openly and willingly. C. This is incorrect. Effective team players participate actively. D. This is correct. Effective team players work at being problem-solvers.

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? a. The charge nurse is unavailable to help the nurses when they have questions about policies b. Some staff are afraid to ask particular charge nurses for help for fear of retribution c. The use of acronyms is confusing to staff members who are new to the unit d. All the above

D

5. Implicit bias affects our understandings 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? a. Implicit bias forms during a lifetime b. Implicit bias can influence clinical decision making and treatment c. Implicit bias contributes to an individual's social behavior d. All the above

D

9. ISBARR provides framework for communicating critical client information. ISBARR is an acronym for:

Introduce, situation, background, assess, recommend, readback

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 MOST important to share with the oncoming nurse?

Introducing the client and his or her diagnosis to the oncoming nurse

7. Social media issue. 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 social media?

Nurses should never post protected health information on a social media site

10. Who is responsible for accepting, transcribing, and implementing physician orders?

Professional nurse

A registered nurse (RN) is caring for a patient who has refused chemotherapy. As the health-care team discusses the reasons why the patient should receive chemotherapy, the RN forcefully restates the patient's wishes. Which type of communication does this scenario best demonstrate? A. Assertive communication B. Aggressive communication C. Interpersonal communication D. Transactional communication

ANS: A Page: 100 A. This is correct. Assertive communication involves standing up for oneself and one's patients and their rights without violating the rights of others. B. This is incorrect. Aggressive communication involves forcing one's wishes or ideas on others. C. This is incorrect. Interpersonal communication provides an opportunity to reflect, construct personal knowledge, and develop collective knowledge. D. This is incorrect. Transactional models of communication consider all individuals to be in the process of sending, receiving, and interpreting messages at the same time.

Which of the following best indicates that an interprofessional health-care team can work together effectively? A. The team has a process in place for sharing information. B. Each team member understands his or her role. C. Team members create goals for the patients according to their specialty and then share with the team. D. Members provide care to a diverse group of patients.

ANS: A Page: 113 A. This is correct. Effective teams need to have a process in place for sharing information. B. This is incorrect. Team members should understand both their own role and the roles of others. C. This is incorrect. Members should work together to create and achieve patient goals. D. This is incorrect. Patient diversity does not indicate effectiveness of the team. However, the team should all have a common group of patients.

An RN is conducting discharge teaching for a patient when he realizes the patient does not have the skills needed to access and use health information. Which of the following most likely describes the barrier this patient is facing to effective communication in health care? A. Cultural diversity B. Cultural competency of health-care providers C. Low health literacy D. Communication skills of health-care providers

ANS: C Page: 101 A. This is incorrect. Cultural diversity as a barrier impedes the ability to access, understand, and utilize health-care services and information. B. This is incorrect. Lack of cultural competency of health-care providers results in a failure to identify and consider cultural practices. C. This is correct. Low health literacy results in a lack of skills needed to access and use health information. D. This is incorrect. Communication skills become a barrier when health-care providers lack the skills needed for effective interpersonal communication.

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:

jot down notes about the situation presented to you, review the patient's history, focus your assessment, and determine what you need for the patient

Which of the following is a rule of netiquette to follow when sending professional e-mails to others in the organization? A. Proofread e-mails before sending them. B. Send the information to anyone who might find it helpful. C. Online behavior requires different rules from in-person behavior. D. Capitalize important words to reinforce points.

ANS: A Page: 105 A. This is correct. Always proofread e-mails before sending them. B. This is incorrect. Send information only to those who need it. C. This is incorrect. The same rules of behavior should be followed online as when dealing with individuals face-to-face. D. This is incorrect. Do not write in all capital letters, as this suggests anger.

A nurse checks her work e-mail for policy updates and spends about 5 minutes deleting spam messages. Spam messages are described in transactional models as which of the following? A. Senders of communication B. Noise C. Time wasters D. Receivers of communication

ANS: B Page: 101 A. This is incorrect. Linear models of communication label individuals who communicate as "senders." B. This is correct. Noise is anything that interrupts communication, which includes spam and instant messaging in the electronic environment. C. This is incorrect. The concept of time in transactional models of communication acknowledges how communication changes through time. D. This is incorrect. Linear models of communication label individuals who receive communication as "receivers."

The use of electronic health records (EHRs) was mandated by the year 2013. Which of the following is the main purpose of computerized record keeping in health care? A. Ease of finding and correcting errors B. Reduction of paper and conservation of resources C. Safe, quality patient care D. Ease of searching records

ANS: C Page: 103 A. This is incorrect. Although EHRs increase the ease of finding and correcting errors, this is not the main purpose. B. This is incorrect. Although reducing the use of paper and other resources is helpful, this is not the main purpose of EHRs. C. This is correct. Providing safe, quality patient care is the main purpose of EHRs. EHRs reduce errors, increase safety, and improve quality of care. D. This is incorrect. Although EHRs do make it easier to search records, this is not the main purpose of EHRs.

Which of the following is the most important reason why the computer on wheels (COW) or workstation on wheels (WOW) gained popularity in health care? A. Cost savings B. Convenience C. Patient safety D. Decreased use of workstations in the nurses station

ANS: C Page: 104 A. This is incorrect. Adding workstations created an expense. B. This is incorrect. Although the COWs and WOWs allow for real time documentation, convenience was not the most important reason for using them. C.This is correct. Computers located only in the nurses station, away from patients, meant documentation was not completed in a timely manner. Additionally, the time spent away from the patients was an increased risk to patient safety. D. This is incorrect. Workstations were utilized more often after the EMRs, and nurses found themselves waiting for one to be free.

Which of the following is a good recommendation for effective communication between shifts? A. Always end with identifying the patient and health-care provider. B. Consistently use the same process for hand-off communication. C. Use a worksheet to keep track of data provided during hand-off communication. D. Use walking rounds to facilitate communication during hand-offs.

ANS: C Page: 106 A. This is incorrect. Begin hand-off communications with identifying the patient, room number, age, gender, and health-care provider. B. This is incorrect. Not every unit uses the same process so it is better to organize the details into a worksheet. C. This is correct. Using a worksheet provides a reference for later and it ensures no important safety information is missed. D. This is incorrect. Walking rounds may be useful on some units, but larger units may find them to be inefficient.

An RN calls the health-care provider to report a change in patient condition. During the conversation the RN describes what has already been done for the patient. Which section of the ISBARR communication does this best describe? A. Situation B. Assessment C. Background D. Recommendation

ANS: C Page: 110 A. This is incorrect. The situation section briefly describes the current problem. B. This is incorrect. The assessment section provides current assessment data. C. This is correct. The background section includes medical, nursing, and family information relevant to the problem, including what steps have already been taken. D. This is incorrect. The recommendation section provides recommendations for future interventions.

There are several benefits to using EHRs. Which of the following is most specifically designed to reduce medication errors? A. Barcode scanning of laboratory labels B. Connection to monitoring equipment, such as telemetry and blood pressure cuffs C. Data tracking D. Barcode scanning of patient identification bracelets

ANS: D Page: 103 A. This is incorrect. Barcode scanning of laboratory labels reduces errors in laboratory testing. B. This is incorrect. A connection to equipment monitoring the patient does facilitate documentation of vital signs, but it does not directly reduce medication errors. C. This is incorrect. Although tracking data through time is an advantage, it does not specifically reduce medication errors. D. This is correct. Barcode scanning of patient identification bracelets and medications are examples of improved safety measures that are directly related to reducing medication errors.

An RN is using a WOW for charting at the patient's bedside. Which of the following is an important reminder for the RN to keep in mind? A. Ensure the WOW has an extension cord. B. Position the WOW between the RN and the patient to facilitate communication while charting. C. Turn the WOW off when not using it. D. Log off when not using the WOW.

ANS: D Page: 104 A. This is incorrect. The WOW should either be plugged in or have a fully charged battery. B. This is incorrect. The WOW should not be positioned between the RN and patient. The RN should be able to make eye contact with the patient and make a personal connection. C. This is incorrect. The WOW should be plugged in when not in use to ensure a full battery, but it is not necessary to turn it completely off. D. This is correct. To protect patient confidentiality, the RN should log completely out of the WOW when not using it.

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 patient's EMR and sees no info regarding his recent hospital stay. How could this have happened?

EMRs are usually practice or hospital specific, so the patient's info will not be accessible to Jane