Leadership exam 4
What is the nurses role when a client is actively seizing
-Ensure that rescue equipment, including oxygen, an oral airway, and suction equipment, is at the bedside. A saline lock can be placed for intravenous access if the client is at high risk for experiencing a generalized seizure. -Inspect the client's environment for items that can cause injury in the event of a seizure and remove items that are not necessary for current treatment. -Assign the client to a room close to the nurses' station -Assist the client who is at risk for a seizure with ambulation and transfers to reduce the risk of injury. -Advise all caregivers and family not to put anything in the client's mouth in the event of a seizure. -Advise all caregivers and family not to restrain the client in the event of a seizure. Instead, ensure safety by lowering the client to the floor if he is not in bed, protecting his head, removing nearby furniture, providing privacy, putting him on his side with his head slightly flexed forward if possible, and loosening clothing to prevent injury and promote dignity -In the event of a seizure, stay with the client, protect the client from injury, and call for help. -Note the duration of the seizure and the sequence and type of movement. -After a seizure, explain what happened to the client, and provide comfort, understanding, and a quiet environment for recovery. -Document the seizure in the client's record along with any precipitating behaviors and a description of the event (movements, any injuries, length of seizure, aura, postictal state), and report it to the provider.
what must a prescription for restraints include
-The treatment must be prescribed by the provider based on a face-to-face assessment of the client. In an emergency situation in which there is immediate risk to the client or others, the nurse can place a client in restraints. The nurse must obtain a prescription from the provider as soon as possible in accordance with agency policy (usually within 1 hr) -The prescription must specify the reason for the restraint, the type of restraint, the location of the restraint, how long the restraint can be used, and the type of behaviors demonstrated by the client that warrant use of the restraint -The provider must rewrite the prescription, specifying the type of restraint, every 24 hr or the frequency of time specified by facility policy -PRN prescriptions for restraints are not permitted Restraints should: Never interfere with treatment Restrict movement as little as is necessary to ensure safety Fit properly Be easily changed to decrease the chance of injury and to provide for the greatest level of dignity
What are the QSEN competencies
1. Patient centered care 2. Teamwork and collaboration 3. Evidenced-based practice 4. Quality improvement 5. Safety 6. Informatics
Conflict aftermath
1.Conflict aftermath There is always conflict aftermath—positive or negative. If the conflict is managed well, people involved in the conflict will believe that their position was given a fair hearing. If the conflict is managed poorly, the conflict issues frequently remain and may return later to cause more conflict
Felt conflict
1.Felt conflict occurs when the conflict becomes emotionalized. Felt emotions include hostility, fear, mistrust, and anger. It is also referred to as affective conflict. It is possible to perceive conflict and not feel it (e.g., no emotion is attached to the conflict and the person views it only as a problem to be solved). A person also can feel the conflict but not perceive the problem (e.g., he or she feels conflict is present but may be unaware of its roots).
latent conflict
1.Latent conflict implies the existence of antecedent conditions such as short staffing and rapid change. In this stage, conditions are ripe for conflict, although no conflict has actually occurred, and none may ever occur. Much unnecessary conflict could be prevented or reduced if managers examined the organization more closely for antecedent conditions. For example, change and budget cuts almost invariably create conflict. Such events, therefore, should be well thought out so that interventions can be made before the conflicts created by these events escalate.
Manifest conflict
1.Manifest conflict, also called overt conflict, action is taken. The action may be to withdraw, compete, debate, or seek conflict resolution. Individuals are uncomfortable with or reluctant to address conflict for many reasons. These include fear of retaliation, fear of ridicule, fear of alienating others, a sense that they do not have the right to speak up, and past negative experiences with conflict situations.
Perceived conflict
1.Perceived conflict Perceived or substantive conflict is intellectualized and often involves issues and roles. The person recognizes it logically and impersonally as occurring but does not feel emotionally involved in it. Sometimes, conflict can be resolved at this stage before it is internalized or felt. In an environment characterized by open communication and mutual support, many conflicts can be resolved simply by pointing out that a potential or actual problem exists.
What actions need immediate dismissal
1.Termination/dismissal: Many people terminate their employment voluntarily before reaching this step, but the manager cannot count on this happening. Termination should always be the last resort when dealing with poor performance. However, if the manager has given repeated warnings and rule breaking or policy violations continue, then the employee should be dismissed. Although this is difficult and traumatic for the employee, the manager, and the unit, the cost in terms of managerial and employee time and unit morale of keeping such an employee is enormous.
What are the steps of termination
1.Verbal warning: includes an informal meeting between the employee and the manager to discuss the broken rule or performance deficiency. The manager suggests ways in which the employee's behavior might be altered to keep the rule from being broken again. Often, an informal reprimand is all that is needed for behavior modification. 2.Written warning: If rule breaking recurs after verbal admonishment, the manager again meets with the employee and issues a written warning about the behaviors that must be corrected. This written warning is very specific about what rules or policies have been violated, the potential consequences if behavior is not altered to meet organizational expectations, and the plan of action that the employee is expected to take to achieve expected change. The employee's signature does not imply that the employee agrees with everything on the report, only that it has been discussed. The employee must be allowed to respond in writing to the reprimand, either on the form or by attaching comments to the disciplinary report; this allows the employee to air any differences in perception between the manager and the employee. One copy of the written admonishment is then given to the employee, and another copy is retained in the employee's personnel file 3.Suspension: If the employee continues the undesired behavior despite verbal and written warnings, the manager should remove the employee from his or her job for a brief time, generally a few days to several weeks. Such a suspension gives the employee the opportunity to reflect on the behavior and to plan how he or she might modify the behavior in the future. 4.Termination/dismissal: Many people terminate their employment voluntarily before reaching this step, but the manager cannot count on this happening. Termination should always be the last resort when dealing with poor performance. However, if the manager has given repeated warnings and rule breaking or policy violations continue, then the employee should be dismissed. Although this is difficult and traumatic for the employee, the manager, and the unit, the cost in terms of managerial and employee time and unit morale of keeping such an employee is enormous.
what action requires written warnings
1.Written warning: If rule breaking recurs after verbal admonishment, the manager again meets with the employee and issues a written warning about the behaviors that must be corrected. This written warning is very specific about what rules or policies have been violated, the potential consequences if behavior is not altered to meet organizational expectations, and the plan of action that the employee is expected to take to achieve expected change. The employee's signature does not imply that the employee agrees with everything on the report, only that it has been discussed. The employee must be allowed to respond in writing to the reprimand, either on the form or by attaching comments to the disciplinary report; this allows the employee to air any differences in perception between the manager and the employee. One copy of the written admonishment is then given to the employee, and another copy is retained in the employee's personnel file
behavior change
: This is reserved for serious cases of dysfunctional conflict. Educational modes, training development, or sensitivity training can be used to solve conflict by developing self-awareness and behavior change in the involved parties.
ombudsperson
: investigate the grievance filed by one party against another and to ensure that individuals involved in conflicts understand their rights as well as the process that is used
Scope of substance use disorder in registered nurses
About 1 in 10, or 10% to 15% of all nurses, may be impaired or in recovery from alcohol or drug addiction. Several factors have been identified as increasing the risk of substance abuse in nurses, including staffing shortages, increased patient acuity and assignment ratios, demanding administrators and physicians, rotating shifts, and long work hours. Nurses turn to drugs or alcohol for many reasons. Co-occurring disorders, such as depression and posttraumatic stress disorder, and genetics contribute to substance abuse as does fatigue and stress Health-care providers may be more susceptible to chemical impairment because of ingrained beliefs that they are invulnerable. They see themselves as caregivers and not patients; in addition, they are more apt to self-diagnose and self-medicate. Compounding the problem is that health-care providers have relatively easy access to controlled substances and other drugs of abuse and institutional controls for storing and distributing narcotics may be inadequate, facilitating the improper removal of drugs from floor stock, waste, or even from a patient's medication supply
Which agencies respond to a disaster
Agencies that have a role in disaster response include the Federal Emergency Management Agency (FEMA), CDC, U.S. Department of Homeland Security (DHS), American Red Cross, Office of Emergency Management (OEM), and the public health system To receive assistance with an MCI, a state must request assistance. Federal programs include the National Incident Management System, National Domestic Preparedness Organization, and Strategic National Stockpile
Destructive negotiation tactics
All too often, negotiations fail because one or both parties get sidetracked by personal issues unrelated to the negotiation at hand. Ridicule: The goal in using ridicule is to intimidate others involved in the negotiation Inappropriate questioning: an authority figure asking about an unrelated event to the negotiation to disarm their peer Sadness: Seeing sadness may bring about feelings of empathy and compassion, making it difficult for the negotiator to focus on objective gains Helplessness: Because nursing is a helping profession, the tendency to nurture is high, and managers must be careful not to lose sight of the original intent of the negotiation—securing adequate resources to optimize unit functioning
Interactionist theory of organizational conflict
Although conflict was still considered primarily dysfunctional, it was believed that conflict and cooperation could happen simultaneously. The interactionist theorists of the 1970s, however, recognized conflict as a necessity and actively encouraged organizations to promote conflict as a means of producing growth. From this, one can infer that some conflict is desired, although its extent is difficult to know. Perhaps more important than the quantification of conflict is the impact this conflict has on the organization
Collaborating
An assertive and cooperative means of conflict resolution that results in a win-win solution All parties set aside their original goals and work together to establish a supraordinate or priority common goal. In doing so, all parties accept mutual responsibility for reaching the supraordinate goal Although conflict is a pervasive force in healthcare organizations, only a small percentage of time is spent in true collaboration Collaboration is rare when there is a wide difference in power between the groups and individuals involved. Many think of collaboration as a form of cooperation, but this is not an accurate definition. In collaboration, problem-solving is a joint effort with no superior-subordinate, order-giving-order-taking relationships. True collaboration requires mutual respect; open and honest communication; and equitable, shared decision-making powers. Collaboration enhances a person's participation in decision-making to accomplish mutual goals and therefore is the best method to resolve conflict to achieve long-term benefits. Because it may involve others over whom the manager has no control and because its process is often lengthy, it may not be the best approach for all situations.
Examples of bullying
Backstabbing Swearing/yelling/shouting Making threats Calling names Invading personal space Threatening gestures Constant eye contact Withholding information/controlling communication Innuendo Exclusion and silence Refusing to help Finding fault Racial slurs Sabotage Unfair assignments Gossip Humiliation Social isolation/exclusion Physical harm Cyber bullying
know what safety checks to perform at the beginning of shift
Checking that equipment is accurately set and functioning properly (oxygen, nasogastric suction) at the beginning and during each shift
What are the potential physical complications of a restrained client
Deaths by asphyxiation and strangulation have occurred with restraints The client can also experience complications related to immobility, such as pressure ulcers, urinary and fecal incontinence, and pneumonia
constructive discipline and destructive discipline
Discipline can also be a powerful motivator for behavior change because it has an educational component as well as a corrective one. Positive or constructive discipline seeks to explain to the employee what positive actions the employer is looking for, opting to focus on the wanted behaviors and outcomes instead of the problems. The idea is to provide motivation for employees to improve. When discipline is constructive, it can assist employee growth. In fact, the word discipline comes from the Latin term disciplina, which means teaching, learning, and growing. In constructive discipline, punishment may be applied for improper behavior, but it is carried out in a supportive and corrective manner. Employees are reassured that the punishment given is because of their actions and not because of who they are. Positive discipline reframes the entire discussion to one in which the employee and employer are working together to achieve their goals—rather than one in which an employee is being punished for their actions. This can have the effect of improving employee morale, even in the face of needing to improve performance.
group norms
Group norms often influence individual behavior and make self-discipline difficult. Group norms are group-established standards of expected behavior that are enforced by social pressure. The leader, who understands group norms, can work within those norms to mold group behavior. This modification of group norms, in turn, affects individual behavior and thus self-discipline.
What happens if a conflict is not handled properly
If the conflict is managed poorly, the conflict issues frequently remain and may return later to cause more conflict
intergroup conflict
Intergroup conflict occurs between two or more groups of people, departments, and organizations. An example of intergroup conflict might be two political affiliations with widely differing or contradictory beliefs or nurses experiencing intergroup conflict with family and work issues.
internal vs external emergency
Internal emergencies occur within a facility and include loss of electric power or potable (drinkable) water, and severe damage or casualties related to fire, weather (tornado, hurricane), explosion, or terrorist act Readiness includes safety and hazardous materials protocols, and infection control policies and practices. External emergencies affect a facility indirectly and include weather (tornado, hurricane), volcanic eruptions, earthquakes, pandemic flu, chemical plant explosions, industrial accidents, building collapses, major transportation accidents, and terrorist acts (including biological and chemical warfare) Readiness includes a plan for participation in community-wide emergencies and disasters.
interpersonal conflict
Interpersonal conflict happens between two or more people with differing values, goals, and beliefs.
intrapersonal conflict
Intrapersonal conflict occurs within the person. It involves an internal struggle to clarify contradictory values or wants. For managers, intrapersonal conflict may result from the multiple areas of responsibility associated with the management role. Managers' responsibilities to the organization, subordinates, consumers, the profession, and themselves sometimes conflict, and that conflict may be internalized. Being self-aware and conscientiously working to resolve intrapersonal conflict as soon as it is first felt is essential to the leader's physical and mental health.
confrontation
Many times, team members inappropriately expect the manager to solve their interpersonal conflicts. Managers instead can urge subordinates to attempt to handle their own problems by using face-to-face communication to resolve conflicts, as e-mails, answering machine messages, and notes are too impersonal for interpersonal conflicts that can have significant conflict aftermath.
What is the nurse role with marginal employees
Marginal employees often make tremendous efforts to meet competencies yet usually manage to meet only minimal standards at best Coaching: With this strategy, the manager attempts to improve the marginal employee's performance through active coaching and counseling. Although this strategy holds the greatest promise for personal growth in the marginal employee, there is no guarantee that the employee's performance will improve or that the end results will justify the time and energy costs to the manager. The strategy chosen for dealing with the marginal employee often varies with the level of the manager. Ignoring the problem is a passive response and is more frequently used by low-level managers. High-level managers tend to employ the more active measures of coaching, transferring, and dismissal.
consequences of workplace violence for nurses
Medical consequences of workplace violence may include an increase in employee health complaints such as neck pain, musculoskeletal complaints, acute pain, fibromyalgia, and cardiovascular symptoms Emotional/psychological consequences may include increased mental distress, sleep disturbances, fatigue in women and lack of vigor in men, depression and anxiety, and adjustment disorders, all of which increase the risk of absenteeism and turnover. When nurses experience any kind of violence directed at them, it becomes more difficult to remain committed to patient-centered care as well as to maintain ethical boundaries. Physical and psychological insults result in health-care worker distraction, which contributes to a higher incidence of medication errors and negative patient outcomes. Other damaging consequences include moral distress, burnout, and job dissatisfaction, which can lead to increased turnover. Zero tolerance should be the expectation because bullying and incivility impact turnover, productivity, and quality of care As a result of these negative worker and patient outcomes, The Joint Commission has called for better protections against workplace violence. It also created "Sentinel Event Alert 59," which addresses violence—physical and verbal—against health-care workers to help health-care organizations better recognize workplace violence directed toward health-care workers and how to better prepare staff to address it, both in real time and afterward
What is mobbing
Mobbing: employees gang up on an individual
reentry program for drug abuse
Most nurses successfully return to work following a treatment program, and this generally takes 1 year. Often, the conditions that the employee has successfully changed his or her lifestyle and will submit to random drug tests must be met before the employee can be allowed to return to work. Informing clients of the nurse's history would violate the nurse's right to confidentiality. A reduced work assignment is not typically required
Health promotion of a young adult - middle age adult
Motor vehicle crashes are a leading cause of death and injury to adults Occupational injuries contribute to the injury and death rate of adults. High consumption of alcohol and suicide are also major concerns for adults Remind clients to drive defensively and to not drive after drinking alcohol Reinforce teaching about the long-term effects related to high alcohol consumption Ensure home safety with smoke and carbon monoxide detectors, fire alarms, well-lit and uncluttered staircases Be attuned to behaviors that suggest the presence of depression or thoughts of suicide Referring clients as appropriate and encourage counseling Teach diving and water safety Encourage clients to become proactive about safety in the workplace and in the home Discuss dangers of social networking and the Internet Ensure that clients understand the hazards of excessive sun exposure and the need to protect the skin with the use of sun-blocking agents and protective clothing
negotiation
Negotiations take place with conflict resolution and with day-to-day operations Because negotiators must be willing to make compromises, they should, however, choose a starting point that is high but not ridiculous. This selected starting point should be at the upper limits of their expectations, realizing that they may need to come down to a more realistic goal. For instance, let us say that you would really like four additional full-time RN positions and a full-time clerical position budgeted for your unit. You know that you could make do with three additional full-time RN positions and a part-time clerical assistant, but you begin by asking for what would be ideal. It is almost impossible in any type of negotiation to escalate demands; therefore, the negotiator must start at an extreme but reasonable point. It also must be decided beforehand how much can be compromised and what is an acceptable bottom line
What signs and symptoms would a nurse with a chemical dependency demonstrate at the workplace
No one wants to suspect that their coworker is chemically impaired. If you suspect a coworker is impaired, you are obligated to notify your immediate supervisor. Failure to do so may result in discipline to your own license as you did not come forward to protect the public. Changes in Personality or Behaviors: Display 25.4, 706 Increased irritability with patients and colleagues, often followed by extreme calm Social isolation; eats alone, avoids unit social functions Extreme and rapid mood swings Euphoric recall of events or elaborate excuses for behaviors Unusually strong interest in narcotics or the narcotic cabinet Sudden dramatic change in personal grooming or any other area Forgetfulness ranging from simple short-term memory loss to blackouts Change in physical appearance, which may include weight loss, flushed face, red or bleary eyes, unsteady gait, slurred speech, tremors, restlessness, diaphoresis, bruises and cigarette burns, jaundice, and ascites Extreme defensiveness regarding medication errors Changes in Job Performance Difficulty meeting schedules and deadlines Illogical or sloppy charting High frequency of medication errors or errors in judgment affecting patient care Frequently volunteers to be medication nurse Has a high number of assigned patients who complain that their pain medication is ineffective in relieving their pain Consistently meeting work performance requirements at minimal levels or doing the minimum amount of work necessary Judgment errors Sleeping or dozing on duty Complaints from other staff members about the quality and quantity of the employee's work Disappears from the work area for long periods of time or may spend long periods of time in the bathroom or around the medication cart
nursing responsibilities for restraints
Obtain a prescription from the provider for the restraint. If the client is at risk for harming self or others and a restraint is applied prior to consulting the provider, ensure that notification of the provider occurs in accordance with facility protocol Offer food and fluids Provide with means for hygiene and elimination Monitor vital signs Provide range of motion of extremities Follow agency polices regarding restraints, including the need for signed consent from the client or guardian Review the manufacturer's instructions for correct application Conduct neurosensory checks every 2 hr or according to facility policy to include: Circulation Sensation Mobility Remove or replace restraints frequently Pad bony prominences Use a quick-release knot to tie the restraint to the bed frame Ensure that the restraint is loose enough for range of motion and has enough room to fit two fingers between the device and the client Regularly assess the need for continued use of restraints Never leave the client unattended without the restraint Behavior or precipitating events that make the restraint necessary Attempts to use alternatives to restraints and the client's response Level of consciousness Type of restraint used and location Education/explanations to the client and family Exact time of application and removal Client behavior while restrained Type and frequency of care (range of motion, neurosensory checks, removal, integumentary checks) The client's response when the restraint is removed Medication administration Seclusion and/or restraints must never be used for Convenience of the staff Punishment for the client Clients who are extremely physically or mentally unstable Clients who cannot tolerate the decreased stimulation of a seclusion room In general, seclusion and restraints should be prescribed for the shortest duration necessary and only if less restrictive measures have proved insufficient. They are for the physical protection of the client, or the protection of other clients or staff. Use of restraints is a difficult adjustment for the client and family. The client loses his freedom and can be embarrassed and experience low self-esteem and depression. The nurse can allay some of the concerns by explaining the purpose of the restraint and that the restraint is only temporary
What contributes to an older adults increased risk for falls
Older adult clients can be at an increased risk for falls due to decreased strength, impaired mobility and balance, endurance limitations, and decreased sensory perception. Other risk factors include decreased visual acuity, generalized weakness, orthopedic problems (diabetic neuropathy), urinary frequency, gait and balance problems (Parkinson's disease, osteoporosis, arthritis), and cognitive dysfunction. Adverse effects of medications (orthostatic hypotension, drowsiness) also can increase the risk for falls. Clients are at greater risk for falls when multiple risk factors are present.
who should the nurse manager confront when seeing bullying of a new nurse
Person bullying the new nurse - zero policy
How to prevent falls
Prevention of client falls is a major nursing priority. Nurses should assess all clients admitted to health care facilities for risk factors related to falls. Based on assessment findings, the nurse should implement preventative measures. Be- be sure the client knows how to use the call light respond - respond to call lights in timely manner orient - orient client to the setting place - place clients at risk for falls near the nursing station ensure - ensure tables are within patient reach maintain- maintain bed in low position keep- keep bed rails up and the bed in a low position for clients who are sedated. •Avoid using full side bed rails for clients who get out of bed or attempt to get out of bed without assistance •Provide the client with nonskid footwear •Keep the floor free from clutter with a clear path to the bathroom (no scatter rugs, cords, furniture) •Ensure adequate lighting •Keep assistive devices (glasses, walkers, transfer devices) nearby after validation of safe use by the client and family •Educate the client and family/caregivers on identified risks and the plan of care •Lock wheels on beds, wheelchairs, and carts to prevent the device from rolling during transfers or stops •Use chair or bed sensors to alert staff of independent ambulation for clients at risk for getting up unattended •Report and document all incidents per agency policy •To evaluate incidence of client falls, a formula based on 1,000 client days can be used. Using this formula, a facility can compare its fall rates to other facilities
How to triage after a mass casualty event
RED/Emergent (Class 1): Highest priority is given to clients who have life‑threatening injuries but also have a high possibility of survival once they are stabilized YELLOW/Urgent (Class 2): Second-highest priority is given to clients who have major injuries that are not yet life-threatening and usually can wait 45 to 60 min for treatment GREEN/Nonurgent (Class 3): The next highest priority is given to clients who have minor injuries that are not life-threatening and do not need immediate attention BLACK/Expectant (Class 4): The lowest priority is given to clients who are not expected to live and will be allowed to die naturally. Comfort measures can be provided, but resuscitation is not provided
What is RACE
Rescue, Alarm, Contain, Extinguish
Third-party consultation
Sometimes, managers can be used as a neutral party to help others resolve conflicts constructively.
Structure change
Sometimes, managers need to intervene in unit conflict by transferring or discharging people. Other structure changes may be moving a department under another manager, adding an ombudsman, or putting a grievance procedure in place. Often, increasing the boundaries of authority for one member of the conflict will act as an effective structure change to resolve unit conflict. Changing titles and creating policies are also effective techniques.
Health promotion of a toddler
Suffocation: ● Teach "back to sleep" mnemonic and always place infants on back to rest. ● Keep plastic bags out of reach. ● Make sure crib mattress fits snugly and that crib slats are no more than 2 3/8 inches apart. ● Teach parents that it is recommended for infants to sleep in a crib or bassinet. Co-sleeping in bed with parents increases the risk for injury. ● Never leave an infant or toddler unattended in the bathtub. ● Do not place anything in crib with infant. ● Remove crib toys, such as mobiles, from over the bed as soon as the infant begins to push up. ● Keep latex balloons away from infants and toddlers. ● Fence swimming pools and use a locked gate. ● Begin swimming lessons when the child's developmental status allows for protective responses, such as closing her mouth under water. ● Teach caregivers CPR and Heimlich maneuver. ● Keep toilet lids down and bathroom doors closed. Poisoning: Keep houseplants and cleaning agents out of reach. ● Inspect and remove sources of lead, such as paint chips, and provide parents with information about prevention of lead poisoning. ● Place poisons, paint, and gasoline in locked cabinet. ● Keep medications in child-proof containers and locked up. ● Properly dispose of medications that are no longer used or are out of date. Falls: Keep crib and playpen rails up. ● Never leave the infant unattended on a changing table or other high surface. ● Use gates on stairs, and ensure windows have screens. ● Restrain according to manufacturer's recommendations and supervise when in high chair, swing, stroller, etc. Discontinue use when the infant or toddler outgrows size limits. ● Place in a low bed when toddler starts to climb Motor vehicle injury: Place infants and toddlers in a rear-facing car seat until 2 years of age or until they exceed the height and weight limit of the car seat. They can then sit in a forward‑facing car seat. ● Use a car seat with a five-point harness for infants and children. ● All car seats should be federally approved and be placed in the back seat. Burns: ● Test the temperature of formula and bath water. ● Place pots on back burner and turn handle away from front of stove. ● Supervise the use of faucets. ● Keep matches and lighters out of reach. ● Cover electrical outlets.
tenants of self discipline
The highest level and most effective form of discipline is self-discipline. When employees feel secure, validated, and affirmed in their essential worth, identity, and integrity, self-discipline is forthcoming Group norms often influence individual behavior and make self-discipline difficult. Group norms are group-established standards of expected behavior that are enforced by social pressure. The leader, who understands group norms, can work within those norms to mold group behavior. This modification of group norms, in turn, affects individual behavior and thus self-discipline. The leader plays an active role in developing an environment that promotes self-discipline in employees. It is impossible for employees to have self-control if they do not understand the acceptable boundaries for their behavior nor can they be self-directed if they do not understand what is expected of them. Therefore, managers must discuss clearly all written rules and policies with subordinates, explain the rationale for the existence of the rules and policies, and encourage questions.
What is the nurse's responsibility about PPE
The nurse should ensure that appropriate equipment is available and that isolation procedures are properly carried out by all health care team members. Staff education on infection prevention and control is a responsibility of the nurse.
avoidance conflict
The parties involved are aware of a conflict but choose not to acknowledge it or attempt to resolve it Avoidance may be indicated in trivial disagreements, when the cost of dealing with the conflict exceeds the benefits of solving it, when the problem should be solved by people other than you, when one party is more powerful than the other, or when the problem will solve itself The greatest problem in using avoidance is that the conflict remains, often only to reemerge later in an even more exaggerated fashion
Soothing one party
This is a temporary solution that should be used in a crisis when there is no time to handle the conflict effectively or when the parties are so enraged that immediate conflict resolution is unlikely. Waiting a few days allows most individuals to deal with their intense feelings and to be more objective about the issues. Regardless of how the parties are soothed, the manager must address the underlying problem later or this technique will become ineffective.
Oxygen therapy in the home
Use and store oxygen equipment according to the manufacturer's recommendations Place a "No Smoking" sign in a conspicuous place near the front door of the home. A sign can also be placed on the door to the client's bedroom. Inform the client and family of the danger of smoking in the presence of oxygen. Family members and visitors who smoke should do so outside the home Ensure that electrical equipment is in good repair and well grounded Replace bedding that generates static electricity (wool, nylon, synthetics) with items made from cotton Keep flammable materials, such as heating oil and nail polish remover, away from the client when oxygen is in use Follow general measures for fire safety in the home, such as having a fire extinguisher readily available and an established exit route should a fire occur
Standard precautions
Use of standard precautions by all members of the health care team should be enforced. Employees who are allergic to latex should have non-latex gloves (e.g., nitrile or vinyl) made available to them. A latex-free environment is provided for clients who have a latex allergy. Many facilities avoid the use of latex products unless there is no other alternative.
What constitutes workplace violence
Verbal abuse is the number-one form of workplace violence against nurses Many episodes of violence directed at health-care workers come from patients and/or their families. Aggressive behavior is common in patients suffering from mental health issues or dementia, especially when the need for psychiatric services exceeds the supply. In addition, patient-to-nurse violence is more likely when patients must stay in the emergency department (ED) for long hours—or even days. Violent behavior also can be a symptom of head injuries or may occur when people come out of anesthesia. Family members and loved ones may lash out when they are upset about the lack of appropriate care or because of the pain the patient is suffering. Medical consequences of workplace violence may include an increase in employee health complaints such as neck pain, musculoskeletal complaints, acute pain, fibromyalgia, and cardiovascular symptoms Emotional/psychological consequences may include increased mental distress, sleep disturbances, fatigue in women and lack of vigor in men, depression and anxiety, and adjustment disorders, all of which increase the risk of absenteeism and turnover. When nurses experience any kind of violence directed at them, it becomes more difficult to remain committed to patient-centered care as well as to maintain ethical boundaries. Physical and psychological insults result in health-care worker distraction, which contributes to a higher incidence of medication errors and negative patient outcomes. Other damaging consequences include moral distress, burnout, and job dissatisfaction, which can lead to increased turnover. Zero tolerance should be the expectation because bullying and incivility impact turnover, productivity, and quality of care As a result of these negative worker and patient outcomes, The Joint Commission has called for better protections against workplace violence. It also created "Sentinel Event Alert 59," which addresses violence—physical and verbal—against health-care workers to help health-care organizations better recognize workplace violence directed toward health-care workers and how to better prepare staff to address it, both in real time and afterward
Responsibility charting
When ambiguity results from unclear or new roles, it is often necessary to have the parties come together to delineate the function and responsibility of roles. If areas of joint responsibility exist, the manager must clearly define such areas as ultimate responsibility, approval mechanisms, support services, and responsibility for informing.
What drugs are most often diverted
opioid pain relievers, such as Vicodin or OxyContin; stimulants for treating attention deficit hyperactivity disorder, such as Adderall, Concerta, or Ritalin; and central nervous system depressants for relieving anxiety, such as Valium or Xanax, are the three classes of prescription drugs mostly commonly misused Stimulants Central Nervous System Depressants Opioids
What class of fire extinguishers are used for what fires
•Class A Combustibles: Paper, wood, upholstery, rags, and other types of trash fires •Class B: Flammable liquids and gas fires •Class C: Electrical fires
What is PASS
•P: Pull the pin. A: Aim at the base of the fire •S: Squeeze the handle •S: Sweep the extinguisher from side to side, covering the area of the fire