NUR 4341 Exam 1 Review

Organizational Theory

The systematic analysis of how organizations and their component parts act and interact. Organizational theory is based largely on the systematic investigation of the effectiveness of specific organizational designs in achieving their purpose. Organizational theory development is a process of creating knowledge to understand the effect of identified factors, such as (1) organizational culture; (2) organizational technology, which is defined as all the work being carried out; and (3) organizational structure or organizational development.

Therapeutic Relationship

There are no definite lines separating the therapeutic relationship from under- involvement or overinvolvement; instead, it is a gradual transition.

Patient Protection and Affordable Care Act

This act was designed to eliminate: -Precondition screenings -Premium insurance fees -Policy cancellation by the insurer when a person becomes seriously ill -Annual lifetime coverage gaps This act also: -Creates price controls -Enables side-by-side comparison of policies by consumers -Creates an Internet-based health insurance exchange -Includes private insurance and health care providers, but allows for subsidies for purchasing of insurance

Veracity

Truthfulness, honesty (giving someone all the information before they make a decision)

Provider of Care

Typically seen in acute care or hospital settings. This role is what most people recall when thinking about nurses. Examples of interventions performed in the provider role are medication administration, bed baths, and intravenous catheter placement.

Lewin's Change Model

Unfreezing, changing, refreezing

Describes why the organization is involved in its particular work.

Vision

Avoiding

Withdrawing, is very unassertive and uncooperative, because people who avoid neither pursue their own needs, goals, or concerns immediately nor assist others to pursue theirs. Avoidance as a conflict-management style only ensures that conflict is postponed, and conflict has a tendency to escalate in intensity when ignored.

Systems Theory

-A common framework in health care for analysis and application of organizational theory -A system is an interacting collection of components or parts that together make up an integrated whole -Individual components of any system interact with each other and with their environment.

Transactional Theories

-A superior "traditional boss" makes the decisions with little or no input from subordinates. -Relies on the power of organizational position and formal authority to reward and punish performance -Contingent reward: leader tries to motivate the self-interest of followers by offering external rewards to generate conformity with expectations -Management by exception: criticism, negative feedback, and negative reinforcement are used

Trait Theory

-Also known as the "Great Man Theory" from Aristotle's philosophy of being "born" with leadership traits -Leaders have traits that inspire others toward a common goal. -Drive, motivation, integrity, and confidence are common traits. -Leads to the question "Are these traits innate or learned?"

Bureaucracy Structure

-An administrative concept imbedded in how organizations are structured -Characterized by formality, low autonomy, hierarchy of authority, rule dominated environment, division of labor, specialization, centralized decision making, high control -High control and clear labor division promote efficiency and productivity -Can lead to frustration and delays due to low autonomy on the front line

Information Required for Informed Consent

-An explanation of the treatment or procedure to be performed and the expected results of the treatment or procedure -Description of the risks involved -Benefits that are likely to result because of the treatment or procedure -Options to this course of action, including absence of treatment -Name of the person(s) performing the treatment/procedure -Statement that the patient may withdraw his or her consent at any time

Transformational Theories

-Arose when globalization and other factors caused organizations to reestablish late in the past millennium -Bass (1990) and Bennis & Nanus (2007) are examples of this type of theory. -Leader attends to the needs and motives of followers -Leader acts as a role model by: inspiring followers through displayed optimism, providing intellectual stimulation, encouraging follower creativity

Functional Structure

-Arrange departments and services according to specialty -This organizational structure tends to support professional expertise and encourage advancement. -It may result in discontinuity of patient care services -Delays in decision making can occur if a silo mentality develops within groups. That is, issues that require communication across functional groups typically must be raised to a senior management level before a decision can be made.

Situational Contingency Theory Application to Practice

-Assess each situation -Determine appropriate action based on the people involved

Assignment versus Delegation

-Assignment is defined as the "routine care, activities and procedures that are within the authorized scope of practice of the RN or LPN/VN or part of the routine function of the UAP" -Delegation occurs when delegatees are requested to perform a specific nursing task, activity, or procedure outside their traditional role, have completed additional education and training, and have validated competency in the delegated area

Modes of Conflict Resolution

-Avoiding -Accommodating -Competing -Compromising -Collaborating

Attributes Characterizing Change Agents

-Commitment to a better way -Courage to challenge power bases and norms -Go beyond role, take initiative, think outside the box -Persona -Caring -Humility -Sense of humor

Defining Elements of Vision

-Communicates purpose and values -Provides direction regarding expected behavior -Provides inspiration/motivation -Reflects the ideal image of the organization projected 5-10 years into the future -Provides a focal point for strategic planning

Nurse Managers must be Competent In:

-Critical thinking -Reasoning and judgment -Planning -Decision-making -Collaborating -Working with interdisciplinary teams -Leadership

Family and Medical Leave Act of 1993

-Developed to create job security -Allows for up to 12 weeks of unpaid leave when an employee: is caring for a new infant (birth or adoption), has a serious illness, needs to care for a spouse, son, daughter, or parent with a serious illness *President George W. Bush signed an amendment to increase unpaid leave up to 26 weeks if caring for a member of the U.S. Armed Forces. *Eligibility requirements include working for at least 12 months (at least 1250 hours) during the preceding 12-month period and providing a 30-day notice (unless it is an emergency situation). *The employer may require use of personal or sick leave during family leave.

Malpractice

-Duty owed the patient -Breach of the duty owed -Foreseeability -Causation -Injury -Damages

Transformational Theory Application to Practice

-Experiment with systems redesign -Empower staff and create enthusiasm for practice -Promote scholarship of practice at the patient-side

Situational Contingency Theory

-Fiedler's (1967) Contingency Model & Vroom and Yetton's (1973) Normative Decision-Making Model are examples of theories with an expanded perspective. -Degree of trust and respect between leaders and follower -Clarity of goals and expectations -Complexity of problems -Leader rewards followers to motivate and exert influence -Adaptability -Elimination of obstacles to goal achievement -Increased staff satisfaction

Stages of Conflict

-Frustration -Conceptualization -Action -Outcome

ADA Protects a Person Who:

-Has a physical or mental impairment that substantially limits one or more of the major life activities of the individual -Has a record of the impairment -Is regarded as having such an impairment (ADA Amendments Act of 2008)

Change Agent

-How care is provided -Where care is provided -When care is provided -To whom care is provided -Why care is provided

Key Traits of a Manager

-Identifies recurring problems -Embodies a persistent and vigilant behavior -Communicates to effectively maintain common loyalty among the team

Employment at Will and Wrongful Discharge

-In the past, employees were free to accept or not accept a job at will, and employers were free to hire or terminate for any reason. -Laws for exceptions were developed.

What are key areas defined as essential knowledge for nurse leaders in the social policy statement of the ANA?

-Increasing public knowledge of health promotion and disease prevention -Understanding complexities in health care, including costs and accessibility -Supporting research and evidence-based practice and appropriate use of technology -Providing knowledge about the need for expansion of self-care for patients, families, groups, and specific populations

Categories of Conflict

-Intrapersonal -Interpersonal -Organizational

Nurse Leader Roles

-Leader -Manager -Collaborator -Change Agent

Autocratic Leadership Model Characteristics

-Leader has complete command -Useful in short-term projects that are routine or risky in nature -Mistakes are blamed on an individual rather than a faulty process

Bureaucratic Leadership Model Characteristics

-Leader strictly follows organizational rules and policies -Manager makes decision -Useful when safe work conditions and quality are required

Leadership Role in Patient Care and Safety: Chief Nursing Officers (CNOs)

-Major influence on patient safety because nurses are the primary source of protection against potential harm to patients -Creates a culture of support in order to receive the best performance from the nurses -Exceptional communication is essential to achieving a culture of support. -Must be committed to their own leadership development

Laissez-Faire Leadership Model Characteristics

-Manager allows staff to make decisions -Useful when employees are loyal, experienced, and intellectual -May lead to problems resulting from a lack of leadership

Professional Health Care Tools Provided by the TJC

-National Patient Safety Goals (NPSGs) -"Do not use" terms, symbols, or abbreviations -Sentinel events (i.e., an unanticipated event, not related to the patient's illness, that occurs in the health care setting and results in death or serious physical or psychological injury)

Leadership Role in Health Care Policy: Chief Nursing Officers (CNOs)

-Often the voice of nursing-related policy issues. -Most policy work done by CNOs is internally focused; however, focusing on external policies is important. -Healthcare, employee, and public policy issues are especially important. -The CNO must be informed about policies affecting nurses and patients.

Managerial Duties Include

-Planning -Organizing -Staffing -Controlling

Key Traits of a Leader

-Possesses the ability to articulate and communicate effectively -Has a vision for future possibilities -Finds opportunities for improvement even in difficult circumstances -Uses creativity or research to find solutions -Adapts to new situations -Thinks critically -Uses experience and knowledge to make decisions and weigh risks

Examples of the measures related to nursing care that are reviewed and reported are:

-Pressure ulcer prevention or prevalence -Ventilator-associated pneumonia -Skill mix (providers on the team, including the RN, LPN, and/or nursing aids or techs) -Voluntary staff turnover (by choice rather than involuntary due to things such as health issues) -Nursing care hours

Age Discrimination in Employment Act of 1967

-Protects employees from age discrimination in the workplace -Mandatory retirement no longer allowed

Nursing Roles

-Provider of Care -Educator -Counselor -Patient Advocate

The Joint Commission (TJC)

-Provides accreditation and monitoring/surveying for health care organizations (every 3 years). If an organization meets TJC standards, they are also deemed to meet CMS standards. -The focus is patient safety and providing professional health care tools

Defining Elements of Mission

-Reiterates the purpose and values of the organization (products or services, market) and those of the organization's primary stakeholders -Asks "What are the responsibilities of the organization toward these stakeholders?" -Asks "What are the main objectives supporting the organization in accomplishing its mission?"

What is the purpose of the Nurse's Social Policy Statement?

-Sets autonomy and accountability standards for nurses -Provides an understanding of how nurses connect with society -Provides an understanding of nurse accountability to members of society who receive care from nurses

Defining Elements of Philosophy

-States the philosophical values and beliefs of the organization -Identifies potential consumers -Identifies the needs of the target market -Identifies the environment or setting in which services will be provided -Explains resources that the organization will use in the provision of its services

Agencies Focusing on Health Care Quality and Safety

-The National Quality Forum -The Joint Commission -American Nurses Association: National Quality Indicators -Core Measures

How does the nursing profession ensure quality of nurse performance according to Nursing's Social Contract?

-The nursing profession expects nurses to care for all individuals regardless of their social, cultural, or economic status. -The nursing profession and nurses are mindful of society's trust in them, so they self-regulate and act responsibly. -The nursing profession has regulatory standards and specific requirements for nursing licensure and testing. -The nursing profession promises society that nurses will be properly educated and practice within a code of ethics to provide quality care.

Which necessary information is included in the mission statement?

-The stakeholders -Why the organization exists -The organization's purpose and values

Purpose of Professional Code of Ethics for Nursing

-To inform the public of the minimum standards acceptable for conduct by members of the health care profession -To help the community understand a discipline's professional responsibilities -To outline the major ethical issues or considerations of the profession -To provide guidelines for professional practice to the members of the profession -To serve as a guide for self-regulation of the profession

Modern Leadership Theories

-Trait theory -Situational contingency theory -Transformational theories -Transactional theories

Leadership Role in the Health Care Delivery System: Chief Nursing Officers (CNOs)

-Typically responsible for the largest number of employees in their organization. -Method of leading nursing services leads to the organization's success. -The support of the work environment for bedside nurses determines the effectiveness of the nurses. -Nurses who are treated well perform their jobs better. -Future leaders will focus on communication, coaching, and developing rather than on traditional controlling and supervising methods.

National Quality Forum (NQF)

-Was designed to create ways to measure and report health care quality. -The Centers for Medicare & Medicaid Services (CMS) developed a policy to no longer pay for problems ("never events") that are the result of poor practice and should not occur under health care provider care.

Role Strain may be Shown By:

-Withdrawal from interaction -Reduced involvement with colleagues -Decreased commitment to the mission and team

Key Traits of a Follower

-Yields to leader when he or she is doing the right thing -Has the courage and integrity to talk to a leader who is doing something wrong or headed in the wrong direction -Uses assertiveness to accomplish outcomes -Asks questions if directions are unclear or not patient-focused -Works well with others, adding value to the work -Carries their own work and helps others when able -Speaks and acts with integrity

Havelock's 6 Step Change Model

1. Building a relationship 2. Diagnosing the problem 3. Acquiring relevant resources 4. Choosing the solution 5. Gaining acceptance (including communication) 6. Stabilizing the innovation and generalizing self-renewal • Emphasizes planning stage • Resistance to change can be overcome with careful planning and staff inclusion • Change agent encourages participation

Kotter's Eight Step Model for Change

1. Create urgency 2. Form a powerful coalition 3. Create a vision for change 4. Communicate the change vision 5. Remove obstacles 6. Create short term wins 7. Build on the change 8. Anchor the changes in the culture

5 Provisions of the ADA

1. Employment: defines purpose of the act and who is qualified under the act as disabled 2. Public services: covers services, programs, and activities of public entities and public transportation 3. Public accommodations and services operated by private entities: prohibits discrimination against the disabled in areas of public accommodations, commercial facilities, and public transportation services 4. Telecommunications: intended to make telephone services accessible to individuals with hearing or speech impairments 5. Miscellaneous provisions: certain insurance matters; incorporation of this act with other federal and state laws

Myths about Leaders

1. Everyone can be a leader 2. People who are at the top are leaders

According to the social policy statement of the ANA, the following six assumptions on the part of professional nurses and nursing leaders create the framework that supports the contract between the profession and society:

1. Humans manifest an essential unity of mind, body, and spirit. The nurse should care for the whole person, not just the physical person. People have spiritual, emotional, mental, and physical aspects as needs. 2. Human experience is contextually and culturally defined. (People have different context in growth and development whether geographically, experientially, or culturally. Society trusts nurses to relate to all people regardless of their contextual differences.) 3. Health and illness are human experiences. The presence of illness does not preclude health, nor does optimal health preclude illness. (Health, wellness, and illness are not separate from each other; they are parts that make up the whole of a person.) For example, this is why patient education is such a valuable intervention; it is an attempt to prevent illness. 4. The relationship between the nurse and patient occurs within the context of the values and beliefs of the patient and nurse. 5. Public policy and the health care delivery system influence the health and well-being of society and professional nursing. 6. Individual responsibility and interprofessional involvement are essential.

According to the social policy statement of the ANA, nursing leadership plays an essential role in six key areas of health care.

1. Organization, delivery, and financing of quality health care 2. Provision for the public's health 3. Expansion of nursing and health care knowledge and appropriate application of technology 4. Expansion of health care resources and health policy 5. Definitive planning for health policy and regulation 6. Duties under extreme conditions

Five Rights of Delegation

1. Right task 2. Right circumstance 3. Right person 4. Right direction/communication 5. Right supervision/evaluation

Role Expectations

A a set of rules about how individuals should behave. Individuals carry out role expectations because of their position, not because of who they are as a person. The diversity of roles requires different levels of skills, knowledge, caring, and education. Patients are more comfortable if they understand the job title of each of their care providers so they understand the provider's role based on their position in society. An example is the difference in appropriateness of an intervention for a nurse versus a physical therapist. A nurse may administer medications; however, it would not be appropriate for a physical therapist to do so.

Second Order Change

A change whereby the basic structure and functioning of a system has changed involving a spontaneous transformation or logical jump "out of" a system. (Unplanned)

Americans with Disabilities Act of 1990

A significant civil rights act that provides employers, employee agencies, labor organizations, and joint-labor management committees with orders or rules to eliminate discrimination in the workplace for people with disabilities. The effect of the act is that those with disabilities are not overlooked for employment, advancement, or compensation unless they are not qualified or not able to do the job.

Management Definition

Ability to plan, direct, control, and evaluate people and other resources to reach organizational goals

Autonomy

Ability to take care of oneself and make one's own decisions

The ADA Amendments Act of 2008

Allows for a broader definition and disallows impairments that are not permanent (6 months duration or less) and/or are minor.

Collaborating

Although the most time-consuming approach, is the most creative stance. It is both assertive and cooperative, because people work creatively and openly to find the solution that most fully satisfies all important concerns and goals to be achieved. Collaboration involves analyzing situations and defining the conflict at a higher level where shared goals are identified and commitment to working together is generated.

Organizational Conflict

Arises when discord exists about policies and procedures, personnel codes of conduct, or accepted norms of behavior and patterns of communication. Some organizational conflict is related to hierarchical structure and role differentiation among employees.

Overinvolvement

Boundary crossings, boundary violations, and professional sexual misconduct.

Transactional Theory Application to Practice

Can lead to positive organization outcomes, such as met deadlines

The Change Process

Changes to a system may be anticipated and planned, or they may be sudden and unexpected. Planned change, or first-order change, is about doing what you currently do in a better way. Second-order change involves completely disrupting the way things are done by redesigning and reconceptualizing how to do things.

Matrix Structure

Complex and designed to reflect both function and service in an integrated organizational structure. In a matrix organization, the manager of a unit responsible for a service reports to both a functional manager and a service or product line manager. For example, a director of pediatric nursing could report to both a vice president for pediatric services (the service-line manager) and a vice president of nursing (the functional manager).

Role Theory

Considers behavioral expectations based on roles, role expectations, and role behavior.

Flat Structure

Decentralized decision making replaces the centralized decision making typical of functional structures. Providing staff with authority to make decisions at the place of interaction with patients is the hallmark of a flat organizational structure. Magnet® hospitals have recognized the benefits of decentralized decision making and its impact on both nursing satisfaction and patient outcomes.

Roles

Defined as expectations held by other individuals about what an individual should do in a given position. For example, a nurse should administer medications, but a restaurant server should not.

Mission

Defines an organization's primary purpose. An organization creates a strategic plan based on the primary purpose stated in the mission statement.

Philosophy (Core Values)

Defines the beliefs that determine how an organization plans to achieve its mission.

Legal Capacity

Determined by age and competency

Trait Theory Application to Practice

Develop self-awareness of traits useful in self-development and in seeking employment that matches traits (drive, motivation, integrity, confidence, cognitive ability, and task knowledge)

American Nurses Association: National Quality Indicators

Developed quality guidelines for the delivery of patient care. These guidelines focus on: -Staffing resources -Staff mix -Nursing hours (provides data, monitors hours worked) -Links between nursing care and patient outcomes -Developing core measures

Underinvolvement

Distancing, disinterest, and neglect, and it can be detrimental to the patient and the nurse.

Nonmaleficence

Do no harm

Beneficence

Doing good or causing good to be done; kindly action

Followership Definition

Each member contributes optimally and agrees to follow a leader or manager in a team that utilizes the best clinical decision-making and actions to achieve clinical or organizational outcomes.

Paternalism

Entails a partial decision being made for someone, rather than that person making his or her own decisions. This usually occurs when the decider does not have sufficient data or expertise.

The American Nurses Association's (ANA) publication Nursing: Scope and Standards of Practice

Establishes the foundation for nursing competencies. It is an important resource for every registered nurse. This resource helps define the scope of practice for nurses at all levels. Included are 17 standards of practice regarding competent nursing practice and professionalism within all levels, settings, populations, and specialties.

Negligence

Failure to use such care as a reasonably prudent and careful person would use under similar circumstances. It applies to both the manager and the direct care nurse. Many experts equate it with carelessness, a deviation from the care that a reasonable person would deliver. If managers are careless in their responsibilities, they could be found negligent. The same applies to the direct care nurse.

Justice

Fairness

Fidelity

Faithfulness; loyalty (keeping agreements and promises)

The National Labor Relations Act of 1935

Federal legislation regarding collective bargaining or unionization. It was created to define and protect collective bargaining. The regulatory agency for this legislation is the National Labor Relations Board (NLRB).

Shared Governance

Goes beyond participatory management through the creation of organizational structures that facilitate nursing staff having more autonomy to govern their practice. Accountability forms the foundation for designing professional governance models. To be accountable, authority to make decisions concerning all aspects of responsibilities is essential. This need for authority and accountability is particularly important for nurses who treat the wide range of human responses to wellness states and illnesses. Organizations in which professional autonomy is encouraged have demonstrated higher levels of staff satisfaction, enhanced productivity, and improved retention.

Role Stress

How a person responds to or copes with the demands of their role

Legal Responsibilities of the Nurse Manager

However, he or she is liable for decisions relating to duty assignments and supervision of care, and negligence in providing direct patient care.

Collaborator

In the performance of their duties and responsibilities, nurses collaborate with: -Patients and families -Health care providers -Community members -Government agencies -Individuals and organizations

Accountability

In the process of delegation, the superior transfers his duties or responsibilities to his subordinate and also gives the necessary authority for performing the required task. This term means answering for the end result.

Role Behavior

Influenced by role expectations. For example, a nurse should be courteous and polite to patients, not rude. Another example is that a nurse should keep patients informed about their plan of care, and explain procedures and/or medications to the patient.

Compromising

Involves both assertiveness and cooperation on the part of everyone and requires maturity and confidence. Negotiating is a learned skill that is developed over time. A give-and-take relationship results in conflict resolution, with the result that each person can meet his or her most important priorities as much of the time as possible.

Reveals the main objectives of the organization and what goods or services it offers.

Mission

Moral Distress

Most often occurs when one is faced with situations in which two ethical principles compete.

Educator

Nurses teach patients and their families about health promotion and disease prevention, and help them cope with their condition. An example would be a nurse teaching a patient about heart failure and ways to prevent exacerbation.

Chaos Theory

Nursing in certain organizations is too "stuck" and thus too unresponsive and unable to adapt to the influences of rapid change.

Intrapersonal Conflict

Occurs within a person when confronted with the need to think or act in a way that seems at odds with one's sense of self. Questions often arise that create a conflict over priorities, ethical standards, and values.

Ways to Reduce Role Strain and Stress

Offering appreciation, ensuring role clarity, implementing training for role changes, monitoring acuity and staff levels, and discussing signs of role strain or stress with staff.

Comprehension

Patients must clearly understand the possible consequences of their refusal

Accommodating

People neglect their own needs, goals, and concerns (unassertive) while trying to satisfy those of others (cooperative). This approach has an element of being self-sacrificing and simply obeying orders or serving other people.

Competing

People pursue their own needs and goals at the expense of others. Sometimes people use whatever power, creativeness, or strategies that are available to "win." Competing may also take the form of standing up for your rights or defending important principles, as when opposition to mandatory overtime is voiced.

Identifies how the organization makes decisions to develop trust with stakeholders.

Philosophy

Nurse Practice Act

Provides this protection and oversight. It sets the scope of practice for the nursing profession and is guided individually by each state. These regulations include advanced practice nurses (APN), registered nurses (RN), and licensed practical nurses or vocational nurses (LPN/VN). A few states have separate acts for RNs and LPNs/LVNs. The act also sets educational and examination requirements, and provides licensing for nurses who have met these requirements.

Core Measures

Quality indicators designed by TJC and NDNQI to improve practice and ensure positive patient outcomes. Include care related to: -Acute myocardial infarctions (AMI) -Congestive heart failure (CHF) -Pneumonia -Stroke -Immunizations

Responsibility

Refers to the obligation and dependability to accomplish work.

Role Strain

Role stress and strain have been linked with absenteeism, or absence from work, which is a way to stay away from an undesirable situation without actually leaving a job. An increased occurrence of absences may indicate role stress or strain, and often precedes resignation.

Vision

Speaks to the future of an organization and how the organization wishes to be perceived now and in the future.

First Order Change

Temporary or superficial changes within a system that do not alter the basic organization of the system itself. (Planned) *Unfreezing, moving, and refreezing

Rogers' Innovation Decision Process Change Theory

The 5 Stages are as follows: 1. Knowledge 2. Persuasion 3. Decision 4. Implementation 5. Confirmation *Useful for individual change

Informed Consent

The authorization by the patient or the patient's legal representative to do something to the patient; it is based on legal capacity, voluntary action, and comprehension.

Service-Line Structure

The functions necessary to produce a specific service or product are brought together into an integrated organizational unit under the control of a single manager or executive.

Interpersonal Conflict

The most common type of conflict and transpires between and among patients, family members, nurses, physicians, and members of other departments. Conflicts occur that focus on a difference of opinion, priority, or approach with others.

Patient Advocate

The nurse acts as a change agent and risk taker to protect the patient's safety and rights. An example is a nurse who recognizes that a patient has several medications that interact with each other and reports their concern to the primary health care provider.

Counselor

The nurse gives relevant health-related advice to patients, families, and communities. May include offering emotional support, or teaching a patient or family new ways to cope with an illness. An example would be helping a patient's mother find ways to emotionally and mentally cope with her child's need for an amputation.

Voluntary Action

The patient was not coerced by fraud, duress, or deceit into allowing the procedure or treatment.

Leadership Definition

The power or ability to lead people and the use of personal traits to collaborate with patients, families, and staff