NUR 473: Final Exam// Fensler

change agents

(examining personal resistance against change, poor motivation to adopt new technologies and evidence based practice strategies) •Engage people in the process that will be affected by the change •Drive and enthusiasm •Lifelong learners •Good communicators •Referent power - Catalyst for change, ability to promote change and enable change to occur, relationships built with those involved - Positively impact culture of change characteristics: •Committed to the best way of doing things •Courageous •Take initiative and think outside the box •Motivated •Caring •Humble •Sense of humor - Respected by peers and serve as role models

competent vs incompetent pts

- Competency includes the ability to understand the consequences of actions or the ability to handle personal affairs - State statutes mandate who can serve as a representative for an incompetent adult

consequences of conflict related to pt outcomes

- Conflict in an interdisciplinary team can result in better patient care when collaborative treatment decisions are based on carefully examined and combined expertise

key concepts of teamwork

- Conflict resolution - Singleness of mission: each team must have a purpose, plan, aim or intention, and team must be 100% committed// shared goals - Willingness to cooperate: members are required to to work together in a respectful and civil manner - Commitment: state of being emotionally impelled and is demonstrated when a sense of passion and dedication are committed to a project or event - Build relationships - Establish a purpose - Active listening, honesty, flexibility - Commit to resolution - Acknowledge all involved

AHRQ

(agency for healthcare research and quality) advances excellence in healthcare by producing evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable.

time management

- Considered a preventative action to help reduce the elements of stress - Is a cyclic process - Appropriate use of tools, techniques, and principles to control time spent on low-priority needs and to ensure that time is invested in activities Techniques: -Organization: promotes efficiency and productivity -Focus on goals: to do lists focus on goal achievements -Use Tools: Use the right tool to plan and prep -Time management plan: helps refocus, gain control, and use information -Emails: prioritize (what is important and urgent) -In person meeting vs. phone call vs. email

compromising/ negotiating

- Each party gives up something - Both parties must give up something equally as important - Win-lose/ win-loser

becoming a "leadership tag" in the complexity theory

-the term "tag" refers to the philosophic, patient -centered, and values driven characteristics that give an organization its personality, the "energy" that it has; a tag is sometimes called an attractor or a hallmark of culture, similar to values-although clinical organizations often perform similar procedures and fxns, an intangible sense that this particular organization has a "caring" or "good energy" attractor differs from one where the sense is the focus on efficiency and cost only.

encouraging non-hierarchical, "bottom-up" interaction among workers in the complexity theory

-those who lead, manage, and follow may have responsibilities that are not served within the traditional hierarchy-shared governance is an example of a decision-making structure in which staff at any level in the hierarchy are engaged in shaping policy and practices that affect patient care

negotiation

1)Resolve ongoing conflicts 2)Agree on steps to take 3)Bargain to protect individual or collective interests 4)Pursue outcomes that benefit mutual interests Nurses use this skill daily: -I will care for patient A today if you care for patient B tomorrow -I will float to... today, if you float next time -Many different strategies used -Use of assertive communication may be needed Direct, honest, non-threatening, aware that others are your equal

supervision principles

- Process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team - Occurs after delegation - Was it completed on time? Was it completed at a satisfactory level? Any unexpected findings I need to report/document? Any assistance required? Does this need re-assigned to someone else? - Intervene if necessary (unsafe clinical practice, untimely action, document unexpected outcomes) - Evaluate the task, identify opportunities for quality improvement activities or re-education opportunities (follow up with pts, what was their perspective?)

professional malpractice

- Professional negligence -concerns professional actions and is the failure of a person with a professional education and skills to act in a reasonable and prudent manner - Ex. Nurse administers large dose of medication due to calculation error. Patient has cardiac arrest and dies

decision making

- Requires critical thinking - Not all decisions are prompted by a problem - Must identify and select options or alternatives - Involves phases within the decision-making process - Goal: shared decision making: patients are the source of control and full partners I decision making and problem solving - Decision making is a goal-directed effort, problem solving is focused on solving an immediate problem

followership

-*each group member contributes while in collaboration with others to achieve clinical or organizational outcomes** - Often misinterpreted -One member is not considered "more important" than another -Willing to be led -Followership does not= "group think" (conforming) - Ex. Nurses serving on committees

What to do when you are given an unsafe assignment

-Discuss with a charge nurse -Request/negotiate a safe assignment -Take the concern up the chain of command ***-Write a written complaint *FAILURE TO ACCEPT AN ASSIGNMENT WITHOUT FOLLOWING THE PROPER CHAIN OF COMMAND CAN BE CONSIDERED PATIENT ABANDONMENT*

principles of QM and QI

-QM most effective in a flat, democratic organization -make decisions with those closest to the work -shared commitment: Leaders, managers, and followers must be committed to quality improvement -Goal of QM is to improve systems and processes, not to assign blame -Customers define quality -Core quality indicators: Surveys//HCAHPS -Quality improvement focuses on outcomes -The primary purpose of QI is improvement of patient outcomes, which relates to prevention of error, quality patient care, and patient satisfaction. -Decisions must be data based

LPN's CAN BE delegated the responsibility of

-monitoring findings (as input to the RN's ongoing assessment) -reinforcing client teaching from a standard care plan (re-education) -performing tracheostomy care -suctioning -checking NG tube patency -administering enteral feedings -inserting a catheter -administering medications (excluding IV meds in some states)

lateral violence

also known as horizontal abuse or horizontal hostility -occurs between individuals who are at the same level within the organization -ex: more experienced nurse can be abusive to a newly licensed nurse -common behaviors: verbal abuse, undermining activities, sabotage, gossip, withholding info and ostracism

decision making styles

autocratic (paternalistic), informed and shared decision making

conflict management styles

avoidance, accommodation, competition, compromise, collaboration

deontological theory

decision making based on obligations, duty, and what one considers to be right or wrong

mass casualty incident

catastrophic event that overwhelms local resources. Federal and state are need to help handle the crisis

strategies for creating a powerful image

networking, collegiality and coalition

persuasion power

o Based on the ability to influence or convince others to agree with one's opinion or agenda. It involves leading others to a viewpoint with data, facts, and presentation skills o (Managers try to persuade change of policy based on EBP)

collegiality

o Demands that nurses value the accomplishments of nursing colleagues and express a sincere interest in their efforts o Turning to one's colleagues for advice and support empowers them and expands one's own power base at the same text o One does not have to be a friend to everyone who is a colleague

thinking systematically in the complexity theory

principles of this theory: -thinking of the big picture -balancing short and long term actions and their effects -recognizing the dynamic, complex, and independent nature of systems// all things are connected and rely on each other -using measurable versus non-measurable data systems

developing self regulation

owning feelings of fear, anxiety, anger and sadness and acting on those feelings in a healthy manner; avoiding passive aggressive and victim responses

four agreements

set of agreements that we can make with ourselves to enhance personal growth and awareness 1. Be impeccable with your word and follow through (speak truth) 2. Do not take anything personally 3. Do not make assumptions (ask clarifying questions) 4. Always do your best

accountability

ties to your license**// accountable to ANA guidelines -determines if the actions were appropriate and provides a detailed explanation of what occurred -(rests within the decision to delegate while responsibility rests within the performance of the task)

passive delegation

when a position description contains functions that are normally performed or are an essential part of the practice of a licensed individual

cultural competence

the process in which healthcare providers continuously strive to achieve the ability to effectively work within the cultural context of a client -5 constructs: awareness, knowledge, skill, encounters, and desire

assignment

Transfer of authority, accountability, and responsibility of routine care activities and procedures within one's scope of practice -when an RN assigns a pt to another RN, both responsibility and accountability are transferred (think charge Nurse giving assignments) -when an RN delegates care to UNP, responsibility is transferred, but accountability ties back to the nurse

cultural sensitivity

- the affective behaviors in individuals —the capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people

leader

- the art of motivating a group of people to act towards achieving a common goal -the use of individual traits and abilities, in relationship with others, to interpret the environment/context where a situations is emerging and enter that situation without the use of a predesigned plan

cultural imposition

- the tendency of an individual or group to impose their values, beliefs, and practices on another culture for various reasons; "ethnocentrism"

leadership styles

Authoritative. Democratic. Laissez-faire. Transformational. Transactional. Authentic

delegator

the licensed nurse WHO IS RESPONSIBLE TO PROVIDE CLEAR DIRECTIONS WHEN A TASK IS DELEGATED

being empathetic

- Valuing differences in perspective - Showing sensitivity to the experiences of others in ways that demonstrate the ability to understand another's perspective on a situation - Engrained in what we do as nurses

quality improvement related to QSEN competencies

a. Care and organizational processes that develop and implement plans that improve health services and better meet pt needs

patient centered care

a. Caring, compassionate, culturally sensitive care that addresses clients' physiological, sociological, spiritual, and cultural needs, preferences and values

teamwork and collaboration

a. Client care that works with multidisciplinary members of the team to achieve continuity of care and positive client outcomes

conceptualization/ Perceived stage of conflict

a. Forms the basis for everyone's reactions to the frustration b. Everyone develops their own perception and ideas as to what is happening

safety

a. Minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others

action/felt stage of conflict

a. Seeking clarification about how another person views conflict b. Actions taken to resolve the conflict c. Successful resolution commonly stems from identifying a common goal that unites

outcome/ manifest stage of conflict

a. Tangible and intangible consequences -two general outcomes are considered when assessing the degree in which a conflict has been resolved: the degree to which important goals were achieved, and the nature of the subsequent relationships among those involved

evidence based practice

a. Use of current knowledge from research and credible resources to base clinical judgement and clinical care

informatics

a. Use of information technology as a communication and information gathering tool that supports clinical decision making and scientifically based nursing practice

frustration/latent stage of conflict

a. When the group perceives their goal may be blocked b. When frustrations occur, it is a cue to stop and clarify the nature and cause

focusing on emergence in the complexity theory

addresses how individuals in positions of responsibilities engage with and discover, through active organizational involvement, those networks that are best suited to respond to problems in creative, surprising, and artful ways - those who think "outside the box" -tied to unleashing constructive energy rather than constraining energy

ethical theory

analyzes varying philosophies, systems, ideas, and principles used to make judgments about what is right and wrong, good and bad two common types: utilitarianism, deontological theory

developmental safety concerns for infants and toddlers

aspiration, water safety, suffocation, poisoning, falls, motor vehicle injury, burns

conventional reume

chronological info about positions and activities

ABC framework

◦Airway -Obstructions or impending obstructions -Anaphylaxis, heavy bleeding from mouth/nose, lodged foreign body, infectious process such as epiglottitis or croup a. Establish an airway if indicated b. Recognize that 3-5 mins without oxygen causes irreversible brain damage secondary to cerebral anoxia ◦Breathing -How effective are the respirations/gas exchange? -Hypoxia, cyanosis, respiratory rate changes with confusion, severe bradypnea or tachypnea a. intervene as needed ◦Circulation -Is there enough blood and blood pressure to meet tissue demands? -Hypotension, loss of pulses either systemically or in a limb, hemorrhage a. Institute actions to reverse or minimize circulatory alteration ◦Disability (Neuro) -Is there changes in normal mental status or are there neurologic deficits? -paralysis, severe localized weakness, new confusion, increased agitation a. Implement actions to slow down development of disability ◦Exposure -Is there a hidden injury, rash, bite, or lesion? remove clients close to allow for complete assessment or resuscitation -Snake bite, bug bite, burn, allergic reaction a. Implement measures to reduce the risk for hypothermia (provide warm blankets and IV solutions or use cooling measures for clients exposed to extreme heat)

QSEN competencies

1. Patient-centered care 2. Teamwork and collaboration 3. Evidence-based practice 4. Quality improvement 5. Safety 6. Informatics

organizational accountability

Adequate resources and appropriate nurse/UNP ratios -driving principle in decision making is pt safety, so in order to accomplish that there needs to be adequate resources and safe ratios

Triage

Process used to determine the priority of treatment for patients according to the severity of a patient's condition and likelihood of benefit from the treatment

incivility

defined as an action that is rude, intimidating, and insulting includes teasing, joking, dirty looks, and uninvited touching

values needed during advocacy

•Caring •Autonomy •Respect •Empowerment

change process

•Knowledge is essential for management of change •Understanding change as related to both individuals and systems is important in order to manage it •Often consider change on an individual basis •Change occurs on the system level too •Systems can be intricate or simple •Systems have subsystems

utilitarianism

(teleological theory): decision making based on what provides the greatest good for the greatest number of individuals

collaborating

- Both parties set aside individual goals and work together to achieve new common goal - Requires mutual respect, positive communication, shared decision making - Win-win

strategies to minimize problems during decision making

- Brainstorming o Focus is on quantity not quality of ideas - Nominal Group Technique o Write down ideas, then share with group, then vote on favorite o Allows equal participation and minimizes the influence of dominant personalities o Disadvantages: time consumed and requires advance preparation - Focus Groups o Meet face to face to explore ideas o Disadvantage: logistics of getting people together , time and group dynamics- Delphi Technique o Systematically collecting/summarizing ideas from an expert panel through rounds o Goal is to achieve a consensus

decision making tools

- Decision grids o Facilitate the visualization of the options under consideration and allow comparison of options using common criteria o Contains things like (time, cost, legal considerations, equipment needed) - SWOT analysis (strengths, weaknesses, opportunities, threats) o Commonly used in strategic planning or marketing efforts

informed consent for minors

- Emancipated minors, minors seeking treatment for substance abuse or communicable diseases, and pregnant minors, court appointed representative// if any of these apply and they are a minor they are able to sign for themselves and not a parent

transformational leadership style

- Empower and inspire followers to achieve a common, long-term vision -looking to transform people into more than what they were// creating leaders to replace when current leader is gone - Role model, ethical, builds others up, inspires, motivates, communicates well, optimistic, involves followers, coaches, and mentors - Build up followers and support followership model - Partnered with followers bring opportunities to meet the goals of the quadruple aim

person centered care

- Empowering people to take charge of their own health rather than being passive recipients of services - Treat each person with dignity, compassion, and respect - Coordinate and personalize care - Support them and help develop their strengths and abilities o Measure performance and quality improvement that includes patient/caregiver feedback - Nurses can help make care more person-centered o Create a welcoming, comfortable environment o Get to know your patient - Thorough assessment that includes assessment of social determinants of health o Engage the patient, as the center of their healthcare team

effects of avoidance with conflict

- Ensures conflict is postponed- Positive side of withdrawing may be postponing an issue until a better time or simply walking away from a "no-win" situation

nurses as "gatekeepers"

- Everything goes through the nurse o Coordinate patient-centered care, services, ensure access

self reflection

- Exploring the thoughts you have about your experiences, actions, and reactions - Active process you can use to strengthen your ongoing professional growth

leadership development

- First step to leading is following - True leaders do not create followers, they create more leaders - Resources: EBP - Resources + potential + support = increased leadership capacity

transactional leadership style

- Focus on immediate problems, maintaining the status quo and using rewards to motivate followers

the emotionally intelligent leader

- Has insight into the emotions of members of the team - Understands the perspective of others - Encourages constructive criticism and is open to new ideas - Manages emotions and channels them in a positive direction - Committed to the delivery of high-quality care - Refrains from judgement in controversial or emotionally charged situations until all facts are gathered

democratic leading style

- Includes group when decisions are made - Motivated by staff achievements - Communication up and down chain - Work output is good when cooperation and collaboration

using power and influence in nursing

- Influence effectively -Influence patients to improve health o Exercise of power=improve patients health by the influence of the education we provide - Develop awareness of organization needs - Collegiality and collaboration: cooperation btwn colleagues// turning to colleagues for advice -exercise of power: coaching/mentoring, punitive power of coercion, power of collaboration, etc. o Nursing associations o Specialty organizations r/t nursing specialty o Sigma Theta Tau- Empowering attitude o Nurses have been proven to be competent and an important part of the healthcare team o Call nurses with doctorate degrees "Dr." o Stop bullying in the workplace o Develop working groups —coalitions o Negotiating: bargaining or making trade offs// ask for more than what you want and work down// must be well informed of their own position and the opposing side// need to know pros and cons of both positions - Nurses in high-status positions o Exercise of power=manage people and the business o Manage large budgets, make challenging decisions, sit in positions of power but stature or title is different than power

authentic leadership style

- Inspire others to follow them by modeling a strong internal moral code -Focus on honest relationships - Be truthful and open - Have a passion for people - Connect with people - Be consistent - Do not be fake —be the real you

shared decision making

- Interactive, deliberate process where staff and manager discuss options and preferences o More satisfied, but also takes more time o Best used when there is conflict likely to occur

fire safety

- Know the procedure of the facility - Know location of exits, alarms, fire extinguishers, oxygen turn-off valves - Make sure equipment does not block doors - Know the evacuation plan for the unit - Follow the RACE sequence -PASS sequence

avoiding/withdrawing

- Known conflict, but both parties refuse to face and work towards solution - Appropriate for minor conflicts, when one party holds more power, or issue can be worked out on its own over time - Because conflict remains, it can surface again later and escalate over time - Lose-lose

living will

- Legal document in all states - Expresses client wishes regarding medical treatment if the client becomes incapacitated and is facing end of life issues - Discusses desires for life prolonging procedures (CPR, mechanical ventilation, artificial nutrition) - Most state laws include provisions that health care providers who follow the healthcare directive in a living will are protected from liability

durable power of attorney

- Legal document that designates a health care surrogate, finances, or both, an individual authorized to make health care decisions for a client who is unable- Only used when client is deemed incapable of making decisions for themselves - POA should be very familiar with the clients wishes and able to follow through with them - Serves as an adjunct to the living will —ensures that clients wish is honored o Document must include: - Name of person you want to be your "attorney in fact" - List the situations which give the attorney power to act - List the powers you want to give (finances, property, banking, healthcare) - List the powers you do not want to give Examples: Court appointed guardian - spouse - Adult child - Adult grandchild - Parent - Relatives - friends

informed consent

- Legal process by which a client gives written permission for a procedure or treatment to be performed - However, to be considered "informed," the client must understand... o Reason treatment is needed and how it will benefit them o Risks involved if choosing the treatment and/or risks involved if they do not get the treatment o Other options available beyond the proposed treatment - Nurses' role in informed consent process is to witness the client's signature on the form and ensure informed consent have been appropriately obtained

change support strategies

- Listen - Establish connection with staff - Build trust - Dialogue - Empower - Facilitate - Manage information - Manage relationships

authoritative leading style

- Makes decisions for the group - Motivates by coercion - Communication occurs down the chain of command - Work output is high, good for crisis situations - Good for employees with little or no formal education

benchmarking

- Making goals set to determine at what level the outcome indicators should be met (ATI)· -Widespread search is conducted to identify the best performance against which to measure others (Book)

autocratic (paternalistic) decision making

- Managers decide what is best for the team - Pro: rapid decision making (like in emergencies)

nursing responsibilities for restraints

- Neurosensory checks q2 (circulation, sensation, mobility) - Offer food and fluids frequently - Provide assist with hygiene and elimination -Monitor vitals - Provide ROM - Follow facility polices - Pad bony prominences and assist with comfort measures - Never leave unattended without the restraint - Document assessment findings before, during, and after use

complexity theory

- Nontraditional theory that has emerged over time from works of physical and social science - Complexity science promotes the idea that the world is full of systems that interact and adapt through relationships - Nurses must be flexible and dynamic to be in tune with the ever-changing system of people, health care, public policy, and human relationships - Change is immerging and highly influenced by everyone involved - Complexity science users: develop networks, focus on immergence and think systematically

informed decision making

- Offers the staff the ability to make a decision after info has been shared, without active involvement of manager o Staff doesn't need manager to decide; Con: time, getting the manager to buy into it

competing/coercion

- One party pursues desired solution at the expense of others - Managers can use this when a quick or unpopular decision must be made - Party who loses something can experience anger, aggravation, and a desire for retribution - Win-lose

accommodating/cooperating

- One party sacrifice something allowing the other to get what it wants - Opposite of competing - Original problem might not actually be resolved - Solution can contribute to future conflict - Lose-win situation

advanced directive

- Plan made by capable person for future medical care - Can be used to appoint the person(s) who should make health care decisions for an individual if that person cannot make their own - If there is no directive, then states will have a decision hierarchy o Components: - Name 1 or more health care representatives (HCR) - State specific health care decisions/treatment preferences, including for mental health/life -prolonging/palliative care -No longer an official or mandatory state form

planned/ first order change

- Planned: deliberate and organized with goal of improvement - First order change: evolutionary and in healthcare its often referred to as continuous change —doing what you currently do in a better way

stress management techniques

- Prayer, exercise, counseling, support groups, stress prevention - identify the source, self-reflection, reframing expectations, humor, increasing leisure time, social/family support, connect with a mentor - Empathy and compassion granted to yourself and others, train brain to deal with chaos, encourage well -being activities, allow time to disconnect and socialize outside of work

falls

- Prevention of falls is a high nursing priority - Patients are at high risk for falls when multiple risk factors are present and/or they have hx of falls - Complete a fall screening o Assess physiological changes, hx of falls, decreased sensory percept, etc. - Prevention measures: o Understand how to use assistive devices o Fall risk patients close to nurses station o Items needed within reach o Lowest locked position of bed o Bed rails up for pts sedated, unconscious, or compromised —otherwise partially up o Non-skid footwear o Adequate lighting o Lock wheels o Chair/bed alarms

advanced care planning

- Process of communication for planning for future medical decisions o Requires reflection (on goals, values, and beliefs), understanding (of possible future situations and decisions), and discussion (of reflections and decisions with those who might need to carry them out)

assigning

- Process of transferring the authority, accountability, and responsibility of client care to another member of the health care team -completed in a downward or lateral manner -Patient factors must be considered first -Patient condition, monitoring needs, equipment needs, special precautions, extensive time commitment tasks -Healthcare team factors are also considered -Knowledge and skill level, staffing mix, nurse to patient ratio's, experience level

conflict resolution

- Requires problem solving o Identify problem and analyze possible solutions o Select and implement solution together, ensuring re-evaluation - Requires open communication among staff and between staff/clients - Nurses must act o Use "I" statements to focus on problem and not personal differences o Listen first, and understand their perspective o Move an escalating conflict to a private location o Make sure communication includes respect —one person speaks at a time; everyone gets a chance to speak - Negotiation is process by which interested parties resolve ongoing conflicts, agree on steps to take, bargain to protect interests, and pursue outcomes that benefit mutual interests

causes of conflict

- Result of opposing thoughts, ideas, feelings, perceptions, behaviors, values, opinions, or actions between individuals; it is inevitable - Ineffective communication, unclear expectations, poorly defined roles/organizational structure, poor organizational structure, conflicts of interest, incompatibility of individuals, varying standards within an organization, turnover (management and/or staff), diversity or lack of it

Steps for QI

- Standards are made available to employees by way of policies and procedures - Quality issues are identified by the staff, management, or risk management department - An interprofessional team is developed to review the issue - Current state of structure and process r/t the issue - Data collection methods are determined· Quantitative methods are primarily used in the data collection process, although client interview is also an option - Data is collected, analyzed, and compared with the established benchmark - If benchmark is not met, possible influencing factors are determined w/ RCA analysis ... · Focuses on variables that surround the consequence of an action or occurrence· Is commonly done for sentinel events but can also be done as part of the QI process · Investigates the consequence and possible causes · Analyzes the possible causes and relationships that can exist · Determines additional influences at each level of relationship · Determines the root cause or causes - Potential solutions or corrective actions are analyzed and one is selected for implementation - Educational or corrective action is implemented - Issue is reevaluated at a preestablished time to determine the efficacy of the solution or corrective action

developing personal strategies or tools for power

- Strategies are used when developing professional power - Honesty, courtesy, smiles often, accept responsibility for mistakes, risk-taker, win/lose gracefully, learn to be comfortable with conflict, give credit to others when credit is due, seek out constructive criticism, network, follow through on promises -set goals and create opportunities to move toward that goal// vision can always be revised based on new opportunities, interests and knowledge and skills that are gained -nurses expertise should not be limited to clinical knowledge// education and practice are means for developing expertise, and the things such as leadership and communication contribute to effectiveness of expertise -high visibility: make yourself seen and known by showing up to meetings and committees and ensuring your opinion is heard

unplanned/ second order change

- Unplanned: disconcerting, unanticipated, adaptive - Second order change: requires radical adjustments in person or structure of the organization/person- Complexity Theory: asserts that system behavior is unpredictable o Not episodic but rather an ongoing experience o Change is viewed as emergent and highly influenced by all within the organization/subgroup within the organization o 3 elements are: chaos as order, the ideal of operating on the edge of chaos, and order -generating rules -while things may appear chaotic, it is organized and there is a careful balance between order and disorder

restraint use

- Used to prevent patients from injuring themselves or others - Seclusion: Placement in a safe room; used for clients who are at risk for injuring themselves or others - Restraint: Application of a device that limits their movement - Chemical restraint: controlling disruptive behavior with medication - Requires a physician order, make sure it has not expired - Improper use of restraints can subject the nurse to be charged - Attempt early release if behavior is calm - Guidelines: o Treatment must be prescribed by the provider based on a face to face assessment - In emergency, where there is immediate risk, the nurse can place them in restraints. Nurse must obtain prescription within 1 hour o Use for shortest amount of time possible o PRN prescriptions for restraints are NOT permitted o Explain the reason for use to pt or family - Prescription must include the reason for restraint, type of restraint, location of restraint, how long to be used, what behaviors to be used for - Facility should have policy regarding timeline usage of restraints o Restraint should be limited to 8 hours for adults

laissez- faire leadership style

- Very few decisions made, little planning - Motivation is based upon the individual - Work output is low, unless an informal leader emerges - Effective with professional employees - Communication occurs up and down chain of command, and between group members

role of the leader in conflict

- When a nurse leader identifies there is conflict between members of their team... o Identify the triggering event o Discover the historical context for each person (hear both sides of the story) o Assess how interdependent they are on each other - Working together, especially closely, requires teamwork and cooperation o Identify the issues, goals, and resources involved in the situation o Uncover any previously considered solution o Work together towards a solution

fragmentation of care

- When different healthcare providers/organizations do not work well together - Role of case manager -pt care is compromised due to conflict btwn providers

power

- ability to influence others in effort to achieve goals; "the capacity or ability to direct or influence the behavior of others or the course of events"

follower characteristics

- acting synergistically with others, being enthusiastic and responsible, speaking and acting with principle and integrity, adding value to the work being accomplished, and questioning decisions and directions that are not congruent with purpose of group - often are the nurses doing the day to day care of patients - help influence and advance the leaders goal - often trusted by their peers-have the ability to divert or negatively impact the leaders initiatives

paternalism

- allows one person to make partial decisions for another and is most frequently deemed to be a negative or undesirable principle

beneficience

- care that is in the client's best interest; promote good

justice

- fair treatment and use of resources

management

- focus is on planning, organizing, staffing, directing, controlling; a "formal" title or position -Makes decisions about the function of the organization, including resources, budget, hiring, firing -ability to plan, direct, control, and evaluate others in situations where outcomes are known or preestablished, where one or more ways of performing have been agreed on based on evidence, where feedback and communication is shared to improve clinical processes and outcomes - Needed to provide structure, a sense of purpose, and safety

respect for others

- highest principle that acknowledges the rights of individuals to make decisions and to live by them

finite power

- if I give you some of my power, I will have less o Sharing focus is low o Avoids cooperation

infinite power

- if I share my power, we are all stronger o Sharing focus is high o Strong collaborator

fidelity

- keeping one's promise about care offered

leader characteristics

- no title needed, requires emotional intelligence (developed over time), desires to help develop people and help them to reach their full potential - Inspiring, takes initiative, energetic, positive outlook, effective communication skills, respectful, problem solver, critical thinker, influence willing followers to move towards a goal -should establish a shared vision amongst followers -achieve workplace unity -develop trust

veracity

- nurses' duty to tell the truth

non-maleficience

- nurses' obligation to avoid causing harm

culture

- often defined with the following 4 characteristics o Cultures develops over time and is responsive to its members o A culture's members learn it and share it o Culture is essential for survival and acceptance o Culture changes with difficulty

sentinel events

- refer to unexpected death or major injury o Major loss of function or death that was not expected with client's condition o Client attempted suicide during round the clock care, transfusion reactions, wrong site/wrong procedure surgery, rape, infant abduction, or discharge to wrong family member

acculturation

- refers to adapting to the dominant culture o Ex. What a particular society calls a particular food o The overall process of acculturation into a new society is extremely difficult and involuntary

assimilation

- refers to the change that occurs when nurses move from another country to the united states, or from one part of the country to another o The person becomes similar to the members of a dominant culture o Ex. A nurse no longer says they are from their country of origin, but rather from where they live and practice

diversity

- term used to describe a vast range of cultural differences among the groups

AP's CAN BE delegated

-ADL's -bathing -grooming -dressing -toileting -ambulating -feeding (without swallowing precautions) -positioning -routine needs -bed making -specimen collection (*AS LONG AS IT DOES NOT REQUIRE STERILE TECHNIQUE*) -I&O's -Vital Signs (*AS LONG AS THE PT IS STABLE*

risks of restraints

-Death by asphyxiation and strangulation -Immobility complications - Legal ramifications-false imprisonment

communication needs in delegation

-Nurse must provide clear, concise, timely and reliable communication -Give information, give directions, seek clarity, and seek advice -Two-way communication is needed -Healthy work relationships are needed -Trust will develop over time

quality assurance

-Programs to monitor healthcare -Used to ensure standard of care -Focuses on clinical aspects of care -Documentation -Adherence to standards Methods: -Chart audits are a common method of addressing process standards -Chart audits over time yield trend charts -Stress that CA are not meant to be punitive but to improve patient care overall

emergency operating roles

-Provider: manage patient numbers and resources -Triage officers: nurses and other emergency personnel -Community relations person: Media liaison -Hospital Incident Command System: offers a clear structure for disaster management at the facility level -Know the command center location

problem solving

-Requires critical thinking -Includes a decision making step -Focused on trying to resolve an issue that's viewed as a gap. Gap of current situation (often seen as the problem) compared to the best available option. -Many different strategies used

incident report criteria

-completed by the person who identifies it (not always done by the person involved) -completed ASAP or w/i 24 hrs -confidential and is not shared with the client, don't acknowledge that report was completed -not put in EMR -includes objective description and actions taken to safeguard the client, as well as assessment and treatment of any injuries sustained -sent to risk management department or officer (varies by facility), possibly after being reviewed by the nurse manager -provides data for performance improvement studies regarding incidence of pt injuries/errors

problem resolution

1. Define the problem 2. Gather data 3. Analyze data 4. Develop solutions 5. Select a solution 6. Implement the solution 7. Evaluate the result

decision making process

1. Defining objectives 2. Generating options 3. Identifying advantages of options 4. Identifying disadvantages of options 5. Ranking the options 6. Selecting the option most likely to achieve the predefined objectives 7. Implementing the option 8. Evaluating the option

steps of quality improvement

1. Identify the standard -identify important needs to consumer 2. Assemble interprofessional team to review identified needs/services 3. Collect data to measure 4. Establish measurable indicators- Benchmarking 5. Select & implement plan to meet outcomes 6. Collect data to evaluate achievement of outcomes

The quadruple aim

1. Improves access to care 2. Improves quality of care 3. Improves cost of care 4. Improves work life of healthcare team - Guiding healthcare professionals to achieve the quadruple aim will help achieve the goal of improved health while keeping the providers engaged and decreasing turnover - Leaders cannot achieve the quadruple aim alone - Followers can impact it because they are often the ones doing the day-to-day work, influencing peers, and are a trusted source - Followers are often aware of the important details, workflows, and barriers in the day to day that influence achieving the Quadruple Aim

Maslow's Hierarchy

1. Physiological (breathing, food, water, etc.) 2. Safety and security (employment and access to resources) 3. Love and belonging (friendship and fam) 4. Self-esteem (confidence, achievement) 5. Self-actualization (morality, creativity, problem solving)

prior to delegating, consider the following:

1. Predictable outcome? 2. Potential for harm? 3. Are complex tasks required? 4. Will it require problem solving? 5. Will high level of interaction or new education be needed?

5 rights of delegation

1. Right task a. A right task is repetitive, requires little supervision, and is relatively noninvasive 2. Right circumstance a. Match the complexity of care demands to the skill level of the health care team member and consider load of that member// don't assign a pt who is unstable 3. Right person a. Task must be within that member scope of practice, and they must have the necessary competence/training 4. Right direction and communication a. Specific task to be performed and client-specific instructions// report findings back to you once task is finished 5. Right supervision and evaluation// Intervene if needed, provide feedback. If delegate reports results outside the expected range, assess patient and re-check yourself **DO NOT GET CONFUSED WITH THE 5 MED RIGHTS, THESE ARE DIFFERENT**

5 domains of emotional intelligence

1. Self-awareness 2. Self-regulation (Managing emotions) 3. Motivating self (internally driven) 4. Empathy (value differences and not choose a side) 5. Social sills (handling relationships)

Magnet institution

A hospital that attracts and retains nurses even in times of nursing shortages -recognized by the American Nurses Credentialing Center -characterized by work environments that empower nurses -leadership activities have been identified as a critical element of the work culture in these hospitals// quality of leadership is the key - Decentralized organizational structure, participative management style, and influential nurse executives) and process factors (professional autonomy and decision making, ongoing professional development/education, active quality improvement initiatives-generally have: o Lower burnout rates o Higher levels of job satisfaction o Provide higher levels of quality care, resulting in greater levels of patient satisfaction - Organization that has characteristics that produce o Improved patient outcomes o Attracts and retains nurses o Demonstrates exemplary professional practice o Transformational leadership o Evidence-based practices

a. become an early adopter

A new nurse wants to be a change agent on the unit. What action listed would be the MOST appropriate for the nurse to take? a. Become an early adopter. b. Wait until a more experienced nurse vocalizes support. c. Seek help from her nurse manager .d. Talk to a peer on another unit about the problems with more experienced nurses.

incident report

A report documenting an incident and the response to the incident; also known as an occurrence report or event report .-includes: med errors, procedure/tx errors, equipment related injury or error, needlestick, pts falls with injury, visitor/volunteer injury, loss of property, threats made to staff or pt

ethnocentrism

Belief in the superiority of one's nation or ethnic group.

Lewin's Force Field Analysis

During evaluation, factors are considered that influence whether change will occur or not •Forces that favor change-Facilitators(if there are more facilitators than the change will more likely occur) •Forces against change-Barriers(if there is more barriers than the change will be less likely to occur)Role of change agent - involves listening and assessing to determine if they all have a shared vision(Tool to understand what it takes to make sustained change within an organization)

disaster response agencies

Federal Emergency Management Agency (FEMA), Centers for Disease Control (CDC), US Dept of Homeland Security (DHS), American Red Cross, Office of Emergency Management, and the public health system

stages of conflict

Frustration/ Latent Conceptualization/ Perceived Action/ Felt Outcomes/ Manifest

agencies used with QM

NDNQI, AHRQ, Joint Commission, National Quality Forum and QSEN competencies

prioritization

Nurses must continuously assess and reassess, set and reset priorities in order to ensure patient needs are met and they maintain safety Priority Setting - Determines the order in which: ◦Patients are seen ◦Assessments are completed ◦Interventions are provided ◦Procedures are completed ◦Components of care are completed Nurses base priorities off data obtained from: ◦Shift report ◦Communications with other team members ◦Review of patient documents/chart ◦Continuous collection and assessment of data

RN CANNOT delegate

Patient education, any task that requires nursing judgment, nursing assessment, critical decision making, blood transfusions - Licensed nurse delegating must base decision on:- Individual patient needs, facility policies, job descriptions, and experience of those delegating to, state nurse practice acts, professional standards, legal/ethical concerns

informed consent responsibilities

Provider: - Provide complete description of treatment/procedure - Note who will perform the procedure - Describe risk of potential harm, pain, discomfort - Provide alternate options if any - Discuss the patient's right to refuse - Discuss risks if treatment is not chosen Patient: - Volunteer consent without coercion - Be competent and of legal age - Receive enough education to make an informed decision Nurse: - Witness/sign the consent - Ensure patient was "informed" and understands - Obtain clients' signature - Notify provider if more questions are received - Document appropriately - Education provided, questions of client, if interpreter was used

active delegation

RN assesses the situation, determines what is appropriate for patient care, directs a UNP to perform certain tasks and hold the individual accountable.

Resume vs CV

Resume: •reflects your skills, knowledge, and background in relation to a specific position. •More specific and tailored to job your are applying for •Shorter length but greater detail CV: •An all-inclusive listing of your professional life •Provides a broad overview of professional accomplishments and experiences •Not a great amount of detail when to use which? •Use what the prospective employer says to use. •If no direction is given, determine whether you are trying to impress with quantity (the CV) or quality (the résumé). •When in doubt, use the résumé and tailor it to the position.

cultural marginality

Situations and feelings of passive betweenness when people exist between two different cultures and do not yet perceive themselves as centrally belonging to either one.

individual accountability

The individuals' ability to explain their actions and results

a. Planned change

The nurse manager for an ICU develops a plan to implement the new sepsis management protocol. The plan includes education, focused sessions to discuss concerns with the staff, and sepsis warning signs in various places on the unit. What does this demonstrate by the manager? a. Planned change b. Complexity management c. Unplanned change d. Open systems

delegation

Transfer of authority and responsibility for activities and procedures from one person to another while retaining the accountability for the outcome -important to know the competence of individual you are delegating to -need to give clear instructions and follow up on care -need to specify to delegatee what info we would like after the task is completed -get feedback of pt that task was actually done

barriers in delegation

Under delegation: -Lacking confidence -Lack of time -Fear of loss of control Over delegation: -Overburdens a delegate with too many tasks/responsibilities Improper delegation: -Delegating tasks outside of the delegates training or education

B. Preparing for meeting by reviewing agenda so you can be an active participant.

Which best demonstrates followership? A. Completing tasks associated with your patient assignment w/o intent of receiving praise from manager B. Preparing for meeting by reviewing agenda so you can be an active participant. C. Assessing clinical situation and following guidelines to delegate tasks to unlicensed personnel D. Administering meds to pt in conjunction with other nursing actions in order to make effective use of time

C.1-day old with a heart rate of 194

Which infant would you assess first? A.2-day old developing jaundice B.2-day old who has only had 2 BM's today C.1-day old with a heart rate of 194 D.1 day old who will not breastfeed

D. Apply high concentration O2 using a non-rebreather mask

Which of the following takes priority for a patient with dyspnea and an 02 sat of 70%? A. Auscultate breath sounds B. Assess heart rate and level of consciousness C. Contact provider for orders D. Apply high concentration O2 using a non-rebreather mask

B. Patient getting IV gentamycin who has developed a rash

Which of the patients should the nurse see first? A. COPD patient with shortness of breath and O2sat of 91% B. Patient getting IV gentamycin who has developed a rash C. Patient who is experiencing a new bleed from their IV site D. Patient complaining of new calf pain

C.60 yo DVT pt complaining of SOB

Which of the patients should the nurse see first? A.24 yo diabetic awaiting discharge instructions B.44 yo who had a left mastectomy yesterday and has a Hgb of 11 C.60 yo DVT pt complaining of SOB D.72 yo with acute diverticulitis complaining of gas, bloating, and nausea

A.40 yo alcoholic with esophageal varices who is bleeding orally

Which patient should be transferred to the ICU first?A.40 yo alcoholic with esophageal varices who is bleeding orally B.24 yo diabetic in DKA C.65 yo COPD patient who has developed a fever of 103 F D.72 yo with a broken hip who is having left hip pain and swelling

B.28 weeks gestation with a 9 lb weight gain within 1 week

While working on the antepartum clinic, the nurse should assess which patient first? A.14 weeks gestation pt with thick white vaginal discharge and irritation B.28 weeks gestation with a 9 lb weight gain within 1 week C.40 weeks gestation complaining of urinary incontinence D.36 weeks gestation with a cold and WBC count of 9.6

grievances

Wrong perceived by an employee based on a feeling of unfair treatment that is considered grounds for a formal complaint -typical steps: started at the first level of management and continued up chain of command, formal hearing if not resolved at a lower level

B.34-year-old with arterial bleeding from a leg wound

Your ER has implemented their mass casualty protocols for a multi-vehicle car accident. Which patient do you assess first? A.22 yr old not breathing B.34-year-old with arterial bleeding from a leg wound C.44-year-old complaining of chest pain and SOB D.20-year-old with no pulse

A. Move the patient closer to the nurse's station

Your patient is a fall risk and keeps getting out of bed, which of the following do you implement first? A. Move the patient closer to the nurse's station B. Make sure all 4 bed rails are up C. Apply soft restraints to the patients' arms D. Sedate the patient

The National Database of Nursing Quality Indicators

a national, nursing quality measurement program from the American Nurses Association that provides hospitals with unit-level performance reports with comparisons to national averages and rankings. - how we collect data related to falls, CAUTI's, etc.

manager characteristics

ability to identify recurring problems and design EB routines to create structure and improve work efficacy, persistent and vigilant behavior in self and others, communication, gives direction, maintains status quo, plans detail, reactive, power and control, policies, and procedures

autonomy

ability to make personal decisions even if not in their best interest

legal authority

ability to transfer select nursing activities in a given situation to a competent individual

bullying

behavior is persistent and relentless and is aimed at an individual who has limited ability to defend themselves -occurs when the perpetrator is at a higher level than the victim -abuse of power that makes the recipient feel threatened, disgraced, and vulnerable

delegatee

competent recipient who is to perform the task, accepts the task/activity, accepts the responsibility of the task

mentoring

competent, experience individuals who develop a relationship with less experienced nurses for the purpose of providing advice, support, info and feedback to encourage the development of that person -provides expanded access to knowledge, power and career opportunities -critical asset to novice nurses trying to negotiate workplace and professional politics -mentors benefit by: expanding their own professional development and that of their colleagues, improving their own self-awareness, experiencing the intrinsic benefits of teaching another, nurturing their own interpersonal skills and expanding their political savy.

negligence

conduct that is lacking in care and typically concerns nonprofessionals// carelessness - Failure to use such care as a reasonable prudent and careful person would use under similar circumstances, carelessness - Practice or misconduct that does not meet expected standards of care and places the client at risk for injury - Ex. Nurse fails to implement safety measures for client who has been identified as fall risk.

resume

customized documents that relate to the qualifications of a specific organizational position and help create an image of you serving in that position -provides details and is presented in short sentences or phrases or both -this is a better choice that a CV for advertising your skills and talents to a prospective employer o Doesn't list everything; designed for specific position or role, all content is geared toward that position or role o Sell yourself!, should still include details o Presented in sentences or phrases but not both o Details and action words help readers view you as accomplishing important work -can be produced in two ways: conventional or functional -*goal is to be direct and sell yourself

conflict

disagreement in values or beliefs within oneself or between ppl that causes harm or has the potential to cause harm - Requires problem solving o Identify problem and analyze possible solutions o Select and implement solution together, ensuring re-evaluation - Requires open communication among staff and between staff/clients - Nurses must act o Use "I" statements to focus on problem and not personal differences o Listen first, and understand their perspective o Move an escalating conflict to a private location o Make sure communication includes respect—one person speaks at a time; everyone gets a chance to speak

developmental safety concerns for preschool and school age children

drowning, motor vehicle injury, firearms, play injury, burns, poison

effective vs ineffective followers

effective: -Engaged and participating -independent thinker -Communicates effectively -Brave, speaks up & advocates-Involved in the day to day care of patients -Optimistic -Autonomous in their work -Spark excitement among their peers ineffective: -Relies heavily on leaders -Wont ask questions or question authority -Have difficulty voicing opinions, concerns, or discussing feedback -Complain without solutions -No loyalty to their team or company -Inflexible -Fights against change

disaster

event that causes serious damage, destruction, injury, and death

fostering and handling social skills and relationships

exhibiting socially appropriate behavior, expanding social networks, and using social skills to help others manage emotions

ethics

expected behavior of a certain group in relation to what is considered right and wrong

types of power

expert, position, information, connection, referent, coercive, reward, empowerment, persuasion, finite, infinite

developmental safety concerns for older adults

fall hazards, home safety concerns

how to motivate self and others

focusing on a goal, often with delayed gratification, such that emotional self- control is achieved and impulses are stifled

cultural humility

helps us explore cultural competence as a process rather than an outcome •Requires cultural desire (the "want to" engage in the process of becoming culturally competent) and awareness (self-examination of own background) - ability to maintain an interpersonal stance that is other-oriented in relation to aspects of cultural identity that are most important to the person -when exploring cultural humility, 3 factors shape the process: •lifelong commitment to self evaluation and critique •Requires a desire to fix power imbalances •Requires aspirations that develop partnerships with people and groups who advocate for others •Must do away with ethnocentrisms (belief that our own way is the best way, more superior way)

fxnl resume

may combine multiple positions into role areas yo are trying to highlight as a strength

journaling

method to support ongoing development, self -confidence, professional practice, critical thinking - Allow you to retrace your thinking and to see improvements in your thinking actions

developmental safety concerns for middle aged adults

motor vehicle crashes, alcohol consumption, depression/anxiety, suicide, social network/internet, skin cancer/protection

developmental safety concerns for adolescents

motor vehicle injury, burns, depression/anxiety, risky behaviors, social networking/internet

developing networks in the complexity theory

network is any related group with common involvement in an area of focus or concerns -social networks are found within organizations but also beyond organizational boundaries that are not served within the traditional hierarchy. -i.e. nursing program// not considered a part of the hospital where clinical expertise takes place, but common interests (supply and preparation of a qualified workforce and demand for clinical services) make this network critically important for both organizations

professional organizations and their value to nurses

o Demonstrates leadership and provides opportunities to meet others to help shape the future of nursing, participate in policy formation, and continue specialized education - Group of people who share a set of professional values and who join their colleagues to effect change o Many set standards and objectives to guide the profession and specialty practice o ANA-American Nurses Association: umbrella organization that represents all nurses throughout the US and its territories o Sense of responsibility to the profession, contributing to the greater good of the profession, enhancing resume and marketability, supporting particular legislative interests, and social networking - ANA amplifies nurses' voices by lobbying Congress and executive agencies, and by offering information and tools that empower nurses to share their perspective and expertise directly with policymakers - Participate in policy formation o Federal advocacy program*some reasons for joining include: feeling a sense of responsibility to the profession, contributing to the greater good of the profession, enhancing your resume and marketability, supporting particular legislative interests and social networking** -nurses want to improve health care through influencing legislation

connection power

o Gained by association with people who are powerful or who have links to powerful people o (Taking time to have conversations with those in power, building relationships)

referent power

o Granted by association with the powerful person o Lacks the relationship aspect o (Neighbor is CNO, student nurse who asks leader to be their preceptor because she wants to work in that organization—not besties but ability to utilize power in future)

coalition

o Group of individuals or organizations with a common interest who agree to work together toward a common goal - Creating change o Goal=effort to effect change o Requires members of one group to reach out to members of other groups

process of QI

o Identify standards and outcome indicators based on evidence (1st step**) - Outcome (clinical) indicators: reflect desired client outcomes r/t the standard under review· Whether the procedure is effective in meeting the desired benchmark· Example in ATI book ** - Structure indicators: reflect the setting in which care is provided and the available human and material resources - Process indicators: reflect how client care is provided and are established by policies and procedures (clinical practice guidelines)· Example of incentive spirometers in ATI book **

networking

o Important strategy for power and politics o Identify networks -Have lunch with someone in another department, a different specialty, or a leader in the organization - Active involvement in nursing organizations o Value relationships - Identify partners that are skilled, insightful, and eager to support he development of colleagues o Maintain relationships - Offer support to them (notes, email, calls, text) - They're willing to offer support to you

creating a powerful image in nursing

o Influence patients to improve health - Exercise of power= improve patients health by the influence of the education we provide o Interaction with other nurses - Exercise of power= coaching/mentoring, punitive power of coercion, power of collaboration, etc. - "in-fighting: - plotting against each other, not collaborating well, limits power of whole nursing profession o Nurses in high-status positions - Manage large budgets, make challenging decisions, sit in positions of power but stature or title is different than power - Exercise of power= manage people and the business

curriculum vitae (CV)

o Listing of anything that relates to your professional life, includes dates, places, and positions or roles, provides no richness except that of quantity -designed to be all-inclusive but not detailed documents continued development of expertise - Is it current?, is your email address professional or overly casual?, what is the font size?, can your contact info be easily located?, do you highlight recent accomplishments?

reward power

o Perceived as bring able to provide rewards or favors as source of power o (Students may think of profs in this way, could be false as profs are grading off performance)

position power

o Possessed by virtue of one's position within an organization or status within a group

PASS

o Pull the pin o Aim at the base of fire o Squeeze handle o Sweep the extinguisher from side to side

RACE

o Rescue and protect patients o Alarm-activate it o Confine it o Extinguish if possible

powerful image: presence

o Self-image: thinking of oneself as powerful and effective o Grooming and dress: ensuring that clothing, hair, and general appearance are neat, clean, and appropriate to the situation o Good manners: treating people with courtesy and respect o Body language: maintaining good posture, using gestures that avoid too much drama, maintaining good eye contact, and being confident in movement o Speech: using a firm, confident voice; good grammar and diction; an appropriate vocabulary; and strong communication skills

coercive power

o Stems from fear of someone's real or perceived fear of another person o (New nurse is worried about upcoming review with manager)

information power

o comes from having important information that others need to do their jobs well o (Charge nurse, nurse on committee working on reducing cath infections)

expert power

o experience and delivers through on promise; based on expertise, reputation, and credibility

responsibility

obligation and dependability of person to accomplish task

quality improvement

ongoing process of innovative improvements, prevention of error, development of staff, which is used by institutions that adopt the QM philosophy o Focuses on OUTCOMES and relies on data-driven decisions which RELATES TO prevention of error, quality Pt care, and patient satisfaction -involves continuous analysis and evaluation of products and services to prevent errors and to achieve customer satisfaction -process, structure and outcome standards -operates most effectively within a flat, democratic organization structure -shared commitment is essential for organizational success

emotional intelligence

possession of social skills, interpersonal competence, psychological maturity, and emotional awareness devoted to helping people work well together - Ability of an individual to perceive and manage the emotions of self and others - Nurse must be able to perceive and understand their own emotions of the client and family in order to provide client-centered care - Single biggest predictor of performance in leadership - Awareness of strengths and weaknesses help us grow and mature as leaders

dualism

ppl only think there is one way, right/wrong to solve problem -black and white answers

empowerment

process of exercising one's power to facilitate the participation of others in decision making and taking action so they are free to exercise power -emphasizes the notion that power grows when shared -nurses who view power as 'finite' will avoid cooperation with their colleagues and refuse to share their expertise -nurses who view power as infinite are strong collaborators who gain satisfaction by helping their colleagues expand their expertise and their power base - Used in nursing texts related to administration and management but also very relevant to clinical practice - Powerful nurses build up their teams and empower them, allowing them to grow professionally - Powerful nurses support their patients, so they are informed, equipped, and able to participate actively in their own care - Empowerment= power grows when it is shared o Ex.: chief nurse executive develops a model of shared governance to enable nurses to have a stronger voice in patient care decisions

National Quality Forum

promotes patient protections and healthcare quality through measurement and public reporting.

developing self awareness

stepping outside oneself to envision the context of what is happening while recognizing and owning feelings associated with the event -deepen this and encourage others to do the same

values

the connecting thoughts and inner driving forces that give purpose, direction, and precedence to life priorities

stress

the gap between what we want life to be and what it really turns out to be •Consequence or response to life •interpretation of life's events determine our level of stress •Decreases our efficiency and decreases our ability to contribute effectively o Nurses are not immune to stress and need management skills o Can be positive (birth of child) or negative (loss of job)

nurse practice act

the scope of nursing practice, those actions and duties that are allowable by the profession that is guided and defined by the state -most important piece of legislation for nursing bc it affects all facets of nursing practice -defines three categories of nurses: LPN's/LVN's, RN's, and advanced practice registered nurses -sets educational and and examinational requirements, provides for licensing of individuals who have met these requirements and define the fxns of each category of nurse -must be read to ascertain what actions are allowable for the three categories of nursing -nurse managers should understand that individual state nurse practice acts may vary among states in defining or delineating nursing practice , especially for advanced nursing roles -main purpose of state board of nursing is to ensure enforcement of the act to protect the public

morals

the values and beliefs held by a person that guide behavior and decision-making

interpersonal conflict

with others who have differing goals, values and beliefs - Most common type of conflict - Transpires between and among patients, family members, nurses, physicians - Focuses on different opinions, priorities, or approaches with others - Interpersonal conflict contributes to burnout and work-related stress - Ex. New nurse is given assignment that is heavier than that of the other nurses, and when the new nurse asks for help, it is denied

intergroup conflict

with two or more groups of individuals, departments, or organizations -caused by new policy/procedure, change in leadership, change in org structure - Occurs between 2 or more groups of individuals - Can be caused by new policy or procedure, change in leadership, or change in organizational structure - Ex. There is confusion as to whether it is the responsibility of the nursing unit or dietary department to pass meal trays to patients - Arises when discord exists about policies, procedures, codes of conduct, or accept norms of behavior

intrapersonal conflict

within ourselves -internal struggle related to contradictory values or desires - Occurs within a person when confronted with the need to think or act in a way that seems at odds with oneself - Questions often arise that create a conflict over priorities, ethical standards and values - Ex. "Do I want to accept the job in the city with more cultural opportunities or remain in my hometown and be close to my family?"

mass casualty triage principles

· Differ from the principles of triage typically followed during provision of day-to-day services in an emergency or urgent care setting· casualties are separated r/t their potential for survival, and treatment is allocated accordingly, this type of triage is based on doing the greatest good for greatest number of people o Emergent or Immediate -red tag o Urgent or Delayed -yellow tag o Nonurgent or minimal-green tag o Expectant-black tag· Nurses can find this situation very stressful because clients who are not expected to survive are cared for last

Total Quality Management

· combinations of QI ideas from theory and research o Combo of QM and QI o Structure: promote decisions being made closest to where they will be implemented - Facilities - Equipment - Staff - Finances o Process- Nurses' role/EBP o Outcome= improve the system, not place the blame -usually full of research and EBP -*focus on reeducation of staff rather than disciplinary action

quality management

· overarching philosophy that describes healthcare culture and describes patient satisfaction, innovation, and employee involvement o Benefits: greater efficiency and proactive planning may overcome some of the resource constraints// identify upper management about resources o Customers define quality: core quality indicators, Surveys-HCAHPS - Care quality indicators—publicly visible (JC or hospital compare) - Surveys -GOAL: to improve systems and processes, not to assign blame and to improve pt outcomes -Successful malpractice suits could be reduced with quality care -Job satisfaction could be enhanced because quality management (QM) involves everyone on the improvement team and encourages everyone to contribute o Quality data must be gathered and analyzed without bias before improvement suggestions/recommendations are made

purpose of quality improvement

· process used to identify and resolve performance deficiencies o Includes measuring performance against a set of predetermined standards set by facility that consider accrediting and professional standards o Focuses on assessment of outcomes and determines ways to improve the delivery of quality care, all levels of employees are involved in QI process

developing power in nursing

•Be authentic •Professional image, attitude, speech, and body language •Commitment to career in nursing •This is not an occupation! •Value continued education

Lewin's Change Theory

•Change involves a 3 stage process which can be used to analyze any type of change •1- Unfreezing •2- Experiencing the change// moving •3- Refreezing •This process can be used to analyze almost any type of change

late majority

•are openly negative and agree to the change only after the majority has already accepted it

unfreezing of Lewin's Change Theory

•helping a a person, group or organization release a current behavior or process •They recognize a change needs to occur and begin evaluating, when a force field analysis occurs

experiencing the change aspect of Lewin's Change Theory

•move toward a new reality, planned interventions and strategies are executed to support the implementation of the change •Education •Vision building •Involving individuals •Implementing small steps towards change

rejectors

•oppose change actively, may even sabotage

early majority

•prefer doing what has been done in the past but eventually accept new ideas

laggards

•prefer keeping traditions and openly express their resistance to new ideas

early adopters

•respected by peers and thus are sought out by their peers for advice and info about innovation/change

refreezing aspect of Lewin's Change Theory

•sustainment process, sometimes this requires overcoming inertia (the desire to keep things the same) •Change agent works to reinforce the new, desired behaviors by praising, rewarding, and providing feedback - This process can be used to analyze almost any type of change

innovators

•thrive on change, can be disruptive to unit stability

high priority issues

◦Systemic before local (life before limb) -Shock vs abdominal pain ◦Acute before chronic, urgent before non-urgent, unstable before stable// within first 2 hours we have better chance of survival) -Stroke symptoms starting 2 hours ago vs stroke symptoms that started yesterday ◦Real problems vs possible future problems -Post-op patient with a fever of 102 F vs the patient who has a high risk of systemic infection from a dog bite ◦Trends before one-time findings (unless the one-time finding is an emergency) -Patient respirations have been steadily increasing over the past 8 hours from 16 breaths/minute to 30 breaths/minute vs. the patient with a respiratory rate of 22 -What if the patient has a respiratory rate of 4?◦Impending medical emergencies before expected findings -Stroke patient who has a worsening headache and pupil changes vs a stroke patient with left sided paralysis and speech difficulties -Post op patient 4 hours out with a fever vs a post-op patient 4 hours out with a bloody ABD dressing ◦Timely medicines before routine meds -Insulin vs a PPI, IV antibiotics vs blood pressure pill - Apply clinical knowledge to procedural standards to determine the priority action

time management prioritization according to pt needs?

◦What must be done immediately? ◦What must be done at a certain time? ◦What must be done by the end of the shift? ◦What can I delegate? ◦Do I have extra time? If yes, offer to help others when crisis or overwork occurs within your team ◦Have I taken a break for my own meal or self-care?