Chapter 3: Organizational Climate and Culture
The culture of patient care must transition from care that is driven by providers to care that is patient-centered and family-centered in which patient and family norms, values, and preferences are respected. This direction in health care services has been sited within (select all that apply): A. the Affordable Care Act (2009). B. The Future of Nursing: Leading Change, Advancing Health (2011). C. the Institute of Medicine's Crossing the Quality Chasm (2001). D. National Healthcare Quality Report from the Agency for Healthcare Research and Quality (2002).
A, B, C, D. Each of the reports and the Affordable Care Act all defined aspects of patient-centered care. The Agency for Healthcare Research and Quality defines this as patient experience and patient partnerships. The patient's experience of care includes communication, care, and understanding of the meaning of his or her illness. This approach changes the focus from a patient with a disease to that of an individual with an experience. Patient partnerships, the second dimension of patient-centered care, are formed when nurses are responsive to patient needs, values, and preferences and then customize the care to the patient. For example, when performing discharge teaching, information that is of high importance and value to the patient is addressed first in a patient-centered model of care. As patient advocates, nurses can be leaders in transitioning an organizational culture from provider-driven care to care that is truly patient-centered.
Identify the statements about organizational culture that impact nursing practice (select all that apply). A. Organizational culture affects the quality of nursing care and patient outcomes. B. Mission statements provide a view of strategic priorities for a nursing organization and work setting. C. Culture is developed over time with the shared values that guide members on how to problem solve and manage relationships. D. Organizational culture means there are hidden assumptions about care that should not be questioned.
A, B, C. Three of the statements are correct about organizational culture. The culture of an organization can be positive towards evidence-based care or negative towards using best evidence in practice. Often the assumptions may be unknown, but in assessing the culture of a practice, unit, or organization, the nurse should question the current practices that exist within the culture of nursing practice. This is important because organizational culture affects the quality of nursing care and patient outcomes. The taken-for-granted practice and assumptions of a work unit group can exert a significant effect on performance and outcomes.
The research leading to the gold standard for nursing excellence has produced which of the following findings (select all that apply)? A. The effects of nursing interventions are facilitated by organizational characteristics at the unit level. B. A health care administrator can nurture a professional nursing environment and advocate for excellence in nursing practice. C. Mortality rates in Magnet hospitals had a significantly lower mortality rate for Medicare patients than that of control hospitals. D. Magnet hospitals' cultures provided lower levels of autonomy and control of practice and fostered stronger professional relationships among nurses and physicians than did those of non-Magnet-designated hospitals.
A, C. Research by Dr. Aiken has found that mortality rates in Magnet hospitals were significantly lower for Medicare patients than those of control hospitals, and the effects of nursing interventions are facilitated by organizational characteristics at the unit level related to culture and climate. A strong visionary nurse leader is necessary, whereas a health care administrator is less likely to nurture and support a professional nursing environment and advocate for excellence in nursing practice. Magnet hospitals' cultures have higher levels of autonomy and foster stronger professional relationships among nurses and physicians than do those of non-Magnet-designated hospitals. A nursing unit culture that supports and values nurse autonomy and the provision of adequate resources and effective communication among providers most likely constitutes an environment where practice excellence is the norm. Magnet hospitals are an example of a positive culture that affects nurse and patient outcomes.
The 14 Forces of Magnetism has directed research on Hospital Magnet Standards which measure certain characteristics. Select the answers that best reflect those measures of Magnet standards (select all that apply). A. Clinically competent peers, education support, adequate staffing, and nurse manager support B. Perceptions of work environment, nursing hours per patient day, and medication errors and near misses C. Customer satisfaction, patient discharge disposition, and patient complaints D. Clinical autonomy, control of nursing practice, and collaborative nurse-physician relationships
A, D. Research that measures the Hospital Magnet Standards focuses on eight characteristics of an excellent work environment: clinically competent peers, collaborative nurse-physician relationships, clinical autonomy, support for education, perception of adequate staffing, nurse manager support, control of nursing practice, and patient-centered values. Seven of the eight measures are found in the first and last answers. While the second and third answers provide measures, the focus has little to do with the climate and culture of nursing practice. The perception of work environment is a measure of climate. Other process elements of climate include supervision, work design, group behavior, and emphasis on quality that is driven by patient centeredness, safety, innovation, and evidence-based practice.
Global research on nurses by Dr. Aiken has determined which of the following statements (select all that apply)? A. The number of nurses may have more influence on patient outcomes than the organization and structure of the work environment itself. B. The number of nurses may have less influence on patient outcomes than the organization and structure of the work environment itself. C. The number of nurses may have less influence on patient outcomes than the perceived level of autonomy, the amount of control over their practice, and the effective collaboration with physicians. D. The number of nurses with bachelor's degrees may have more influence on patient outcomes than a larger staff of less-skilled nurses and caregivers.
B, C. Two statements are correct and have been replicated internationally: the number of nurses may have less influence on patient outcomes than the organization and structure of the work environment, and the number of nurses may have less influence on patient outcomes than the perceived level of autonomy, the amount of control over their practice, and the effective collaboration with physicians. The first statement is incorrect and in opposition to the research finding of the second statement. The last statement comparing the number of nurses with bachelor's degrees to a larger staff of less-skilled nurses and caregivers has not been consistently found to be true.
Culture is a concept that is best portrayed in nursing with which of the following statements? A. Culture provides a common bond so members know how to relate to one another and what is valued. B. A relationship-based nursing care model is used, which represents a belief in patient-centered care. C. Culture is a multifaceted phenomenon, difficult to comprehend. D. Culture is a set of values, beliefs, and assumptions that are shared by members of an organization.
B. The best portrayal is the care delivery model of relationship-based nursing care that guides nursing practice to interpret the culture, because it represents an underlying belief in patient-centered care. The other statements are ways that culture has been described. The visible parts are the mission statement, policies, procedures, organizational charts, and the way people dress and the language they use, and the invisible parts in the organization are the unwritten rules and customs that pervade the work environment. The patient-centered care delivery model is dependent upon good communication and collaboration between providers, patients, and their families.
Quality and Safety Education for Nurses (QSEN) was initiated to accomplish which of the following (select all that apply)? A. Implementing patient-centered care, teamwork, and collaboration that support quality improvement, safety, and informatics on nursing units B. Geared toward nurses who have been practicing 20 years and need new competencies through continuing education C. Creating nursing curriculum that emphasizes evidence-based practices, quality improvement, safety, and informatics D. Preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care system
C, D. The purpose of QSEN is to address the challenge of preparing future nurses with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems in which they work. QSEN program does support schools of nursing in creating a nursing curriculum that emphasizes implementation of patient-centered care, emphasis on teamwork and collaboration, integration of evidence-based practice and creation of a culture that supports quality improvement, safety and informatics. QSEN was not designed to implements patient-centered care, teamwork and collaboration that support quality improvement, safety and informatics on nursing units. QSEN is not geared toward nurses who have been practicing 20 years and need new competencies through continuing education.
Climate is often confused with culture. Which statement best describes aspects of climate? A. Culture is the perceptions of the work environment, and climate is the personality of the organization. B. Climate is the shared beliefs, values, and assumptions that exist in an organization. C. Climate enhances the stability of a social system, and culture is the voice of the organization. D. Culture and climate can both be measured.
D. Culture has been measured, and climate has several measureable characteristics, such as decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feelings of warmth, and risk. The first statement is incorrect, because climate is the personality of the organization as well as the perception of the work environment. The second statement is incorrect, because it describes the culture, not the climate. The third statement is incorrect, because culture enhances the stability of the social system, and climate is the perceptions.
