Leadership Quiz 2

lean model (QI)

Assumes that all processes contain waste and involves the thought process of doing more with less Builds on four basic principles All work processes are highly specified. All customer and supplier relationships are clear. Pathways between people and process steps are specific and consistent. Improvements are made based on scientific methods and at the lowest level of the organization. Empowers staff to identify problems and make improvements at the point of care

regulations

Directly and indirectly influence nursing practice and the nature and functioning of the health-care system. They are developed and implemented by federal, state, and local governments as well as private organizations. They can affect the quality of patient care, workplace environment, availability of resources, and finances. Nurse leaders and managers must Stay current regarding federal and state laws and regulations that can affect patient care.

stages of team development !!! TQ

Forming storming norming performing adjourning

teamwork

Involves integrating the knowledge, expertise, and experience of health-care professionals to work collaboratively in planning and delivering safe patient-centered care Includes the following core competencies: Values and ethics for interprofessional practice Knowledge of other's roles/responsibilities Responsible interprofessional communication Application of the principles of team dynamics

responsibility

Obligation one has to accomplish work The individual's obligation to perform competently at the level the person has been educated To delegate, nurse leaders and managers must Determine the competence of the delegate and appropriateness of delegation. Supervise and evaluate the performance of the delegate. The delegate Accepts responsibility when he or she agrees to perform a task delegated to them Is responsible for his or her own actions

unplanned change

Occurs when the need for change is sudden and necessary to manage a crisis Can cause anxiety and stress among staff

standardization

Process of developing and implementing uniform criteria, methods, processes, designs, or practices Improves clinical outcomes, reduces inefficiencies, and decreases costs

what can be delegated

Specified by state nurse practice acts, regulatory agency guidelines, and institutional policies Examples include Monitoring patients Collecting specimens Documenting data

automatic action

When cognitive adaptive mechanisms kick in, resulting in "auto-pilot" Can negatively impact patient safety because nurses pay less attention to details

overdelegation

occurs when The workload is more than the delegate can accomplish in the allotted time frame. The RN feels uncomfortable performing a certain task.

strategies to promote interprofessional communication

-Team Rounding: Key members of the interprofessional team gather at the specific time to talk about the progress of the patient plan of care.. This gives the patient and their family a chance to meet with the interprofessional team and contribute to the plan of care. This strategy enhances communication among health care professionals , producing quality outcomes, increasing patient satisfaction, reducing error rates, and improving patient safety. -Team STEPPS: Team strategies and tools to enhance performance and patient safety. This is a evidence based teamwork system developed by the U.S . Department of Defense in collaboration with the Agency for Healthcare Research and Quality that is aimed at optimizing patient safety outcomes by improving communication and teamwork skills among the healthcare team. This is a positive and conflict free communication tool its focus is concise information exchange including 1.) Two challenge rule - Nurse should voice their concern at least twice to receive acknowledgment from another interprofessional team member. If the team member does not acknowledge the concern being challenged then the nurse should take stronger action by following the hospital chain of command. 2.)Call out- Simultaneously informing team members of important information and assigning tasks during critical events 3.)Check-back- nurse should always check back and confirm that the information being received is correct . -SBAR: Situation Background Assessment Recommendation... this assists team members in organizing and prioritizing their thoughts (Murray, 2017, pg.129-130).

management and teams relationship

A big part of managing a successful team is having good team work and collaboration. When Managing a team you should foster open communication, mutual respect and shared decision making in order to achieve the ultimate goal - quality patient care. The American Nursing Associated and the American Organization of Nurse Executives developed the document Principles for Collaborative Relationships Between Clinical Nurses and Nurse Mangers that outlines the necessary principles for intra professional teamwork and collaboration. -effective communication: active listening, fostering a open and safe environment for individuals to voice their opinion, making sure information is accurate when giving/receiving it, making sure that the right person is getting the right information. -authentic relationships: being true to yourself and making sure that your actions match your words, empowering other to participate and voice their ideas, recognizing each others strengths, being honest 100% of the time with yourself and others, respecting personalities .. Needs.. And wants of others, asking for what you want but staying open to negotiating the difference, assuming good intentions from everyone and believing they are doing their best. -learning environments and culture: inspiring creative thinking, valuing what is going well, creating a culture of safety both physically and psychologically, sharing knowledge and learning from mistakes.

RCA (QI)

A problem-solving approach to identifying and understanding the underlying causes of an event, focusing on system factors Completed after a patient safety event and includes the sequence of events that led up to the event, possible causal factors and root cause, and an action plan that identifies specific strategies to reduce the risk of a similar incident occurring in the future Often used to get to the root cause of an error and to implement a change aimed at improving or alleviating the cause

six sigma model (QI)

A rigorous method that encompasses five steps: define, measure, analyze, improve, and control Used in QI to define the number of acceptable errors produced by a process Involves improving, designing, and monitoring processes to minimize or reduce waste

right task

A task that can be safely delegated to a specific delegate for a specific patient Appropriate activities include those that Frequently occur in the daily care of patients Are within the scope of practice of the LPN/LVN or UAP Do not have risks that are predictable or beyond minimal Nurse leaders and managers must Ensure that delegated activities are identified in the LPN/LVN and UAP job description. Describe the expectations and limitations of activities in organizational policies and procedures.

joint commission

Accredits and certifies health-care organizations in the United States based on established standards and reviews agency activities in response to sentinel events Established the Speak Up programs, with the goal of urging patients to take an active role in preventing medical errors by becoming informed participants in their care Established the National Patient Safety Goals (NPSGs) program to assist health-care organizations in addressing patient safety concerns

joint commission

Accredits more than 20,000 health-care organizations in the United States Internationally accredits health-care agencies in more than 90 countries Accredits many types of health-care organizations, including hospitals, doctor's offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services

systems approach to med errors

Acknowledge that errors happen because humans are not perfect. Focus less on the individual making the error and more on system processes that led to the error. Concentrate on changing the work environment by establishing barriers and safeguards against the errors.

types of medical errors

Adverse event or patient safety event—occurs when an injury to a patient is caused by medical management rather than the patient's underlying condition Error of omission—results when an action that is a standard of care is not taken or omitted Error of commission—results when the wrong action is taken or committed Unsafe act—occurs in the presence of a potential hazard, sometimes as the result of a violation, not an error

TeamSTEPPS

Aimed at optimizing patient safety outcomes by improving communication and teamwork skills Focused on concise information exchange techniques, including the two-challenge rule, call out, and check-back

strategic planning

Aligns an organization with defined goals Forecasts the future success of an organization by ensuring its mission, vision, and philosophy are up to date Maximizes organizational performance

fishbone diagram (QI tools)

Also known as an Ishikawa diagram or a cause-and-effect diagram Used to identify the many possible causes of a problem and any relationships between the causes Provides a retrospective review of events and can help determine the root causes of a problem Provides a graphic display of the relationship between an outcome and possible factors Used by nurse leaders and managers to Investigate a medication error or an event such as a patient suicide.

organizational culture

An informal group philosophy or worldview that guides behaviors of the members of the organization Shaped by the mission, vision, and philosophy of the organization and reflects its values and beliefs as well Includes the following: Mission statement—describes the organization's overall purpose Vision statement—reflects the image for the future the organization plans to create Philosophy—states the organization's beliefs, values, concepts, and principles that reflect its ideas, convictions, and attitudes

QI tools

Are available to communicate information, determine if a problem exists, or help in decision making Help to guide data collection, identify trends and possible problems, and provide a way to display data collected Are selected depending on the appropriate tool for the QI project

emerging change theories

Are cyclical rather than linear and require organizations to react with speed and flexibility Are based on a systems approach to change and innovation that results in a comprehensive view and a realization that systems are complex Include new theories based on complexity science, which recognizes that the world is in continual motion and that a change in one area can result in numerous changes in other areas Include two theories based on systems theory and complexity science: chaos theory and learning organization theory

for profit organization

Are owned by stockholders, shareholders, or corporate owners Must reinvest into the organization to keep it running and to develop new services May not always be readily available for certain purposes that can affect nurses and patient care

what cant be delegated

Aspects of the nursing process: Performing an assessment Formulating a nursing diagnosis Developing and updating a plan of care Evaluating the patient progress Communicating with health-care providers Implementing orders from health-care providers Providing teaching to patient and/or family Evaluating patient status and triage

delegation process

Assessment and planning Specification of the knowledge and skills required to accomplish the task Development of a plan of care with the patient and his or her family Communication Provision of clear directions to the delegate, including unique patient information and expectations regarding what to do, what to report, and when to ask for assistance Inclusion of mindful communication, in which those involved are focused on attending to, responding to, and perceiving information Surveillance and supervision Surveillance—process of observing and staying attuned to the patient's status and staff performance and following up on any problems Supervision—monitoring of the task and of compliance with standards of practice and policies and procedures Evaluation and feedback Evaluation—assessment of the effectiveness of the delegation, the outcome, and the potential need to modify the plan of care; should occur throughout the delegation process Feedback—review of whether the task was performed correctly, whether the desired patient outcome was achieved, and any areas for improvement

centralized structure

Authority for decision making is held by a few individuals at the top level of management, typically the chief executive officer and administrators. This allows for minimal innovation or creativity. The flow of communication is from top to bottom and is tightly controlled.

decentralized structure

Authority for decision making is shared by a number of individuals across the organization. This fosters autonomy at all levels. The flow of communication is bottom up and between units.

effectively leading meetings

Avoid holding unnecessary meetings. Schedule monthly staff meetings on the same day. Prepare an agenda several days ahead of the meeting and send to team members for review. Begin and end meetings on time. Take control of the meeting from the beginning to set the tone. Encourage participation of team members during the meeting. Supply a summary of the meeting shortly after.

hinders of interprofessional comm

Barriers to effective communication include factors such as lack of time, hierarchies, defensiveness, varying communication styles, distraction, fatigue, and workload . Communication among members of the health care teams can be challenging for many reasons. Ineffective communication can make someone feel inferior, create dependence on electronic systems, and create linguistic and cultural barriers. Hierarchies within health professionals are created by isolated education practices that are perpetuated in the professional workforce. Hierarchies are common within health care and can create dysfunctional communication patterns working against effective interprofessional teamwork. These can create barriers to effective communication, teamwork, and effective patient-centered care. Many facilities have an organizational structure that is management led with little to no voice of employees for changes being implemented. This top-down approach can create a barrier to effective communication. Professional nurses are trained to understand the "why" of practice. This top-down approach often lacks the communication to answer that question of why and the impact on patient care for the implementation of change This type of top-down approach can lead to feelings of powerlessness over personal professional practice.

general systems theory

Based on an open and a closed system A closed system: Has little or no interaction with systems outside Is overly focused on internal functions An open system, such as a health-care organization Interacts with systems inside and outside Is composed of interrelated elements including inputs, throughputs, and outputs

contemporary organizational theories

Build on the classical theories, and elements of classical theories are present. Reflect patterns, purposes, and processes and require a continuum-based, person- and outcome-driven system design. Approach cyclically rather than linearly and require organizations to react with speed and flexibility. Include the general systems theory, complexity theory, and learning organization theory.

purpose for building teams

Building the intraprofessional nursing team for the unit to provide specific services or care depending on the unit or department Building an intraprofessional or interprofessional committee within the organizational structure, including Nursing professional practice committees Hospital ethics committees Unit/department special task forces or ad hoc committees

classical organizational theories

Bureaucratic management theory—focused on the structure of formal organizations, the authority of management, and rules and regulations to improve the success of an organization Principles of management theory—best known for identifying management functions of planning, organization, command, coordination, and control Scientific management theory—introduced the concept of using financial rewards to increase productivity Principles of negotiation, conflict resolution, and power sharing—explored the underlying differences in human behavior, characteristics, and roles of the work group

five rights of delegation

Can be used as a guide for nurses to clarify critical elements of the delegation decision-making process The right task is assigned to the right person under the right circumstances with the RN providing the right direction/communication and the right supervision. right task right circumstances right person right direct/comm right supervision/eval

right direction/comm

Clear concise description of the task, including its objective, limits, and expectations Situation-specific communication includes Specific data to be collected and timelines for reporting Specific activities to be performed and any patient-specific instructions and limitations Nurse leaders and managers must Communicate acceptable activities, competencies, and qualifications of all staff through standards of practice Facilitate open communication with all staff and encourage them to express concerns

steps of strategic planning

Clearly define the purpose of the organization. Establish realistic goals and objectives consistent with the mission and vision of the organization. Identify the organization's external stakeholders and determine their assessment of the organization's purposes and operation. Clearly communicate the goals and objectives to the organization's stakeholders. Develop a sense of ownership of the plan. Develop strategies to achieve the goals. Ensure effective use of organization resources. Provide a benchmark to measure progress. Provide a mechanism for informed change as needed. Build a consensus about where the organization is going.

IHI

Collaborates with the health-care improvement community to remove improvement roadblocks and launch innovations that dramatically improve patient care Developed the 100,000 Lives Campaign to significantly reduce morbidity and mortality in the U.S. health-care system Developed the 5 Million Lives Campaign to significantly reduce illness or medical harm

synergy importance

Combines strengths of members of a team to result in remarkable outcomes that would not have been possible if members worked alone Catalyzes, unifies, and unleashes the greatest strengths within people Fosters creativity, imagining, and intellectual networking Requires members to value their own expertise as well as others' expertise and to be open minded

Run chart (QI tools)

Communicates data, shows trends over time, and reflects how a process is operating Contains a vertical axis that represents the process variable and a horizontal axis that represents time, with the mean or median of data displayed as a horizontal line Allows nurses and the QI team to see changes in measurements without having to compute statistics Is used by nurse leaders and managers to Investigate possible causes for the increase in falls during those months.

interprofessional communcation

Communication with all members of the health-care team as well as patients and their families Fostering of patient-centered care, resulting in quality outcomes Failure to effectively communicate interprofessionally associated with many preventable medical errors Differences between nurses and physicians -Nurses—more descriptive; sometimes intimidated by physicians -Physicians—more concise manner; sometimes dismissive to nurses

intraprofessional teams

Consist of nurses at various levels in the organization Ensure patient care is continuous and reliable Create synergy

continuum of care

Covers the delivery of health care over a period of time, as expansive as from birth to end of life Ensures safe and quality care and decreases fragmentation of care Needs to be understood in order to integrate health promotion, injury prevention, disease prevention, and disease management elements

prioritization

Deciding which patient needs or problems require immediate action and which are not urgent and can be addressed at a later time

teamwork benefits

Decreases adverse events and increasespatient satisfaction Decreases nurse fatigue and burnout and improves morale and work satisfaction Decreases litigation and turnover as well as improves the organization's reputation

steps for creating synergy

Define a clear purpose or goal. Actively listen. Maintain honesty. Demonstrate compassion. Commit to resolution of conflicts. Be flexible.

delegation

Delegation Requires problem-solving skills, critical-thinking skills, and clinical judgment Is based on patient needs, potential for harm, stability of a patient's condition, complexity of the task, and predictability of the outcome Nurses cannot delegate: Certain aspects of the nursing process to LPNs, LVNs, and UAPs A task that is not in the scope of practice of the delegate

complexity theory

Derives from the general systems theory as well as physics Suggests that relationships are the key to everything Includes key concepts—attractors, patterns, nonlinearity, self-organization, and emergence Nurse leaders and managers must Embrace the complexity of health care to promote a relationship-oriented structure. Constantly monitor the balance between stability and complete chaos to maximize variety and creativity within the system. Focus on outcomes, develop fluid roles, and be able to act with speed and adaptability through chaos.

magnet recognition program

Designated by American Academy of Nursing task force through a study on nursing practice in hospitals Requires the following three goals are met: Promote quality in a setting that supports professional practice. Identify excellence in the delivery of nursing services to patients/residents. Disseminate best practices in nursing services.

avoiding med errors

Develop a culture that is founded on the concept of safety for both patients and staff. Standardize as many processes as possible, while simultaneously allowing staff the independent authority to solve problems in a creative manner as well as avoiding automatic action. Implement initiatives created by health-care organizations to improve safety and quality. Analyze complex processes using appropriate tools. Collect data on errors and incidents within their unit in order to identify opportunities for improvement and track progress.

assignment

Distribution of work that each staff member is responsible for during a given time period When assigning tasks, nurse leaders and managers must Ensure the activity is within the individual's scope of practice.

UAPs

Do not hold a license but may be certified Can provide low-risk care that does not require nursing knowledge or nursing judgment Typically assist patients with activities of daily living, such as bed making, bathing, and assisting with dressing

communication with teams

Does anyone know the difference between the two ??? Interprofessional communication: Is communication between healthcare professionals, the patient, and the patients family ... these individuals work together to collaborate , communicate, and integrate care to ensure that all patient care is continuous and reliable (Murray,2017,Pg.128). Intraprofessional communication: Is communication between health care professionals within one single profession (Murray, 2017,Pg. 133). Formal Communication: Interviewing, Counseling, Dealing with complaints, Managing conflict, evaluating ... used by nurse leaders! Informal Communication: Open communication that is also used by nurse managers to establish open lines of communication with staff and to allow employees to feel connected with each other. (Murray, 2017, pg. 127). Organizational communication: relevant to nurse leader, how they convey the same message across the entire system... email, fax, bulletins. Downward Communication: reflects the hierarchical nature of the organization.... Sending info from administration to management to staff. Ex. expectations for employees and feedback Lateral communication: information sharing among nurse leader and managers ... and staff members to each other. Diagonal Communication: Communication with others in the organization who are not on the same level. Upward Communication: sending information up the hierarchy... ex. staff nurse to nurse managers for a request for resources. (Murray, 2017, pg. 127-128). ** Be cautious of GRAPEVINE COMMUNICATION... this type of communication spread fast and is misinformation... this can decrease moral and productivity.... Management must intervene quickly to provide the team with accurate information. **

communication

EEFCTIVE COMMUNICATION is a key element to nursing leadership and management of teams. Without effective communication the team wont be able to function. Nurse managers have a obligation to promote effective communication for staff and must model this to staff. Effective communication is timely, accurate, enhances quality of care, and fosters a healthy work environment (Murray, 2017,Pg.119). Characteristics of effective communication are respecting what others have to say, having empathy, listening actively, avoiding sarcasm, asking not commanding, not talking down or up to others, and encouraging input from others (Murray, 2017,Pg.120). Researchers found that many healthcare workers don't use effective communication. The 5-15% of healthcare workers who voice their concerns with effective communication had positive patient outcomes (Murray, 2017,pg. 120).

intraprofessional teamwork

Effective communication: An understanding of the underlying context of the situation An appreciation for the tone and emotions of a conversation Accurate information Active listening Authentic relationships: Cultivating caring relationships with each other Recognizing and leveraging each other's strengths Respecting the personalities, needs, and wants of others Staying open to negotiation Assuming good intent from the words and actions of others Learning environment and culture Inspiring innovative and creative thinking Creating a culture of safety, both physically and psychologically Sharing knowledge and learning from mistakes Questioning the status quo

mission, vision, philosophy

Emerge from the organization and should articulate the nature of the nurse's role, the values of nursing, and a purpose statement Should be known and understood by everyone within the organization, including health-care providers, patients and families, and the community Nurse leaders and managers must Model the core values of the organization. Ensure activities of their unit or department reflect the vision, mission, and philosophy of the organization.

accreditation

Ensures that health-care organizations meet certain national quality standards Means that an accrediting agency has conferred deeming status on an organization and an organization has met Medicare and Medicaid certification standards Required by Medicare, Medicaid, and most insurance companies through accreditors including The Joint Commission and the DNV GL

breaking down delegation barriers

Establishment of guidelines, policies, and procedures that support the delegation Inclusion of delegation in the job descriptions of all nursing personnel Nurse leaders and managers must Hold all staff accountable to principles addressed in the job description. Provide periodic feedback related to the delegation process. Focus efforts on creating a supportive environment that promotes effective communication and teamwork. Identify strategies to improve the delegation process.

SWOT as strategic planning

Evaluation of the organization's Strengths, Weaknesses, Opportunities, and Threats Can assist nurse leaders and managers in improving care delivery by identifying: Strengths of the unit and/or staff Areas for improvement Opportunities for facilitating positive change Steps include the following: Collect data that may include staff and patient characteristics. Analyze data and sort into strengths, weaknesses, opportunities,and threats.

persons approach to med errors

Focus on unsafe acts of health-care professionals and errors as the result of human behaviors. Correct human behavior through naming, blaming, shaming, and retraining.

formal communication

Follows the line of authority in an organizational hierarchy and reflects the culture of the organization Is planned rather than allowed to occur randomly Examples—interviewing, dealing with complaints, managing conflict, evaluating, and disciplining Nurse leaders and managers must -Use plain, direct language and avoid jargon. -Listen objectively. -Give clear, concise direction or instructions. -Seek and provide frequent feedback.

importance of strong team leadership

Has a positive impact on manager-staff relationships and team experiences Enhances job satisfaction and promotes staff retention Leads teams toward success

pt safety advocacy groups

Have emerged over the last two decades in response to concerns about the questionable quality of the U.S. health-care system and the prevalence of patient safety concerns Acknowledge that humans make errors and replace the blame-and-shame game with systems thinking Have put safety initiatives in place that can be used by nurse leaders and managers to promote safe and quality care

flow chart (QI tools)

Helps clarify complex processes, shows blocks in activity in the process, and serves as a basis for designing new processes Provides a picture of the various steps in a sequential process Allows QI teams to understand an existing process, identify complexity, identify non-value added steps, and develop ideas about how to improve a process Used by nurse leaders and managers to Identify problematic areas in the process of admitting a patient

types of HCO

Hospitals -The largest type of health-care organizations -Employ more nurses than any other type of health-care organization Other types include -Extended care facilities -Retirement and assisted living facilities -Ambulatory care centers -Substance abuse treatment facilities

reasons behind med errors

Human factors—include staffing levels, staff education and competency, and staffing shortages Communication—includes intraprofessional and interprofessional communication as well as interactions with patients and their families Leadership—includes leadership and management at all levels, organizational structure, policies and procedures, and practice guidelines

intraprofessional teams

Include health-care professionals, the patient, and his or her family Work together to collaborate, communicate, and integrate care to ensure reliable patient care Require health-care professionals to actively involve or give control to the patient and family

right supervision/eval

Includes feedback to the delegate as well as appropriate monitoring, evaluation, and intervention Nurse leaders and managers must Assure adequate human resources are available to provide for sufficient supervision. Evaluate the outcomes of the patient population and use information to develop quality improvement programs and risk management plans.

right circumstances

Includes the patient setting, available resources, and other relevant factors Nurse leaders and managers must Assess the needs of the patient population on the unit/department. Identify collective nursing care needs, priorities, and resources. Ensure appropriate staffing and skill mix. Provide sufficient equipment and supplies.

right person

Involves knowing the competency levels of those on the patient care team Nurse leaders and managers must Establish organizational standards consistent with state laws to ensure educational requirements and competencies of RNs, LPN/LVNs, and UAPs. Ensure competence standards related to delegation are integrated into organizational policies. Routinely assess performance of RN, LPN/LVN, and UAP. Initiate steps to remedy any failure to meet standards.

QI process

Involves setting standards of care, taking measures according to standards of care, evaluating care, recommending improvements, ensuring improvements are implemented, and evaluating the improvements Nurse leaders and managers -Are integral in the QI process because they are responsible for ensuring the safety and quality of nursing care -Can improve patient safety by applying the QI principles using a patient-centered approach

collaboration

Involves working jointly with others in a mutually beneficial and well-defined interprofessional relationship to achieve common goals Improves coordination, communication, quality, and safety of patient care Requires commitment to shared goals by all parties

delegation

Is considered a core skill to deliver safe and effective care Is necessary to obtain desired outcomes through the work of nursing staff Allows nurse leaders and managers time to handle more complex activities that require higher levels of expertise

chaos

Is nonlinear and unpredictable Explains why a small change in one area can have alarge effect across an organization (known as the "butterfly effect") Using this theory, nurse leaders and managers must -Be aware of the complexity of health care, the unit, and the organization. -Understand that decisions made can result in changes that were unintended.

just culture

Is part of a culture of safety Refers to a culture that is fair to those who make an error Improves patient safety because it encourages nurses to learn from each other's mistakes and to report all errors and near misses without fear of repercussions Requires responsibility for one's own actions and constructive feedback provided to peers

planned change

Is purposeful, calculated, and collaborative Includes the deliberate application of change theories Is usually well received by staff

authority

Is the legal right of an RN to delegate specific tasks to other RNs or a competent LPN/LVN or UAP Is based on the state nurse practice act and should also be reflected in a nurse's job description Using authority, nurse leaders and managers Determine how staff resources will be distributed on the unit based on patient needs. Plan, implement, and evaluate nursing care.

interprofessional team rounding

Key members of the interprofessional team gather at specified times to discuss the progress of the patient's plan of care. Contributions from all members provide individual expertise to a holistic plan of care.

leader/manager related barriers to delegation

Lack of guidelines that address who can delegate and what tasks can be delegated Lack of policies that protect nurses from inappropriate assignments and delegation of inappropriate nursing activities or responsibilities Poor staffing levels Absence of processes for validation of competencies for delegation

delegate related barriers

Lacking willingness to do the task Lacking skill or comfort with the skill required for the task Feeling overworked or perception of an unfair assignment Feeling physically unable to do the work

organizational communication

Lateral communication—the sharing of information among nurse leaders and managers or other staff at the same level Diagonal communication—communication to others in the organization who are not on the same level in the hierarchy Upward communication—sending of information up the hierarchal chain

WHO

Launched the Patient Safety Programme Established the High 5s Project, which Addresses major concerns about patient safety globally Uses standardization across multicountry settings and a multipronged approach to evaluating the standard operating protocols

ANA

Launched the Patient Safety and Quality Initiative to educate nurses about quality measurement and inform the public about safe and quality health care Established the National Database of Nursing Quality Indicators (NDNQI) to measure and evaluate quality of care and assist in improving patient safety Designated nursing-sensitive quality indicators that reflect elements of patient care directly impacted by the quality and quantity of nursing care and include Structure indicators—relate to the care environment Process indicators—relate to how nursing care is provided Outcome indicators—relate to the results of nursing care

role in strategic planning

Lead strategic planning and conduct SWOT analysis. Provide strategic direction for their department and units. Provide leadership in the development of the organizational mission, vision, and philosophy.

BEFORE QUIZ 2

Look up Ch. 6 (pp. 127-134) and write notes on it!!!

steps of QI process

Monitor and improve performance—Determine what to monitor, determine priorities in monitoring, select approaches for assessing performance, formulate criteria and standards, obtain the necessary information, choose how to monitor, construct monitoring systems, and bring about behavior change. Form an interprofessional team to implement the QI process, including nurses at all levels and promoting teamwork and collaboration. Foster staff involvement in safety initiatives and QI processes to begin changing the processes, attitudes, and behaviors of staff.

bar chart (QI tools)

Most common method to display categorical data Contains categories along the horizontal axis and frequencies or percentages on the vertical axis Used by nurse leaders and managers to Illustrate categorical data.

learning organization theory

Moves away from traditional authoritarian organizations and instead creates learning organizations. Requires adoption of the following five disciplines: Systems thinking Personal mastery Mental models Building shared vision Team learning Nurse leaders and managers must Involve staff in problem solving and decision making. Promote interprofessional and intraprofessional teamwork. Improve communication and empower staff.

future of strategic planning

Needs to shift from a traditional business approach to a focus on patient experiences, and safety and quality of care Strategic foresight—seeing the relevant opportunities that could emerge from the future and strategizing how to make the most of them Futures thinking—bringing vision to the planning process, seeing the relevant opportunities that are emerging, and creating a desired future Nurse leaders and managers must Become self-aware of the current mental model and embrace changing to futures thinking. Practice collaborating, reflecting, envisioning, and strategizing.

change in healthcare

Occurs due to constantly evolving technology, new regulations, changing public expectations, increasing environmental concerns, and heavy demand on scarce resources Is inevitable and unpredictable, and can create uncertainty Affects staff, patients, and the organization overall Can result in conflict

nurse-nurse transitions of care

Occurs when a patient is transferred from the care of one nurse to another Involves the transfer of accountability and responsibility from one nurse to another Requires acquainting the nurse who has not cared for the patient with the patient's history Requires effective communication to avoid negative consequences for patients Potentially causes errors during handovers including environmental distractions and little or no prior information for receiving nurse on the patient's history or condition handoff report

QI

Originated in other industries and developed into total quality management (TQM) Used by health-care organizations through the implementation of QI programs Entails a systematic and continuous series of actions that leads to measurable improvement in health care

organizational structure

Outlines who is accountable and responsible for the work in an organization and subsequently helps define working relationships Typically hierarchical, reflecting: Chain of command—refers to a formal line of authority from thetop to the bottom of the organization, with each unit connected to another Unity of command—suggests that each individual employee is accountable to only one manager, with expectations clearly defined and well understood Span of control—defines a manager's scope of responsibility and reflects the number of employees who report to a given manager

state regulations

Oversee the licensure and certification of health-care organizations. Address compliance with building codes, fire safety, and space allocations. Certify health-care organizations through periodic inspections.

DNV GL

Partners with National Integrated Accreditation for Healthcare Organizations (NIAHO) to provide accreditation for health-care agencies Has standards based on Medicare Conditions of Participation standards and the International Organization for Standardization (ISO) 9001 quality management standards Has accredited more than 500 hospitals

delegate

Person to whom the task is being delegated, typically other RNs, LPNs/LVNs, and UAPs Must also have the appropriate education and skills to carry out the activity

delegator

Person, usually the RN, delegating the task Must have the appropriate qualifications, education, and authority to delegate per the state nurse practice act

non profit organization

Possible sources of funding include public and/or government funding, grants, and private donations Typically services a large number of nonpaying patients May have to cut services or make other changes to ensure a positive cash flow

pt safety issues

Present an ongoing threat to achieving quality health care and a high risk of serious harm to patients. Remain a national and global public health concern. Nurses: Are in the key position to impact patient safety and quality care Have an ethical obligation to promote safe and quality care Must ensure patient safety in all aspects of care delivery

levels of service

Primary care Serves as first line of defense Focuses on health education and health screening Examples—health-care providers' offices and wellness centers Secondary care Involves emergency care and acute care Focuses on diagnosis, treatment, and limiting disability Examples—hospitals and urgent care centers Tertiary care Involves restoration and rehabilitations Focuses on maintaining and improving current state of health Examples—rehabilitation centers and assisted living centers

accountability

Professional accountability—is an obligation not to abuse trust and to be able to justify professional actions Organizational accountability—involves providing sufficient resources for nurses to effectively and safely provide nursing care Nurse leaders and managers are accountable for Setting the expectations for appropriate delegation Ensuring that RNs, LPNs/LVNs, and UAPs are aware of individual roles Providing a safe environment that supports the delegation process

donabedian model (QI)

Provides a framework for examining and evaluating the quality of health care by looking at three categories of information that can be collected to draw inferences about the quality of health care Structure—the conditions under which care is provided Process—the activities that encompass health care Outcomes—the desirable or undesirable changes in individuals as a result of health care Provides a starting point for any QI activity

culture of safety

Provides blame-free environment in which staff members feel comfortable reporting errors and near misses Supports nurses in that it is nonpunitive and emphasizes accountability, excellence, honesty, integrity, and mutual respect includes three stages

QI key principles

QI works as systems and processes. There is a focus on patients. There is a focus on being part of the team. There is a focus on the use of data.

delegation

RNs can delegate to other RNs, LPNs/LVNs, and UAPs. LPNs/LVNs can delegate to a UAP if directed to do so by an RN. A LPN/LVN cannot assign or delegate to an RN.

magnet recognition program allows organizations to

Recruit and retain top-notch nursing talent. Improve patient care, patient safety, and staff safety. Increase patient satisfaction. Foster a collaborative culture. Advance nursing standards and professional practice. Improve business stability and financial success.

learning organization theory

Requires all staff to be involved in problem solving and implementing change and innovation Includes five disciplines: thinking, personal mastery, mental models, building shared vision, and team learning Using this theory, nurse leaders and managers must -Help staff see the larger system to build understanding of complex problems. -Enable staff to develop long-term changes and work together to impact the whole system.

pareto chart (QI tools)

Resembles a bar chart in which the height of the bars represents frequency and are arranged on the horizontal axis in order from highest to lowest Designed to look at various causes of a specific problem and is based on the 80/20 principle Visually shows areas that are most significant and provides information to help identify where to focus improvement for the greatest impact Used by nurse leaders and managers to Focus on the most significant cause when there are many causes

culture of safety three stages

Safety management is based on rules and regulations. Good safety performance becomes an organizational goal. Safety performance is seen as dynamic and continuously improving.

LPNs/LVNs

Scope of practice dictated by state nurse practice acts Can perform all tasks UAPs are qualified to do plus other duties Duties include monitoring patients' health status, updating initial assessments performed by the RN, and reinforcing teaching

AHRQ

Set out to build a foundation to better understand patient safety Established the Patient Safety Network (PSNet), a website featuring essential resources relevant to the patient safety community Provides tips for preventing medical errors and promoting patient safety, and suggestions about measuring health-care quality Nurse leaders and managers can use PSNet for the following: -Suggestions about measuring health-care quality -To access consumer assessment of health plans, evaluation software, report tools, and case studies

national quality forum

Sets standards for health-care measurements Identifies and accelerates quality improvement priorities Advances electronic measurement to capture necessary data needed to measure performance Provides information and tools to help health-care decision makers Aims to reduce preventable hospital admissions and readmissions, the incidence of adverse health-care-associated conditions, and harm from inappropriate or unnecessary care Establishes its own set of nursing-sensitive quality indicators

types of medical errors

Slips, lapses, and mistakes—refer to actions that do not result in the intended outcome Near miss—is a potential error that was discovered before it was carried out Sentinel event—refers to a patient safety event that results in death, permanent harm, and severe temporary harm and intervention required to sustain life

characteristics of successful teams

Team leadership—directing and coordinating the activities of team members, including assigning tasks, developing team knowledge, and motivating team members Mutual performance monitoring—developing common understandings of the team environment and applying appropriate task strategies Backup behavior—anticipating other team members' needs through an accurate understanding of their responsibilities Adaptability—adjusting strategies based on information gathered from the environment through the use of backup behavior and reallocation of team resources Team orientation—considering other team members' behaviors during group interactions and the belief in the importance of the team goals over personal goals Shared mental models—organizing knowledge structure of the relationships among the tasks the team is engaged in and how the team members will interact Mutual trust—believing that team members will perform their roles and protect the interests of their teammates Closed-loop communication—exchanging information between a sender and a receiver irrespective of the medium

SBAR

Team members must: Organize and prioritize their thoughts before communicating with other health-care professionals. Develop a brief synopsis of the reason for the contact. Benefits include: Increases the satisfaction level of nurses and patients Improves the safety of the care being delivered Decreases the rate and frequency of medical errors associated with miscommunication Facilitates proficient communication and continuity during the transfer of care

norming

The third stage is when the team overcomes resistance and progresses through the storming phase. Members give up individual goals and begin working as a team toward the common goal. Nurse leaders and managers step back and allow the team members to take responsibility.

Forming

This is the initial stage when members of the team first meet each other, share information about themselves, and begin discussion about goals. Members avoid controversial topics and focus on getting along. Nurse leaders and managers help direct the team and explain the purpose

storming

This is the second stage when the team begins to work together. Members share their opinions, resulting sometimes in intragroup conflict. Nurse leaders and managers assist with resolving conflict and coach team members through conflict.

IHI model of improvement

Three fundamental questions are asked in any order. What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? The Plan-Do-Study-Act (PDSA) cycle is implemented. Plan involves developing a plan to initiate a small change. Do is implementing the plan and collecting data about the process. Study includes studying and summarizing the results of the change. Act encompasses three possible actions: adopt the change, adapt the change, or abandon the change.

TEEAMS approach

Time—recognizing the importance of spending adequate, quality, and face time with the team Empowerment—understanding that empowerment is important to building a strong team Enthusiasm—committing to the team's success and demonstrating enthusiasm for the individuals on the team Appreciation—recognizing a job well done Management—managing teams and holding them accountable Support—supplying support to the team, including their personal, professional, and organizational needs

role of nurse leader

To be instrumental in facilitating successful change at both the unit and organizational levels To serve as agents of change, or change agents To develop a basic understanding of change theories and models To embrace change to ensure that safe and quality nursing care is provided To recognize that conflict is always present in the workplace

role of nurses on interprofessional teams

To promote patients' capacity for optimum in their care and problem solving To recognize each profession's value and contributions To develop mutual trust, respect, open discussion, and shared decision making To bring their unique nursing perspective to interprofessional teams

supervision

To provide guidance or direction, oversight, evaluation, and follow-up To supervise, nurse leaders and managers must Monitor the delegate's performance and assure compliance with standards of practice. Adhere to organizational policies and procedures in place to support the nurse delegating the task.

Lewins force field model

Traditional change theory One of the most widely used theories and the basis of many other theories Based on the belief that change results from two field or environmental forces Driving forces (helping forces) that attempt to facilitate the change and move it forward Restraining forces (hindering forces) that attempt to impede change and maintain the status quo Includes three steps: unfreezing the status quo, moving toward the new way, and refreezing or stabilizing the change for sustainability

model components of a magnet recognition program

Transformational leadership—must use futures thinking and demonstrate advocacy and support on behalf of staff and patients Structural empowerment—must develop, direct, and empower staff to participate in achieving organizational goals and desired outcomes Exemplary professional practice—must promote interprofessional collaboration and teamwork New knowledge, innovations, and improvements—must focus on redesigning and redefining practice to be successful in the future Empirical quality results—must participate in establishing quantitative benchmarks for measuring outcomes related to nursing

TEEAMS approach

The TEEAMS approach is one way in which nurse managers can create and lead a successful team. Time-Nurse managers must focus on spending adequate face to face time with their team and getting to know them. Empowerment-Nurse managers must empower their team members , by doing this it shows that the manager has trust in their team to make appropriate decisions with minimal interventions from management. Enthusiasm-By having enthusiasm it will get the team excited to reach their goals , and shows that the nurse manager is committed to the success of the team and wants to see them reach their goals. Appreciation- Managers must show appreciation for members of the team as they work hard toward their goals, this will build the team members self esteem. Higher self esteem leads to improved patient outcomes and increased willingness to work toward future goals. Management-Holding the team accountable and making sure the team understands the job expectations and performance parameters. It is the managers responsibility that the team members have the resources available that are necessary to perform their duties. Support- Managers should support their team including personal ,professional, and organizational needs. Managers should be accessible, engage in daily rounding, return calls, create an environment that encourages work engagement. (Murray, 2017, Pg. 321) Management should hold meetings regularly in order to create a successful team. When holding a meeting management should show that team members are respected and their time is valued, there should be an agenda for the meeting and it should begin and end on time out of respect for the team.

histogram (QI tools)

Type of bar chart used to display frequency distributions Becomes useful when the time sequence of events an event is not available Assists the team in recognizing and analyzing patterns in numerical data that may not be apparent by looking at data in a table or finding the mean or median of data Is used by nurse leaders and managers to Illustrate the average length of stay of surgical patients on the unit.

organizational comunication

Used to convey the same message across theentire system Typically written and occurs in staff meetings, group discussions, and committee meetings Types include Downward communication—reflects the hierarchical nature of the organization and includes directives to employees, expectations for employees, and performance feedback DIAGONAL COMMUNICATION (nurse with other professions)

informal communication

Used when talking to patients about personal business Can help establish open lines of communication with staff and create a culture in the workplace that allows employees to feel connected with each other Grapevine communication—negative form of informal communication that flows quickly and haphazardly at all levels of the organization and becomes distorted Nurse leaders and managers must -Monitor the grapevine and intervene quickly to provide accurate information. -Provide as much information as possible with staff.

FMEA (QI)

Useful in determining what aspect of a process needs to change Includes the following goals: To prevent patient safety events by identifying all possible ways a process could result in failure To estimate the probability of failure To estimate the consequences of failure To establish an action plan to prevent potential failures from occurring Steps include failure modes, or what could go wrong; failure causes, or why would the failure happen; and failure effects, or what would be the consequences of each failure.

performing

The fourth stage is when team members understand their roles. Members accept each other's individual idiosyncrasies and develop group norms. Nurse leaders and managers focus energy on other projects.

considerations when building teams

What are the tasks the team needs to accomplish? Is representation from various levels of the organization needed? Is geographical, educational, and interprofessional diversity needed? What skill mix is necessary for the team to succeed? Are the same people on the teams as usual or has new staff been encouraged to join?

challenges of delegation

When ineffective, they can jeopardize the provision of safe and quality patient care in a timely manner and can result in missed care or omitted care. Challenges can result in conflict between the delegator and the delegate. Barriers to effective delegation can be related to the delegator, the delegate, and leadership and management.

leading and managing teams

When managing a team you must model "expert leadership practices to interprofessional team members and healthcare consumers". Nurse managers are fundamental to building effective teams. When managing a team you must constantly remind team members about the goal, missions, and accomplishments of the team. Effective nurse leadership can have a positive impact on manager- staff relationships and team experiences, as well as enhance job satisfaction and promote staff retention. Good nurse managers lead their team towards success, encourage and mentor members, provide constructive criticism, and celebrate successes of the team.

intraprofessional communication

Working with other nursing staff to deliver safe and quality patient care Principles related to effective intraprofessional communication include the following: Engage in active listening. Know the intent, purpose, and expectations of a message. Foster an open and safe environment. Be sure information given or received is accurate. Speak to the right person.

underdelegation

occurs when There is failure to transfer authority for a task or to provide clear direction to the delegate because the RN fears losing control or authority, feels insecure, believes he or she can accomplish the task quicker, or is inexperienced.

rogers innovation decision process

transitional change model Consists of a series of actions and choices over time that an individual or decision-making unit must follow Recognizes that the common behavioral responses to change individuals may experience can facilitate change Includes five stages: knowledge, persuasion, decision, implementation, and confirmation Requires everyone involved with the change and/or affected by the change to be committed to the change

kotters eight stage process of creating major change

transitional change model Involves a multistep process that overcomes all sources of resistance and must be directed by high-quality leadership Includes eight stages: establishing a sense of urgency, creating the guiding coalition, developing a vision and strategy, communicating the change vision, empowering broad-based action, generating short-term wins, consolidating gains and producing more change, and anchoring new approaches in the culture

lippitts phases of change model

transitional change model Uses language similar to the nursing process Focuses more on the people involved in the change process rather than on the change process itself Stresses the importance of communication and rapport with those involved in the process Includes seven steps: diagnosing the problem, assessing the motivation and capacity for change, assessing the change agent's motivation and resources, selecting progressive change objectives, choosing an appropriate role for the change agent, maintaining the change after it has started, and terminating the helping relationship