Leadership week 1 + 2
Marquis-Huston Critical Thinking Teaching Model
archives desired learning outcomes 4 overlapping spheres - each have component of teaching leadership and management didactic personalized learning group process problem solving learning situations = learning exercises
nurses role in QI
on committees make policies and procedures use reliable sources for info incr knowledge collect data compare results act as role model re ecaluate
Authoritarian
strong control others motivated by coercion others directed with commands communication goes downwards choices dont involve others differences in status = i and you criticism is punitive predictable groups, decr frustration, security productivity high creative, self motivated, autonomy low found in large bureaucracies = armed forces
conflict resolution
opposing thoughts, idea, feelings, perception, behavior, values, opinion, actions inevitable to happen lack of conflict = stasis too much = demoralizing, anxiety, burnout common causes: ineffective communication unclea expectation poor organize structure incompatibility of ppl management or staffing changes diversity r/t age, gender, race, ethnicity
Priority setting frameworks
-Maslow's Hierarchy -Airway, Breathing, Circulation (ABC), disability, exposure (remove clothes( -Safety/Risk reduction -Assessment/Data Collection First -Survival Potential -Least Restrictive/Least Invasive -Acute vs. Chronic/Urgent vs. Nonurgent/Stable vs. Unstable
10 Fatal Leadership Flaws
1. A lack of energy and enthusiasm 2. Acceptance of their own mediocre performance 3. Lack of a clear vision and direction 4. Having poor judgment 5. Not collaborating 6. Not walking the talk 7. Resisting new ideas 8. Not learning from mistakes 9. A lack of interpersonal skills 10. Failing to develop others
managerial decision-making model
1. Determine decision and outcome (set objectives) 2. Research + identify options 3. Compare/contrast options + consequences (SWOT) 4. Make decision 5. Implement action plan 6. Eval results SWOT = strengths, weakness, opportunities, threats
integrated ethical problem solving model
1. State prob. 2. Collect additional info, analyze prob 3. Develop alternatives, analyze, compare them. 4. Select best alternative, justify decision. 5. Develop strategies to successfully implement chosen alternative, take action. 6. Evaluate outcomes, prevent similar occurrence By Park, after 20 existing models, 2012
stages of conflict
1.) latent conflict conflict not yet developed, factors present that have high likelihood of causing conflict ex. new scheduling process, change = drama 2.) perceived conflict party perceived prob is present through actual conflict might not exist ex. nurse thinks nurse manager is unfair w/ scheduling, but really bc nurse misunderstood nurses scheduling request 3.) felt conflict those involved begin to feel emotional response to conflict ex. nurse feels anger to nurse manager after finding out she is scheduled to work 2 holidays in a row 4.) maifest conflict conflict and action is taken, action at stage + or - or withdrawal of one or more parties from situation ex. nurse manager and nurse on unit agree current scheduling system causing issues and agree to fix it 5.) conflict aftermath completion of conflict process, + or - ex. + = nurse manager and nurse on unit happy w/ new schedule, feel values for conflict resolution ex. - = nurse manager and nurse cant find new fix, need to continuing fixing
Gold Mark Report
1923 quality of nursing edu was bad on a # of counts including use/exploration of students for service at the expense of educ need university educ need accreditation system for schools need licensure + exam code of ethics
human relations management
1930-1970 people rather than machines mary parker follet 1926 - participative decision making or participative management "The giving of orders" - managers authority w/ not over workers Hawthorne - Mayo - relation b/w factory and productivity, if managers pay attnetion to workers = productivity incr, regardless of enviro conditions doug mcgregor - 1960 manager attitudes about workers correlated w/ worker satisfaction, XY theory, X managers believe worker are lazy, need const supervision, Thoery Y workers enjoy work, self motivated chris argyris - 1964 supported mcgregor and mayo = manager domination = workers discourages/passive, if self esteem + independence arent met = quit
ANA no strike policy
1950 really bad working conditions pt care was suffering no strike policy weaked ANA negotiating position + bc progres in wages and work conditions that had been made was inadequate --> got ride of no strike policy in 1968 nursing group is too big to go unnoticed by labor unions
steps in progressive discipline
1st infraction = informal reprimand, manager and employee meet, discuss issue, suggestion for improvement 2nd = written warning, manager meets w/ employee distribute written warning, review specific rules, potential consequence is infraction continues 3rd = employee placed on suspension w/ or w/o pay, time away from work gives employee opportunity to examine issues, consider alternatices 4th = employee termination, follows after many warning have been given, employee continues to violate rules and polices
management
5 functions planning - decision regarding what needs to be done, how it will be done, who is doing it organizing - line of authority, channels of communication, where decision are made staffing - acquisition and manage of staff and staff mixing direction - leadership by manager that influence and motive staff to do their roles controlling - eval straff performance, eval unit goals, see outcomes are met characteristics of managers: have formal positions of authority + power possess clinical expertise network w/ members of team, coach subordinates, make choice about function of organ = resources, bidget, hiring, firing
Standards of Nursing Practice
ANA: Scope & Standards of Practice - Standards allow nurses to carry out professional roles, serves as protection for the nurse, the patient, & the institution where health care is provided 1973 accountability and responsibility 2015 - removed "delegation"
intuitive decision-making model
Arriving at decisions w/o conscious reasoning model argues that in given situation, experts making decisions scan enviro for cues to recognize patterns should be used with another model RPD - recognition primed decision model- Klein = how ppl make effective choices under time and pressue w/ uncertanity
Nursing Process
Assessment Diagnosis Planning Implementation Evaluation by Ida jean orlando in late 1950s weakness - no clear objectives, no clear goals in planning stage
Successful Decision Makers
Courageous Sensitive Energetic Creative
decision making tools
Decision grids - visual alternatives and compare on same criteria ($, politics, department effect, time) Payoff tables - cost profit volume relationship, good for quantitative info (ex items cost, predicted use), use probabilities/historical data (hospital census), not gaurantee ex. class cost 500 to have, if 20 ppl 25$ each, if 40 ppl 12.50 each, use data form past Decision trees - tied to outcome of other events Consequence tables - many alternatives create different consequences, list objectives for solving prob down one side and rate how each alternative would meet objective Logic models - schematic or pic of how programs intended to operate, resources, processes, outcomes, relationship b/w 3 components Program evaluation and review technique - PERT, determine timing of choices, by Booz Allen Hamilton + US navy + Missile program,
Full Range Leadership Model
FRLM bass and avolio - 1993 - 1st full rnage leader as leader who could apply transform, transac, laissez at anytime has augmentation effect 9 factors: inspirational motivation (transfor) idealized influence (attributed) "" idealized influence (behavior) "" intellectual stimulation "" individualized consideration :: contingent reward (transsac) active management by exception "" management by exception passive ""\ nonleadership (laissez)
management functions identified
Herni Fayol 1925 plan, organ, command, coordinate, control gulick expanded on this - 7 activities of management + +ed report, budget POSDCORB planning - philosophy, goals, objectives, policies, procedures, rules, long and short term, fiscal course staffing - interview, hiring, scheduling, socialization control - appraisals, fiscal, ethical, professional
ANA/AONE
I. Effective Communication high-intensity enviro, is not merely transaction of words, requires an understanding of underlying context of situation, tone, emotions, accurate info. principles relating to effective communication Principles 1. Engage in active listening to fully understand and contemplate what is being relayed. 2. Know the intent of a message, and what is the purpose and expectations of that message. 3. Foster an open, safe environment. 4. Whether giving or receiving information, be sure it is accurate. 5. Have people speak to the person they need to speak to, so the right person gets the right information. II. Authentic Relationships with their patients, supporting in meeting their physical, mental, spiritual needs r/t health. To bolster profession, quality of care patients receive, nurses must reciprocate that kind of relationship w/ each other. nurses engage in art, science of caring, by their very nature, nurses thrive when they experience caring from their colleagues. principles r/t authentic relationships give nurses guide for developing types of interactions w/ one another, cultivate nurse's sense of being cared for that promotes their ability to do same for patients. Principles 1. Be true to yourself = actions match words, those around you are confident = what they see is what they get. 2. Empower others to have ideas, share ideas, participate in projects 3. Recognize/ leverage each others' strengths. 4. honest 100% - with yourself, others. 5. Respect others' personalities, needs, wants. 6. Ask for what you want, stay open to negotiating difference. 7. Assume good intent from others' words, actions, assume they are doing their best. III. Learning Environment and Culture attributes of learning enviro = both objective and subjective; some are clear and visible, some are just sensation or feeling. Principles 1. Inspire innovative, creative thinking. 2. Commit to cycle of eval, improving, celebrating, value what is going well. 3. Create culture of safety, both physically/psychologically. 4. Share knowledge, learn from mistakes. 5. Question status quo - ask "what if", not "no way."
heuristics
Mental shortcuts or "rules of thumb" that often lead to a solution (but not always). people rely on these uses trial and error
Intraprofessional collaboration
Nurse-Nurse
prioritization and time management
Nurses continuously set + reset priorities in order to meet needs of many clients + to maintain client safety priority setting requires that decision be made regarding to order in which: pt seen, assessment done, intervention provided, steps in pt procedure completed, components of pt care are completed establishing priorities requires nurse make choices based on evidence obtained: during shift report, other communication w/ members, careful documents, continuously and accurate collecting client data
4 metaparadigm def and examples
Nursing: art/science of nursing; actions/interventions. what nurses DO. nurse applying professional knowledge, procedural, technical skills, indirect/direct (hands-on) care. Person: one receiving care. defined according to recipient of nursing care (patient/client), may include family, friends, community. Health: relative to person, defined according to patient's perspective. What one considers healthy, may be considered unhealthy to another, refers to patient's level of wellness (wellness-illness continuum), physical, psychological, mental, intellectual, emotional, spiritual. Environment: internal, external, social factors that impact patient's health (genetics, immune function, culture, interpersonal relationships, economics, mental state, geo-location, educ, politics, ecology, social status, job)
Students will demonstrate mastery of the 11 Maine Nurse Core Competencies:
Patient Centered Care: holistic care, preferences, values, needs, respect Professionalism: accountability for delivery of standard-based nursing care, moral, altruistic, legal, ethical, regulatory, humanistic principles. Leadership: Influence behavior of ppl/groups of individuals within enviro = facilitate establishment, acquisition/achievement of shared goals. System Based Care: awareness/responsiveness to larger context of health care system, demonstrate ability to effectively call on microsystem resources to provide care that is optimal quality/value. Informatics & Technology: communicate, manage knowledge, mitigate error, support decision making. Communication: Interact effectively with patients, families, colleagues, fostering mutual respect, shared decision making, enhance patient satisfaction, health outcomes. Teamwork & Collaboration: Function effectively within nursing, interdisciplinary teams, fostering open communication, mutual respect, shared decision making, team learning, development. Safety: Minimize risk of harm to patients, providers through both system effectiveness, individual performance. Quality Improvement: Uses data to monitor outcomes of care processes, improvement methods to design/test changes to continuously improve the quality/safety of health care systems. Evidence-Based Practice: Identify, evaluate, use current evidence coupled with clinical expertise, consideration of patients' preferences, experience values to make practice decisions Geriatrics: complex chronic needs; recognizes unique psychosocial, physical, cultural needs, differentiates normal aging from pathology, provides safe/effective care
PRIORITIZATION PRINCIPLES
Prioritize system before local ("life before limb") - interventions for pt in shock over interventions for pt who has localized injury Prioritize acute (less opportunity for physical adaption) before chronic (greater opportunity for physical adaption) - care for pt with new illness (confusion/chest pain) b/f exacerbation of illness/long term Actual problems before potential future problems - admin of meds for pain b/f ambulation Listen carefully to clients and don't assume - ask pt w/ new dx of DM what he feels most important to learn about disease menagement Recognize and respond to trends vs transient findings - see decel in pt on coma scale Recognize signs of medical emergencies and complications vs "expected client findings" - incr ICP to pt w/ new dx of stroke vs findings expected following stroke Apply clinical knowledge to procedural standards to determine the priority action - timing of admin of antidiabetic + antimicrobial meds more important than admin of other meds
PBL
Problem-based learning is a teaching approach that relies on problems. occures best in groups
National League for Nursing (NLN)
Professional organization whose members represent multiple disciplines. The National League for Nursing conducts many types of programs, including accrediting nursing education programs. 1912
Maine nurse core competencies
Professionalism Leadership Patient-Centered Care Evidence-Based Practice Teamwork and Collaboration Communication System-Based Practice Informatics and Technology Safety Quality Improvement Geriatrics 11 of them
delegating and supervising
RN --> RN, PN, AP PN --> PN, AP only delegate tasks appropriate for skill + educ level of health care team emmeber who receiving assignment RN not to delegate the nursing process, pt education, task that need clinical judgement to PN or AP can delegate education, task that need clinical judgement to PN or AP, nursing process task factors: prior to delegating care consider: predictability of outcome potential for harm complexity of care need for prob solving + innovation level of interaction w/ pt
leadership competencies into management
Skills Knowledge Abilities gardner - integrated leader manager they think long term - effect yr on they look outward, toward the larger org - big pic they influence others beyond group they emphasize vision, values, motivation they are politically astute - they think in terms of change and renewal
the Maine State Board of Nursing
The mission of the Board of Nursing is to protect the public health and welfare in the area of nursing practice
managers
organizational members who are responsible for attainment of organizational goals by planning, organizing, leading, controlling assigned position by organ legit source of power specific duties control, deciosopn making, analysis, results manipulate people, enviro, money, time, resources willing and unwilling subordinates
Scientific Management
a management theory using efficiency experts to examine each work operations and find ways to minimize the time needed to complete it frederick taylor - father of scientific management systematic soldiering - wokers get min standards doing least amount of work possible one best way --> incr productivity traditional rule or thumb - science to incr efficiency time/engery scientific personnel system - hired, trained, promoted fit - into org, common goals, pay based on work relation b/w managers and wokers weber - what made some worker more effecient than others --> bureaucracy
grievances
a wrong perceived by employee based on feeling of unfair tx that is considered grounds for formal complaint cannot be satisfactory resolved b/w parties involved can require management by 3rd party facilities have formal grievance policy should be followed when conflict cant be solved steps: formal presentation of complaint using chain of command, formal hearing is issue not resolved at lower level, professional mediation if not reached in formal hearing
legal and morally permissible
abortion, amputation, hysterectomy, circumcision, separate conjoined twins, vaccinations, assisted suicide, withdrawal from life stating tx
illegal and morally permissible
abortion, assisted suicide, conscientio objection
legal and morally impermissible
abortion, vasectomy, sex reassignment, hemicorpectomy, withholding nutrition or hydration, assisted suicide, withdrawal of life sustaining tc
leadership theories and theories
aristotle - great man theory lewin and white - leadership styles follett - law of the situation fielder - contingency leareship blake and moulton - task vs relationship in determining leadership hersey and blanchard - situational leadership tannenbaum and schmidt - """" kanter - organizational structures shapes leader effectiveness burns - transaction and transformational bass and avolio - full range, transformational kouzes and posner - 5 practices for exemplary leadership gardner - integrated leader-manager
Assigning, delegating & supervising
assigning - transferring authority, accountability, responsibility of care to other member of team delegating - transferring authority, responsibility to another team to complete task while retaining the accountability supervising - directing, monitoring, ecal task by another member of team, RN responsible for supervision care task delegating to AP and PNs
Leadership Styles
authoritarian: makes choices for the group, motivates by coercion, communication down chain of command, work output by staff is high = good crisis situations + bureaucratic settings, effective for employees w/ little/no formal educ democratic: includes group in choices, motivators by support staff, communication up + down chain, work output by staff good quality = good when cooperate/collaborate are needed laissez-faire: few choices, little planning, motivated by staff members, communication up + down + between groups, work output is low unless informal leader evolves, effective w/ prof employees
negotiation examples
avoiding/withdrawling = know there is a prob but dont want to work on it, escalates over time, lose lose situation ex. accept or reject idea smoothing - one party attempts to smooth another party by truing to satisfy other party, to preserve or maintain peaceful work enviro, lose lose competing/coercing - pursues solution at expence of others, managers use when quick or unpop choice must be made, one party loses something, win lose ex. nurse feels unqualified to work on floor = nurse wins, manager loses, nurse might be terminated but pt would be at risk cooperating/accommodating - one party sacrifies something so others get what they want, opposite of competing, original prob not be solved, solution to future conflict, lose win ex. nurse accommodates mangers request, kids at risk for incompetent care, practice liability is another issue for consideration compromising/negotiating - each party gives up something, win lose, equal ex. min the losses for all involed while making certain each party gains something = nurse offers to work on another floor not peds = each party give up something, win win collaborating - set aside original goals and work together new common goal, win win manager and nurse provide safe care, nurse will orientat to ped unit
pitfalls in using decision making tools
base decisions on 1st impressions = confirmation biases = affirm impression and preference as other alternative are evaluated focus on event that leaves strong impression = bisas not always time to involve large group
accountability means
being answerable, especially to those who provide funds, ensure stated goals are accomplish ANA - protection human subjects = common rule
responsibility
blameworthiness or praiseworthiness liability for actions
resource management
budgeting and resource allocation human, financial, maternal budgeting = manager, staff nurses asked to provide input resource allocation = manager, RN proficing cost effective pt care should not compromise quality RN need to effectively use resources
transactional and transformational leadership
burns 2003 - leader follower interactions, both can raise each other to higher levels of motivation and morality = transformational leadership transactional = focus management tasks, committed, trade offs to meet goals, does not identify w shared values, examines causes, contingent reward transformational = common values, caretaker, inspires others w/ vision, long term vision, looks at effects, empowers others Huber 2015 - important tenants of transformational leaders is collective empowerment = leader and followers are working together for goal ANA 2016 - leaders do more than delegate, dictate and direct = help other reach highest potential Kauzes and posner 2012 - best known authors in transformational, leaders culture in which relation b/w leaders and willing followers can thrive transformation will fail w/o traditional management
Competencince =
confidence and vice versa
cost effective care
cost-containment = strategies promote efficient and competent pt care, needed revenues for continues productivity ex.plan to meet needs of pt medical prob + eliminate unneeded use of resources or extended hospital stays cost effective = optimal results in relation to money spent to achieve reulsts, getting your moneys worth ex. spending incr money on staff training for precautions = incr use of PPE, decr infection transmission and saving in cost of caring
clinical elements in decision making
define objectives clearly gather data take time needed generate many alternatives think logically choose and act decisively gather data = sometimes confirmation bias = search for favored data logical thinking = inferences = deductive reasoning 3 ways: overgeneralizing - a is like this, so all other a's have this, sterotypical affirming the consequences = just because you are using B and not A, does not make one better than the other arguing from analogy = A is present in B, then A and B are alike in all aspects, good nurses should mean good manager
leaders
dont delegate authority gain power through influence wider varieties of roles than managers may/not formal part in organization goals that may/not reflect organization no delegate of authority wider variety of roles focus on groups, info, feedback, empowering may/no formal hierarchy of org emphasize interpersonal relations willing followers goals may/not reflect org
disciplinary action
during performance appraisal or course of employment in writing, corrective action based on policy and termination of employment some offenses = mistreatment = alcohol = immediate dismissal less = give staff opportunity to correct unacceptable behavior staff who witness action by coworker = report up the chain
delegatee factors
education, training, experience knowledge of skill level of thinking needed demonstated competence delegatee culture polices and procedures, legislation
decision making in organizations
effects of organizational power - powerful ppl get their way, rational and admin decision making - managers make choices that don't fit objective rationality theory economic man - rational choices, complete knowledge of prob, list of alternatives, rational system of ordering preferences, selects choice that max utility admin man - choices are good enough, complete knowledge not possible = fragmented knowledge, consequences occur in future = impossible to predict accurately, chooses among few alternatives, final choice satisficing rather than max most use admin bc time and too much info to know
characteristics of a critical thinker
energy assertive communicate flexible caring risk taker creative willing to take control
illegal and morally impermissible
eugenic sterilization, euthanasia, assisted suicide, female genital mutilation, forced meds, forced feeding, restraints
performance appraisal and peer review
formal system for performance appraisals should be reflective of staff members jobs data collected over time peer review = from orientation, use a tool, shared w/ peers and manager, orientee provide their imput private setting feedback goals member can repeal = written comments
Variations in Decision Making
gender - women larger frontal (prob solving), limbic (regulate emo), men 6.5x more gray matter, women 10x more white matter (work faster) values - consciously or not, influence perceptions, life experience - edu, mature + broader background = more alternatives, more autonomy than others, good or bad choices in past individual preference - more risk, physical, eco, emo risk, time, energy, cost
historical development of leadership theory 1900 - present
great man theory/trait theories (1900-1940) basis for leadership research man = Aristotelian philosophy - some ppl are born to lead, other born to be led, leaders arise when situation demands traits = some ppl certain characteristics/personality traits = leaders behavioral theories (1940-1980) mcGregor - influence on leadership + management not on traits, but what he or she did Lewin 1951, white, lippitt 1960 = leadership styles = authoritarian, democratic, laissez faire
traditional prob solving process
identify prob gather data, analyze causes explorer alternate solutions eval alternatives select solution implement solution eval effective but takes too much time to implement and lack of initial objective setting step
steps in prob solving
identify prob - state in objective terms, min emotional overlay discuss possible solutions - brianstorm, think outside box analyze identified probs - probs and cons of each to narrow down select solution - base an analysis above implement selected solution - procedure and time line for implementation should accompany implementation of selected outcome eval solution ability to resolve original prob
Characteristics of leaders
initiative inspiring energy positive attitude communication skills respect pro solving + critical thinking transformational leaders - empower followers to assume responsibility for communal vision, personal development is seconday transactional leaders - immediate probs, maintaining status quo + using rewards to motivate emotional intelligence - ppl to perceive + manage emotion of self and others, must know own emotions and emotions of clients, emo intelligence get it from applying and understanding emo leader = insight into emo team, understand perspectives, constructive critisism, multitaksing, high quality care, no judgement
categories of conflic
intrapersonal = within peron, from internal struggle r/t contradictory values or wants ex = nurse wants to move up on later, but having fam probs interpersonal = 2 or more ppl with different goals, beliefs, bullying, seen for new nurses, burnout, stress related ex = nurse give heavy assignment and no one will help her intergroup = 2 or more groups, departments, organizations, policy, procedure, change in leadership, change in organization structure ex = who passes meal trays = nurses or dietary
brain hemi and thinking styles
left = analytical, linear, language, logic, # right = creative, intuitive, nonverbal upper left = analytical, factual data, # lower left = organizes, details, stable work, safety upper right = big picture, futuristic, intuition, take risks lower right = emo, sympathetic, kinesthetic, empathetic, interpersonal aspects
democratic leader
less control is maintained economic and ego awards are used to motivate others directed though suggestion/guidance communication flow up/down decision making involves others use we not I and you criticism is constructive long periods of time together, promotes autonomy, growth less efficicent than authoriative
interprofessional teams
members from different professions with varied/specialized knowledge, skills, methods. Team integrate observations, expertise, decision making --> coordinate, collaborate, communicate optimize care for patient/group
critical thinking
mental process when analyzing elements of clinical situation and using analysis to make choices supports decision making by: guide nurses through process of assessing + compiling data selecting + discarding data based on relevance prob solving and decision making clinical judgment: made by regarding course of action based on critical analysis of data analyze data, related evidence, meaning of data, apply knowledge
assertive communication
needed during conflict negotiation allows expression in direct honest, non threatening ways don't infringe on others rights acknowledges and deals w/ conflict, see others as equal, direct statements of feelings elements of assertive communication: good location, eye contact, trust, sensitive to cultural needs, speaking using I, avoid you, state concerns using open, honest direct statements, conveying empathy, fair solution
five stages of nursing ability
novice nurse - students, newly licensed, low clinical experience, approach situation from theoretical perspective rely on context free facts, establish guidelines, rules govern practice adv. beginner - most new nurses, practice independently, many tasks, make some clinical judgment, begin to rely on prior experience to make practice choices competent nurse - nurse who have been in practice for 2-3yrs, incr level of skill, proficiency, clinical judgement, abstract, analytical thinking, long term outcomes proficient nurse - a lot of experience, observational abilities, well developed critical thinking, skills allow nurses to see and respond to unexpected change expert nurse - holistically, process info, adv level of intuition, analytical ability, no need rely on rules to comprehend situation and take action
time management
organize care according to pt needs/priorities use time saving strategies and avoid time waster good time management: facilitates greater productivity, decr work related stress, help ensure quality, incr satisfaction w/ care provided poor time management: impairs productivity, feelings of being overwhelmed + stressed, incr omission of important task, creates dissatisfaction w/ care time management is a cyclic process - develop a plan, set goals, reprioritize remaining tasks, time analysis teamwork - offer to help self-care = mental breaks, breaks, meals
quality improvement
performance improvement, quality control by joint commission focus on assessment of outcome, determines ways to improve delivery quality care all level of employees involved quality improvement process: outcome indicators = reflect desired outcomes related to standard under review structure indicators = reflect setting in which care is provided, available human and material resources process indicators = how clint care provided, established by polices, procedures benchmarks = goals set to see what level outcome indicators should be met ex. incentive spirometer in post op 92% (process indicator), but rate of post pneumonia determined to be 8% (outcome indicator). if benchmark is set at 5% benchmark that outcome indicator is not being met and structure and process variables need to be analyzed for areas for improvement can be found in policies and procedures can be identified by managers, staff, risk management if benchmark not met = influencing factors determined root cause analysis = consequences of action, done for sentinel events, QI process, cause and relationship that can exist, determines additional influences at each level of relationship = educ or corrective action done
assigning
performed in downward or lateral manner w/ regard to members of team pt factors: cardiac monitoring, mechanical vent, special precautions, time team factors: skills, supervision, staff miz (RN/CNA), nurse to client ratio, experience w/ similar clients additional factors: unsafe scheduling,
Laissez-faire
permissive, little/no control motivates by support when requested by group little/no direction up and down communication b/w members disperese decision making through group emphasis on group no criticize can be frustrating, disintrest, if high sefl motivation can work, good for brain storming
audits
produce valuable quantitative data types: structured = influence of elements that exist separate from or outside pt staff interaction process = how care was provided and relationship b/w nurses and quality care provided outcome = what results if wany occure nursing sensitive outcomes = directly affected ny wuality of nursing care - fall rates timing of audits: retrospective = after pt gets care concurrent = while pt gets care prospective = future pt
cost effective care stratigies
pt w/ needed educ to decr future medical cost associated w/ future complaints ex. teach pt w/ dx DM how adjust insulin dose depending on activity level = decr hypogly = decr medical care promoting use EBP = incr outcomes ex. EBP techniques to care for pt who have Cath = decr CAUTI promoting cost effecting resource management ex. necessary equipment and properly charging pt ex. training staff w/ equipment ex. return unused equipment
critical thinking =
reflective thinking
medicine and the region of technology
reiser 1978 technology has created distance b/w nurse the patient and physician and pt
negotiation
resolve ongoing conflicts, agree on steps to take, bargain to protect ppl or collective intrests, puruse outcomes that benefit mutal intrests nurse do it on daily basis can use many conflict stratefies focus on win win solution or win lose where both parties have to give and take
interactional leadership theories (1970-now)
schein 1970 - humans are complex, working neviro was open system to which they respond = system, open if it exchanges matter, energy, info w/ enviro: ppl are complex, high variable motive don't stay constant, change over time goals differ in situations performance and productivity are affected by nature of task, experience, motivation no single leadership strategy is effective for all hollander 1978 - leaders and followers had roles outside leadership situation, both may influenced by events occurring in their other roles dynamic 2 way process leader, including personality, perceptions, abilities followers, personalities, perceptions, abilities situation w/i leader and followers function, formal + informal, size, density ouchi 1981 - interactional leadership theory - japanese style management, theory Z - like theory Y, choice making, fitting workers to jobs, job security, incr promotion, exam long term , lifetime employment 1990 theory Z decr - US couldn't do it kanter 1977 - structural aspects of job shaped leaders effectiveness, leader gets power from formal and informal systems, need opportunity, power, proportions nelson + burns 1984 - organizations + leaders 4 developmental levels, levels influence productivity ad worker satisfaction reactive - focus on past, crisis driven, abuse subord responsive - mold subs to work together, lead makes choices proactive - leader + followers become future oriented, hold common values high performance teams - max productive + worker satisfaction
suggested code 1926
self development can best be nurtured in the soil of economic self respect
Nursing Metaparadigm
set of concepts, propositions that sets forth phenomena which discipline is concerned most general statement of discipline, functions as framework in which more restricted structures of conceptual models develop concepts that identify phenomena of central interest to discipline propositions that describe those concepts, their relationships to each other For a theory to be considered nursing theory, 4 metaparadigm concepts must be addressed most general basis of nursing practice = the elements of nursing = most abstracts (not concrete)
education and training
steps in providing educ programs: identify and respond = need for knowledge or skill proficiency analyze = deficiencies, develop learning objectives research = address learning objectives based on EBP plan = objectives using resources implement = programs conductive to staff attendance, online learning modules eval = materials + observate measure behavior changes to learning objectives improved nursing ability = incr knowledge and competence goal of staff educ competence = meet requirements role at established level of performance, many stages 5 stages of nursing ability = patricia benner, based on level of competence, related to length of time in practice, exposure to clinical situations, when nurses move to new clinical setting, new skills and knowledge, level of competence will return to lower stage
situational and contingency leadership theories (1950-1980)
style should vary according to situation or ppl involvement follett - books, ahead of her time, so ppl didnt listen, law of the situation, contingency leadership fielders 1967 contingecy approeach = no one leadership style is ideal for every situationd blake and mouton's 1964 grid, many combincations of concer/focus that managers had for or on productivity, tasks, ppl, rank high to low = combos of leadership behaviors hersey and blanchard 1977 - tridimensional leadership - predicts which style is appropriate tannenbaum and schmidt 1958 - off work of lewin + white + lippitt, manager need varying mixtures of autocratic and democratic leadership
Belmont Report (1979)
summarizes the basic ethical principles and guidelines for the protection of human subjects of research. (Respect for persons, beneficence and justice)
performance, appraisal, peer review and disciplianry action
supervisor ecal employee performance in relation to job description for employee position and other expectation facility can have performance appraisal = done at regular intervals, more frequent for new employee expectation based on standards set forth in job description allow nurses opportunity to discuss personal goals w./ unit manager appraisals = motivational tool deficiencies = performance appraisal or reposted by coworkers might need to be addressed in disciplinary manner
5 rights of delegation
task circumstance person direction and communication supervision and eval task - yes = ap for bedpan, no = give neb circumstance - yes = AP for stable pt, no = if unstable person - yes = PN enteral feedings, no = AP enteral feedings direction and communication - yes = hygeine, room, before 9, no = hygein to pt supervision and eval - yes = ambulate w/ watching
management theory development 1900-1970
taylor - scientific management weber - bureaucratic org fayol - management functions gulick - activities of management follett - participative management mato - hawthorne effect mcGregor - theories X and Y argyris - employee participation
Nursing Metaparadigm -->
then philosophy --> conceptual model --> grand theory --> middle range theory --> situational specific theory
ex of task nurses may delegate
to PN --> monitor findings, reinforce teaching, trach care, suction, NG patency, admin enteral feeings, cath, admin meds = no IV in some states AP --> ADL, feeding w/o swallow precations, VS for stable client
consequence table
top has alternative 1, 2, 3 has x's for which alternative meets which criteria 1.) decr falls meets standards cost effective first policy
conflict resolution strategies
use i statements, remember focus on prob not personal differences
overcoming individual vulnerability in decision making
values - know your own life experience - use resources, lit, involve other ppl, analyze choices later, export networks individual preference - need self awareness, honesty, risk taking individual ways of thinking - need other people, join thoughts
5 Competencies
• pt-centered care • Teamwork and collaboration • Evidence-based practice (EPB) • Quality improvement (QI) • Safety QSEN competencies
