NP4 FINAL EXAM!!!

The integration and coordination of health services to a specified population of individual patients has been described as case management. Select the best statement to describe this approach.

A comprehensive process to identify individuals who would benefit from activities of assessment, problem identification, care planning, care delivery, advocacy, monitoring, and evaluation of care provided for relevance to client and caregiver and health care team's ability to meet desired outcomes and established goals

People are knowledgeable about natural disasters within their local regions; however, many have not had to consider the devastation that can be caused by terrorism such as radiological exposures, nuclear blasts, conventional bombings, or agricultural contamination. Identify the correct statement.

A cyber disaster is a catastrophic event affecting large numbers of people and lasting more than a few hours that impacts the ability to use information technology.

Conflict is a natural and inevitable outcome in any group or organization. Select the correct statement from the following statements.

A defensive framework for conflict resolution includes winning some resources and losing others. To build effective interdisciplinary teams, conflict must be present, and managers have a role with conflict resolution to achieve a win-win solution rather than a win-lose or lose-lose solution. Conflict can be a positive force in a group, and some conflict is absolutely necessary for a group to make better decisions and get work done. Conflict arises when differences in professional judgment challenge the uniform behaviors within the role and responsibilities of a job description or policies and procedures written as guidelines.

Diversity assists with team effectiveness, improves retention of the best people, capitalizes on out-of-the-box thinking, lays the groundwork for future business growth, and provides more supportive work environments. Which of these are benefits to the nursing workforce?

A diverse workplace allows synergy of diverse viewpoints to improve nursing's knowledge base and care strategies. The benefits are improved patient data collection, increased preventative care, reduced care disparities from better evidence-based practices, increased cost savings from reduced errors with the right frequency of treatments, and reduced missed visits to family nurse practitioners.

Chief nursing officers (CNOs) are accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements related to delegation, for both RNs and delegates. Which statements are correct? (Select all that apply.)

A key element in delegation is to assess the competency level of the staff. A state's nurse practice act consists of rules that govern how RNs delegate to competent staff. Any traveling nurse unaware of the organizational systems in place to establish competency requirements for the unlicensed assistive persons.

Which is the statement that best defines management?

A process of coordination and integration of resources through group activities of planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives Management is a process of planning and directing human effort to attain established objectives, but it also involves efficient use of scarce resources. Management is a process that requires resources and skills. Management is working with executives, individuals, groups, and other resources such as equipment, capital, and technology to accomplish the organization's goals.

Culture is a concept that is best portrayed in nursing with which of the following statements?

A relationship-based nursing care model is used, which represents a belief in patient-centered care. The best portrayal is the care delivery model of relationship-based nursing care that guides nursing practice to interpret the culture, because it represents an underlying belief in patient-centered care.

Hersey and colleagues identified three skills needed for leading or influencing workers. Identify three skills leaders must possess to influence people. (Select all that apply.)

Adapting Diagnosing Communicating The correct competencies include diagnosing, which is a cognitive activity that involves being able to understand the situation and the problem to be solved or resolved; adapting, which is a behavioral skill that involves being able to adapt behaviors and other resources to match the situation; and communicating, which is a process to advance the process in a way that individuals can understand and accept.

Important decisions are made by nurses. Which of the following are examples of collaborated decisions? (Select all that apply.)

Address complicated and difficult client care risks and problems regarding infection, injury, and contamination. Plan steps to achieve organizational goals, implement multisystem change processes, and improve service delivery and client outcomes. Nurses collaborate on complex client care issues that require the talents and perspectives of various health care professionals to maximize client outcomes. Nurses collaborate with colleagues from various disciplines, including medicine, social work, pharmacy, and pastoral services, to address complicated and difficult client care problems. Nurse managers and directors collaborate with those in other disciplines to achieve organizational goals, implement multisystem change processes, and improve service delivery and client outcomes.

Nurses and nurse managers are guided by both legal and ethical considerations in making decisions. Which of the following is the correct statement regarding this fact?

Administrative rules include those regulations promulgated and adopted by federal or state agencies to implement statutory law adopted by Congress or state legislatures. The Centers for Medicare & Medicaid Services would be an example of a federal agency that uses administrative rules to implement the acts legislated by Congress and signed by the President.

Given the interdisciplinary nature of case management, who would be best in the case manager role?

Advanced practice nurses draw on a wealth of knowledge to lead and coordinate the health care team.

Management is often described in three core roles. Select the statement that is true about the decision-making role.

Allocating resources, negotiating contracts, handling disturbances, and proposing new services. these are decision-making roles. Monitoring processes, disseminating guidelines, and speaking for nurses in organizations are informational roles.

Nursing must have standardized, uniformly collected, retrievable, and comparable service-related management data elements. A Nursing Management Minimum Data Set (NMMDS) provides nurses which of the following options?

An integrated management information system for collecting, storing, retrieving, and processing a collective set of data to evaluate nursing interventions, staffing, and costs on client outcomes

The areas where leadership and management overlap are explained by which of the following statements? (Select all that apply.)

Bring teams together Direct activities while the goals for the teams may be different. Where managers use teams to make improvements, often leaders use teams to accomplish change for different reasons.

Marketing is a social and managerial process where individuals or groups obtain what they need and want by a process of exchange with others. For most nurses, the primary markets are clients, the employing organization, and physicians. Identify the correct statement for nurses and nurse managers to take advantage of marketing.

Building relationships with customers and gathering and analyzing information about needs and wants will lay the foundation for proactive capitalization on change opportunities.

The critical care nurses' specialty organization identified five factors that should be considered to make the best decisions. Which of the following identifies all five factors?

Care is complex and requires attention, adaptation, or innovation in approach, with some risk that the activity may cause potential harm, and the level of patient interaction and the patient's response to the activity are unpredictable. the five factors of when not to delegate: (1) When the potential for harm or risks for the activity are high for an individual patient; (2) when the complexity of the task makes it less desirable to delegate; (3) when the amount of problem solving and innovation requires special attention, adaptation, or an innovative approach for a particular patient; (4) when the outcome is unpredictable, which depends on how stable the patient is; and (5) when the level of patient interaction with delegated activity increases or decreases the amount of time the RN can spend with the patient and patient's family. Every time a nursing activity is delegated or one or more additional caregivers become involved, a patient's stress level may increase, and the nurse's opportunity to develop a trusting relationship is diminished.

Leaders and managers should know the many aspects of case management. Identify the two correct statements. (Select all that apply.)

Case management entails providing holistic care, conservation of resources, and care across episodes and settings. A current trend is the push for accountability and accreditation for case management organizations.

In one research-based model, which of the following behaviors were core to clinical leadership success?

Challenge the process, inspire a shared vision, model the way, enable and trust others to act and encourage others work-outcomes. Leaders go beyond the status quo processes to search for opportunities, research-based evidence, and take risks. Leaders foster collaboration, strengthen others, and recognize others. Trust and honesty are behaviors expected within leaders.

Change is inevitable in health care, just as it is in life. Which two statements are true about change? (Select all that apply.)

Change is inevitable and is necessary for organizational viability. Individuals become aware of the need for change when needs are unmet.

The 14 Forces of Magnetism has directed research on Hospital Magnet Standards, which measure certain characteristics. Select the answers that best reflect those measures of Magnet standards. (Select all that apply.)

Clinical autonomy, control of nursing practice, and collaborative nurse-physician relationships. Clinically competent peers, education support, adequate staffing, and nurse manager support. characteristics of an excellent work environment: clinically competent peers, collaborative nurse-physician relationships, clinical autonomy, support for education, perception of adequate staffing, nurse manager support, control of nursing practice, and patient-centered values. The perception of work environment is a measure of climate. Other process elements of climate include supervision, work design, group behavior, and emphasis on quality that is driven by patient centeredness, safety, innovation, and evidence-based practice. Not only hospitals but long-term care facilities can achieve Magnet Recognition Program® status by meeting five key components for transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes.

Select the statement that describes how clinical decision making differs from managerial decision making.

Clinical decision making focuses on diagnosing client health issues, risks, or problems and planning or coordinating nursing interventions, whereas managerial decision making focuses on resolution of organizational problems and the plans to achieve organizational goals.

Managers who proceed with a change can best engage staff and prevent resistance by doing which of the following?

Communicating accurate information to engage staff and overcome misunderstanding regarding the need for change The manager needs to model the change in actions and words as well as listen to staff interpret what the change is all about within informal communication with peers and ensure message is accurate. Executives and managers should not limit staff involvement by controlling communication about changes; they should involve staff in implementing the project, which is important for smooth transition and change. Managers can expect resistant behaviors of frustration, aggression, and indifference, but they should be ready to handle these disengaging behaviors with greater communication and involvement.

Five competencies were identified by nurse leaders in recent research. What are those competencies?

Communicating vision and strategy internally, translating vision into strategy, building effective teams, managing patient-centered customer focus, and managing conflict the steps to empowering workers are part of building teams and decision making is not unique to leadership roles. While managing conflict and sharing a vision with workers are important competencies, analyzing performance, guiding and empowering workers, and directing operations are often completed by nurses managing patient care. While focusing on the patient and customer, building effective teams, and managing conflict are skills, analyzing performance can be accomplished by many nurses as they are directing and guiding workers.

Which management theory's principle is to consider the situation and all elements when making a management decision?

Contingency theory The principle of complexity theory is the behavior over time of certain complex and dynamically changing systems with a concern for the predictability of the behavior of systems and how under certain conditions the system performs in regular and predictable ways, and in other conditions of change it becomes irregular and unpredictable. Management is a process of handling the stability of the system. The principle of chaos theory is the behavior that is unpredictable in spite of certain regularities. Nurses often are handling the unpredictable, yet organizing and planning and controlling for these unpredictable situations. The principle of systems theory is to recognize that a manager's work is embedded within a system and to understand what a system is. Nurses are a part of a larger agenda for health care services, and managing the role within the system produces the efficiencies and effectiveness.

Effective communication can best be described by which one of the following statements?

Conversation that is clear, direct, straightforward, and offers frequent message transmission is most effective.

The Institute of Medicine (IOM) identified five areas of management practice for leaders to attend to during turbulent times. Which of the following are included in those areas? (Select all that apply.)

Creating and sustaining a trustworthy, learning, and evidence-based organization Balancing reliability and efficiency in service delivery Involving workers to manage and sustain change The IOM identified the need to focus on implementing evidence-based management, balancing reliability and efficiency tensions, creating and sustaining trust, developing a learning environment, and managing and sustaining change with open communication and involvement with others.

Quality and Safety Education for Nurses (QSEN) was initiated to accomplish which of the following? (Select all that apply.)

Creating nursing curriculum that emphasizes evidence-based practices, quality improvement, safety, and informatics Preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care system QSEN program does support schools of nursing in creating a nursing curriculum that emphasizes implementation of patient-centered care, emphasis on teamwork and collaboration, integration of evidence-based practice, and creation of a culture that supports quality improvement, safety, and informatics.

Decision-making tools and strategies support the process for decisions. Select the one statement that is true.

Critical pathways are a type of decision tree. they are used for clinical care and other industry decisions.

Effective leadership is an integrated blend of leadership principles and characteristics with management principles and techniques. Principles of leadership and management are best described by which of the following statements?

Critical skills in leadership are interpersonal, decision making, and problem finding and solving. Leadership effectiveness is based on the ability to adapt in a complex and chaotic environment. Followership is best described as an interpersonal process of participation and implies an engagement of the group of followers with the leader who provides guidance and direction to accomplish group goals. Empowerment means giving people the authority, responsibility, and freedom to act on their expert knowledge and skills. Important skills for leading include diagnosing, adapting, and communicating, but not directing.

Cultural differences are characteristics that define individuals beyond unique numbers and names. Which statement is true?

Cultural differences in ways of doing things and in beliefs about health and illness are learned and transmitted via cultural environments. Each generation possesses unique characteristics that are not associated with race and ethnicity values, behaviors, and practices, which are also characteristics of diversity. Cultural differences do include eye contact norms, gender issues, touching and physical contact, and food practices. Cultural differences do impact communication, which can change the safety and quality of care through misunderstandings, meanings of words and gestures, and missing context due to translation.

Climate is often confused with culture. Which statement best describes aspects of climate?

Culture and climate can both be measured. Culture has been measured, and climate has several measurable characteristics, such as decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feelings of warmth, and risk. Climate is evident in staff perceptions of policies, practices, and goal achievement.

Identify the statements about organizational culture that impact nursing practice. (Select all that apply.)

Culture is developed over time with the shared values that guide members on how to problem solve and manage relationships. Organizational culture affects the quality of nursing care and patient outcomes. Mission statements provide a view of strategic priorities for a nursing organization and work setting. The culture of an organization can be positive toward evidence-based care or negative toward using best evidence in practice. Often the assumptions may be unknown, but in assessing the culture of a practice, unit, or organization, the nurse should question the current practices that exist within the culture of nursing practice. This is important because organizational culture affects the quality of nursing care and patient outcomes. The taken-for-granted practice and assumptions of a work unit group can exert a significant effect on performance and outcomes. On the other hand, organization culture is complex and enduring over time which makes it hard to change, whereas the climate is easier to change with policy and practices.

Centralization and decentralization are organizational philosophies about where decision-making authority resides in the institution. What is the best description of centralization and decentralization?

Decentralization is dispersing decision-making authority throughout the organization. Decentralization facilitates greater innovation, more input, and faster response times when staff are directly responsible for implementing changes and delivering care

Any decision in a chaotic health care delivery environment may cause an unanticipated future problem. Identify the true statement about decision making.

Decision making is used to solve problems.

A nurse manager and a nurse are liable for which of the following? (Select all that apply)

Decisions and actions Competency of licensed and unlicensed personal Supervising completion of appropriate tasks and functions Delegating to unlicensed assistive personal

Nurse leaders and their teams need to understand the guidelines and plan processes at local and regional levels. Clearly defined roles can prevent duplication of efforts and enhance coordination and orchestration of the all-hazards plan during an actual disaster. This will help allocate scarce resources and implement triage criteria for care in disaster events. Which of the following reflect is expected during disaster management? (Select all that apply.)

Determining prophylactic pharmaceutical dissemination plans to activate for protecting staff and their families Having procedures to provide easy-to-follow, step-by-step action plans, fact sheets, and algorithms to identify the type of disaster, how to intervene, and what authorities to notify

A transformative leadership style influences the effectiveness of group decision making. The rational group decision-making model is based on which of the following?

Economic perspective of decision making and maximum utility

Nursing data are used to evaluate client care, provider staffing, administration of care and the organization, and knowledge-based research for evidence-based practice. The analysis of large data warehouses using epidemiological methods would best support which function?

Effectiveness research A management information system dashboard is an integrated system to collect and manipulate data for the purposes of directing and controlling resources. Quality improvement studies are analyses to identify common causes of variation and visual display of data trends and generally would not require the rigorous epidemiological methods to find variation. Practice-based evidence is informing practice from the analysis of patient data collected during the delivery of care.

Identify the elements of organizational structure that address patient safety. What structural changes do you recommend for further improving safety in an organization using organizational design principles?

Empowering employees to report problems or potential problems, encouraging innovations and improvements in processes, and rewarding continual learning and exploration

Which of the following describes ways in which nurse managers can create an environment devoted to health care safety?

Establishing a culture of safe, effective, patient-centered, timely, efficient, and equitable care

Health information exchange (HIE) is defined as the electronic movement of health-related information among organizations according to nationally recognized standards. Health information exchange organizations are responsible for which of the following?

Establishing a provider directory and secure provider messaging, exchanging the continuity of care document, and e-prescribing for ambulatory medications

Community stakeholders, including local government, fire and rescue workers, and hospitals, have been focused on gathering information from a variety of resources, developing collaborative response plans, and preparing for a probable disaster. As nurse managers and leaders, what steps are essential first?

Establishing an all-hazards preparedness plan to create an all-hazards preparedness task force (AHPTF) that includes knowledge of the national response plan and state and local disaster response plans

The resources for nurse executives, nurse leaders, or other nurse representatives would include some of the following references to conduct a gap analysis to determine needs, but where should the managers begin to access knowledge about planning for disasters?

Federal Emergency Management Association (FEMA)

__________ is being loyal and faithful to commitments and accountable for responsibilities.

Fidelity Autonomy is a client's right to self-determination and freedom of decision making. Veracity is a norm of telling the truth and not intentionally deceiving. Values are strongly held beliefs that are freely chosen.

Nurses involved in the selection or development of a nursing care delivery system should consider which of the following as important? (Select all that apply.)

Fiscal accountability, client characteristics, staffing composition, case mix severity, and clinical service intensity Direct and indirect client nursing care interventions, end of shift reporting, physician-prescribed care, and communication Practice guidelines and new medication information and technology Role of the RN, practice expectations, accountability of nurses, decision making about care, and provider competencies and experience

Great leaders possess four essential skills. Identify two statements that describe those skills. (Select all that apply.)

Great leaders possess a sense of integrity with a distinctive and compelling vocal tone to engage others in shared meaning. Great leaders possess a combination of hardiness and the ability to grasp context, called adaptive capacity. Great leaders have (1) a sense of integrity, (2) a distinctive and compelling vocal tone, (3) the ability to engage others in shared meaning, and (4) a combination of hardiness and the ability to grasp context, called adaptive capacity.

Which time management strategies are the best strategies to reenergize people to handle the activities of the workplace and decrease the stress response?

Having time to think about priorities, expectations, and having some routines. A key survival technique in health care services where timeliness is of the essence for many is having time to think. the secrets to effective time investment are time for priorities, expectations, and routines because these three things can unlock the potential to manage even the most chaotic situation, regardless of the context, at work or home. There is a need to create time, plan for it, and commit to it. An appointment for thinking time is self-energizing. It has been recommended to have at least 2 hours.

Healthier work environments are associated with better staffing, lower burnout, lower turnover, and improved nurse-physician collaboration. Nurse managers likely should support which of the following statements? (Select all that apply.)

Health care agencies that obtain Magnet status often have improved nurse satisfaction, decreased nurse burnout, and better client outcomes. An astute nurse manager can match the skill sets and experience with the patient care needs to deliver the best possible care for clients.

Violence in hospitals is caused by a combination of internal and external factors. A systematic review of the literature on the effects of violence toward nurses reported the predominant responses to be anger, fear, anxiety, posttraumatic stress disorder symptoms, guilt, self-blame, and shame. Which of the following is correct regarding violence in the workplace?

Horizontal violence is common in nursing and is a form of bullying.

Select the best statement for why communication processes are important to organizations.

Human interaction issues are the general area in which leaders and managers spend most of their time.

NIOSH, the National Institute for Occupation Safety and Health, recognizes that workplace violence happens in the health care industry and recommends which violence prevention strategies for employers? (Select all that apply.)

Implementing behavior modifications such as worker training in recognizing and managing assaults and resolving conflicts Implementing environmental designs such as signaling systems, alarm systems, monitoring systems, security devices, security escorts, and lighting Implementing administrative controls such as adequate staffing patterns to prevent personnel from working alone, controlled access, and systems to alert security personnel

Research has shown which two of these statements are correct? (Select all that apply.)

In crisis situations, members work in a team that capitalizes on the skills and strengths of each team member. Nurses need to be responsible for beliefs, values, meanings, goals, and relationships. experienced leaders feel comfortable with the circle pattern communication style or interaction among the group equally. experienced leaders because feel more comfortable with the star pattern communication style or having nurses direct everything to the manager. nurses work in teams and scripting an SBAR message is an effective way to communicate with physicians while briefs, debriefs, and huddles are efficient ways to communicate common scripted care information to staff team members about what to watch or observe with residents and patients and when to report (TeamSTEPPS).

During the start-up, the system-wide task force will need to meet frequently and begin with which steps?

Including the public health department, police, and other critical community organizations in all-hazards community preparedness plan meetings and conducting a hazard vulnerability analysis to create and emergency operations plan

Which process best describes leadership?

Influencing behavior of either an individual or a group in an effort to achieve goals in a given situation Empowerment means giving people the authority, responsibility, and freedom to act on their expert knowledge and skills. Planning, organizing, coordinating, directing, and controlling resources to accomplish specific institutional goals are management processes. Working with and through individuals and groups and other capital and technology resources to accomplish organizational goals are management processes.

The distinction between change and innovation is best described in which of the following statements? (Select all that apply.)

Innovation is often linked with creativity and viewed as the use of a new idea to solve a problem, whereas change means improving incrementally. Innovation refers to the process of bringing any new or problem-solving idea into use, whereas change is a process for reducing variation within an existing process with a problem Change is a disruption; innovation is systematic, takes hard work, and has little to do with genius and inspiration. Innovation is a systematic process for bringing any new idea or new service method such as a problem-solving idea implemented into use and often linked with creativity and viewed as the use of a new idea to solve a problem or change a service. Change process is used to reduce variation within an existing process. Change is a disruption, and change does result in incremental improvements.

Which of the following are the building blocks that nurses should use to develop the organizational structures to support an evidence-based practice environment? (Select all that apply.)

Integrate evidence-based practice into the governance structure of nursing departments and the health care system. Incorporate evidence-based practice terminology into mission, vision, strategic plan, and performance appraisals. Demonstrate the value of evidence-based practice through administrative behaviors of the chief nurse executive. Establish explicit expectations about evidence-based practice for nursing leaders with a culture that values clinical inquiry.

In nursing, group process theory relates to how to work as an employee within an organization that is often large and complex. Which statement best reflects the need for teams and groups?

Interdisciplinary work teams are necessary for complex situations. The high-performance teams create an organization's efficiency and effectiveness because the collaborative knowledge of the team achieves high-quality work outcomes and controls costs.

The roles of sender and receiver must be assumed in interpersonal communication. This is reflected within which description of communication?

Interpersonal communication is a two-way level of communication involving face-to-face interactions between people who are consistently aware of each other. The roles of sender and receiver evolve in the later work by others and may be seen when talking about leaders, managers, and followers.

Manager decisions and treatment of employees associate with workplace violence. Any toleration of hostile or threatening behavior can result in escalation that results in physical harm. Which type of behavior is often tolerated and not reported?

Intimidation, pushing, and slapping Employees being fired; acts of bullying with verbal threats; presence of weapons; and the use of alcohol or drugs tend to get the attention of employees, and when employees are comfortable, they will report to managers.

Which is a perceived antagonistic process at the individual-organization level of interaction that affects productivity, morale, and teamwork in organizations?

Job conflict Interpersonal conflict is a dynamic between interdependent parties who experience reactions to perceived disagreements and interference with attaining their goals. Organizational conflict is defined as the struggle for scarce organizational resources with those opposing this being opposed and preventing cooperation. The two parties (i.e., nurses and physicians) have perceived differences in goals for patient care and the human or material resources needed for those goals. Social conflict is a struggle between opponents over what is valued most in hopes to claim scarce status, power, and resources. In politics the allocation of funds to respective parties is often influenced by power.

All nurses must know how to be effective team players, which includes a variety of skills such as technical and functional expertise, problem-solving and decision-making skills, and interpersonal skills. Which of the following statements best reflects this?

Leaders and managers must be able to function both independently and interdependently with others. This statement applies to all nurses as well. The formation of a well-functioning group or team is never the work of just the leader.

A number of industry-based models for quality management and measurement have been adopted by the health care industry over the past two decades. The model that provides a holistic approach to enterprise transformation and focuses on stakeholder's value propositions and interdependencies to determine effective processes before achieving efficiency in work flow across the enterprise would be:

Lean Enterprise. Six Sigma is a strategy to reduce variation and error rates. This approach measures defects, and, though a historical approach used by business for many decades, the approach has been deployed in health care for over two decades. High-reliability involves anticipation and containment, therefore organizations use collective mindfulness to ensure problems are anticipated and strategies are in place in the event problems occur. Health care is complex so processes are not simplified and organizations commit to being resilient to quickly return operations to normal and rely on frontline staff for their knowledge of daily operations. BNQA establishes a set of performance standards in seven areas of excellence: (1) leadership, (2) strategic planning, (3) customer and market focus (focus on patients, other customers, and markets), (4) information and analysis, (5) human resource focus, (6) process management, and (7) business results (organizational performance results).

What are two health care trends that can affect the use for measuring and managing outcomes? (Select all that apply.)

Management decision making should be evidence based wherever possible in order to optimize quality of care. Cost-containment strategies often involve a focus on decreasing staff coverage or reducing the proportions of registered nurses in staff mixes without forethought to the potential consequences.

A complex combination of a hierarchical structure with project teams is the definition of which type of organization structure?

Matrix Decentralized organization is when the power to make decisions is filtered down toward the individual worker. Centralized organization is when the power to make decisions is concentrated at the top of an organization. The divisionalized organization is a collection of semiautonomous units linked by a central administrative structure.

The research leading to the gold standard for nursing excellence has produced which of the following findings? (Select all that apply.)

Mortality rates in Magnet hospitals had a significantly lower mortality rate for Medicare patients than that of control hospitals. The effects of nursing interventions are facilitated by organizational characteristics at the unit level. The provision of adequate resources in unit practice environment is visible. mortality rates in Magnet hospitals were significantly lower for Medicare patients than those of control hospitals, and the effects of nursing interventions are facilitated by organizational characteristics at the unit level related to culture and climate. A strong visionary nurse leader is necessary, whereas a health care administrator is less likely to nurture and support a professional nursing environment and advocate for excellence in nursing practice. Magnet hospitals cultures have higher levels of autonomy and foster stronger professional relationships among nurses and physicians than do those of non-Magnet-designated hospitals. A nursing unit culture that supports and values nurse autonomy and the provision of adequate resources and effective communication among providers most likely constitutes an environment where practice excellence is the norm. Magnet hospitals are an example of a positive culture that affects nurse and patient outcomes.

Antagonistic behaviors including gossip, verbal, and non-verbal innuendo, scapegoating, passive-aggressiveness, disrespecting privacy, and bullying have a psychological impact on working relationships. They can impair work performance and impact health care delivery. Leaders and managers have a responsibility to act. Which of the following is a step with such overt and covert behaviors?

Multidisciplinary assessment teams convene to not overlook warning signs

Resolving conflict requires interventions. One type of intervention requires preparation and planning, ground rules, clarification and justification, bargaining and a closure with implementation. Which of the following is this type of conflict management?

Negotiation Negotiation is the major process used in an alternative dispute resolution.

Leaders who give and take exchanges aimed at resolving issues are doing which of the following?

Negotiation When a leader gives and takes exchanges aimed at resolving issues or uses a dialogical discussion between two or more parties to arrive at an agreement about some issue, that is negotiation. Bargaining is the exchange of a series of offers and counteroffers about what each party will do, give, and/or receive, until an agreement is reached to the satisfaction of all. Effective communication is a skilled process necessary in negotiation, persuasion, and bargaining and is the trust, respect, and empathy created with the interaction. Persuasion is influencing another to modify thoughts and behaviors of others.

Trends in twenty-first century health care in the United States are described as revolutionary by various individuals. Leaders will innovate and change toward preventive and wellness health care services because of which of these trends?

New laws and regulations from the Affordable Care Act (ACA) to cut costs and improve indicators of quality and staffing challenges. The ACA is not just a payment or insurance program but aims to guide the United States to shift health care priorities to wellness and prevention.

Management must understand and address aspects of generational workforce diversity. Which of the following statements best describes aspects of the generations?

Nexters can create solutions that other generations could not have imagined. X'ers prefer a balanced life and protect themselves from the capriciousness of business challenges, constraints, and rules. Boomers ignore or break rules and will still be successful. The Silent Generation treasures and exhibits conformity.

Nurses who challenge assumptions, consolidate a purpose, build the culture, and move a vision forward are more likely within which role?

Nurse executives Nurses coordinate, integrate and provide care, restore health and nurture human beings in their experiences of health and illness. Nurse managers concentrate on day-to-day administration and coordinate services provided by a group of nurses by integrating human, fiscal, and other nursing resources to accomplish nursing practice with 24-hour accountability for client care units or areas. Clinical nurse leaders and advanced practice registered nurses (APRNs) provide leadership in the care transitions of individuals and populations while providing expertise in specialty areas to guide other nurses through process, measurement, and evidence-based practice changes.

Which of the following describe the four tenets embraced by members of the IOM Committee on Quality of Health Care in America and how these tenets incorporate into nursing practice? (Select all that apply.)

Nurses use assessments to collect patient data to diagnose problems and risk and to identify the state of optimal health care across the continuum. Nurses use standardization of processes when using nursing diagnoses to identify issues with clients and using nursing interventions to identify best practice to improve client's status. Using the methodology of PDCA (plan-do-check-act) is like the nursing process.

New policies, programs, projects, and services are developed to meet the needs of patients. Which statements are descriptions of when nurses take steps to use these items? (Select all that apply.)

Nurses use the principles of strategic planning with other stakeholders to explore programs, projects or services to promote population health, patient satisfaction, and decreased health care costs. Strategic management is nurses making decisions about the delivery of care. Strategic management is the processing of an organization's vision or mission.

The advantages of group problem solving over individual problem solving are best described by which of the following?

Obtaining a wider range of knowledge and information from group members stimulates thinking. Strength in diversity, more individual perspectives, and member's commitment to the decision save time. The group has increased acceptance of the solutions when individuals are affected by the decision and committed to implementing it. When more approaches to a problem are considered, the group diversity exceeds the individual effort.

A health care organization plans to integrate an electronic health record (EHR), health information network, and clinical data analysis into all clinical areas. Using the five theories of organization as a social system would put forward to manage the challenge, which approach is best for nursing?

Open systems theory where the leaders emphasize the dynamic interaction and interdependence of the organization with its external environment and internal subsystem The best information is then used to select and implement clinical data analysis and the health information network with the EHR system in the organization

What habits are characteristics of critical thinking by nurses? (Select all that apply.)

Open-mindedness, perseverance Confidence, creativity, flexibility Questioning, reflection, contextual perspective critical thinking has a purpose, is systematic, considers alternative viewpoints, occurs within a frame of reference, and is grounded in information. reflection was key to refining one's clinical judgment capabilities. clinical experience helps one to refine clinical judgments. As a nurse gets more experience, the intuitive component of judgment allows the nurse to grasp the cues more quickly.

Leadership is necessary across all organizational levels, and different roles can support implementing evidence-based changes. Which of the following roles are important to the success of this transformation of practice? (Select all that apply.)

Opinion leaders Chief nurse executives

Implementation of a shared governance model is best accomplished when which of the following steps are considered within the organization? (Select all that apply.)

Organizational executives, managers, and point-of-care staff receive education and support. Offer opportunities for formal empowerment to advance practice and time for nurses' involvement in leading practice.

Outcomes management is a process that can be described accurately by which of these statements?

Outcomes management is an interdisciplinary process designed to provide quality care, decrease fragmentation, and constrain costs.

When the leader engages in dialogue with the nurse to share ideas and help in making decisions, what style of Situational Leadership® communication is being used?

Participating

Which of the following statements is true about problem solving?

Problem solving is a rational and logical thought process. a high-level skill nurses and others use is critical thinking, a cognitive skill. critical thinking and effective decision making are the foundation of effective problem solving. Health professionals improve the effectiveness by using the skill of critical thinking. the use of interdisciplinary members of the team enhances the timeliness of a decision that is made in a silo.

There are six competencies described as needed by nurses who are serving on boards and/or policy committees so that they can contribute in a productive manner. Which of the following best describes how nurses engaged in this approach?

Professional commitment to serve, knowledge about bylaws and position descriptions, and standard business protocols; manage intense/uncivil situations. knowledge about board types, bylaws, and job descriptions; an understanding of standard business protocols, board member roles, and voting processes; a willingness to use principles for managing and leading effective and efficient board meetings; an appreciation for the ethical and legal processes for conducting meetings; and the ability to employ strategies for maintaining control during intense/uncivil situations. The competencies highlighted are for participating in high-level decision making to influence patient care outcomes and professionals' roles.

Leaders are change agents and have a role in change that includes which of the following?

Providing reliable information and details to those who are to implement the change and understand their view of expectations and plan adequate, timely education on the change. and to avoid setting expectations or promising anything beyond what can be delivered. When expectations are high, and the project or program does not meet the expectations, the effort is seen as unsuccessful. Change agents motivate through rewards and benefits to help the change along. They frequently communicate the purpose for change through direct communication. Change agents will need to do much more to communicate and motivate change than just posting the change steps for others to read in the usual communication place, where they will likely miss many staff members.

Case managers were deployed to decrease fragmentation; reduce expense by streamlining care; and control costs by linking, advocating, coordinating, negotiating, educating, and monitoring. Today the model that guides hospitals and clinics to case manage is best described in which of the following statements?

Public health guides the health care organization to coordinate and integrate services across the continuum from hospital to community to reduce costs and eliminate redundancy of services.

Which of the following statements correctly describes case management?

Registered nurses (RNs) have emerged as the large majority of case managers, especially in hospitals, because of their specialized expertise for the function of determining medical necessity for health care payment and because of care coordination for complex medical discharge planning needs.

Change behaviors displayed in a variety of ways. Identify the two correct statements on how leaders identify, support, and promote innovators. (Select all that apply.)

Seeks out knowledgeable experts Comfortable with uncertainty

Team dynamics will need to be addressed to form an effective team. Select the best strategy to help address the challenges in forming effective teamwork.

Set group norms on how team members treat each other, how support is demonstrated, how conflict is handled, and the decision-making process to help team members operate with disruptive behaviors.

When nurses actively engage in making decisions regarding nursing practice, quality of patient care, education, nursing peer issues, and issues in the work environment, what model is likely being used?

Shared governance model

Shared governance requires slow, gradual development, role modeling, and mentoring by nurse leaders, and continual coaching, nurturing, and education for nursing staff and management. Select the statement that is an accurate statement about shared governance.

Shared governance models empower nurses to provide quality care and efficient point-of-service expertise. The goal is to transfer leadership wisdom not only to leaders but to all employees to commit to the quality and patient safety.

Nurse leaders who encourage transformation through their commitment to the journey will find roles changing. Which of the following statements best describe the role of nurse managers? (Select all that apply.)

Staff members in decentralized organizations are more accountable because fewer people provide functional supervision, quality monitoring, or unit-specific responsibilities. Nurse managers are accountable for transactional processes such as budgets, productivity, and quality monitoring, on top of their roles as coaches, mentors, and leaders to staff nurses Nurses have an opportunity to take leader roles in integrated care networks with shared governance, and the nurse manager's role shifts to one of facilitating, enabling, and supporting the staff personnel.

Professional nurses develop performance and quality improvement programs and conduct evidence-based improvement studies and research. Which statement is true about standards?

Standards essentially define quality, against which performance and outcomes are measured.

What is the administrative and systematic process to be responsive to environment-related and future-oriented changes that are sensitive to the correct positioning of the organization known as?

Strategic management tactics are operational choices for action that are made to implement strategy. Strategy is a competitive move or business approach designed to produce a successful outcome. Performance effectiveness is achieving the measureable progress toward objective targets for the mission and vision.

A business approach that ensures a competitive advantage over similar enterprises involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. Which of the following statements is correct?

Strategic management involves strategic planning and implementation. This provides a blueprint for operating, establishing a competitive position, ensuring customer satisfaction, and reaching goals and objectives

Criteria can be used to assess co-workers competency for delegation. Which of the following methods can be used to assess the competency of nursing assistive personnel? (Select all that apply.)

Supervising with periodic review and performance feedback. Checking with unlicensed assistant when completing the task to obtain feedback about the patient. Orienting to the job description and evaluating tasks within a designated time frame. The immediate feedback from UAP ensures supervision and validates the competency by asking questions.

People are often unaware of exactly how they are spending their time. Which of the following is the best strategy to manage your time?

Take control of your calendar using a time journal to see precisely where all your time is spent in 30-minute increments. this makes the abstract idea of time a concrete reality and allows for finding opportunities to eliminate time wasters.

Managers of health care organizations have an ethical obligation to protect the safety of workers. What information, approaches, or practices would help managers with this ultimate responsibility?

The Occupational Safety and Health Administration (OSHA) is a regulatory agency that oversees the safety and health of health care workers and issues fines for workplace safety violations.

Placing someone from a high-context workplace culture into a setting dominated by leaders from a low-context culture will increase the likelihood of perceptions of inequity and workplace conflicts. What are the differences between low-context and high-context cultures? Select the two statements that are correct. (Select all that apply.)

The cultural context of the Western world is low context, and in low-context cultures the explicit verbal or written message carries the meaning, while in high-context cultures, most of the meaning is assumed to exist by the nature of the situation that is the context. in high-context cultures, often found in the non-Western world, that which is written or stated rarely carries the meaning, because the meaning of the message is understood by reading between the lines for what is not written or stated, whereas the low-context cultures in the Western world require extensive detailed explanations and information because they are making up for what is missing in a situation or the context.

The five factors that are used to described and determine successful planned change: relative advantage, compatibility, complexity, trial-ability, and observability. The statements below relate to these success factors. Leaders will present information on two of these to explain the necessity for the change and the expectations. Which of the following are those two? (Select all that apply.)

The degree to which the change is thought to be better than the status quo. The degree to which the change is compatible with existing values of the individuals or group (relative advantage) and the degree to which the change is compatible with existing values of the individuals or group (compatibility) are identified as being positively correlated with successful change.

Health care quality and safety principles and practices form the foundation of any accessible, reliable care services. In establishing this foundation, which of the following statements helps guide it?

The importance is on outcomes rather than process and structure.

Nurses may communicate using humanizing and dehumanizing attitudes which affect the outcome of communication. Select the most humanizing option below.

The manager engaged nurses to share their concerns and ideas openly along with their fears about the developing project.

The difference between the focus of managers and leaders is best described by which one of the following statements?

The manager focuses on systems and structure, and the leader focuses on people and innovation.

Which of the following are efforts to measure nursing workload?

The number of client days and the intensity and hours of nursing care required per client day.

Staffing management is one of the most critical, highly complex, and time-consuming activities for nurse leaders at every level of the health care organization today. Which of the following statements is correct?

The staffing management plan is a structured approach to the process of identifying and allocating unit-based personnel resources to optimize care needs, quality outcomes, and effectiveness.

Levels of job stress that are either too low or too high have which consequence?

They decrease individual productivity.

Nurse managers, in collaboration with nursing leadership, design nursing systems for the provision of client care and the betterment of the organization. Nurse managers should consider which of the following as important?

They should include staff nurses in the development and selection process of the professional practice model.

A situational leader can best be described by which of the following statements?

This leader tailors his or her leadership style based on the employee, experience, and circumstances. The laissez-faire leader requires minimal participation and directing, but this does not result in high productivity. The transactional leader is one who maintains and sustains good care processes with a focus on daily operations. The transformational leader motivates employees to their full potential or empowers employees to advance innovative changes to create new services and improve existing processes.

What is a wrongful act committed against another person or organization or their property that causes harm and can be remedied by a civil lawsuit?

Tort (other than a breach of contract) Malpractice is the failure of a professional person to act as other prudent professionals with the same knowledge and education would act under similar circumstances. Legal liability is legal responsibility for harm caused to others. Nurses, nurse managers, and health care facilities are all subject to being found legally responsible for harm caused to others by wrong practice from expected practice or evidence-based practice. Negligence is the failure to exercise the proper degree of care required by the circumstances.

Multiple unique goals are achieved with case management services that are different from the goals of managed care. Nurses as case managers contribute to which of these goals? (Select all that apply.)

Tracking outcomes and guiding services across time and settings through ongoing evaluation of assessments Providing nursing interventions to meet diagnosed client needs in the most cost-effective manner Coordinating client-focused care by planning and arranging access to appropriate services and interventions

Critical thinking is central to decision making. Which of the following is a true statement?

Two cognitive processes, intuition and analysis, are used in critical thinking for nursing judgments. critical thinking is a set of cognitive skills that include interpretation, analysis, evaluation, inference, explanation, and self-regulation. a critical thinker challenges and questions the norm and considers potential unintended consequences in the context of decision making. reasoning is based on aspects of thinking skills, such as inductive or deductive reasoning for diagnosing.

Quality can be defined in which of the following ways? (Select all that apply.)

When outcomes compare favorably with standards The measurement of effectiveness, efficiency, benefits, and appropriateness of care services When higher volume of procedures is associated with lower mortality

The determinant for the decision to delegate is the legal scope of delegation rules described within:

a nurse practice act. The state's nurse practice act contains language that allows registered nurses to delegate. Some state nurse practice acts clearly define scope of practice concerning delegable activities, and others are more unclear. Some nurse practice acts have not been updated to account for the current prevalence of home and community-based health care delivery, which can cause role blurring and confusion of delegable tasks. Certain discrete tasks may be delegated in any health care setting, the nursing process consisting of assessment, clinical judgment, and evaluation of outcomes may not be delegated. This foundational fact should direct the nurse's response concerning delegation no matter whether it is a scope-of-practice or organizational issue. Institutional policies do not set rules but rather provide further interpretation of the procedural steps to guide nurses in the intervention of delegation.

An overarching organizational strategy to ensure accountability of all employees, to incorporate evidence-based health care quality indicators, and to improve care delivered to various populations is best known as:

a performance improvement program.

Healthy work environments increase patient satisfaction, support patient outcomes, and avoid errors. Healthy work environment standards to adopt would include:

acknowledgment, awareness, and assessment of workplace stress. Health care organizations that want to assure quality care for patients can begin with the acknowledgment, awareness, and assessment of workplace stress.

The degree to which a client or population with common personal or environmental characteristics continues a negotiated treatment in a parameter that functions to meet a variety of collective needs. To measure this indicator in a community or interdependent organizations, such as ACOs, would be:

adherence. Compliance is the degree to which a client initially assents to a treatment plan. Maintenance is the degree to which a client continues positive health behaviors without supervision. Noncompliance is behavior that fails to coincide with a health-promoting or therapeutic plan between client and provider. This type of behavior is based on several defining characteristics found during assessments.

Although all clients need coordinated care, population health management best serves the needs of targeted, high-risk populations for:

building personal relationship to identify knowledge deficits, counseling needs, facilitate monitoring, treatment adherence, and stabilization.

A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet multiple service needs of clients and families is known as:

case management.

The process for determining better scientific evidence on the effect of different treatments on client-centered health outcomes is:

comparative effectiveness research. The goal of comparative effectiveness research is to produce new knowledge and reduce uncertainty about effects on patient health outcomes of treatments, prevention, and other interventions.

A deliberate and cognitive process of becoming responsive and sensitive to the client's culture, values, and learning to avoid imposing on them is:

cultural awareness. this is the first step in the process of realizing that cultural mismatches exist and being open to respond proactively to others who have unique values, beliefs, and cultures. Cultural knowledge is a process of seeking and obtaining an educational background about the different world views of various cultures. Cultural diversity is not a process but rather the variety and differences in the customs and practices of defined social groups. Cultural skill is a process of learning how to do a cultural assessment, allowing the nurse to identify an individual client's perceptions, beliefs, and practices.

A model of population care coordination would include:

data analysis of population, population needs assessment, identification and selection of health services, multidisciplinary planning, implementation of wellness and prevention interventions, and monitoring/evaluation of care management.

Effective delegation skills are important for leaders and managers whose function is to get work done through the efforts of others. The individual who accepts this work is called the:

delegate. Delegates accept the service, work, activities, or projects that need to get done. In nursing, a team of delegates from an organization may gather together to do service projects locally in communities or in third world countries. An adaptor is an individual who generates new solutions to problems. A supervisor is an individual who guides others to accomplish a specific task or activity. A delegator is an individual who assigns a task to another.

Similarities between the nursing process and the strategic planning process allow nurses to shortcut the learning curve and begin to move forward with the implementation phase. Strategic management involves:

developing a strategic mission or vision, setting objectives, developing strategies to achieve the objectives, implementing the strategies, and evaluating the results.

Ethical dilemmas encountered as a result of the clash between clinical and organizational ethics differ from those encountered in clinical practice. Budget cuts, the inability to replace equipment that is failing, and lost time to complete services would be examples. Proactive strategies by managers would include:

developing an organizational culture of respecting each other's ethical standards and not asking nurses to compromise their ethics. The proactive steps to develop such a culture would be educational opportunities; processes that include communication plans and networking plans; evaluation of risks; and early intervention techniques, such as rapid responses by skilled teams to reduce the impact of a dilemma which can cause distress to some.

Disadvantages of group decision making over individual decision making would include: (Select all that apply.)

disruptive conflicts. individual domination. premature decisions. The premature decisions lead to the minority view being pressured to accept the majority decision and acceptance of a less than evidence-based decision. The individual domination can become costly and time-consuming for a group's productivity, because the interpersonal dynamics slow progress and cause an unpleasant experience. The disruptive conflicts can occur over personality differences, differences of opinion, or clashes of values, and these conflicts can become destructive.

Scheduling by predictive modeling forecasts unplanned patient and staff events, such as admissions by day of week and unplanned sick calls. Principles supporting such a scheduling process for demand management would include:

embedding a decision support system that receives continuously measured progress on patient outcomes in real time, throughout a patient's stay, with which actual progress may be compared on individual patient changes in the outcomes-driven acuity system.

Which are the four emphasized practices for current workplaces that are fostered in learning organizations. Examples of practices would include:

empowerment, shared governance, shared decision making, and self-direction

The type of power exhibited when providing the opportunity for others to take responsibility and accountability for their work while also inspiring self-confidence is:

empowerment. Referent power is a power based on charisma and interpersonal appeal, which is used to inspire others. Expert power is power within individuals who possess special skills, talents, and knowledge. Legitimate power is the authority to act based on position.

Role strain means:

expectations of the multiple responsibilities of the manager can produce stress. this is an unpleasant feeling of frustration and an intense labile emotional state. Role incongruity means the role expectations are incompatible with the professional values. Role overload is when one cannot possibly complete all assigned activities in the scheduled time frame. Role ambiguity is when role expectations are unclear to the nurse.

A number of decision-making strategies have been identified for clinical and managerial decision making. An effective strategy for nurse managers to select in examining possible causes related to delivery of services would be:

fish bone charts. fish bone or cause-and-effect charts. This strategy helps identify processes, materials, equipment, role responsibilities, or environment as potential causes for the clinical or management effect. Pilot projects are limited experimental trials used to develop an optimal and alternative solution to a problem. Cost-benefit analysis is an appropriate strategy to use when deciding budgetary issues and may include listing the positive and negative aspects of a given outcome to assist with decision making. Scenario planning is used in a group setting to brainstorm about the future and is a beneficial strategy to use in a constantly changing environment.

Changing the operational process of an organization is often necessary when adding or updating patient care and health information technologies. Three key dimensions of the organization design to engage in making this change are: (Select all that apply.)

formalization coordination. centralization.

When clients are grouped together and cared for by one nurse, this is known as:

group nursing. Group nursing is when clients are grouped together and cared for by one nurse. It is a model used in the past but is how physicians have organized their care around a group or panel of patients for whom they are responsible. Functional nursing is the assignment of tasks to registered nurses (RNs), licensed practical/vocation nurses (LPN/LVNs), or aides. Team nursing is coordination of care with RN, LPN/LVN, and aide assignments by an RN to a group of clients. Primary nursing is the assignment of clients to one nurse who has 24-hour accountability.

Managers and executives in practice will struggle to make decisions regarding staffing and practice to achieve best outcomes. Staffing levels have often but not always been associated with a number of unfavorable outcomes, including increased surgical mortality, failure to rescue, and rates of complications due to errors in care such as urinary tract infections, intravenous line infections, decubitus ulcers, and patient falls. Managers and executives can take steps to:

identify and use data systems that are comprehensive for outcomes management in order to support the monitoring of nursing-sensitive outcomes and establish continuous monitoring of outcomes against internal and external benchmarks using a national database of quality indicators.

Valid, reliable, and operationally defined measures that are important, feasible, and have clinical logic and measurement properties are known as:

indicators End results are the end product from formal tests or outcomes research to explain what the condition or level is for a client. Outcomes are dependent on measured and quantified observed or described changes within indicators. Findings are dependent on what was collected, how it was collected, when it was collected, where it was collected, and who collected it, all of which relies on defined indicators that are valid, reliable, and collected in a systematic way. Findings provide the evidence for shaping practice environments and processes.

Implementation of a strategic plan can be accomplished when a priority order for achieving the strategic objectives or outcomes exists, responsibility for achieving these objectives has been determined, and some available financial support is provided within an expected timetable. The role of nurses would include:

integrating the strategy into daily activities and keeping the strategy a major agenda item for their nursing department or service.

When the group decision-making procedure is that the entire group decides, whether by a two-thirds vote, simple majority, consensus, or some other process, this is known as:

joint decision making. The delegated decision procedure is when the leader allows participants to make the final decision. The autocratic decision procedure is when the leader controls the power, and the committee exists mainly for the sake of appearance. A consultative decision procedure is when decisions involve employee participation, but the leader still makes the final decision alone.

Personal conflict can arise when trying to ingratiate another person because there is the use of:

lavishing praise on another to make him or her feel important to gain favor. Ingratiation is the use of lavishing praise on another to make him or her feel important to gain a favor, thus initiating personal conflicts with others. power is used to influence an individual or group to gain a scarce resource, so others are not involved. Reward power is used to provide a pay raise, promotion, or advancement and often does not lead to conflict with others. Coercive power is the use of threats, discipline, or negative consequences, but this is not ingratiating behavior.

A blend of marketing strategies and models used to achieve established goals is known as:

marketing mix. Exchange relationship is the act of obtaining a valued product from someone by giving something in return where the trade is for mutual benefit. Marketing orientation is focusing energy on identifying needs and on the delivery of services that create satisfied customers. Communal relationship is based on mutual caring and support. The marketing of health care is more like the communal relationship with clinical practice though the business of health care is an exchange relationship.

Demand management focuses on:

measuring, predicting, and understanding demand for services, and deploying resources and management to meet consumers' wants and needs.

An increasing number of nurses are being recognized for their knowledge, expertise, and contributions to the health care system. As nurses assume expanded roles, such as advanced practice and case management, the image of nurses is being elevated from a subservient one to one that reflects an autonomous, credible health care provider. The marketing goals incorporated in the organizational strategic plan should focus first on:

nurse leaders and managers can market workforce characteristics such as shared governance and professional development opportunities for nurse retention and recruitment.

Customer relationships concentrate energy on the identification of the needs and wants of customers and on the delivery of services that create satisfaction. A daily example of this is when:

nurses provide care by using the nursing process to diagnose and intervene on needs for health promotion or problems and risks.

The process of integrating nursing and health sciences with computer and information sciences to manage and communicate data, information, knowledge, and wisdom in practice is known as:

nursing informatics. CIS is the capture of clinical data to support more efficient and effective decision making and clinical care delivery. Data repository is a process of storing specific data longitudinally over multiple episodes of care, making it accessible to provide continuity of care to the individual patient. Technology with informatics combines the sciences of engineering, computers, and information with the cognitive health sciences.

A strategy of demonstrating an opportunity for improvement at baseline, outlining current practice related to specific care process indicators is:

performance gap assessment. Outreach or academic detailing is a marketing strategy in which a trained individual meets one on one with practitioners in their setting to provide information about the evidence-based algorithms, work flows, or practices and indicators to improve practice. Change champions are practitioners from the local peer group who continually promote the practice change by using new technologies, interventions, and work flows that include evidence-based practices. Audit and feedback is the ongoing monitoring of critical indicators of practice and providing periodic reporting of data and information back to the clinicians responsible for client care.

The accountable care organization (ACO) will need to measure progress toward optimized population health. The measures for the ACO would include:

population health measures on clinical process and outcome indicators, patient satisfaction, functional status, quality of life, economic and utilization indicators, and changes in health disparities.

Effective leadership is exemplified by values, confidence in employees, and a sense of security in the face of uncertainty. This aspect of leadership is known as:

self-awareness. this is the ability to know one's own emotional state and be aware of how mood and actions affect relationships, while having confidence in others and comfort in dealing with uncertainty. crucial to effective leadership. Relationship management is the use of effective communication with others to disarm conflict and the ability to develop the emotional maturity of the team members. Social awareness is the intuitive skill of empathy and expressiveness in being sensitive and aware of emotions and moods of others. Self-management is the ability to take corrective action and not to transfer negative moods to staff relationships.

Variables that influence nursing practice and client care delivery include:

skill mix for client condition severity, nurse-to-client ratio, use of temporary staff, workload, nursing education and experience, and technology level.

The individual in a clinical nurse specialist role would be known as holding the:

staff position. The clinical nurse specialist would be in a staff position that provides expertise and knowledge for accomplishing organizational goals. An analyst position is held by individuals trained in business, data, or financial processes to design, plan, or handle processes to do the sustaining work of the organization. The line position is described as the direct line of hierarchical authority. Support staff are individuals who perform activities that enable individuals to do the direct work of the organization.

Duty of care owed by the nursing professional to the client is the minimum requirements that define an acceptable level of care. The minimum requirements are best located in:

state nurse practice acts, standards published by nursing professional organizations and specialty practice groups, and/or a facility's policy and procedure manuals. Standards of care can be found in the state nurse practice acts, standards published by the American Nurses Association or other professional organizations and specialty practice groups, federal agency guidelines and regulations, and the facility's policy and procedure manuals. In malpractice cases, the standard of care owed to the injured client is commonly introduced into evidence by expert witnesses, and the impact of that evidence is ultimately determined by the jury after receiving instructions from the judge on the law applicable to its use.

The electronic health record (EHR) implementation of computerized provider order entry (CPOE), clinical decision support (CDS), barcode scanning, and electronic medication administration records (eMAR) applications is dependent on design and use. The best statement about clinical documentation to support these EHR applications is:

the EHR design and clinical documentation with evidence-based definable terms must support nursing care models and the nursing process work flow for patient-centered care.

The culture of patient care must transition from care that is driven by providers to care that is patient-centered and family-centered in which patient and family norms, values, and preferences are respected. This direction in health care services has been sited within: (Select all that apply.)

the Institute of Medicine's Crossing the Quality Chasm. The Future of Nursing: Leading Change, Advancing Health. the Affordable Care Act. National Healthcare Quality Report from the Agency for Healthcare Research and Quality. The patient's experience of care includes communication, care, and understanding of the meaning of his or her illness. This approach changes the focus from a patient with a disease to that of an individual with an experience. Patient partnerships, the second dimension of patient-centered care, are formed when nurses are responsive to patient needs, values, and preferences and then customize the care to the patient.

The organization and individuals engaged in scientific investigation using methods and variables that influence the rate and extent of adoption of practices to improve clinical services is known as:

translation research. Evidence-based practice involves steps to integrate research and other best evidence with clinical expertise and client values in daily health care decision making. Research utilization is a process of using research findings as a basis for practice. Best practice is applying the most recent, relevant nursing interventions in clinical practice which describe innovative practices that are recognized by peer organizations and contribute to meeting quality or fiscal goals.

When nurse leaders are pressured to implement organizational change from powerful economic and political interests, the purpose for change is driven externally and not internally. Nurse leaders can implement changes to alleviate immediate problems and:

use positional influence to outline nursing's own destiny and prevent destructive practices. evaluate and quantify the external imposed changes for long-term effects. speak up, articulate, and support the value of a nurses role. calls for more nurses to be involved in leadership roles in the health care system and to use their own positional influence to chart nursing's own destiny and prevent destructive practices like those that emerged in the 1990s. Evaluating and quantifying the impact of externally imposed changes provides nurses with information and knowledge to speak up and voice the impact and consequences to a nurse's role.

Desires that are satisfied by specific products or services that are influenced by external cues are:

wants. Market is actual or potential buyers and users of goods, services, and ideas. Needs are basic biological, psychological, and social needs. Products are goods, services, or ideas that satisfy the wants and needs of individuals.