Ch. 18

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is: a. Conflict. b. Task clarity. c. Commitment. d. A designated leader.

C Team-building involves moving toward a common vision, which requires commitment. Conflict and clarification of tasks are components in the development of this commitment.

The SBAR system of communications is one of the most used communication systems in health care because: a. It deals with all aspects of communications in patient care except with the physician. b. The nurse is on the same communication level as administration. c. It focuses on a system in which information is provided and gleaned in an honorable way. d. It honors an unstructured transfer of information.

C The SBAR system was developed by professionals in the Colorado Kaiser Permanente System and involves direct, respectful communication skills among professionals with the aim of quality patient care.

After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that: a. Two very outspoken members tend to dominate discussions in meetings. b. This behavior is indicative of a high level of communication among her staff. c. Staff members are very committed to the team and have strong opinions. d. Ongoing discussion outside of meetings is conducive to creativity.

C When team communication is dominated by a few members, leaving others uninvolved or bored, disagreement is not expressed openly. As a result, team members "stuff" their feelings and wait until after meetings to voice their opinions.

The nurse educator was giving a workshop on team building. She noted that effective communication is essential for team building. One of the key questions in the workshop was, "What is the best way to check to see if what you have communicated to a team member is understood the way you meant it to be understood?" The correct response is which of the following options? a. Active listening and feedback b. Cues from nonverbal communications c. Content and context clues d. Reliance on paralanguage

A Active listening is a skill in listening in which one listens with the full intention of understanding what is being communicated, listening to the degree that you are able to repeat exactly what was said. Feedback helps to verify that the message you received was the one that was sent. Paraphrasing and restating the message are important feedback skills ("What you meant was....").

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or operationally define trust? Trust: a. Can be described as a belief that although the nurse is capable of helping in times of distress, the nurse is unlikely do so. b. Is the basis by which leaders facilitate the activities and progress of a team. c. Is very critical in teams and interdisciplinary teams. d. Is an important aspect of interpersonal relationships.

A All the alternatives except A are operational definitions of trust based on the work of numerous studies.

The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a project or event, describes: a. Commitment. b. Control. c. Willingness to cooperate. d. Communication.

A Commitment is described as having a sense of passion and commitment to a project without necessarily having a need to control.

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team-building, it would be important that everyone: a. Work together in a respectful, civil manner. b. Use avoidance techniques when confronted with a conflict. c. Develop a personal friendship with each other. d. Socialize frequently outside of work.

A For team-building to occur, team members need to be able to listen actively and respect one another's opinions, while feeling comfortable in assertively expressing their own.

Which of the following is not a necessary requirement for formation of a team? In forming a team, the leader should keep in mind that the team: a. Should include only members with similar personalities. b. Is responsible for creating its own vision. c. Should decide the goals and objectives. d. Should encourage participants to be actively involved.

A In forming a team, it is helpful to ask the following: 1. Why would you want a homogeneous group? 2. What purpose would it serve if all members were similar? 3. What if all members were introverts?

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because: a. If there are no agreements, each member will make up his or her own procedures without consensus. b. People are naturally difficult and will not work well together without such agreements. c. People will naturally ask for agreements about how to be together. d. A way to eliminate nonproductive team members must be available.

A It is important to establish team norms (how the team will function). Some of the rules will center around communications and how team members will treat one another, how conflict will be handled, and the decision-making process.

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams: a. Can create a form of synergism in which the outcome is greater than the sum of the individual performances. b. Do not necessarily need goals, objectives, vision, and a clearly stated purpose. c. Do not always have effective communication patterns. d. May or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.

A Research on team-building over many years has established that high-functioning teams are characterized by synergy that takes the team from a collection of individuals to an outcome that is greater than the sum of the parts.

Which of the following would not be a characteristic of an effective team nurse leader? a. An autocratic perspective b. Excellent communication skills c. Awareness of everyone's abilities d. A genuine interest in team members

A A team approach involves collaboration, which is not the approach that an autocratic leader would typically use. If team members work in an authoritarian environment, they may be hesitant to make decisions for themselves and may fully depend upon the authoritarian leader.

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members: a. Do not volunteer unwanted information. b. Actively listen to each other. c. Listen to the person who believes he or she is an expert. d. Do not speak unless they are absolutely sure they are correct in their views.

B Active listening in a group creates synergy in that team members really hear one another's ideas and share in decision making.

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to: a. Therapeutic communication with patients. b. Effective communication in the workplace. c. Increased emphasis on sender-receiver dyads. d. Generational differences in communication.

B Nursing programs teach therapeutic communications with patients and their families. However, little focus is placed on effective communication in the workplace, although communication is essential to building and maintaining smoothly functioning teams.

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, "We will speak supportively," prevents: a. Side conversations during meetings. b. Gossip and backbiting. c. Feedback when one member of the group disagrees with the discussion. d. Voting negatively on motions.

B This is an example of a rule that a team can implement to prevent certain negative behaviors such as gossip, backbiting, and bickering that undermine the productivity and functioning of a group

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication: a. Is a reflection of self-analysis. b. Is a result of thoughtful consideration. c. Consists of thoughts, ideas, opinions, emotions, and feelings. d. Focuses on the sender of the message.

C Communication involves both senders and receivers and may or may not be a reflection of self-analysis and thoughtful consideration. It always, however, involves thoughts, ideas, opinions, emotions, and feelings.

The chief nursing officer decided that the nurse managers need a series of staff development programs on team-building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is: a. Lack of clarity in the mission. b. Lack of control of the environment. c. Fear that one can't handle the consequences. d. Fear that the boss will not like one's work.

C Fear of not being able to manage consequences undermines confidence and a sense of competency.

Marcy, a new staff nurse, is very concerned about "fitting in" on the rehabilitation unit. She addresses her concerns and speaks with the head nurse. The head nurse speaks with the rest of the staff and reminds them how important it is for a staff member to feel that he or she is part of the group. Which of the following statements would she not include in her talk? "Staff members who feel included: a. Are more cooperative." b. Are harder workers." c. Are part of the 50% who feel their strengths are used." d. Bring enthusiasm and commitment to the group."

C Less than 20% of employees feel their strengths are used every day (Wagner & Harter, 2006). When nurses do not feel their skills are utilized, they are more prone to be in the "out group." This leads to being unengaged and even disengaged in the workplace. This is not supportive of a positive, creative work environment. Researchers have demonstrated that those who feel "in" cooperate more, work harder and more effectively, and bring enthusiasm to the group.

A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning: a. As a team. b. Independently. c. Interdependently. d. As a group.

D A group is a collection of interconnected individuals working together for the same purpose. A team is a unified group that is committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. The conflict indicates that the staff may not be united in a common purpose.

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following? a. Speed up your internal processes so that you can process more data. b. Realize that the first words of the sender are the most important. c. Be prepared to make an effective judgment of the communication sender. d. Cultivate a desire to learn about the other person.

D Active listening means suspending judgment about what is about to be said and listening to all that is said (and not just the first or last words). It is motivated by a genuine desire to learn about the other person.

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree to disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, which of the following basic rules was she talking about? a. Listening actively b. Being compassionate c. Being flexible d. Committing to resolution

D Caregivers must listen to the other person's perspective, listen to the message accurately, identify differences, and creatively seek resolutions.

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about. This is an example of: a. How expectations and objectives need to be made clear in team situations. b. The need to encourage open discussion of disagreements in opinions. c. The importance of involving all staff in discussions in group settings. d. The enduring nature of first impressions.

D First impressions are lasting and, as Sally indicates to her colleagues, are often an unconscious response.

Healthcare agencies and hospitals expect their practitioners to be effective team members. Two key players in the healthcare team are nurses and physicians. Which of the following statements accurately defines the roles and responsibilities of nurses and physicians? a. Doctors are the hub of the team, whereas nurses are peripheral members. b. Nurses are considered to be the hub of the team, and doctors are peripheral members. c. Doctors focus on the holistic needs of the patient, whereas nurses focus on the condition that caused the patient to seek healthcare services in the first place. d. Physicians are the first point of contact. They focus on the disease process, whereas nurses focus on the holistic needs of patients.

D Physicians diagnose and treat diseases, prescribe drugs, and perform medical and surgical specialties. The admitting physician provides the initial medical diagnosis. Nurses develop and implement comprehensive nursing care in all settings and provide leadership for healthcare teams. The admitting nurse establishes the initial nursing care plan and works with other professionals.

"I really wish that my supervisor would realize and acknowledge all the things I do well..." In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on: a. New staff. b. Care assignments with which the individual is not familiar. c. Making corrections. d. The strengths of the individual rather than the weaknesses.

D The research of Rath (2007) included many recommendations, one of which was that focusing on mediocre behaviors and on a person's weaknesses will not lead to excellence. Focusing on weaknesses tends to decrease the appreciation, and thus the acknowledgements.

The nurse manager was upset with the staff nurse and said, "You did not understand what I said." Which element in the communication process was she referring to? a. Feedback between receiver and sender b. A message channel c. A receiver who decodes the message d. A set of barriers that may occur between sender and receiver

D This is the basic circular communication model, and a number of assumptions have to be made. Problems can occur at any point and result in miscommunication. However, it can be assumed that there was a sender, a receiver, a channel, and feedback. In this scenario, barriers such as outside noise and the staff nurse's inattentiveness can be assumed.