Ch. 21 Managing Patient Care

Steps involves in the nursing process

ADPIE 1. assess patient problems 2. identify patient diagnosis 3. develop a plan of care 4. implement nursing intervention 5. evaluate patient outcomes

While inserting the IV catheter, the nurse asks the nursing assistant to help stabilize the patient's hand. Which type of clinical care coordination is the nurse following? A. priority setting B. use of resources C. time management D. clinical decision making

B. rationale: appropriate use of resources is an important aspect of clinical care coordination and is useful for effective patient care. Priority setting is helpful in sequencing nursing interventions to solve collaborative problems. Time management skills are helpful in reducing work-related stress. Clinical decision making is helpful in determine the proper course of action.

Which leadership quality can result in the success of the health care organization after decentralization? A. delegation B. decision making C. team communication D. clinical care coordination

B. rationale: decentralization is a component of the hierarchical level of decision making found in health care institutions. Decision making is a critical component of an effective leader and manager and is a leadership quality that can help in the success of the health care organization after decentralization. Delegation is defined as transferring responsibility for the performance of activity or task while retaining accountability for the outcome. Team communication and clinical care coordination do not specifically address decentralization.

Which statement is true regarding responsibility? A. it is the freedom of choice B. it reflect a person's ownership C. It is a legitimate power to give a command D. it refers to an individual being answerable for his or her actions

B. rationale: responsibility reflects ownership Freedom to choose aspects of care is referred to as autonomy. A legitimate power to give a command or other is referred to as authority. Accountability is being answerable to the given task or role.

Right circumstances

Consider the appropriate patient setting, available resources, and other relevant factors, In an acute care settings patients' conditions often change quickly. Good clinical decision making is necessary to determine what to delegate.

Case management

Coordinates and links health care services across all levels of care for patients and their families whole streamlining costs and maintaining quality. The case-management system is focused on achieving patient outcomes within effective time frames and with available resources.

Which responsibility is that of a nurse executive? A. conducts regular patient rounds B. uses transformational leadership C. establishes a unit performance plan D. maintains a professionnel satisfaction of the staff

D. rationale: a nurse executive has a critical role inn maintaining healthy communication and professional satisfaction among staff members. The nursing manager has the responsibility of conducting regular patient rounds, using transformational leadership to empower the staff, and establishing the unit performance plan.

Autonomy

Freedom of choice and responsibility for the choices. Consistent with the scope of professional nursing practice maximizes a nurse's effectiveness. With clinical autonomy you make independent decisions about patient care plan patient care within the scope of professional nursing practice, and implement independent nursing interventions. Work autonomy: a nurse makes independent decisions about the work of the unit, such as scheduling or unit governance.

Right Direction and Communication

Give a clear, concise description of the task, including its objective, limits, and expectation. It is essential for communication to be ongoing between the RN and AP during a shift of care.

Principles of Time Management: Goal setting Time Analysis Priority Setting Interruption Control Evaluation

Goal setting - review pt's outcomes and cares that needs to be accomplished for the day and any goals you have for activities Time analysis - keep track of how you use your time in diff activities. This helps you become more aware of how well organized you really are and areas you may need to improve upon Priority setting - set the priorities that you have established for pts within set time frames Interruption control - Evaluation - at the end of each day take time to think and reflect about hoe effectively you used your time.

Primary nursing model

One primary RN assumes responsibility of the caseload of patients The RN develops the care plan and delivers appropriate nursing care. The other members managing patient care may assist the primary RN in the care delivery process.

Patient-and family-centered care

Promotes mutual partnerships among the patient, family, and health care team to plan, implement, and evaluate nursing and health. Four core concepts: 1. dignity and respect - ensuring that the care provided is given baed on a pt's and family's knowledge, values, beliefs, and cultural backgrounds 2. information sharing - meaning that HCPs communicate and share information so that pts and families receive timely, complete, and accurate info to effectively participate in care and decision making 3. participation - pts and families are encouraged and supported in participating in care and decision making 4. collaboration - demonstrated by the health care leaders collaborating with pts and families in policy and program development, implementation, and evaluation

Right Supervision and Evaluation

Provide appropriate monitoring, evaluation, intervention as needed, and feedback. AP must feel comfortable asking questions and seeking assistance. Be aware that accountability remains with the delegating nurse in many situations. A major advantage of delegation is that tasks are completed in a more timely manner when all staff are working together to reach the common goal for the patient.

The 5 rights of delegation

Right Task Right circumstances Right Person Right Direction and Communication Right Supervision and Evaluation

Which strategy improves staff communication in a health care team? SATA A. staff meetings B. newsletters C. standing orders D. protocols E. meeting minutes

a, b, e rationale: staff communication is an important component of any health care team. It can be improved through staff meetings to discuss major issues. Newsletters are helpful in updating staff members about activities in the unit. Meeting minutes help update the team members on staff meetings.

Delegation

The process of assigning part of your responsibility to another qualified person in a specific situation.

Shared governance

The typical decentralized structure used within health care agencies today. This structure creates Ann environment in which managers and staff become more ac timely involved in making decisions to shape the identity and determine the success of a health care agency. Working in a decentralized structure has the potential for greater collaborative effort, increased competency in all staff, increased staff motivation, and ultimately a greater sense of professional accomplishment and satisfaction.

Case managers

Work with patients and families to identify issues and overcome barriers to help patients become healthier. They oversee the management of patients with complex nursing and medical problems across all levels of care. Case managers are often APNs who, through specific interventions, help to improve patient outcomes, optimize patient safety by facilitating care transitions, decreasing length of stay and lower health care costs. They are accountable for cost management and quality. Case managers do not provide direct care

A nurse who is an effective leader would possess which characteristic? SATA A. take initiative and sustain motivation, especially during times of uncertainty B. maintain a neutral approach in decision making C. rebound from setbacks with positivity D. identify the need to change and support change effectively E. display impassivity toward others to avoid discrimination

a, c, d rationale: an effective leader uses a variety of evidence-based strategies to create healthy work environments and lead their teams through change. The nurse should take initiative and sustain motivation, especially during times of uncertainty. The nurse should identify the need to change, support change effectively, and rebound from setbacks with positivity. Maintaining a neutral approach in decision making and displaying impassivity toward others to avoid discrimination are not characteristics of effective leaders.

Which characteristic describes that of an effective team? A. different purposes B. effective communication C. trust D. the ability to keep feedback to oneself E. effective conflict management

b, c, e rationale: a good team is important to effective nursing care. the team should be able to communicate properly and avoid miscommunication, the team members should also be able to trust each other. Conflicts may arise among team members; the team should be able to manage them amicably. All the team members should have a common purpose so that their efforts are focused. Providing feedback to each other helps improve patient care.

The team nursing model

one RN leads the team of other RNs the team leader does not provide direct care to the patient but plans the work and delegates it to other team members.

Right Task

refers to delegating care for a specific patient and ensuring that the task is within the health care professionals scope of practice. If a task is delegated to unlicensed AP, the task should be a skill that is repetitive, requires little supervision, is relatively noninvasive, has predictable results, and poses minimal risk to the patient

Which nursing student action word the AP indicates effective learning regarding delegation? A. delegating a basic patient care task to the AP B. Allotting a specific time to the AP for clarifying his or her doubts C. limiting communication with the AP during the shift for efficiency D. providing the AP with feedback after completion of all the tasks

A. rationale: APs attend to basic patient needs (hygiene, meal assistance, ambulation). The AP should have as much time necessary for clarifying doubts. The nursing student or nurse should have ongoing communication with the AP during the shift. The nursing student or nurses provide feedback to the AP while tasks are being completed to provide efficient patient care.

Which responsibility does a nurse manager have? A. recruiting new health care providers B. making rounds with the health care provider C. dealing with the cost-effectiveness of the care plan D. establishing structure to achieve the organizational goal

B. rationale: the manager should make rounds with the health care provider to check the health of the patients and quality of care provided. The nurse manager is responsible for recruiting new nursing staff, not health care providers, The nurse executive deals with cost-effectiveness if the care plan. The nurse executive also established a structure that helps achieve organizational goals.

A nurse must help a hospitalized patient with diabetes eat; the health care provider has also requested a urine sample. Which leadership element would the nurse use in this situation? A. autonomy B. organizational skills C. clinical decision making D. transactional leadership

B. rationale: It is important for a patient with diabetes to have meals on time, as is sample collection, so the nurse must use his or her organizational skills to get everything done efficiently.

Which task delegated to a newly graduated nurse is the nurse' lowest priority? A. clearing an obstructed airway B. teaching self-hygiene home care C. teaching the patient about a new drug therapy for an untreated problem D. taking measures to decrease postoperative complications

B. rationale: providing discharge education and self-hygiene home care is considered a third-level problem or low priority. Clearing an obstructed airway is an emergency situation and is classified as a high priority. Anticipating and teaching the patient about a new drug therapy for an untreated problem and taking measures to decrease postoperative complications are considered second-level problems.

When unit staffing includes AP, which scenario is characteristic? A. the AP have formal training and are able to function independently B. the AP do not have clinical duties one a patient care unit C. the RNN is accountable for the tasks delegated to the AP D. delegating asks to the AP is not in the scope of the RN's practice

C. rationale: Nurses remain accountable for patient outcomes whether or not the specific tasks are performed by nurses or nurse extenders. Accountability implies being responsible and answerable for actions or inactions of oneself or others in the context of delegation, The AP do not function independently but can have clinical duties on a patient care unit. Delegation of tasks is within the scope of the RN's practice

Which example demonstrates the nurse performing the skill of evaluation? A. explaining the side effects of the new BP medication prescribed for the patient B. asking the patient to rate pain on a scale of 0-10 before administering the pain medication C. completing the teaching, then observing the patient draw up and administering an insulin injection D. changing the patient's leg ulcer dressing using the aseptic technique

C. rationale; evaluation is one of the most important aspects of clinical care coordination; it involves the determination of patient outcomes. Observing a patient demonstrate what was taught ensures the he or she has understood the teaching, Asking the patient to =rate pain is not an evaluation because it occurs before administering a pain medication. Explaining medication side effects and changing a wound dressing are interventions, not evaluations.

The hospital nursing staff is competent and motivated and receives high patient satisfaction scores. Which concept is most likely responsible for this achievement? A. accountability B. magnet recognition C. case management D. decentralized decision making

D. rationale: decision making at the level of staff members in an organization is called decentralized decision making. It allows the managers and staff more active involvement in shaping and determining the success of the health care organization, which increases staff competency and motivation. Case management is a nursing care delivery model. Magnet recognition is something the hospital may earn, but it does not facilitate the achievement itself. Accountability refers to nurses being responsible for their own actions.

The nurse manager organizes a committee that includes RNs, LPNs, health care providers, social workers, and volunteers. Which staff involvement approach is the nurse manager exemplifying? A. shared governance B. staff communication C. interprofessional rounding D. interprofessional collaboration

D. rationale: interprofessionnel collaboration among nurses and health care providers involves bridging representatives of various disciplines together to work with patients and families to deliver quality care. Establishing nursing practice through shared governance involves senior clinical staff nurses, who establish and maintain care standards for nursing practice on their work unit. Staff communication is an approach of staff involvement that ensures all staff members receive the same message. Interprofessional rounding involves the patient and family in planning care and improving patient care coordination and communication among the health care team.

Which type of care management approach coordinates and links health care services to patients and their families while streamlining costs and maintaining quality? A. primary nursing B. total patient care C. team nursing D. case management

D. rationale: case management is a care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality. Case management is defined as "a collaborative process of assessment, planning, and facilitation, and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost-effective outcomes

A nurse is promoting change and innovation on the unit by spending time with the staff, sharing ideas, and showing appreciation by recognizing team members for a job well done. Which model is the nurse using? A. team nursing B. primary nursing C. magnet recognition D. transformational leadership

D. rationale: the nurse is using the transformational leadership model to promote change and innovation by spending time non the unit with staff, sharing ideas, empowering the staff, supporting opportunities to enhance the team, showing appreciation, recognizing team members for a job well done, and holding team members accountable. Team nursing and primary nursing are traditional models of nursing care delivery. In team nursing, the RN assumes the responsibility for providing complete patient care in collaboration with the other nurses and AP. Primary nursing refers to a nurse being accountable for a patient's outcomes. Magnet recognition encourages nurses to make changes and take innovative steps to improve the quality of patient care.

Accountability

Refers to individuals being answerable for their actions. It involves follow-up and a reflective analysis of decisions and an evaluation of their effectiveness. It means that as a nurse you take responsibility to provide excellent patient care by following standards of practice and agency policies and procedures. You assume responsibility for the outcomes of the actions, clinical judgments, and omissions in providing care.

Responsibility

Refers to the duties and activities that you are employed to perform. A position description outlines your responsibilities as a professional nurse and your expected level of participation as a member of a nursing unit. Reflect ownership and obligation.

Authority

Refers tot he legal ability to perform a task. It provides the power for a nurse to make final decisions and give instructions related to the decisions. You use authority to determine whether collaboration was successful.

Right Person

The right person is delegating the right task to the right employee for performance on the right patient

Which statement by the nursing student indicates effective learning regarding a characteristic of an effective leader? SATA A. "a leader is a role model for the staff" B. "a leader is an effective communicator" C. "a leader is consistent in managing conflict" D. "a leader avoids a participatory approach to decision making" E. "a leader may not be competent in all aspect of delivery of care"

a, b, c

The head nurse is delegating responsibilities to the staff. Which order would be given to the nurse manager? SATA A. "conduct regular staff meetings" B. "make rounds with health care providers" C. "submit staffing schedules for the unit" D. "provide care to the patients using a holistic approach" E. "participate in the development of nursing policies and procedures"

a, b, c rationale: the nurse manager is responsible for conducting regular staff meetings, making rounds with health care providers, and submitting staff schedules for the unit. The nurse manager is not responsible for providing direct care to the patients and participating in developing nursing policies and procedures. The NP provides holistic care to the patient. The nurse educator participates in the development of nursing policies and procedures. The nurse manager is also responsible for reviewing and recommending new equipment for the unit.

Which principle is included in time management? SATA A. goal setting B. time analysis C. priority setting D. interruption control E. clinical decision making

a, b, c, d rationale: there are various principles of time management. goal setting, time analysis, priority setting, and interruption control are principles of time management. clinical decision making is part of clinical care coordination

Which factor is important during clinical care coordination? SATA A. evaluation B. use of resources C. interruption control D. time management E. organizational skills

a, b, d, e rationale: clinical care coordination is essential to delivering patient care in a timely and effective manner. Clinical care coordination includes factors such as evaluation, use of resources, time management, and organizational skills. It also includes setting priorities and clinical decision making. Interruption control is a principle of time management

The nurse, who has experience working in a non-magnet hospital, has found a new job in a magnet hospital. Which difference would the nurse expect to find in the new hospital? SATA A. the staff feels valued B. there is a clinical promotion system C. there is increased dependence on other staff members D. solo work is preferred to working in a team E. it empowers nurses to be innovative

a, b, e rationale: A magnet hospital empowers a nursing team to make changes and be innovative. Professional nurse councils at the organizational and unit levels are one way to create an empowerment model. An effective empowerment model leads to a staff that feels values, increases autonomy, and a work environment that promotes job satisfaction. This culture and empowerment combine to produce strong collaborative relationships among the team members and improve patient quality outcomes. Autonomy and working inn teams are encouraged in a Magnet hospital.

Which tip would help the RN appropriately delegate patient care to AP? SATA A. Listen attentively to the AP B. Communicate clearly with the AP C. Let the AP perform tasks independently D. Assign tasks a little higher than the AP's skills E. Assess the knowledge and skills of the AP

a, b, e rationale: Delegation is the act of transferring responsibility for the performance of an activity or task while retaining accountability for the outcome

Which method does the nurse manager use to encourage staff involvement? SATA A. provide ongoing learning programs B. encourage good time management C. encourage interprofessional rounding D. evaluate the care given to the patients E. establish shared governance councils

a, c, e rationale: The nurse manager should conduct ongoing educational learning programs so the nursing staff is updated with the current trends in clinical settings. This helps staff involvement. the nurse manager also encourages staff involvement by establishing professional shared governance councils and by encouraging interprofessional rounding. Shared governance helps establish care standards for the nursing staff in a clinical unit. Interprofessional rounding helps involve the family and the patients in the care plan along with the health care team.

Which characteristic does the primary nursing care delivery model exhibit? A. one primary RN assumes the responsibility for a caseload of pts B. team members provide direct patient care under the supervision of a RN C. The same RN provides care for a group os patients during their entire stay in an agency D. There is hierarchical communication from charge nurse to charge nurse E. The RN assesses the patient, develops the care plan, and delivers appropriate nursing interventions

a, c, e rationale: the primary nursing care delivery model has a variety of characteristics. Communication is lateral from nurse to nurse and caregiver to caregiver. Team members providing direct patient care under the supervision of an RN is a characteristic of the team nursing model.

Which action by the RN exhibits leadership skills after a mass-casualty event? SATA A. motivating coworkers B. acting as a patient advocate C. prioritizing the needs of a patient D. managing patient care effectively E. briefing a nursing student about the task effectively

a, e rationale: motivating and empowering the staff and coworkers is a characteristic of an effective leader inn a mass-casualty event. Characteristics of an effective leader also include effective communication; briefing a nursing student about the task effectively determines the leadership skills of the RN. Acting as a patient advocate, prioritizing basic patient care needs, and managing care of patient effectively are entry-level nurse competencies rather than characteristic leadership traits.

Which duty would a case manager perform? SATA a. prescribe medications to the patient in the health care provider's absence b. coordinate acute care of the patient in the hospital c. supervise the care delivered by the other staff d. actively coordinate patient discharge planning e. provide alternative therapies to the patient

b, c, d rationale: a case manager is often an APN who is responsible for helping yo improve patient outcomes, optimizing patient safety by facilitating care transitions, decreasing lengths of stay, and lowering health care costs. A case manager coordinates a patient's acute care in the hospital and follow up after patient discharge. Case manager are not involved inn direct care of the patient. They work with and manage the care delivered by other staff and health care team members. When the patient is ready to be discharged, the case managers actively coordinate patient discharge planning. Prescribing medications and providing alternative therapies to the patient are not the duties of a case manager.

A group of RNs inn a 75-bed, pediatric health care agency are planning to apply for Magnet status for the hospital. One of the nurses proposes decentralizing the care-managing process to improve the nursing management system. Which advantage of decentralized management may have led the nurse to propose this concept? SATA A. It makes the RNs the decision makers B. It keeps all the managers and staff members actively involved C. It facilitates a greater collaborative effort for patient care D. It limits the work of AP E. The nursing staff are highly motivated in this system of management

b, c, e rationale: Decentralized management is a management system in which managers and all staff members become more actively involved in the decision-making process. Every member plays a major role in determining the success of the situation. In this management system, there are greater collaborative efforts for patient care. Because all members are included inn the decision-making process the staff is highly motivated. Decision making is not limited to the RNs in this system. Care management is equally divided among all the staff members, including unlicensed nurses and nurse assistants.

Which factor is essential to a philosophy of care? A. management of patient care B. selection of proper interventions C. selection of the management structure D. selection of a nursing care delivery model E. knowledge of roles and responsibility of a nurse

c, d rationale: a philosophy of care helps support professional nursing care. selection of the management structure and selection of a nursing care delivery model are essential to the philosophy of care. These factors help provide quality nursing care. Management of patient care is a skill required of an entry-level nurse; it is not related to the philosophy of care. The knowledge of roles, responsibilities, and functions of a nurse is something nurses should possess.

Which characteristic of team nursing holds true? SATA A. The RN works directly with the patient and the family B. The RN assumes responsibility for the caseload of patients C. The RN leads the team of other nurses and AP D. The team leader develops patient care plans and coordinates with team members E. The team members provide direct patient care under supervision of the RN

c, d, e rationale: In the team nursing model, the RN leads the team of other nurses and AP. The team leader develops patient care plans and coordinates accordingly. The team members provide patient care while the RN supervises. The RN works directly with the patient and the family in the total patient care model. The RN assumes responsibility for the caseload of patients in the primary nursing model

Which statement describes a disadvantage of the total patient care model? SATA A. the team leader needs to take time to delegate work, which may be time consuming B. There is a lack of collaboration with other health care team members C. The associate nurse is unable to change the care plan without discussing it with the primary nurse D. A greater number of RNs are needs to provide care E. Continuity of care is a problem if the RN is unable to communicate patient needs

d, e rationale: The total patient care model is similar to the primary nursing model, which requires a greater number of RNs to provide the care. Continuity of care is a problem is the RN is unable to communicate the patient's needs. In the team nursing model, the team leader needs to take time to delegate work. The total patient care model does not have a lack of collaboration; rather the model allows a high degree of collaboration with other health care team members. In the primary nursing model, the associate nurse cannot change the care plan without discussing it with the primary nurse.

Total patient care model of nursing

the RNs plan the care and work directly with patients, families, and health care team members. The care can also be delegated to subordinates

Transformational Leadership

the nurse manager who uses transformational leadership is focused on change and innovation through team development, serves as a mentor for staff, and develops and supports the moral agency of nurses. Transformational leaders spend time on the unit with the staff sharing ideas, empowering the staff, supporting opportunities to enhance the team, showing appreciation, recognizing team leaders for a job well done, and holding team members accountable