Exam 1

Factors that may Influence Decision Making:

-Priorities -Gender -Values -Life Experiences -Individual Preferences -Brain Hemisphere Dominance

Critical Elements in Problem Solving & Decision Making:

1. State a clear objective 2. Gather data carefully 3. Take the time necessary to analyze data 4. Use an evidence-based approach 5. Generate many alternatives 6. Think logically 7. Choose and act decisively

scientific management-Four principles:

1. Traditional "rule of thumb" - time / motion studies 2. Scientific personnel system - match skills with job 3. Workers "fit" into the organization-motivated only by $ 4. Relationship between managers and workers is cooperative and interdependent. Managers as foremen Worker does the work

Three Steps of the Quality Control Process

1. •Determine the criterion or standard 2. •Collect information to determine whether the standard has been met 3. •Take educational or corrective action if the if the criterion has not been met

Called for protection and privacy of medical information, including any information about a patient, whether oral or recorded in any form or medium, that is created or received by a health-care provider, health plan, public health authority, employer, life insurer, school or university, or health clearing house Confidentiality can be breached when necessary for legitimate professional need

1996 Health Insurance Portability & Accountability Act (HIPAA)

Using the SBAR model, when the nurse is providing the background of a patient to teammates, what information should the nurse include? Select all that apply. A. Past medical history B. Current medications C. Admitting diagnosis D. Issues identified for discussion E. Patient's name and room number

A, B, C, E

A nurse manager wants to increase the effectiveness of communication with a staff member since the staff member did not respond positively to the same message previously. What action by the manager would improve communication? (Select all the apply). A. Use common terminology B. Have the staff member state understanding of the message C. Use the previous technique with the staff member D. Stay positive when sending the message E. Make the message clear and concise

A, B, D, E

In the SBAR model, what should be conveyed when explaining the situation? (Select all that apply). A. Recommendations for treatment changes B. Assessment data collected C. Information in a narrative or story form D. Events currently happening E. Objective statement of the problem

A, B, D, E

7. A nurse manager is assessing the internal climate of communication with a group of staff members prior to a meeting. What would the manager consider to be part of the internal climate of communication? A. Values B. Status C. Power D. Feelings E. Stress

A, D, E

A nurse manager is relaying information about staffing changes to the staff on the night shift. What form of communication is the nurse manager using to deliver changes? A. Downward B. Diagonal C. Grapevine D. Horizontal

A. downward

A nurse leader is introducing a new glucometer protocol to members of the staff. What method of communication would best be used to make all of the staff aware of the this change? A. Written communication B. Nonverbal communication C. Verbal communication D. Telephone communication

A. written communication

A new nurse leader asks for strategies to improve communication skills since there has been a large turnover of nursing staff. What suggestions from the director would be beneficial for the nurse leader? A. "Be congruent in your verbal and nonverbal communication." B. "Restate messages using passive language." C. "Allow them to think you are listening to your complaints." D. "Use aggressive communications to show the staff you are in charge."

A."Be congruent in your verbal and nonverbal communication."

Some lead- some follow Great leaders will be there when needed

Aristotle - "Great MAN Theory"

Implementing change

Assess -Internal -External Plan -Who, how, when Implement -Rational/empirical -Social forces -Power -Competency based Evaluate

Control; coercion Communication flows downhill Criticism in punitive

Authoritarian leader

A nurse manager is using face-to-face communication when discussing a staff member's performance evaluation. What does the manager determine are the benefits of this method of communication in this situation? (Select all that apply). A. It will prevent any misunderstandings from occurring. B. It will combine verbal and non-verbal communication to convey messages. C. The staff member will agree with all aspects of the evaluation. D. The manager can determine if the staff member understands the evaluation. E. It will strengthen the connection between the manger and staff member.

B, D, E

In the SBAR model, when giving recommendations, what kinds of things should be communicated? Select all that apply. A. A concise evaluation of the situation in a couple of sentences B. Opinions for further action C. The background or context of the situation D. The patient's condition and state what you think the problem is E. Any new treatments or changes ordered

B, E

A nurse working in a large, diverse university hospital informs the charge nurse, "I never know how far apart to stand from someone since we have patients from many cultures." What is the best response by the charge nurse? A. "It doesn't really matter, people should just accept it." B. "The degree of space is going to vary with cultural norms." C. "For personal interactions, you should stand at least 5 feet away. D. "About 14 inches is appropriate for a social interaction."

B. "The degree of space is going to vary with cultural norms."

When you explain what the nurse believes the issue is, which stage of SBAR would the nurse be demonstrating? A. Recommendation B. Assessment C. Background D. Situation

B. Assessment

Which is NOT a factor in solving a problem successfully? A. Using an evidence-based approach B. Doing all work independently C. Stating a clear objective D. Watching for faulty logic

B. Doing all work independently

14. A health care provider is attempting to improve their connection with the nursing staff. What communication strategy would be appropriate for the health care provider to use to make this change? A. Use touch as a nonverbal cue of acceptance B. Maintain eye contact and nod or vocalize to show interest in conversation C. Hesitate prior to responding D. Interrupt nurses going off on tangents in order to model keeping them focused

B. Maintain eye contact and nod or vocalize to show interest in conversation

According to the report To Err is Human by the Institute of Medicine (1999), which of the following causes at least 44,000 deaths per year in the U.S.? A. Breast cancer B. Medical errors C. Automobile accidents D. AIDS

B. Medical errors

Which is a characteristic of a successful decision maker? A. Impulsiveness B. Courage C. Decisiveness D. Whimsy

B. courage

Why Take the Chance of reporting?

Better patient outcomes More satisfied with the workplace Willingness to put forth effort beyond the minimum requirement Higher morale Intend to stay

Drive, motivation, confident Desire to lead

Born with the necessary traits

Nonverbal communication is through to make up ____% of the communication process? A. Over 90% B. 35%-50% C. 50%-70% D. Less than 35%

C. 50-70%

Which of the following is a form of communication that allows people to express themselves in direct, honest, and appropriate ways reducing tension in the workplace? A. Aggressive Communication B. Passive-Aggressive Communication C. Assertive Communication D. Passive Communication

C. Assertive communication

. Rapidly advancing communication technology has great potential for increasing the productivity and effectiveness of an organization. What is the threat or challenge that exists with new methods that include intranet and electronic information systems? A. Replace active listening B. Will replace nonverbal communication C. Pose a threat to patient confidentiality D. Ineffective communication tool

C. Pose a threat to patient confidentiality

Standards must be: A. Subjective B. Uniform across all organizations C. Attainable D. All of the above

C. attainable

Group members perform

Certain tasks that facilitate work. Roles that assist with group-building activities. Roles to meet their individual needs.

Several Rules That Should Be Followed in Implementing Change

Change should only be implemented for good reason- want evidence of why we should change. Change should always be gradual. All change should be planned and not sporadic or sudden. All individuals who may be affected by the change should be involved in planning for the change.

Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care Also called standardized clinical guidelines Should reflect evidence-based practice (EBP)

Clinical Practice Guidelines

Good Managers

Coordinate resources Optimize resource use Meet organizational goals and objectives Follow rules Plan, organize, control, and direct Use reward and punishment effectively to achieve organizational goals

A charge nurse informs a staff nurse that they will be admitting the next patient that arrives on the unit. The staff nurse states acceptance and then proceeds to tell the other nurses that the charge nurse is unfair. What type of communication is the staff nurse displaying? A. Assertive communication B. Aggressive communication C. Passive communication D. Passive-aggressive communication

D. passive aggressive

Leadership Roles

Decision maker Communicator Evaluator Facilitator Risk taker Energizer Mentor Critical thinker Buffer Advocate Coach Counselor Teacher Forecaster Visionary Influencer Creative problem solver Change agent Diplomat Role model

•complex, cognitive process of choosing a particular course of action •thought process of selecting a logical choice from available options

Decision making

Less control Communication flows up and down Criticism is constructive

Democratic leader

Between individuals at differing hierarchy levels and job classifications Tends to be less formal than other types of communication *not that important

Diagonal- not that important to us

forces that push the system toward change

Driving (facilitators)

A longitudinal electronic record of patient health information produced by encounters in one or more care settings

Electronic Health Record (EHR)

Good Leaders

Envision the future Communicate their visions Motivate followers Lead the way Influence others to accomplish goals Inspire confidence Take risks Empower followers Master change

Identify the ways that a process can fail Why it might fail Determine the effects of that failure Prioritize potential failures for further action

Failure Modes and Effects Analysis (FMEA)

A patient's health improvement is the primary determinant in his or her satisfaction with the hospital stay True False

False

4 Stages of Group Communication

Forming Storming Norming Performing

Differences significantly affect the types and quality of organizational and unit-level communication:

Gender Power Status

Putting others including employees, customers, and the community as the number one priority Fostering a service inclination in others that promotes collaboration, teamwork, and collective activism

Greenleaf's Servant Leadership

Productivity got better when people knew they were being studied

Hawthorne effect

leadership style changes based on situation; less task-focused; more relationship oriented Primary determinants of leadership style should include: Nature of the situation Skills of the manager Abilities of the group members

Hershey & Blanchard (1977) - situational approach

Launched by AHRQ in mid 90's Includes instruments for assessing quality of care in both ambulatory and institutional settings (adult inpatient-excluding psychiatric pts)

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Characteristics of a Critical Thinker

Insight Intuition Empathy Willingness to take action

Permissive, little control Little to no direction Doesn't criticize

Laissez-faire leader

Leader- personality, perceptions, abilities Staff - personality, perceptions, abilities Situation - group norms

Leadership as 2-way process (Hollander)

Guidelines for Writing Effective Memos

Memos should make main point in beginning. Only essential information should be included Should be written simply, without inflated or authoritarian language. Headings should be used to direct reader to issues. Include contact information from sender

Rules of Netiquette

Only say what you would say face to face Send information only to those who need it. Avoid flaming Do not write in all capital letters Respect other people's privacy Proofread your email Avoid emoticons and abbreviations -lol, Follow rules of communication within the organizations

DDI Tool (Development Dimensions International)

Open: Ensure that the discussion has a clear purpose and that everyone understands the importance of accomplishing it. Clarify: There are two types of information to collect in this step—facts and figures and issues and concerns. Both are essential to building a complete picture of the situation. Develop: When developing ideas, it is important to ask questions and include others in the process. Most likely leaders will have ideas about what to do, and should share them. However, they should put equal emphasis on seeking others' ideas. Agree: It is important that leaders and the people involved agree on a plan for following through on the ideas that were developed and for supporting those who will take action. Close: This is the final chance to check that everyone is clear on agreements and next steps and committed to following through.

HCAHPS Goals:

Produce data on patients' perspectives of care that allow comparisons Create incentive for hospitals to improve quality of care Enhance public accountability by increasing transparency

Actions to Take when under Attack by an Aggressive Individual

Reflect. Repeat the assertive message. Point out the implicit assumption. Restate the message by using assertive language. Question.

forces that pull the system away from change

Restraining (barriers)

STEEEP:

S-safety T-timely E-effective E-efficient E-equitable P-patient-centered

A technique for communicating critical information that requires immediate attention and action concerning a patient's condition

SBAR: Situation (identify yourself, the resident, and the problem). Background (history, vitals, results, etc). Assessment (findings, severity, life-threatening?). Recommendation (what is next?, needs, timeframe).

Components of Quality Care (STEEEP)

Safe Timely Effective Efficient Equitable Patient-centered

How to Handle Negative Interactions

Seek out motive/source of comments "Can you elaborate on that?" "Tell me more about what you meant by that." "That's an interesting perspective/observation; I need some time to think about that." Admit when you're wrong* best thing you can do Acknowledge the other person's feelings Use assertive communication to address the other person's behavior "I feel that your anger is directed at me; I would ask that we try to focus on the situation" Move to Action If at a complete loss and/or situation is deteriorating Make a short statement to bring the interaction to an end e.g. "I need to think about this and get back to you."

Successful Decision Maker

Self-aware Courageous Sensitive Energetic Creative

Five Components of Emotional Intelligence

Self-awareness Self-regulation Motivation Empathy Social skills

Elements of Nonverbal Communication

Space (Proxemics) Environment Appearance Eye contact Posture Facial expression and timing Vocal expression Silence

No current intention to change

Stage 1: Precontemplation

Individual considers making a change.

Stage 2: Contemplation

There is intent to make a change in the near future.

Stage 3: Preparation

Individual modifies his or her behavior.

Stage 4: Action

Change is maintained and relapse is avoided.

Stage 5: Maintenance

crucial conversations can be difficult bc:

Stakes are high Emotionally Sensitive Differences in opinions

majority that occur are systemic and are not the result of poorly performing clinicians.

Systemic Preventable Healthcare Errors

Findings: failure to raise three concerns that undermine the effectiveness of current safety tools Dangerous shortcuts Incompetence Disrespect

The Silent Treatment (AACN, AORN) 6500 nurses and nursing leaders

Individuals' resistance typically depends on four things:

Their flexibility to change Their evaluation of the immediate situation The anticipated consequences of the change Their perceptions of what they have to lose and gain

Theory X & Y

Theory X - employees lazy; need constant supervision Theory Y - employees enjoy work; self-motivated; work hard to meet personal & organizational goals

Consensus decision making Holistic concern for employees; Strong bond with leader

Theory Z - (Ouchi)

Effective leadership requires the nurse manager or leader to develop verbal communication skills in order to decrease tension in relationships, decrease anxiety, and prevent depression. True False

True

New nurses should question and challenge nursing traditions. True False

True

The American Nurses Association and the National Council of State Boards of Nursing have established principles for social networking. True False

True

The change agent convinces members of the group to change or guilt, anxiety, or concern are elicited. (Ensures that employees are ready for change)

Unfreezing

Steps to Assertive Communication

Use "I" statements Keep responses short Slow down verbally Monitor tone of voice Maintain eye contact 75% of the time Watch non-verbals - facial expression, posture Listen Respond in a timely way

Different motives drive people differently Performance affected by task and ability of staff

Work as a complex system (Schein)

Coercing others to your way of thinking. Forcing your views on another Dominating the conversation

controlling

•Apply different types of knowledge •Weigh evidence •Think about arguments •Reflect on process •Arrive at diagnosis or decision

critical reasoning

•Mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information •To reach an answer or conclusion

critical thinking

Taking Charge of Emotions You and only you create emotions You can act on them or be acted upon BY them

crucial conversations

Focus has often been to try to determine who is at fault This approach leads to hiding rather than reporting errors and is the antithesis of a culture of safety.

culture of blame

when an adverse event occurs, the focus is on what went wrong, not who is the problem

culture of safety

Accountability to patients and families is a hallmark of a patient safety culture.

disclosure

From superior to subordinate Directive communication-traditional form of communication in organizations that helps to coordinate activities in various levels of the hierarchy Helps to coordinate activities in various levels of the hierarchy

downward communication

the ability to use emotions effectively and is required by leaders/managers in order to enhance their success. critical for building a cooperative and effective team.

emotional intelligence

fostering collaboration, trust, and the sharing of power

enabling others to act

recognize, appreciate, and celebrate followers and the achievement of shared goals

encouraging the heart

maintains control; molds team

responsive

What is the first step in managerial decision-making model?

set objectives

Any act to purposefully withhold information from the pool of meaning.

silence

Activities include: Paying attention to multiple points of view Searching for common ground Prioritizing continuous learning in the workplace Promoting collaborative relationships (Wong)

strength-based leadership

SWOT analysis:

strengths, weaknesses, opportunities, threats- helps you to make a decision

Assume that a relationship exists between quality care and setting or "structure" in which patient care is provided Do not assess actual patient care provided but rather assess those factors that provide a safe and effective environment in which to provide care Examples: evaluating staffing ratios, assessing equipment safety, and documenting emergency preparedness planning

structure audits

Rapid Allows receiver to clarify message at time it is received Does not, however, allow the receipt of nonverbal messages for either the sender or the receiver Safety—accents in a multicultural workforce

telephone communication

Focuses on management tasks Is a caretaker Uses trade-offs to meet goals Does not identify shared values Examines causes Uses contingency reward

transactional leader

Identifies common values Is committed Inspires others with vision Has long-term vision Looks at effects Empowers others

transformational leader

Channels of communication include upward communication, downward communication, horizontal communication, diagonal communication, and grapevine. True False

true

Determine what needs to change Ensure there is strong support from upper management Create the need for change Manage and understand the doubts and concerns

unfreeze

From subordinate to superior Needs and wants are communicated upward to the next level in the hierarchy Allows for more employee input

upward communication

Pulling out of the conversation altogether

withdrawing

Most often used in large organizations reflects greatly on both the manager and the organization. Managers must be able to write clearly and professionally and use understandable language. Ex) Memos, reports, e-mails and test messages

written communication

aim for improving healthcare

•Improve patient experience •Improve population health •Reduce the per capita cost of health care

CUS Tool:

-I am Concerned about my resident's condition. -I am Uncomfortable with my resident's condition. -I believe the Safety of the resident is at risk.

rogers personality types

-innovators -early adopters -early majority -later majority -laggards

4 Types of Verbal Communication

-passive -passive-aggressive -unfeminine -assertive

Types of Audits Frequently Used in Quality Measurement

-structure -process -outcome

three good reasons for change

-to solve some problem -to make work procedures more efficient -to reduce unnecessary workload

Modes of Communication

-written -face-to-face -telephone -nonverbal -social media/electronic

Ten Fatal Leadership Flaws

1. A lack of energy and enthusiasm 2. Acceptance of their own mediocre performance 3. Lack of a clear vision and direction 4. Having poor judgment 5. Not collaborating 6. Not walking the talk 7. Resisting new ideas 8. Not learning from mistakes 9. A lack of interpersonal skills 10. Failing to develop others

A common approach to a RCA is a "Cause and Effect Diagram". This is a four-step process:

1. Identify the problem 2. Develop causes for each "branch," developing a list of causes 3. Complete the diagram indicating relationships among causal chains 4. Develop causal statements

Management Functions:

planning-> organizing-> staffing-> directing-> controlling

future oriented; common values; more participative

proactive

Perhaps the greatest factor contributing to the resistance encountered with change is

a lack of trust between the employee and the manager or the employee and the organization.

Expressing oneself in a direct and often hostile manner Infringes on another person's rights Generally oriented to "winning at all costs"

aggressive

Communicating that allows people to express themselves in direct, honest, and appropriate ways Should not infringe on another person's rights. expresses your beliefs, feelings, opinions and thoughts in an open respectful manner that doesn't violate the rights of others It involves rights and responsibilities for ALL parties in the communication Done in a calm manner

assertive

You move from winning the argument to making the person suffer Belittling Threatening

attacking

Suggests that in order to lead, leaders must be true to themselves and their values and act accordingly balanced processing, internalized moral perspective, relational transparency, and self-awareness.

authentic leadership

Steering completely away from the sensitive subject.

avoidance

A job title alone does not make a person a leader. Only a person's

behavior determines if he or she occupies a leadership position

The process of measuring products, practices, or services against best-performing organizations Organizations can determine how and why their organization differs from these exemplars and then use the exemplars as role models for standard development and performance improvement

benchmarking

Need for formalized authority, consistent rules and regulations

bureaucracy

identifying opportunities and taking action

challenging the process

Communicate often Dispel rumors Empower action Involve people in the process

change

To give a different position, course, or direction To making something different from what it was

change

begins the moment two or more people become aware of each other's presence. Critical leadership skill. is a high-level management function. impacts all management activities and cuts across all phases of the management process. effectively often determines success as a leader-manager.

communication

involves perception and feeling. Does not depend on information May represent shared experiences. In contrast to information sharing, superiors must continually communicate with subordinates.

communication

•Part of decision making •Systematic process focusing on analyzing a difficult situation

problem solving

Measure the process of care or how the care was carried out Assume that a relationship exists between the process used by the nurse and the quality of care provided Example: evaluates whether an intervention was performed in compliance with an accepted standard of care (e.g., clinical guideline, care pathway, facility or unit protocol)

process audits

•models that seek to ensure that quality currently exists

quality assurance

•activities that evaluate, monitor, or regulate services rendered to consumers

quality control

•assumes that the process is ongoing and that quality can always be improved

quality improvement

Includes external factors such as the weather, temperature, timing, status, power, authority, and the organizational climate itself

external climate

Serious conversations (ex: Layoffs) are almost always best when done:

face to face

Informal, haphazard, and random, usually involving small groups The most informal type of communication Flows quickly Subject to error and distortion Sender has little accountability for the message sent

grapevine

the degree to which services for individuals and populations increase the likelihood of desired health care outcomes and are consistent with current professional knowledge

healthcare quality

maximum productivity and worker satisfaction

high performing

From peer to peer

horizontal

formal, impersonal, and unaffected by emotions, values, expectations, and perceptions.

information

entails visioning that inspires followers to want to participate in goal attainment

inspiring a shared vision

Includes internal factors such as the values, feelings, temperament, and stress levels of the sender and the receiver

internal climate

Predetermined level of excellence that serves as a guide for practice Must be objective, measurable, and achievable

quality standards

States that leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur Suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity

quantum leadership

crisis mentality

reactive

Anchor the changes into the culture Develop ways to sustain the change Provide support and training Celebrate success!

refreeze

The change agent assists in stabilizing the system change so that it becomes integrated into the status quo. (Ensures that the change becomes permanent)

refreezing

Putting a label on people or ideas so we can dismiss them under a general stereotype or category

labeling

inventor or creator of the planned change

leader

Empower others; maximize workforce effectiveness Needed to implement the planned change that is part of system improvement

leaders

mechanic who implements the planned change

manager

Guide, direct, and motivate others Intervene when goals are threatened Emphasize control

managers

requires value clarification and self-awareness so that behavior is congruent with values

modeling the way

The change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces.

movement

Defined as the end result of care, or how the patient's health status changed as a result of the intervention Determine what results (if any) occurred as a result of a specific nursing intervention Examples: rates of patient falls, prevalence of pressure ulcers, rates of healthcare-associated infection (HAI), and patient satisfaction scores

outcome audits

Occurs when a person suffers in silence, although he or she may feel strongly about the issue Nonassertive A form of communication in which the person does not share his or her wants, needs, desires, or opinion

passive

Aggressive message presented in a passive way Limited verbal behavior with incongruent nonverbal behavior A style in which individuals appear passive on the surface but are really acting out anger in a subtle, indirect, or behind-the-scenes way Mutter to themselves rather than confront the person or issue Have difficulty acknowledging their anger Use facial expressions that don't match how they feel - i.e., smiling when angry Use sarcasm

passive-aggressive

in contrast to accidental change or change by drift, is change that results from a well-thought-out and deliberate effort to make something happen.

planned change