Leadership Exam 3

Primary nursing is a type of care delivery in which the nurse: A. is responsible for the client's daily care B. cares for a patient 24 hours a day C. monitors care from admission to discharge D. provides total care for the patient

-CHECK PPT

A ____ is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes within an appropriate length of stay in a hospital setting.

-critical path

_______ has garnered considerable attention in health care in part because of the publication Crossing the Quality Chasm, a health care quality initiative of the Institute of Medicine (IOM, now called the national Academies of Sciences, Engineering, and Medicine, Health and Medicine Division). A. Case Management B. Development research groups C. Disease management D. Diagnosis-related groups

-C

the first step in the development of a case management program is? A. to identify high-volume or high-risk case types B. to develop a pilot program C. to assess the organization and the client population served D. to form an interdisciplinary care team

-C

nurse managers are responsible for developing the unit culture supporting innovation and evidence-based care. The nurse manager can facilitate and support EBP work by: (Select all that apply) A. set the expectations for the unit B. promote staff questioning practice C. allocate resources as needed D. encourage and respond to new ideas E. set the staffing schedule

-A, B, C, D

to promote an organizational culture that embraces evidence-based practice, an organization must: (select all that apply) A. adopt an evidence-based practice model B. recruit nurses with interest in evidence-based practice C. discourage nurse from questioning their practice D. provide education about evidence-based practice E. recognize and reward the work

-A, B, D, E

the determination of a care delivery model or system of care delivery depends on: (Select all that apply) A. fiscal responsibility B. government reimbursement C. accountability to the consumer D. quality and safety considerations E. the organization's philosophy

-A, C, D

A well-known conceptual framework by Donabedian (1988) is used to promote positive outcomes in an organization. The framework is composed of concepts related to: (Select all that apply.) A. processes B. values C. quality D. outcomes E. structure

-A, D, E

which of the following collaborative processes assesses plans, facilitates, coordinates, advocates, and evaluates options and services required to meet an individual's comprehensive health needs? A. population health management B. case management C. disease management D. care management

-B

clinicians tend to buy into the need for practice change when: (Select all that apply) A. the practice change is endorsed by organizational executive leadership B. the topic addresses an identified need C. there is a strong evidence base D. the practice change offers a relative advantage E. data demonstrates an opportunity for practice improvement within the clinical areas

-B, C, D, E

which of the following components are common to all case management models? (Select all that apply) A. population management B. Monitoring service delivery C. Client identification and outreach D. Environmental management E. Individual assessment and diagnosis F. Evaluation

-B, C, D, E

The _______ Act provides incentives for adoption and implementation of electronic health records (EHRs) while enhancing provacy and security for patients and providing incentives for practitioners and hospitals to engage in meaningful use. A. anti-kickback B. HIPAA C. HITECH D. Stark

-C

11. A common-sense look at the workplace to find existing or potential hazards for workplace violence is: a. worksite analysis. b. risk management. c. administrative rounds. d. hazard prevention and control.

ANS: A Worksite analysis is a common-sense look at the workplace to find existing or potential hazards for workplace violence.

A clearly recognizable process of providing care that has an evidence base demonstrating that it reduces the likelihood of harm is: a. risk adjustment. b. a sentinel event. c. a patient safety practice. d. a performance measure.

ANS: C Patient safety practices are "discrete and clearly recognizable processes or manners of providing care that have an evidence base demonstrating that they reduce the likelihood of harm due to the systems, processes, or environments of care"

A clinical nurse specialist is meeting one on one with staff nurses while they are working to discuss data about the EBP. This is known as: A. academic detailing B. champion coaching C. individual instruction D. professional mentoring

A. academic detailing

Which of the following will positively influence how quickly a practice change is adopted? A. clearly defined patient outcomes are expected as a result of the change B. complex and detailed interventional practice changes are important C. Senior management leaders are the sole members of the team D. The new practice is much different from current practice

A. clearly defined patient outcomes are expected as a result of the change

1. An evaluation of a specific threat of violence and an evaluation of the person making the threat is conducted by ______.

ANS: threat assessment teams A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT reviews troubling or threatening behavior of patients or workers. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015).

17. Jenna, a registered nurse (RN), has been accused of gossiping and bullying a new graduate RN on her unit. This type of workplace violence is called _____ violence. a. horizontal b. co-worker c. threatening d. nurse-to-nurse

ANS: A A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker's performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload (Hamblin et al., 2015).

1. What percentage of assaults in the workplace are committed against health care workers? a. 50% b. 20% c. 15% d. 40%

ANS: A Although health care workers incur less than 20% of all workplace injuries, health care workers nevertheless suffer 50% of all assaults in the workplace.

2. A long-standing mental health nursing tool may be used in an aggressive or violent situation. The use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting is known as: a. de-escalation. b. chemical restraint. c. stress management. d. emergency assistance programs.

ANS: A De-escalation is a long-standing mental health nursing tool. De-escalation is defined as "a gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance and non-confrontational limit setting that is based on respect" (Cowin et al., 2003, p. 65).

19. _____ may be useful in preventing loss caused by domestic violence that extends to the workplace. a. Employee assistance programs b. Stress leave for up to 6 weeks c. Termination of the perpetrator d. Arrest and conviction of the perpetrator

ANS: A Employee assistance programs can be very useful in preventing or mitigating loss caused by domestic violence that extends to the workplace (ASIS/SHRM 2011, p. 10).

13. An integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits is called _____ management. a. risk b. threat c. total quality d. human resources

ANS: A Risk management is an integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits.

8. One of the several legal issues surrounding workplace violence is: a. an employer may be subject to liability claims. b. maintaining mandatory security ratios. c. Department of Labor laws requiring employers to report each incidence of workplace violence. d. the patient's right to unrestricted visitation.

ANS: A To date, 29 states have introduced legislation related to workplace bullying, often referred to as the Healthy Workplace Bill (HWB) or some version thereof (HWB, 2016; Mao, 2013). Basic provisions of the model HWB legislation, developed and introduced by Yamada in 2000, include a clear definition of an "abusive work environment," a legal right for those harmed by workplace bullying to seek recourse, and decreased employer liability when prevention and corrective policies and plans are implemented (Mao, 2013).

Mercy Hospital compares its surgical site infection rate to General Heart Hospital, which is known as a best-in-class hospital for its surgical site infection rates. Mercy Hospital studies General Heart Hospital's methods for reducing surgical site infection rates and uses that information to improve its own performance. This quality performance method is called: a. benchmarking. b. evidence-based practice. c. enterprise risk management. d. continuous quality improvement

ANS: A In ambulatory care (and other settings), benchmarking "is the process of comparing a practice's performance with an external standard. Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others"

The specific tools used to make quality visible to stakeholders in health care are called: a. indicators. b. outcomes. c. variable selections. d. quality measures.

ANS: A Indicators are valid and reliable measures related to performance. They are the specific tools used to make quality visible to stakeholders in health care.

Sentinel Event Alerts are published by TJC to do which of the following? a. Allow facilities to learn from sentinel events that have occurred in other facilities and incorporate recommendations for prevention into their policies. b. Notify hospitals that if a sentinel event occurs during an alert, the hospital will be subject to withdrawal of Medicare and Medicaid certification and reimbursement. c. Prevent a near-miss from occurring. d. Assist hospitals to find national standardized performance measures to benchmark themselves against other similar hospitals.

ANS: A Sentinel Event Alerts are published by TJC to review the lessons learned from those facilities that had experienced these sentinel events. The hope is that other hospitals will incorporate the recommendations into their policy to avoid making similar errors.

1. Administrative controls that may affect workplace violence include: (Select all that apply.) a. adequate staffing levels. b. controlled access. c. development of systems to alert security personnel to threats of violence. d. conflict resolution. e. architectural modifications.

ANS: A, B, C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Administrative controls include (1) adequate staffing patterns to prevent personnel from working alone and to reduce waiting times, (2) controlled access, and (3) development of systems to alert security personnel when violence is threatened.

A framework for understanding health care improvement has been proposed by the IOM Committee on Quality of Health Care in America. The aims for health care quality improvement propose that health care systems ensure that care is: (Select all that apply.) a. safe. b. timely. c. efficient. d. cost-controlled. e. patient-centered.

ANS: A, B, C, E A framework for understanding health care improvement has been proposed by the IOM Committee on Quality of Health Care in America. These six aims for health care quality improvement propose that health care systems ensure that care is safe, effective, patient-centered, timely, efficient, and equitable.

TJC requires accredited organizations to participate in their core measure initiative. The current core measure sets include: (Select all that apply.) a. stroke. b. tobacco treatment. c. pneumonia measures. d. iatrogenic pneumothorax. e. venous thromboembolism. f. acute myocardial infarction.

ANS: A, B, C, E, F The current core measure sets include perinatal care, stroke, venous thromboembolism, substance use, tobacco treatment, hospital outpatient department, pneumonia measures, heart failure, acute myocardial infarction, surgical care improvement project, hospital-based inpatient psychiatric services, emergency department, children's asthma care, and immunization (TJC, 2016d).

The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. The standards in areas of excellence include: (Select all that apply.) a. leadership. b. strategic planning. c. environment of care. d. human resource focus. e. medication management.

ANS: A, B, D The standards in seven areas of excellence established by the BNQA are: (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).

2. The main components in a violence prevention program are: (Select all that apply.) a. a written plan. b. worksite analysis. c. criminal control. d. security staff training. e. record keeping and evaluation of the program.

ANS: A, B, E The main components in a violence prevention program are: (1) management commitment and worker participation, (2) worksite analysis and hazard identification, (3) hazard prevention and control, (4) safety and health training, and (5) record keeping and program evaluation. Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.

Areas of data evaluation on a balanced scorecard include: (Select all that apply.) a. metrics. b. key performance indicators. c. environmental. d. turnover rates e. benchmarks

ANS: A, B, E Metrics (specific measurement standards like operating room start time), key performance indicators (a metric with a performance indicator such as revenue by year end), and benchmarks (the gold standard or best practices such as the pulse should be between 50 and 80 beats per minute) are the specific elements for collecting, monitoring, and analyzing quality improvement and decision-making data

A nursing quality improvement supervisor is proposing to enhance the current quality improvement program. One of the most important themes that a nursing quality improvement supervisor should consider is: a. budgetary considerations. b. collaboration between health care teams. c. regular staff training programs. d. suggestions from patients.

ANS: B Collaborative partnerships are part of this imperative and shape the way professional nurses act clinically and how they participate in performance and quality improvement efforts. As the complexity of care increases, multidisciplinary and inter-professional teamwork is used to solve complex problems in practice

Quality planning establishes the design of a product, service, or process that will meet customer, business, and operational needs to produce the product before it is produced. Quality planning follows a universal sequence of steps. List the universal sequence of steps in order. a. Identify customers and target markets. b. Discover hidden and unmet customer needs. c. Develop a service or product that exceeds customer's needs. d. Transfer these designs to the organization and the operating forces to be carried out. e. Translate these needs into product or service requirements: a means to meet their needs. f. Develop the processes that will provide the service, or create the product, in the most efficient way.

ANS: A, B, E, C, F, D Quality planning follows a universal sequence of steps, as follows: Identify customers and target markets. Discover hidden and unmet customer needs. Translate these needs into product or service requirements: a means to meet their needs (new standards, specifications, etc.). Develop a service or product that exceeds customer's needs. Develop the processes that will provide the service or create the product in the most efficient way. Transfer these designs to the organization and the operating forces to be carried out (Juran Institute, 2009, pp. 1-2).

A successful enterprise risk management (ERM) program will: (Select all that apply) a. identify risks. b. improve quality. c. prevent damage. d. control occurrences. e. control legal liability.

ANS: A, C, D, E ERM program is defined as an organization-wide program to identify risks, control occurrences, prevent damage, and control legal liability; it is a process whereby risks to the institution are evaluated and controlled.

Key examples of patient-focused outcome indicators are: (Select all that apply.) a. patient satisfaction. b. birth rates. c. health status. d. quality of life. e. ability to function.

ANS: A, C, D, E Patient-focused outcomes can include indicators such as disease status, symptom experience, or pain. Other outcomes indicators incorporate a broader impact of disease and its management on clients' lives. These outcomes, often measured through surveys of patient perceptions and experiences, include quality of life, functional status, health status, and patient satisfaction.

Principles of a fair and just culture include: (Select all that apply.) a. zero-tolerance for reckless behavior. b. reduction of personal accountability and discipline. c. recognition that competent professionals make mistakes. d. errors and unintended events being reported unless no patient harm occurs. e. acknowledgment that even competent professionals develop unhealthy norms.

ANS: A, C, E A fair and just culture "is an approach to medical event reporting that emphasizes learning and accountability over blame and punishment" (CAPSAC, 2016, p. 1). Everyone throughout the organization is aware that medical errors are inevitable, but all errors and unintended events are reported—even when the events may not cause patient injury. This culture can make the system safer as it recognizes that competent professionals make mistakes and acknowledges that even competent professionals develop unhealthy norms (shortcuts or routine rule violations), but it has zero-tolerance for reckless behavior.

The Agency for Healthcare Research and Quality (AHRQ) developed a set of categories of desirable attributes of a quality indicator. The categories include: (Select all that apply.) a. feasibility. b. efficiency. c. importance. d. cost-effectiveness. e. scientific soundness.

ANS: A, C, E Recently, the AHRQ developed a set of three broad categories of desirable attributes of a quality indicator: (1) importance; (2) scientific soundness, including clinical logic and measurement properties; and (3) feasibility.

3. Examples of environmental designs that can improve worker safety include: (Select all that apply.) a. well-lit parking lots. b. critical incident debriefing. c. de-escalation training for all staff. d. metal detectors at hospital entrances. e. posting security guards in the main lobby.

ANS: A, D, E NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.

15. Posters have been distributed with information about workplace violence such as typical profiles of workplace killers, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. This approach is completed by: a. the FBI. b. threat assessment team. c. human resources. d. senior leadership.

ANS: B A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). Still another procedural approach for the TAT would be to circulate generalized information such as typical profiles of perpetrators of extreme workplace violence, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem.

9. The most prevalent source of violence against nurses is from: a. a current or former employee. b. customers, clients, or patients. c. criminals with no other connection to the workplace but who simply intend to commit a crime. d. someone who is not employed at the workplace but has a personal relationship with an employee.

ANS: B Customers, clients, patients, or students are regarded as the most prevalent source of violence against nurses

Outcomes measurement is complex because: a. budgets are unable to allocate sufficient funds. b. health care is multidimensional. c. patients may not cooperate. d. treatments are not always necessary.

ANS: B A patient-focused definition of outcomes considers them "the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives" that are "inherently condition-specific and multidimensional" (International Consortium for Health Outcomes Measurement

The field in health care that aims at a better understanding of the end results of health care practices and interventions is called: a. patient safety. b. risk management. c. outcomes research. d. quality management

ANS: C Outcomes research aims at a better understanding of the end results of health care practices and interventions, such as the impacts of care that are most important to patients, families, payers, and society.

Hospitals must submit specific quality performance data regarding Medicare patients or risk: a. an increase in federal tax. b. decreased payments. c. fewer physician referrals. d. sanctions by The Joint Commission (TJC).

ANS: B In 2011, CMS developed the Hospital Value-Based Purchasing Program, which applied to payments beginning in fiscal year 2013 for discharges occurring on or after October 1, 2012. Under the program, CMS makes value-based incentive payments to 3500 acute care hospitals based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a baseline period. Reimbursement is based on quality of care, not quantity. The higher a hospital's performance or improvement during the performance period for a fiscal year, the higher the hospital's value-based incentive payment for the fiscal year would be

Which of the following is an example of a nurse-sensitive indicator? a. Cardiac patient mortality b. Hospital-acquired pressure ulcers c. Pulmonary embolus after knee surgery d. Iatrogenic pneumothorax after central line placement

ANS: B Nurse-sensitive indicators refer to the structure, process, and outcomes of professional nursing care. These include falls and falls with injury, hospital-acquired pressure ulcers, health care-associated infections, nursing care hours per patient day, nursing care hours, nursing turnover, physical restraints, RN survey, and skill mix.

The outcomes concept that emphasizes the multidisciplinary process of providing health care is known as outcomes: a. maintenance. b. management. c. measurement. d. monitoring

ANS: B Outcomes management is defined as a multidisciplinary process designed to provide quality health care, decrease fragmentation, enhance outcomes, and constrain costs

Outcome indicators such as nurse burnout, turnover, and job satisfaction are examples of which type of indicator? a. Patient-focused b. Provider-focused c. Organizational-focused d. Nursing-focused

ANS: B Provider-focused outcomes include phenomena such as nurse burnout, turnover, and job satisfaction.

To provide the best care to every patient every day through integrated clinical practice, education, and research is an example of a(n): a. accountability agreement. b. mission statement. c. organizational standard. d. vision and value proposal.

ANS: B The mission statement of an organization is a concise statement that answers the question: What business are we in today?

The process of managing outcomes includes five steps. List the five steps below in the correct order. a. Variances are investigated. b. Data are collected about outcomes. c. Trends are identified from data analysis. d. Changes are implemented and reevaluated. e. Appropriate service delivery changes are determined.

ANS: B, C, A, E, D In managing outcomes, the information derived from measuring client outcomes is collected, trends are identified, variances are examined, and appropriate care needs are determined to improve care to an individual, group, or population.

Implementation of the Transitional Care Model (TCM) has been associated with which of the following favorable outcomes? (Select all that apply.) a. Decreased length of stay b. Reductions in total health care costs c. Reductions in preventable hospital readmissions d. Increased overall satisfaction with the care experience e. Long-term improvements in physical health, functional status, and quality of life

ANS: B, C, D The TCM is a delivery system innovation that is designed to increase the alignment of the care system with the preferences, needs, and values of high-risk individuals and their family caregivers and achieve higher-quality outcomes while reducing health care costs (Naylor, 2012). Implementation of the TCM has been associated with the following favorable outcomes: (1) reductions in preventable hospital readmissions; (2) short-term improvements in physical health, functional status, and quality of life; (3) increased overall satisfaction with the care experience; and (4) reductions in total health care costs.

1. Which of the following are never events? (Select all that apply.) a. A minor medication error b. A foreign object left in the body during surgery c. Surgery on the wrong body part d. A mismatched blood transfusion e. Hip fracture acquired in the hospital f. Pressure ulcer acquired in the home g. Catheter-associated urinary tract infection h. Surgical site infection

ANS: B, C, D, E, G, H A never event is an event that should never happen. The insurer will never pay. Insurers will no longer pay for never events. A pressure ulcer will be covered if it was not acquired in the hospital facility. A minor medication error that causes no harm to the patient will not cause an insurer to withhold payment.

Tenets embraced by health care professionals and promoted by health care leaders and organizations such as TJC and the IOM include which of the following? (Select all that apply.) a. People and systems are the problems, not processes. b. Quality measurement and monitoring is everyone's job. c. Quality cannot be enhanced by non-punitive work cultures. d. Standardization of processes is key to managing work and people. e. The impetus for quality monitoring is not primarily for accreditation or regulatory compliance.

ANS: B, D, E Tenets embraced by health care professionals and promoted by health care leaders and organizations such as TJC and the IOM include the following: processes and systems are the problems, not people; standardization of processes is key to managing work and people; quality can be enhanced only in safe, non-punitive work cultures; quality measurement and monitoring is everyone's job; the impetus for quality monitoring is not primarily for accreditation or regulatory compliance, but rather as a planned part of an organization's culture to continuously enhance and improve its services; based on continuous feedback from employees and customers, consumers and stakeholders must be included in all phases of quality improvement planning; consensus among all stakeholders must be gained to have an impact on quality and safety; and health policy should include a focus on continuous enhancement of quality and safety

Donabedian's aspects of quality include: (Select all that apply.) a. goals. b. process. c. policies. d. structure. e. outcomes

ANS: B, D, E Indicators are used to measure all three of Donabedian's (1985) aspects of quality: structure, process, and outcomes. Donabedian's framework is useful to understand the relationship between outcomes and the structure and processes that have produced them

4. A nurse executive is a member of a collaborative committee assigned to revise the violence prevention program. After reviewing the program, the committee has determined that the following components already were included in the existing program: a written plan available to all employees, a system for tracking work-related assaults, and specific strategies for reducing the severity of violent injuries. A primary revision recommended by the committee should be the inclusion of a: a. detailed description of last year's injuries. b. list of preferred work injury health care providers. c. method for evaluating the effectiveness of the program. d. way to determine whether an employee is at fault.

ANS: C According to the Occupational Safety and Health Administration (OSHA), the main components in a violence prevention program are a written plan, a worksite analysis, hazard prevention and control, safety and health training, and record keeping and evaluation of the program.

10. Jeff, the manager of security at Methodist Hospital, has required that all of his security guards attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is: a. hazard prevention. b. environmental designs. c. behavior modification. d. administrative control.

ANS: C Behavior modifications provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness (OSHA, 2015b).

6. Employee assistance programs: a. allow employers to place staff into anger management programs designed to help control potentially violent behavior. b. encourage employees to provide assistance to co-workers experiencing workplace violence. c. provide services to help employees cope with stressors that occur at home or work. d. train employees to deescalate violent situations.

ANS: C Employee assistance programs provide a range of services to help employees cope with stressors that occur at home and at work.

7. An important role of the human resources department in limiting workplace violence is: a. allowing the local police force to control violence within the facility. b. delegating the control of workplace violence to individual unit managers. c. developing comprehensive violence prevention policies and procedures. d. empowering each nurse to assess each situation and react accordingly.

ANS: C Human resource management policies addressing hiring, discipline, counseling, training, threat assessment, threat management, and reporting are essential for the prevention and/or mitigation of violence from current or former workers in health care organizations.

14. County Hospital has purchased a computerized reporting system for reporting incidents, including acts of violence. Violence reports are aggregated, trended, and used to mitigate future incidences of workplace violence. This type of management framework is _____ management. a. risk b. threat c. total quality d. human resources

ANS: C In a systems approach, organizational culture is also considered an aspect of environment. A worksite analysis conducted by a TAT or similar task force is among the recommendations by OSHA and is consistent with a total quality management approach. Such an effort analyzes records, trends, workplace security, physical characteristics, operating policies, and screening surveys of staff to provide an overview of the work environment.

3. The chief operations officer of a local hospital has issued a memorandum indicating that the modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence? a. Administrative controls b. Behavior modification c. Environmental design d. Fixture adaptation

ANS: C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.

Which comment by the nurse manager would indicate that the hospital places a high value on patient safety? a. We have safety posters throughout the hospital that encourage people to report problems. b. We have monthly safety in-services. c. We encourage patients and families to participate in their care. d. All employees are required to update their knowledge of safety practices each year.

ANS: C Nurse leaders will continue to play an important role in designing care delivery systems that promote patient and family engagement (Pelletier & Stichler, 2014a). Various toolkits have been developed to assist staff nurses and managers who desire to engage patients and their families in hospitals (AHRQ, 2013c; Pelletier & Stichler, 2014b) and ambulatory and primary care

Mary Lou is studying the 48-hour readmission rate of cardiac patients whose care was provided by nurses with associate degrees versus nurses with bachelor's degrees. The type of research Mary Lou is performing is called _____ research. a. quality b. patient outcomes c. nursing outcomes d. outcomes management

ANS: C Nursing outcomes research is a subspecialty within the larger field of health outcomes research that focuses on determining the effect of different contexts and conditions, related specifically to nurses and nursing care, on the health status of patients. Nursing outcomes researchers are interested in the structures or management strategies for nursing care delivery, as well as the mix of health care workers best equipped to care for them.

16. The agency that oversees the safety and health of health care workers is: a. The Joint Commission (TJC). b. the Department of Public Health (DPH). c. OSHA. d. CMS.

ANS: C OSHA is the agency that provides health and safety programs for health care workers, through the U.S. Department of Labor.

To determine whether her patient has responded favorably to a nursing intervention, a staff nurse should observe the client for: a. improved health. b. increased complaints. c. outcome indicators. d. signs and symptoms

ANS: C Indicators are valid and reliable measures related to performance. They are specific markers used that make quality and quality differences visible to stakeholders in health care.

The industry-based model for quality management and measurement whose premise is that operational waste needs to be eliminated is: a. Six Sigma. b. ISO 9000. c. Lean Enterprise. d. Baldrige National Quality Award Program.

ANS: C Lean Enterprise is a model of quality measurement that was originally associated with Deming but reintroduced to the United States by Womack in the mid-1990s (Jones & Womack, 2003). The premise of this model is that operational waste in an organization needs to be eliminated.

The degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge is known as the: a. care delivery quotient. b. excellence index. c. quality of health care. d. standard of care.

ANS: C Quality of health care is defined as the degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge

The risk manager wants to illustrate the causes that have been leading to an increase in patient misidentification. The most appropriate tool to use is a: a. pareto chart. b. control chart. c. fishbone diagram. d. detailed flowchart.

ANS: C The fishbone diagram resembles diagramming sentences. The effect is illustrated in a box at the end of a midline (or head of the fish). The causes are generally four or five categories of elements that might contribute to the effect (e.g., machines, methods, people, materials, and measurements) and the specific activities. Under each of these category headings, individual items that might lead to the effect are listed. By diagramming all of the possible contributors, the predominant or root causes may be found more readily.

Nurse managers can create an environment that is devoted to health care safety by doing which of the following? (Select all that apply.) a. Adopting and embracing the concept of disciplining staff who commit errors b. Learning the concepts and tools related to quality improvement and quality assurance c. Becoming a role model for staff and peers in practicing health care safety concepts d. Encouraging staff to be constantly vigilant in identifying potential risks in the care environment e. Creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks

ANS: C, D, E Nurse managers can personally create an environment that is devoted to health care safety by doing the following: learning the concepts and tools related to risk identification, analysis, and error reduction; adopting and embracing the concept of non-punitive error reporting; advocating for the establishment of a non-punitive culture if it is not currently a strong ideal within the organization; encouraging staff to be constantly vigilant in identifying potential risks in the care environment; creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks; and becoming a role model for staff and peers in practicing health care safety concepts.

Attributes of a total quality organization according to BNQA include: (Select all that apply.) a. accreditation by TJC. b. a commitment to obtaining Magnet designation. c. strategic planning. d. focus on patients, other customers, and markets. e. organizational performance results.

ANS: C, D, E The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. Named after the Secretary of Commerce, the BNQA "was established by Congress in 1987 to enhance the competitiveness and performance of U.S. businesses" (National Institute of Standards and Technology, 2007, p. 1). The standards in seven areas of excellence are: (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). Organizations committed to quality improvement choose to adopt the BNQA approach as another means of defining and improving their organizational processes to achieve quality outcomes.

5. Staff nurses may be able to avoid bullying behavior through: a. increasing time spent with patients at the bedside. b. ignoring the assaults. c. filing a grievance. d. cognitive rehearsal training.

ANS: D On an individual level, cognitive rehearsal training can help nurses avoid bullying behavior. It can also teach nurses how to intervene in situations where they see others bullying (Stagg et al., 2013).

12. Employee assistance programs can be especially useful when mitigating which source of violence? a. Patients b. Current or former workers c. Criminals with no connection to the employer d. Someone who has a personal relationship with an employee

ANS: D The implications for management of the threat of workplace violence vary depending somewhat on the source of violence. In dealing with someone who has a personal relationship with an employee, employee assistance programs can be especially useful.

18. What is the primary component of a violence prevention program? a. Regulatory guidelines b. Employee commitment c. Financial commitment d. Management commitment

ANS: D Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.

Which of the following responses from the nurse manager is consistent with a culture that promotes patient safety? a. We make sure that we don't have any errors on this unit. b. We identify who made the error and take corrective action. c. We provide remedial training for all staff on the unit when there is an error. d. We report any medical error or near-miss to help us find the root cause of the problem.

ANS: D Health care organizations that embrace a fair and just culture identify and correct the systems or processes of care that contributed to the medical error or near-miss. Managers believe that more health care professionals will report more errors and near-misses when they are protected by a non-punitive culture of medical error reporting, and this will further improve patient safety through opportunities for improvement and lessons learned (CAPSAC, 2016). The American Nurses Association has endorsed just culture as a means of ensuring safe care

The results people care about most when seeking treatment is known as a(n): a. achieved benefit. b. benchmark. c. expected response. d. outcome.

ANS: D Simply put, an outcome is the result or results obtained from the efforts to accomplish a goal. A patient-focused definition of outcomes considers them "the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives" that are "inherently condition-specific and multidimensional" (International Consortium for Health Outcomes Measurement

Responding to a code called in the psychiatric unit where she works, a staff nurse finds that a patient has committed suicide. The staff nurse correctly identifies this as a: a. benchmark incident. b. quality improvement issue. c. performance breach. d. sentinel event

ANS: D Specific sentinel event outcomes are considered "reviewable" by TJC. Reviewable sentinel events are events that have resulted in an unanticipated death, permanent harm, or severe temporary harm and include suicide of any patient receiving care, treatment, and services in a staffed around-the-clock care setting.

The purpose of a root cause analysis (RCA) is to: a. discipline the staff involved in the patient safety event. b. disclose the medical error to the patient/patient s family. c. identify the person(s) responsible for committing the error. d. identify the systems issues that led to a sentinel event.

ANS: D The purpose of the RCA is to drill down to the most common cause(s) for the event and determine what process improvements can be made to prevent the sentinel event from occurring in the future.

A Healthcare Failure Modes and Effects Analysis (HFMEA) for a new bar-coding system is being conducted by an interdisciplinary team. List the steps of the HFMEA in the correct order. a. Identifying prevention strategies b. Endorsing action plans for implementation c. Assessing risk points within the process steps d. Flowcharting the steps of the process being studied e. Designing out the most critical of the potential failures f. Recommending process improvements for prevention of the failures g. Ranking key risk points in terms of their impact on the potential failure of the system h. Reporting action plans for implementing prevention strategies to the enterprise leaders

ANS: D, C, G, E, F, A, H, B The HFMEA is conducted by an interdisciplinary team of professionals who own the process being studied and is facilitated by someone with knowledge and skills in quality improvement tools. The HFMEA begins with flowcharting the steps of the process being studied. The team assesses risk points within the process steps, and these key risk points are ranked in terms of their impact on the potential failure of the system. Scores for severity and probability are calculated to give a hazard score to the identified breakdown, and detectability of the failure mode is factored into the analysis of its impact on the overall process. The team then designs out the most critical of the potential failures and recommends process improvements for prevention of the failures. Once these prevention strategies are identified, action plans for implementing them are reported to the enterprise leaders and endorsed for implementation

_____ is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

ANS: Evidence-based practice Evidence-based practice is defined by Sackett and colleagues (1996) as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

_____ involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators.

ANS: Risk adjustment Risk adjustment involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators. Comparisons of outcomes across settings or time periods are meaningful only when potentially important differences in the characteristics of patients involved are taken into account

The improvement process in which an organization measures its strategies, operations, or internal process performance against that of best-in-class organizations within or outside its industry determines how those organizations achieved their performance levels, and uses that information to improve its own performance is known as _____.

ANS: benchmarking Benchmarking "is the process of comparing a practice's performance with an external standard. Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others" (Agency for Healthcare Research and Quality [AHRQ], 2013a, p. 11).

A(n) _____ is the result or results obtained from the efforts to accomplish a goal.

ANS: outcome An outcome is the result or results obtained from the efforts to accomplish a goal. The term outcomes has also been defined as the conditions in patients and others that health care delivery aims to achieve.

A multidisciplinary team makes a decision to develop a plan for the use of thrombolytics in the emergency medical service system. Questions are asked such as, "Is the client a candidate for thrombolytic therapy? Does the client have a history of gastrointestinal bleeding? Has the client ever had a stroke? Does the client have any bleeding disorders?" Which of the following decision-making strategies would work best in this situation? A. Cost-benefit analysis B. Decision tree C. Problem critique D. Trial and error

B. Decision tree

Research utilization encompasses the: A. collection of study data B. critique of study results C. determination of statistical tests D. development of a study

B. critique of study results

A long-term care facility has been busy for several months with patients who have a very high acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making style? A. Autocratic B. Consultative C. Delegative D. Facilitative

C. Delegative

Evidence-based practice includes: A. collaborative practice dynamics between health care professionals. B. documentation of patient care as evidence of nursing practice. C. integration of research with clinical expertise and patient values. D. mutual goal setting and application in the clinical setting

C. Integration of reasearch with clinical expertise and patient values Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values in health care decision making (Sackett et al., 2000).

The responsibility to articulate the business case for evidence-based practice to governing boards lies with: A. the nurse B. the organization C. senior leadership D. the nurse manager

C. senior leadership

A team of nurses is gathered to examine the benefits and uses and to conduct a cost analysis of various intravenous pumps. After thoroughly reviewing the data and piloting several intravenous pumps, the team and the nurse leader vote to determine which pumps to use. This example depicts which of the following decision styles? A. Autocratic B. Consultative C. Delegative D. Facilitative

D. Facilitative

Intravenous lines being dressed using sterile technique with a 2-´2-inch gauze and occlusive sterile tape versus a transparent dressing are being evaluated for infection rates. These data are collected and compared with current research to suggest an opportunity for improvement. This is an example of: A. best practice evaluation. B. current practice critique. C. practice difference analysis. D. performance gap assessment.

D. performance gap assessment.

The nursing CEO has discussed implementation of EBP at hospital wide meetings. She is leading a team to incorporate EBP terminology into the vision and mission of the institution. She is also advising the multidisciplinary leadership team to incorporate evidence-based practice expectations into the performance appraisals of all staff members. The chief executive nursing officer is modeling: A. continuous quality improvement methodology and techniques B. marketing tactics that will help familiarize the staff with new terminology C. professional duties for new protocol acceptance throughout the institution D. strategies for incorporation of evidence-based practice into the infrastructure of the organization

D. strategies for incorporation of evidence-based practice into the infrastructure of the organization

A team has formed to determine which methods have worked best and which factors influence the implementation of an evidence based practice program. This is known as _______ research? A. authoritarian B. autocratic C. transformational D. transactional

D. transactional