Leadership Unit 1

Reactive, Responsive, Proactive, and High performance teams

4 developmental levels

Beef, Eggs, and Fried Foods

A Chinese American client is menstruating, a condition considered to be yin (cold). The nurse anticipates that which type of food would be eaten by the client who is striving to promote balance?

Continue to monitor the clients status

A Native American client who has a low grade fever tells the nurse on the reservation that he will only use a sweat lodge to treat his illness. which approach by the nurse would be most therapeutic?

A three day postoperative client who will be discharged tomorrow morning

A RN who is the charge nurse for the shift is making assignments for the day. Which client should be assigned to the LPN?

Listen to report, check on the status of all clients, review morning lab results, including glucose monitoring, check the medication administration record

A RN working on the medical unit arrives at work 15 minutes late. The nurse is assigned five clients, and an admission is on the way. Place in order of priority how the nurse should complete the following activities at the beginning of the work shift.

"Do you have your competency checklist that we can review?

A UAP who usually works in pediatrics is reassigned to work on an adult medical surgical unit. Which question should the charge nurse ask prior to making delegation decisions?

I don't know much about the procedure, but will find out and bring you the information about it.

A client asks about a new diagnostic test with which the nurse is unfamiliar. What is the best response by the nurse?

Use pictures and nonverbal cues to communicate

A client can only understand only minimal English, and no interpreter is available. What alternative measures can the nurse use to enhance communication?

I hear frustration or perhaps anger in your voice. Can you tell me more about how you are feeling right now?

A client has been on the nursing unit for a few weeks because of surgical complications requiring extensive wound care. During the last dressing change before discharge to home with home health services, the client becomes angry with the nurse and says, "You don't have to be so carful. I'm being sent home anyway!" Which response by the nurse would be therapeutic?

Placement of a second IV site

A client in experiencing respiratory distress. Respirations are 32 bpm and shallow. The client is positioned in an orthopneic position, with a heart rate of 118 bpm and a blood pressure of 90/40. The client is pale and confused. which task should the nurse delegate to the charge nurse?

Explain unit noises and physical surroundings

A client who is legally blind has been admitted to the cardiac unit. Which action by the nurse would be best to promote adjustment to the environment?

Notify physician of the client's health practices, and monitor the condition for an impending crisis

A home health nurse is assigned to an Asian American client who refuses to take the blood pressure medication prescribes by the physician. The client is using acupuncture treatments and does not believe in taking pills. How can the nurse best help this client?

Observe the client's religious beliefs and allow family and minister unlimited access to the client

A hospice nurse in a small Appalachian community is caring for a client at home who is an active member of the community church. As death nears, the minister and several members of the congregation come together in the home for a "death watch". which action by the nurse is most therapeutic?

Before touching the client, explain the procedure and ask for permission to continue

A male nurse needs to check the vital signs and oxygen saturation level of a female client from a different culture. As the nurse approaches, the client moves to the other side of the bed and draws up the blanket. What is the best nursing action at this time?

Obtain specifics of the disfigurement to better control first reactions by the nurse

A nurse floating to the nursing unit learns during intershift report that a client suffered disfiguring injuries in an accident a week ago. What is the best way for the nurse to prepare for the first encounter with this client?

Task, Supervision, and Skill

A nurse has delegated a venipuncture to an UA who has been off of orientation for five days. The UA reports " This client has a large raised red area where the needle was inserted" The nurses subsequent assessment reveals a hematoma in the venipuncture area. What elements of delegation have been breached?

Two clients have different culturally influenced ways of coping with pain

A nurse is caring for two clients who have had abdominal surgery. One client is of Hispanic heritage, who writhes in pain and moans when touched. The other is an Asian client, who appears calm and rarely verbalizes pain or discomfort. the nurse appropriately draws which conclusion from these observations?

CNA: Measure vitals signs and LPN: Give oral medications on assigned clients

A nurse is delegating care of clients tot eh CNA and LPN. Which tasks should the nurse give the CNA and LPN?

Praise the client for aspects of the procedure done accurately and correct the clients mistakes

A nurse is evaluating a client's ability to change the surgical dressing before discharge. During the demonstration, the nurse notices the client has not performed the procedure correctly. What is the most appropriate action of the nurse at this time?

Begin a unit of packed red blood cells for a client with a hematocrit of 23.2%, Irrigate a NG tube on a client who had a colectomy the previous day, Flush a poorly draining urinary catheter on an older client, Change a dressing on a client with an infected diabetic foot ulcer, Check vital signs on a 30 year old client with a BP of 114/68 and a heart rate of 94

A nurse is preparing for a busy day on a medical nursing unit. Prioritize the tasks and place the options in order

Repositioning a client with severe weakness caused by multiple sclerosis

A nurse is preparing for the shift, and makes a list of delegated tasks for the UAP. Which task should the nurse delegate to the UAP?

Ask the client to blink once or twice in response to questions

A nurse is trying to establish whether a client who appears unconscious can communicate. What would be the best approach for the nurse to use?

Dressing change for a client with wounds

A nurse plan to delegate some responsibilities of clients care to an LPN. which task should the nurse delegate to the LPN?

Perform routine tracheostomy dressing care

A patient has had a tracheostomy for two weeks. What task could the RN safely delegate to an UAP?

Nursing staff uses electronic medical record daily in routine documentation

A quarterly audit is now due to evaluate implementation of an electronic medical record system on the nursing unit. As the unit representative who supervised the adaptation of this documentation system, how can the nurse best determine if nursing staff have accepted this change?

Monitoring changes in patients condition, Implementing treatment to human responses and assisting in prevention of complications

Accountability

Evaluating team progress and saying good byes

Adjourning Stage

If A is good and you are doing B. B must be bad

Affirming the consequences

Rechecking vital signs on a 30 year old client with a BP of 100/60. Measuring and recording hourly urine output for a client who underwent nephrectomy

After receiving the intershift report, the RN has many tasks to complete during the next 12 hours. Which tasks would the nurse delegate to an UAP?

A client with a three day old total knee replacement, a client who is postoperative for colectomy, and a client who is postoperative for hysterectomy.

An obstetric nurse is floated to a medical unit to care for a group of acutely ill clients. The charge nurse should assign which group of clients to the float nurse?

If A is present in B, then A and B are alike in all aspects

Arguing from analogy

Reinforcement of isolation precautions with visitors

As the RN responsible for a patient in isolation, which tasks can be delegated to a LPN?

Power, coercion, punishment, used as motivators ." I" is used a lot

Autocratic (Authoritarian)

Operant conditioning, reinforcement is key to behavior

B.F. Skinner

UAP's

Cannot preform Sterile or Invasive procedures

People are just drawn to the person

Charismatic Power

Gained from ability to punish others for unfavorable actions

Coercive Power

Use the leadership style most appropriate to the situation at hand

Contingency Theory

Transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome

Delegation defined by ANA

Transferring to a competent individual the authority to perform a selected nursing task in a selected situation

Delegation defined by NCSBN

Participation, majority rules, uses rewards, constructive criticism

Democratic

Restating terms or phrases in different ways if the client does not understand

During a nursing assessment of an older adult female client, the nurse would enhance communication by taking which action?

Cath urine specimen to be obtained, Nitropaste 1/2" to ACW, EKG, Finger stick blood sugar, Daily weight

Duties of LPN

Telemetry, Initiate a heplock, Oxygen at 2 lpm, Continue home meds, Type and cross match 2 units PRBC's, Initiate seizure precautions, Initiate fall precautions

Duties of RN

Strict I/O, Vitals Signs, Vital signs per protocol

Duties of UAP

First meeting, getting to know each other.

Forming Stage

Motivator and Hygiene theory

Frederick Herzberg's

Leaders are born, leadership skills are inherited

Great Man Theories

When management pays special attention to workers, productivity increases, regardless of environmental working conditions

Hawthorne Effect

The pattern approach

Heuristics

Planning, Organizing, Leading, Controlling

Hogan Text

Focuses on worker satisfaction in regards to production. Premise is that happier people are more productive

Human Relations Theory

Salary, supervision, Interpersonal relations, job security

Hygiene Factors

Gained by having information to provide to the group

Information Power

Leadership behavior is determined by the relationship between the leaders personality and the situation

Interactional

Reinforcement teaching only, Non complex, stable patient with a predictable outcome, skills

LPN Role

They have met competency for procedure

LPN and LVN can ONLY start IV's or push IV meds if

Sterile procedure, dressing, colostomy care, Resp. suctioning Reinforce teaching some medications, NG feedings

LPN and LVN nursing skills

Permissive, little or no control. Believes that followers should just be left alone

Laissez-faire

Gained from degree, licensure, certification, or role in organization

Legitimate Power

Responsible and accountable for accomplishing the goals and objectives of the organization. Always a formal position.

Manager

Planning, Organizing, Staffing, Directing, Controlling

Marquis Text

Avoid work, dislike work , lazy

McGregor's Theory X

Like and enjoy work, self directed

McGregor's Theory Y

Achievement, recognition, responsibility, advancement

Motivator Factors

Occurs when resistance is overcome, team members can resolve conflicts and respect each others view points

Norming Stage

Assess, Diagnose, Plan, Implement, Evaluate

Nursing Process

Incompetence or Lazy

Over Delegation

(Stereotyping) If A has a certain characteristic ten all A's must have the same characteristic

Overgeneralization

Cohesion, collaboration and solidarity are evident.

Performing Stage

How well followers actually do what they are told to do

Power - Authority Gap

Nursing process, Assessment, Primary/Initial teaching, Complex care, Unstable patient

RN Role

Responsible for assessment, diagnosis, care planning, evaluation and teaching. Responsible fro interpreting

RN responsibilities

Gained because of trust or respect for people or organizations one is associated with

Referent Power

Gained from ability to reward others for favorable actions

Reward Power

Use science to determine the one best way to organize and perform tasks

Scientific Management

Power over ones own life

Self Power (ego)

Use the leadership style most appropriate to the followers maturity. Examples are new grads, some experience, and highly experienced

Situational

Members relax and interpersonal issues and differences of opinion cause conflict

Storming Stage

Whole is greater than the sum of its parts

Synergy

Irrigating a urinary catheter on a client admitted from a skilled nursing facility. Changing a dressing on a client with a diabetic foot ulcer in the metatarsal area

The RN is assigned to five clients for the shift. Which tasks are best delegated to the LPN?LVN?

A client who was transferred from the critical care unit 3 days ago and is ambulatory

The RN must delegate care of an assigned client to an UAP for the shift. Which client would be best to delegate to the UAP?

A patient with peripheral vascular disease (PVD) with an ulceration of the lower leg

The care of which of these patients should the nurse delegate to an UAP?

Complete an incident report and report findings to the pharmacy and nursing administration

The charge nurse on the night shift reports that a narcotic count is incorrect. The nurse has spoken to the responsible staff nurse and believes that substance abuse by the nurse is the cause. If substance cause proves to be the cause of the incorrect count, what is the most appropriate next step?

Wound care and oral medications for all clients

The delivery of care system on a medical floor is team nursing. On wing A, there is an RN, LPN?LVN, and an UAP to care for eight clients. Which tasks would be best delegated to the LPN?

Client's ability to perform the skill

The home heath nurse asked the client to demonstrate self injection technique. In doing so, the nurse is primarily attempting to determine which of the following?

UAP

The measurement and documentation of vital signs is expected for patients in a long term care facility. Which staff type would be the most appropriate to delegate these tasks?

Monitor the patient's response to ambulatory activity

The nurse assigns UAP to care for a patient who ambulates with a leg splint. What task requires supervision of the UAP during this patient's care?

Malpractice

The nurse caring for a patient in the neonatal intensive care unit administers adult-strength Digitalis to the three-pound infant. As a result of her actions, the baby suffers permanent heart and brain damage. The nurse can be charged with:

Move the chair a foot or two away from the bed and observe the clients response

The nurse enters a clients room to obtain an admission history, moves the chair to the top of the bed by the client's head, and sits down to better hear the client. The client draws back and moves to the opposite side of the bed. What is the best response by the nurse?

Listen to comments from the client

The nurse has explained a therapeutic diet to a client. To ensure that learning has occurred, the nurse should take which follow up action?

Herbal medicines are believed to be as important as Western medicines in treating illness. Depending on the specific illness, hot or cold foods would be used in treatment. The client may want a caregiver of the same gender to enhance privacy

The nurse has taken a position in an ambulatory clinic in a Hispanic neighborhood. The nurse would use knowledge of which practices to provide culturally sensitive care to this population?

Stop feeding the client in room 1 and medicate the client in room 3 for pain

The nurse is assisting a client in room 1 with lunch. The charge nurse calls the nurse and states the client in room 3 is reporting pain and requests pain medication. What is the nurse's best and first action?

Take it home

The nurse is caring for a Native American woman who has given birth. The nurse anticipates that the couple will make which request regarding the umbilical cord?

Have the dietary department replace the entire meal tray

The nurse is checking the dietary trays that have been delivered to the nursing unit. A client of Orthodox Jewish faith has received a tray containing a chicken dinner with vegetables, tea, and a carton of 2 % milk. What action by the nurse is best?

Speak slowly and provide brief and simple explanations

The nurse is preparing to explain an upcoming procedure to a 72 year old, English speaking Latino client. The nurse determines that which approach is best to verbally communicate with this client?

Fraud

The nurse is suspected of charting medication administration that he did not give. The nurse can be charged with:

You look tense. Can you tell me if something is making you afraid or nervous?

The nurse observes a client who is fidgeting, wringing the hands, and has body tenseness and wrinkled brow. What is the best response to the client by the nurse?

Administer a client and family satisfaction survey

The nurse on the hospital quality improvement team has been asked to evaluate nursing care on the nurse's assigned unit. After deciding to ask the nurse staff for assistance in this effort, what would be most appropriate for the nurse to initially ask the staff to do?

Fidelity

The nurse tells the patient that she will be back in 30 minutes to administer pain medicine, but does not return. After an hour the patient calls the desk in severe pain. Which ethical principle has the nurse violated?

Value extended family, Have patriarchal outlook, Respect authority

The nurse working with a client who immigrated from Mexico would consider during care that which cultural characteristics are typically associated with Mexican American culture?

State, " Let's talk while I change your colostomy bag"

The nurse, who has a heavy work assignment for the shift due to high client census, sees that a client is crying. What would be the best way for the nurse to convey a willingness to be with the client for support?

The patient with a radium implant for cervical cancer

The registered professional nurse is making assignments for the day. Which patient should not be assigned to the pregnant nurse?

The experienced RN will be assigned the postoperative client who underwent hip replacement

The staff nurse who is in charge of the medical surgical unit for the shift is receiving four admissions. The ED is sending a client with hypertension and an exacerbation of heart failure, and a client who has pneumonia and a history of diabetes mellitus. The PACU is transferring a client who had a total hysterectomy and a client who underwent hip replacement. If the staff consists of two RN's and two LPN's, what assignment would be appropriate?

Employees are lazy, need constant supervision and are indifferent to company goals

Theory X

Employees enjoy work, are self motivated and willing to work hard to meet personal and organizational goals

Theory Y

Built on the principle of social exchange where leader and follower except certain things from each other

Transactional

Leaders and followers can raise each other up to higher levels of performance. Inspires others to be committed to the vision

Transformational Leader

Assist with ADLs, communication, basic hygiene needs, maintain safe environment, recognizes situations to report

UAP Role

Bathing, feeding, toileting and ambulating patients

UAP skills

Teach, Evaluate, Assess

UAPs do not

Inability to ask others, Do it myself attitude, Fear of liability/uncertainty

Under Delegation

Venipuncture, EKG, and oxygen administration

Upon calling a health care provider regarding a client with heartburn, diaphoresis, and irregular pulse, the nurse receives stat orders for the following ; EKG, cardiac panel, morphine 2 mg IV push, nitro 0.4 mg sublingual, and ASA 325 mg p.o. chew and swallow. Which task should the nurse delegate?

Offer empathy

What would be the best approach for a nurse to use to encourage a client with psychological distress to develop an awareness of feelings and express them effectively?

Find out what the client knows or has heard about the disorder

When beginning to present information about heart disease to a client newly diagnosed with heart disease, what is most important for the nurse to do first?

Assist the patient with ambulation after supervising a gown change

When caring for a patient with an IV for pain control, a nurse should ask the unlicensed UAP to do what action?

MATERIALISM, youth, AND competition

When teaching an in service on culturally competent care, the nurse explains that which cultural values tend to be associated with Anglo American culture?

In a nursing home setting

Where can LPN or LVN delegate?

Inserting sutures and clips in surgery

Which assignment should not be performed by the registered nurse?

When a good relationship exists and client's anxiety level is low

Which of the following would be appropriate time for the nurse to use confrontation as a therapeutic technique in communication with an assigned client?

"You said your back pain has not gone away since surgery. How difficult has it been to adapt to having pain during everyday activities"

Which statement by the nurse best encourages a client to express feelings and allows the nurse to genuinely respond to those feelings?

Provide stoma care for a patient with a well functioning ostomy

Which task can be safely delegated to a LPN by the charge nurse?

Asking the UAP to assess and evaluate the client response to IV medication

Which task would not be appropriate for the RN to delegate to a LPN or UAP?

Client contracting

Which teaching strategy should the nurse choose as being most likely to be effective when providing health instruction to an adolescent client?

Ask about the significance and suggest that it be placed more safely on the body

While conducting an initial assessment of an infant, a home health nurse notices that the infant is wearing a soiled piece of braided yarn around the neck. Which action by the nurse is most appropriate?

Extended family, Religion, interdependence

While realizing that all clients are unique, the nurse would tend to associate which cultural values with clients of African American descent?

Transference

While talking with the nurse, a client says, "You are just like my mother; you don't trust me or like me. You and she wish I were dead." The nurse interprets this statement as indicating which process?