Prioritizing Client Care: Leadership, Delegation, and Emergency Response Planning

Purpose of the primary assessment

Identify any client problem that poses an *immediate* or potential *threat to life* - ABCs

Function of management

Planning Organizing Directing Controlling

Team nursing

RN team leader *delegates* - Each staff member is accountable

Functional nursing

Task-oriented - Focus on delegated task rather than whole client - Risk for lack of accountability

Accountability

Process in which individuals have a duty to act and are answerable for their actions - Assume responsibilities only in scope - Responsibility to patient in accordance to standards of nursing practice and adherence to ethical codes

Case manager

Professional nurse who assumes responsibility for coordinating client care *at admission and after discharge* - Plan of care made with patient - Coordinate interdisciplinary care + referrals - Facilitates discharge - Knowledgeable in health insurance

Affordable Care Act

Reduce uncompensated care the average U.S. family pays by requiring everyone to have health insurance or pay a tax penalty - Protect against arbitrary actions by insurance companies

Five rights of delegation

Right task Right circumstance Right person Right direction/communication Right supervision

Modular nursing

Similar to team nursing, but takes into account the structure of the unit - Unit is divided into modules -> nurses can care for a group of clients who are geographically close by

Middle manager

Supervise staff, budget, schedule, write + implementing policies that guide client care + unit, maintain quality of care (ex. unit manager and supervisor)

LPN can

- Administer oral/IM meds - Reinforce teaching by RN - Routine data collection, dressing changed, urinary catheter insertion, naso-oral suctioning

American Red Cross (ARC)

- Given authority by fed gov to provide disaster relief - Free, located across U.S. - Participates in Community disaster plans - Identifies and trains personnel - Works with businesses and labor organizations to identify resources and individuals for disaster work - Public education on disaster prevention - Operates shelters to meet emergency needs, crisis counseling - Inquiries from family - Coordinate relief with other agencies

RN cannot delegate

- Handling invasive line or sterile equipment - Nursing process (ADPIE) - Patient education - Pre-op and post-op assessment - Triage, care for unstable clients

With the ARC, the nurse

- Helps with first aid - Participate in emergency response plans + disaster relief programs - Blood drives, immunizations

Level I disaster

Massive disaster - Significant damage - Presidential declaration - Major federal involvement - Full engagement of national resources

Level III disaster

Minor disaster - Could result in presidential declaration of an emergency

Phases of disaster management

Mitigation Preparedness Response Recovery

Secondary assessment

- Life-threatening problems - Health hx - Physical assessment, vitals

Level II disaster

Moderate disaster - Likely to result in presidential declaration of an emergency - Moderate federal involvement

Triage yellow

Non-life threatening - Can't walk - Spontaneous breathing - RR <30 - Radial pulse present, cap refill <2 sec - Obeys commans - Treated within 30 min - 2 hrs

Multicasualty event

Number of casualties can be managed by a hospital

Mass casualty event

Number of casualties exceeds capabilities of hospital

Client problems, ________, interventions, and expected ________________ are documented in the care plan

goals, outcomes

Triage green

Able to walk, minor injuries - Can wait at least 2 hours

Servant leadership theory

Based on desire to serve others - Works on developing skills of individual team members

Case management

Healthcare delivery system strategy that supports managed care - Interprofessional - Comprehensive client care throughout illness - *High-quality + cost-effective care* - Assessment, development of plan of care, coordination of services, referral, follow-up - Critical pathways are used, variation analysis is conducted

The charge nurse is planning the assignment for the day. Which factors should the nurse remain mindful of when planning the assignment? Select all that apply. 1. The acuity level of the clients 2. Specific requests from the staff 3. The clustering of the rooms on the unit 4. The number of anticipated client discharges 5. Client needs and workers' needs and abilities

1, 5

Process for Medication Reconciliation

1. Obtain current med list from client 2. Develop accurate list of new rx 3. Compare new meds and current list 4. Investigate any discrepancies + talk to HCP as needed 5. Communicate final list with client and team members

Lewin's Change Model

1. Unfreezing: problem + rationale for change identified 2. Changing: planned + implemented 3. Refreezing: change is stabilized

Medicaid

Joint federal and state program - Eligible low income adults, children, pregnant women, elderly, + disabled - Fraud + abuse is a concern

The nurse manager is discussing the facility protocol in the event of a tornado with the staff. Which instructions should the nurse manager include in the discussion? Select all that apply. 1. Open doors to client rooms 2. Move beds away from windows 3. Close window shades and curtains 4. Place blankets over clients who are confined to bed 5. Relocate ambulatory clients from the hallways back into their rooms

2, 3, 4

The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an assistive personnel (AP)? 1. A client requiring colostomy care 2. A client receiving continuous tube feedings 3. A client who requires urine specimen collection 4. A client with difficulty swallowing food and fluids

3

A nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on the evening shift. The nurse should assign priority to which client? 1. A client complaining of muscle aches, headache, and history of seizures 2. A client who twisted her ankle when rollerblading and is requesting medication for pain 3. A client with a minor laceration on the index finger sustained while cutting an eggplant 4. A client with chest pain who states that he just ate pizza that was made with a very spicy sauce

4

A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse determines that which scenario is characteristic of the team based model of nursing practice? 1. Each staff member is assigned a specific task for a group of clients 2. A staff member is assigned to determine the client's needs at home and begin discharge planning 3. A single registered nurse (RN) is responsible for providing care to a group of 6 clients with the aid of an assistive personnel (AP) 4. An RN leads 2 licensed practical nurses (LPNs) and 3 APs in providing care to a group of 12 clients

4

Bureaucratic leadership

Leader believes that individuals are motivated by external forces - Relies on organizational policies and procedures for decision making

Triage red

Life-threatening, need immediate attention - Chest pain, amputation, acute neuro deficits, resp or cardiac arrest - Can't walk - Can't breathe with airway positioned - RR >30 - Radial pulse absent, cap refill >2 sec - Doesn't obey commands

Medicare

Federal health insurance program, >65 yo, certain younger people w/ disabilities, ESRD, dialysis renal transplant Part A: covers hospital stays, SNF stays, hospice care, and some home health care Part B: not covered by A Part C: Supplements by Private insurance agency Part D: covers prescription meds

Nurse practitioner

Advanced RN that can dx and tx acute and chronic conditions

Marketplace insurance companies

Aetna Blue Cross Blue Shield Cigna Humana Kaiser United TriCare/Humana

Authoritarian leadership

Focuses and maintains strong control, makes decisions, addresses all problems - Dominates and commands rather than seeking suggestions or input

Front-line manager

Functions in supervision of roles involved with client care (ex. charge nurse, team leader, client care coordinator)

Laissez-faire leadership

Manager assumes a passive, nondirective, and inactive approach - Decisions made by the group

Quantum leadership theory

Based on chaos theory, maintaining a balance between tension and order prevents an unstable environment and promotes creativity

Charismatic leadership theory

Based on personal beliefs and characteristics of influence

What pulse location is used during emergency situations?

Central: carotid or femoral

Critical pathway

Clinical management care plan for providing client-centered care, planning, and monitoring the client's progress within an established time frame - Based on evidence-based practice - Goal: *anticipate and recognize negative variance* - Ensure care is within budget + care for complex clients

Situational leadership

Combination of styles based on circumstances

Relationship-based practice (primary nursing)

Concerned with keeping nurse at bedside, actively involved in client care, planning goal-directed individualized care while in hospital + on discharge - Associate nurse wil primary is off duty

Variation analysis

Continuous process that the case manager and other caregivers conduct by *comparing the specific client outcomes with expected*

Centralization

Decision making by few individuals at the top

Democratic leadership

Decisions based on input from every member - aka participative management

Decentralization

Delegation of decision making closer to client

Mitigation

Disaster prevention and damage reduction (determine community hazards, awareness of available resources)

Triage black

Dying or dead - Apnic - No hope for survival

Change agents

Facilitate change

Client-focused care

Total care or case method - RN assumes total responsibility for planning and delivering care to a client

Discharge planning begins when the client is ___________________

admitted

Shared leadership theory

based on belief that several individuals share the responsibility for achieving the health care agency's goals

Transformational leadership theory

based on individual's commitment to the health care agency's vision, focuses on promoting change - motivating staff members through shared mission

Transactional leadership theory

based on social exchange theory

In addition to the HCP and primary nurse, the ___________ and ____________ are involved in developing the plan of care

client, family