Exam 1
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.
Factors that may Influence Decision Making:
-Priorities -Gender -Values -Life Experiences -Individual Preferences -Brain Hemisphere Dominance
4 Types of Verbal Communication
-passive -passive-aggressive -unfeminine -assertive
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)
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
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."
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."
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 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
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
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.
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."
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
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
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
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
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
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
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
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
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
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
Which is a characteristic of a successful decision maker? A. Impulsiveness B. Courage C. Decisiveness D. Whimsy
B. courage
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%
. 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
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
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
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)
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
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
forces that pull the system away from change
Restraining (barriers)
STEEEP:
S-safety T-timely E-effective E-efficient E-equitable P-patient-centered
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
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
Any act to purposefully withhold information from the pool of meaning.
silence
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
rogers personality types
-innovators -early adopters -early majority -later majority -laggards
three good reasons for change
-to solve some problem -to make work procedures more efficient -to reduce unnecessary workload
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.
You move from winning the argument to making the person suffer Belittling Threatening
attacking
Steering completely away from the sensitive subject.
avoidance
Need for formalized authority, consistent rules and regulations
bureaucracy
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
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
Includes external factors such as the weather, temperature, timing, status, power, authority, and the organizational climate itself
external climate
formal, impersonal, and unaffected by emotions, values, expectations, and perceptions.
information
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
Types of Audits Frequently Used in Quality Measurement
-structure -process -outcome
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
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
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
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
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
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
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
Characteristics of a Critical Thinker
Insight Intuition Empathy Willingness to take action
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.
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
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
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
identifying opportunities and taking action
challenging the process
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
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
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
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
Management Functions:
planning-> organizing-> staffing-> directing-> controlling
future oriented; common values; more participative
proactive
•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
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
maintains control; molds team
responsive
What is the first step in managerial decision-making model?
set objectives
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
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
