Leadership Ch. 5 & 7

8. An example of an external variable that may affect communication is: a. circumstance. b. personality. c. thoughts. d. feelings.

ANS: A Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own control. We have little control over others or the situation, because those are external to us

6. A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about: a. interpersonal communication. b. clarity. c. image. d. intention.

ANS: A If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse's non-verbal behavior may suggest that she is not interested in interacting with the family

10. Nurse managers are in a position of impacting the stress levels of employees through improving work environments and creating a culture of enhanced staff satisfaction. Having structures and processes in place to prevent work-related stress from happening in the first place requires: a. genuine intention and corresponding action. b. additional evidence about the human and financial costs of work-related stress. c. more stability in the health care industry. d. decreased demands from payers, consumers, and regulators.

ANS: A It has always been challenging to secure the necessary resources for prevention, even for patient care. However, failure to do so puts employees at risk, which in turn can jeopardize the lives of patients. It is no longer possible to wait for more evidence about the human and financial costs of work-related stress. Waiting for more stability in the industry, which may never come, wastes precious time. Once that is embraced and there is genuine intention, then design and creation can begin in earnest

12. Nurses on the midnight shift are experiencing difficulty with receiving materials from the central supply department. Last night a patient was admitted to the unit from the emergency department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be placed in the unit as a standby in case the patient required its use. The central supply unit did not comply until the patient required its emergent use. The nurse was stressed. This is an example of which type of stress? a. Job stress b. Overload of role c. Moral distress d. Role conflict

ANS: A Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity

3. A communication model that focuses on compassion, expression of emotion, and providing validation via support is the: a. validation, emotion, reassurance, activity (VERA) framework. b. situation, background, assessment, and recommendation (SBAR) Communication Theory. c. nonviolent communication (NVC) model. d. Human Relationship Model.

ANS: A The VERA (validation, emotion, reassurance, activity) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties (Hawkes et al., 2015)

12. Organizational tones are based mostly on: a. unspoken cultural norms. b. commitment to success. c. communication behavior. d. leadership styles.

ANS: A The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole.

13. When a nurse leader is able to fully embrace the American Association of Critical-Care Nurses' (AACN's) Healthy Work Environment and engage others in its achievement, what is the leader demonstrating? a. Authentic leadership b. Meaningful recognition c. True collaboration d. Skilled communication

ANS: A The nurse leader is demonstrating authentic leadership when he or she is able to embrace and model the AACN's Healthy Work Environment.

4. Nurses who must manage unplanned and regular responsibilities simultaneously may experience: a. complexity compression. b. resilience. c. moral distress. d. empowerment.

ANS: A When unexpected conditions are added to regular responsibilities, nurses may experience what experts call complexity compression, which has been linked to burnout, turnover, and other types of work-related stress (Krichbaum et al., 2007). Nurses experience this when they must manage unplanned (complexity) and regular responsibilities simultaneously (compression)

7. Conflict and stress in the workplace can be managed through building relationships. Organizations can foster the building of relationships through: (Select all that apply.) a. social media. b. informal social gatherings. c. mentoring. d. confidential meetings.

ANS: A, B, C Building relationships can be fostered in organizations by formal and informal social gatherings, mentoring, social media, and deliberate culture creation (Moreland & Apker, 2016). Perceived supportive work environments are characterized by perceptions that supervisors are supportive, there is fairness, and there is open communication. Stress is reduced when nurses feel that win-win solutions occur in the work environment

10. Max is a nurse on the 7 PM to 7 AM shift on the orthopedic floor. He is the most experienced nurse on the unit during this shift, with 6 years of nursing experience. Max usually acts as charge nurse during his shift while caring for a group of patients. Recently there has been an influx of new graduates working on his shift. Some nights, he is expected to orient a new nurse, act as the charge nurse, and mentor other new nurses working on the floor. He is concerned that with all the new nurses, there are not enough mentors for all of them, resulting in less-than-optimal care delivery. Which factors have been shown to decrease stress for nurse leaders? (Select all that apply.) a. Support from others b. Autonomy c. Predictability d. Transparency

ANS: A, B, C High stress is experienced by nurse leaders and stems from the challenges of a multifaceted job with myriad sources of stress. Having support from others (e.g., supervisors, comanagers, and coworkers) is a factor that decreases stress (Kath et al., 2012; Shirey et al., 2010). The amount of autonomy and predictability in the job mitigates the negative effects of stress as well (Kath et al., 2012)

6. Managers have a key role in mitigating stress in the workplace. Which strategies will assist the manager in creating a more healthy work environment? (Select all that apply.) a. Recognize nurses for the value they bring to the organization. b. Partner with the nursing staff to make policies and lead organizational operations. c. Keep information confidential regarding safety concerns or initiatives. d. Ensure staffing is an effective match between patient needs and nurse competencies. e. Ensure that the manager maintains responsibility for all aspects of unit functioning.

ANS: A, B, D A healthy work environment (HWE) is one that is safe, empowering, and satisfying. Nurse managers can foster an HWE by recognizing nurses for the value they bring to the organization, partnering with the nursing staff to make policies and lead organizational operations, and ensuring that staffing is an effective match between patient needs and nurse competencies.

9. A staff RN is writing an article for a prestigious nursing journal. The deadline is in 1 week, and she is feeling overwhelmed about completing her work. She is unable to keep up with home management, and she is beginning to procrastinate on the project. She also has other responsibilities, such as taking her elderly mother grocery shopping and to health care appointments. She is married to a busy executive and has three children, all of whom are active in high school sports. Which of the following stress management strategies would be helpful? (Select all that apply.) a. Schedule "think time" appointments at least once a week for a block of time; get out of the office for these times. b. Bring a water bottle to work and refill as needed to keep hydrated. c. Cut extra activities out of her schedule, such as her morning walk. d. Create a "getaway" place at work where she can spend a few minutes in silence and thought.

ANS: A, B, D Scheduling "think time" appointments and spending a few minutes in silence can help her clear her mind and regroup. Keeping hydrated will help keep energy levels up. Exercise is important to help the nurse deal with stress and would not be wise to delete from her schedule, if possible

1. Definitions of stress are: (Select all that apply.) a. a negative emotional experience that is associated with biological changes that trigger the body to make adaptations. b. the accomplishment of specified activities during an available time period. c. a physical, mental, psychological, or spiritual response to an experience. d. a response that is evaluated by the individual as a threat to one's sense of well-being.

ANS: A, C, D Stress is a negative emotional experience associated with biological changes that trigger the body to make adaptations. It can be a physical, mental, psychological, or spiritual response to an experience that is evaluated by the individual as a threat to one's sense of well-being

6. Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes e. Safety culture

ANS: A, C, D Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process

1. Effective communication is fostered through which of the following ingredients? (Select all that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy

ANS: A, C, D Trust, respect, and empathy are the three ingredients needed to create and foster effective communication

2. Which of the following responses may occur related to stress? (Select all that apply.) a. Increased heart rate b. Decreased blood glucose levels c. Emotional exhaustion d. Burnout e. Chronic health conditions

ANS: A, C, D, E Stress has a variety of induced changes, including increases in heart rate and blood glucose levels, emotional changes, and burnout, and it can lead to acute and chronic health problems

4. What are some methods that nursing staff can use to manage personal stress levels? (Select all that apply.) a. Take personal time each day. b. Take on extra shifts to keep the mind occupied c. Get enough sleep. d. Pay attention to diet and exercise. e. Have a strong support network of friends and family.

ANS: A, C, D, E While stress management is unique to each person, some of the tools that may be effective include taking personal downtime each day, getting enough sleep, eating right, exercising, and having a strong network of friends and family for support.

9. E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.) a. When you are mad. b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing

ANS: A, D, E Electronic communication has assisted us to be better informed regarding our patients. However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. Warrell (2012) noted that there are four times you should never use e-mail: (1) when you are mad, (2) when rebuking or criticizing, (3) if there is any chance your words could be misunderstood, or (4) when you are canceling or apologizing. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed

16. A nurse manager has several complaints from her staff that she is inaccessible during the day. What is the best strategy the nurse manager takes to improve her staff satisfaction? a. Notify staff when she will be out of the office. b. Block time for daily rounds with staff. c. Set realistic follow-up deadlines for staff issues, questions, and concerns. d. Ask the staff to communicate with her through their supervisors.

ANS: B Blocking time to round with staff is the best way the nurse manager can be on the unit and visible to her staff. Notifying staff when she is out of the office, setting realistic deadlines for following up with issues, and delegating certain activities to the supervisors are good time management strategies, however they don't address the staff's issue of not seeing her

15. In setting boundaries it is important to do which of the following? a. Set rigid boundaries. b. Set boundaries based on individual needs. c. Consider where one is in the lifespan when setting boundaries. d. Set boundaries even if it produces more stress than not having boundaries at all.

ANS: B Boundaries need not be exceedingly rigid and may change over time. Boundaries should be set based on individual needs, not gender, stereotypes, or even where someone is on the lifespan. The most important thing is that setting them should not induce more stress on the individual than not having them at all.

1. The process in which information, perception, and understanding are transmitted from person to person is: a. articulation. b. communication. c. evaluation. d. pronunciation.

ANS: B Communication is the process in which information, perception, and understanding are transmitted from person to person

9. _____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing

ANS: B Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff.

7. The transformational leader engages staff by: a. punishing errors. b. sharing vision and decision making. c. taking a top-down approach to leadership. d. making unilateral decisions for the team.

ANS: B Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism.

11. There is evidence of a link between _____ employees with higher productivity and more satisfied customers. a. stressed b. empowered c. financially focused d. creative

ANS: B Employees who are empowered in their jobs are also more engaged and satisfied. Research indicates that structural empowerment leads to higher productivity and satisfaction for the employee, which translates to more satisfied customers

7. An internal obstacle that may contribute to moral distress is: a. lack of resources. b. lack of confidence. c. lack of structure. d. lack of processes.

ANS: B Moral distress occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers (Rushton, 2006). Internal obstacles include personal characteristics such as fear or lack of confidence. External obstacles include a lack of resources, structures, or processes that prevent taking the desired and right action

5. Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity.

ANS: B Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes.

15. The number one cause of preventable medical errors is: a. hostile work environments. b. poor communication. c. ineffective leadership. d. staff competency.

ANS: B The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program (AHRQ, 2016)

16. Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing)

ANS: B To address the "communication arm" of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.

4. Which of the following are examples of patient privacy or security breaches? (Select all that apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient's diagnosis e. Discharge summary given to patient's spouse

ANS: B, C Fax transmissions sent to the incorrect physician's office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.

3. A client's wife is concerned about her husband's declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed "no breathing machine" for long-standing care, but she is unsure of his wishes if he were to need a "breathing machine" for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client's physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client's concerns with the rest of the team. What type of communication technique is being utilized by the nurse? (Select all that apply.) a. Bargaining b. Negotiation c. Persuasion d. Spiritual assessment e. Collective action

ANS: B, C Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co-operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse

2. NVC communication processes are grounded in: (Select all that apply.) a. confrontation b. empathy c. compassion d. honesty e. assertiveness

ANS: B, C, D NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding

5. Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all that apply.) a. Culture b. Beliefs c. Values d. Social e. Religious

ANS: B, C, D, E Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients' health care decisions and preferences

5. What are some potential reasons that nurses experience higher levels of stress? (Select all that apply.) a. Nurses are skilled at setting boundaries. b. Nurses often put others' needs ahead of their own. c. Staff nurses are under pressure to do more with less. d. There are support staff cuts. e. There are fluctuations in staffing levels.

ANS: B, C, D, E Staff nurses are under constant pressure to do more with less, and this can cause professional and personal stress for staff as well as managers. Support staff have been cut, jobs are fewer, and staffing levels fluctuate. Nurses may have a difficult time dealing with stress, because they often put others' needs ahead of their own and need to be able to create healthy boundaries.

8. Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness? (Select all that apply.) a. Members are organized and secure about their roles in the forming stage. b. At the forming stage, the group needs direction in defining goals. c. During the storming period, there is more willingness to accept the group goals. d. The group becomes self-managing during the norming period. e. During the performing period, the members willingly perform the task.

ANS: B, C, E At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing

3. Which of the following statements are true regarding job stress? (Select all that apply.) a. Job stress is related more to external demands that are brought into the workplace. b. Job stress can lead to burnout. c. Job stress is manifested as emotional and/or physical exhaustion. d. Job stress increases productivity. e. Levels of job stress that are too low or too high decrease individual productivity.

ANS: B, C, E Job stress is a tension that arises related to the environmental demands of a person's role or job. Job stress can accumulate to levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion. Levels of job stress that are too low or too high decrease individual productivity.

7. Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges. e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety.

ANS: B, D, E Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious. Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy (Sears, 2010)

6. A staff nurse has a concern about a co-worker who may be diverting medications. The staff nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake of patient safety. This nurse is experiencing: a. stress. b. procrastination. c. moral distress. d. burnout.

ANS: C Moral distress occurs when clinicians know what is the ethical action to take, yet are prevented by either external or internal obstacles. Moral distress will contribute to stress and eventual burnout if the staff nurse does not take action

13. Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues

ANS: C Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue.

2. Unspoken affective or expressive behaviors best describe which type of communication? a. Effective communication b. Ineffective communication c. Non-verbal communication d. Verbal communication

ANS: C Non-verbal communication is unspoken. It is composed of affective or expressive behaviors.

4. A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: a. advisement. b. consultation. c. persuasion. d. suggestion.

ANS: C Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading

8. Job stress can accumulate into: (Select all that apply.) a. better time management skills. b. feelings of elation. c. burnout. d. physical exhaustion.

ANS: C, D Chronic stress can lead to acute and chronic health problems. Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity. Levels of job stress that are too low or too high decrease individual productivity.

14. A new nursing manager is falling behind on the staffing schedule, the monthly budget, and employee evaluations. She says to her director, "I'm working 60 hours per week and I still don't have enough time to do it all. The nursing director suggests which of the following to her? a. Setting priorities b. Obtaining additional preceptoring. c. Scheduling blocks of time for each activity to be accomplished. d. Giving up management and returning as a regular staff nurse.

ANS: C Time management involves a deliberative process of identifying, focusing, and completing activities needed to accomplish specific tasks and achieve goals. Blocking time to get tasks done is a strategy that can be used to for time management at work.

1. _____ is defined as the accomplishment of specified activities during the time available. a. Stress b. Mismanagement of resources c. Time management d. Self-management

ANS: C Time management is defined as the accomplishment of specified activities during the time available. It is the process of managing the things an individual does with his or her available time. At its core, time management is self-management

8. A new nurse manager is provided with a smartphone in order to efficiently manage her time. What is the most effective method of managing stress related to e-mail? a. Create an auditory cue that alerts the manager to incoming messages so they can be processed immediately. b. Set aside time during meetings to read and respond to messages. c. Schedule blocks of time to tackle e-mail. d. Delete e-mails that require a lengthier response.

ANS: C Time management will not be effective if the manager is expected to respond to messages as soon as they arrive. Managers can set a rule to check e-mails two to three times per day rather than constantly and should use a sorting a flagging methodology to effectively manage the need for follow-up. Managers should not utilize meetings in order to read and respond to messages

5. Creating a safe, empowering, and satisfying work environment can be accomplished through implementation of: a. Institute of Medicine Coalitions. b. health care reform. c. the Troubled Asset Relief Program. d. Healthy Work Environment (HWE) standards.

ANS: D A Healthy Work Environment (HWE) is one that is safe, empowering, and satisfying. The American Association of Critical-Care Nurses.(AACN) has established six standards that support Healthy Work Environments (AACN, 2005). Although developed for nurses, they are applicable for all types of employees

14. A communication system developed originally to address communication patterns in critical situations is: a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS.

ANS: D Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events

10. Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n): a. breach of beneficence. b. example of maleficence. c. potential assault and battery charge. d. violation of the Health Insurance Portability and Accountability Act (HIPAA).

ANS: D HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality

11. Interpersonal communication is defined as: a. the conscious intent by one individual to modify the thoughts or behaviors of others. b. a combination of written and spoken communication. c. a theory used to describe a manner of communicating. d. communication between two or more individuals involving face-to-face interaction.

ANS: D Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.

3. Jay, a nurse in the intensive care unit, has been caring for a patient with end-stage renal disease, congestive heart failure, and a stroke. The client has had four cardiac arrests in 4 days. Despite the grave prognosis, the client's family continues to want resuscitation at all cost. Jay knows that further medical care is futile. Jay is at risk for: a. confrontational conflict. b. resilience. c. burnout. d. moral distress.

ANS: D Moral distress is linked to issues related to patient care, including ethical dilemmas that can put professionals in difficulty and give rise to feelings of unease. It occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers (Rushton, 2006)

2. Nurses who are successful at time management: a. display an ability to set measurable goals and objectives. b. frequently volunteer for new and creative projects. c. hesitate to delegate because of perfectionist characteristics. d. tend to accomplish specific activities within a time frame.

ANS: D Time management is accomplishing specific activities during the time available. It is a process of managing the things an individual does with his or her available time.

9. The first critical step in creating an environment to prevent and address work-related stress is: a. delegation. b. motivation. c. innovation. d. intention.

ANS: D To prevent and address work-related stress, creation and innovation are needed. A creation is something new that did not previously exist in that form and occurs in a multitude of fields, not just the arts (Creation, n.d.). Experts who study creativity may differ on the requisite attributes of creative individuals and exact steps in the creative process. However, most agree that intention is the critical first step (Ditkoff, 2010). Without intention, no action is ever taken