Leadership Level 2

A patient says to the nurse, "I know that I am being discharged home today, but I don't know how I will get to my doctor's appointments and get my medications." What is the nurse's best response? "A case manager will be assigned to you to help coordinate care." "I am going to notify the social worker to assist you with resources." "We are going to have to have a health care conference to help you sort this out." "Your physician has been notified, and we will set up a meeting with you and your family."

"A case manager will be assigned to you to help coordinate care." Rationale The nurse's best response to the patient is, "A case manager will be assigned to you to help coordinate care." The case manager is one of the most important members of the health care team who assists with care coordination. Care coordination is the deliberate organization of and communication about patient care activities between two or more members of the health care team (including the patient) to facilitate appropriate and continuous health care to meet the patient's needs. A social worker may not be assigned to the patient in the capacity of a case manager. Setting up a health care conference with the patient is not effective for providing ongoing communication between health care team members after the patient is discharged. A physician/family conference is important, but many patients need individualized coordinated care that may be beyond the family's ability to provide. Furthermore, the physician will need the assistance of a care coordinator to facilitate the communication between health care team members after the patient has been discharged. p. 3

A registered nurse is teaching a nursing student about the National Patient Safety Goals (NPSGs) published by the Joint Commission in 2002 with reference to health care law. Which of a nursing student's statements indicates a need for further training? "They seek to address issues such as safe drug administration." "They focus on the relationship of family members and nurses." "They cover topics such as health care-associated infections." "They continue to add goals each year to meet quality standards." Rationale

"They focus on the relationship of family members and nurses." Rationale The NPSGs are not designed to address the relationships between family members and nurses. They were first established in 2003 to focus on safety practices that involve nursing and health system approaches. They address high-risk issues such as safe drug administration, health care-associated infection, and communication efficiency among health care team members. The Joint Commission continues to add NPSGs yearly to meet quality standards. p. 4

What knowledge must a nurse gain to develop core competency in patient-centered care? Select all that apply. Explore ethical and legal implications of patient-centered care. Respect patient preference for degree of active engagement in the care processes. Recognize personally held values and beliefs about the management of pain and suffering. Provide patient-centered care with sensitivity and respect for the diversity of human experiences. Examine how the safety, quality, and cost-effectiveness of care can be improved through the active involvement of the patients and families.

*Explore ethical and legal implications of patient-centered care. *Examine how the safety, quality, and cost-effectiveness of care can be improved through the active involvement of the patients and families. Rationale A nurse needs to explore ethical and legal implications of patient-centered care and examine how the safety, quality, and cost-effectiveness of care can be improved through the active involvement of the patients and families. This knowledge aids the nurse in developing the core competency of patient-centered care. A nurses should respect a patient's preference for degree of active engagement in the care processes and recognize personally held values and beliefs of the patient about the management of pain and suffering, but these are attitudes rather than knowledge. A nurse should also provide patient-centered care with sensitivity and respect for the diversity of human experiences, but this is considered a skill, not knowledge. p. 2

Which points regarding The Joint Commission (TJC) are true? Select all that apply. It is an international health care organization. It accredits only acute care health care facilities. It offers peer evaluation for certification every three years. It encourages patients and families to become safety partners. It published National Patient Safety Goals (NPSGs) in 2002.

*It offers peer evaluation for certification every three years. *It encourages patients and families to become safety partners. *It published National Patient Safety Goals (NPSGs) in 2002. Rationale TJC offers peer evaluation for certification every three years for all types of health care agencies in the United States. It encourages patients and families to become safety partners in protecting patients from harm. In 2002, it published its first annual NPSGs which focus on specific priority safety practices. TJC is a national health care organization in United States; it not only accredits acute care health care facilities but also home care agencies, nursing homes, and ambulatory care centers. p. 4

To improve communication between staff members and health care agencies, procedures for hand-off communication have been established. Which acronym represents a method of hand-off communication used in nursing practice? Select all that apply. SBAR MET I-SBAR CARE RRT

*SBAR *I-SBAR Rationale SBAR and I-SBAR are acronyms representing methods of communication used in nursing practice. SBAR includes communication about the situation, background, assessment, and recommendation. I-SBAR is a modification of SBAR. The "I" reminds the individual to identify himself or herself. MET is an acronym for the Medical Emergency Team, also referred to as the RRT or the Rapid Response Team, which saves patient lives and reduces risk of harm to patients by providing care before a respiratory or cardiac arrest occurs. CARE is not an acronym that refers to popular methods of communication used in nursing practice. p. 6

One of the most important members of the interdisciplinary team is the case manager (CM). Which statements about the CM are correct? Select all that apply. The CM is also a part of the Rapid Response Team (RRT). In acute care hospitals, the CM is always a registered nurse (RN). The CM coordinates inpatient and community-based care before discharge. The CM may coordinate with other CMs employed by third-party health care payers. The CM may be called in to manage a critical case before a cardiac arrest.

*The CM coordinates inpatient and community-based care before discharge. *The CM may coordinate with other CMs employed by third-party health care payers. Rationale The CM coordinates inpatient and community-based care before discharge and may coordinate with other CMs employed by third-party health care payers. The work of the CM is to provide quality and cost-effective services and resources to achieve positive patient outcomes through collaboration and coordination. In acute care hospitals, the CM is not always an RN; he or she may also be a social worker. The CM is not part of the RRT; members of an RRT are critical care experts, while a CM simply coordinates cases and collaborates with patients and caregivers. The CM may not be called in to manage a critical case before a cardiac arrest-the RRT is called in for that. p. 3

Research has shown that which factors generally cause patient harm and errors? Select all that apply. Over-monitoring of patients Unclear and inadequate communication Errors in interpretation of provider prescriptions Lack of mandatory reporting in the health care setting Patient advocates who are not health care professionals

*Unclear and inadequate communication *Errors in interpretation of provider prescriptions *Lack of mandatory reporting in the health care setting Rationale Unclear and inadequate communication, errors in interpretation of provider prescriptions, and lack of mandatory reporting in the health care setting are among the factors that generally cause patient harm and errors. Lack of patient monitoring, not over-monitoring, and lack of patient advocacy, not existing advocates, are other factors that cause patient harm and errors. pp. 3-4

What are the expectations of the nurse receiving hand-off communication from another health care professional? Select all that apply. Audio record the hand-off report. Use standardized forms and checklists. Create a list of tasks to delegate to the UAP. Avoid questioning the nurse giving the hand-off. Obtain history and key information about the patient. Exchange contact information for additional questions. Rationale

*Use standardized forms and checklists. *Obtain history and key information about the patient. *Exchange contact information for additional questions. Rationale Nurses giving, as well as receiving, hand-off reports are expected to use standardized forms and checklists according to the facility protocol. History and key information about the patient are an integral part of the hand-off. The nurse ensures a successful "hand-off" communication by exchanging contact information to resolve additional questions that may arise when caring for the patient. The nurse receiving hand-off should question the nurse giving hand-off to obtain clarity in nursing care for the concerned patient. The nurse receiving the hand-off should prepare tasks for the UAP after all information is shared, rather than during the process. It is not necessary to audio record a hand-off. pp. 5-6

A nursing team consists of a registered nurse (RN), a licensed practical nurse (LPN), and a patient care assistant. Which patient does the RN assign to the LPN? 75-year-old with diabetes who requires a dressing change for a stasis ulcer 55-year-old with terminal cancer being transferred to a hospice home care 15-year-old with acute leukemia reporting pain in the legs and hands 45-year-old with a fracture of the right leg who asks to use the urinal

75-year-old with diabetes who requires a dressing change for a stasis ulcer Rationale The LPN should be assigned a stable patient with a predictable outcome such as the patient with diabetes who requires a dressing change. The patient with terminal cancer being transferred to a hospice home care requires nursing judgment, so the case is best handled by an RN. The patient with acute leukemia who reports pain requires nursing assessment; an RN is the appropriate caregiver. Assisting a patient with a fracture to use the urinal is a standard, unchanging procedure which can be assigned to the patient care assistant. p.6

A health care organization requires the nursing staff to attend an inservice training session for the prevention of catheter-associated urinary tract infections (CAUTIs). Which objective is the health care organization addressing? Promoting a culture of safety Prevention of a sentinel event Prevention of an adverse event A National Patient Safety Goal (NPSG)

A National Patient Safety Goal (NPSG) Rationale The objective the health care organization is addressing is an NPSG. The NPSGs address high-risk situations including prevention of health care-associated infections, such as CAUTIs. A sentinel event is a severe variation in the standard of care that is caused by a human or system error and results in an avoidable patient death or major harm. A culture of safety provides a blame-free approach to improving care in high-risk, error-prone health care organizations using interprofessional collaboration. Variations in the standards of care are referred to as adverse events. p. 4

Evidence shows that the SBAR process improves communication among members of the health care team. What does the "A" in SBAR stand for? Analysis Application Assessment Administration

Assessment Rationale The "A" in SBAR stands for assessment. Analysis, application, and administration are not parts of the SBAR process. p. 5

The medical-surgical nurse is delegating tasks to the unlicensed assistive personnel (UAP). Which task is appropriate for the nurse to delegate? Wet to dry dressing changes Ambulation of the patient with a walker Administration of a rectal suppository followed by an enema Diet education to a patient with diabetes

Ambulation of the patient with a walker Rationale Before assigning tasks to a UAP, the nurse must ensure the task is within the UAP's scope of practice. The most appropriate task to delegate to the UAP is ambulation of a patient with a walker. Dressing changes, medication administration, and patient education require the skill and knowledge of a licensed nurse. p. 6

Evidence shows that the SBAR process improves communication among members of the health care team. What does the "B" in SBAR stand for? Basis Benefit Bedside Background

Background Rationale The "B" in SBAR stands for background. Basis, benefit, or bedside are not parts of the SBAR process. p. 5

Nurses plan, implement, and evaluate patient care together using an interdisciplinary plan of action. What term best describes this activity? Delegation Supervision Collaboration Self-management

Collaboration Rationale Collaboration refers to planning, implementing, and evaluating patient care together using an interdisciplinary plan of action. Self-management is patient autonomy where the patient is recognized as an autonomous individual capable of making informed decisions about his or her care. Delegation means authorizing a competent person to perform a selected nursing task or activity in a selected patient care situation. Supervision is guidance or direction, evaluation, and follow-up by the nurse to ensure that the task or activity is performed appropriately. pp. 5-6

Which important aspect of coordinating care within the interdisciplinary team is facilitated by use of the SBAR procedure? Policymaking Communication Implementation Protocol development

Communication Rationale SBAR is an acronym for "hand-off" methods of communication used by health care organizations to share information between shifts and between departments. SBAR is not a type of implementation (of patient care). Implementation, the fourth step of the nursing process, is an action rather than a coordination of care. SBAR is not a type of policymaking or protocol development. p. 5

A nurse is planning which tasks to delegate to the unlicensed assistive personnel (UAP). In explaining how to perform the task, which "right" of delegation is the nurse following? Task Supervision Circumstances Communication

Communication Rationale The right communication involves clearly and concisely explaining how to perform a task when delegating it to unlicensed assistive personnel (UAP). The right task is ensuring the UAP is competent to perform it and it is within the UAP's scope of practice. The right supervision involves monitoring and evaluating the UAP and intervening when necessary. The right circumstances involve ensuring the patient care setting and resources are appropriate. p. 6

A patient is brought to the hospital following a stroke. How does the case manager assist this patient? Delegate nursing care for the patient. Coordinate inpatient and community-based care. Provide discharge teaching to the patient and family. Arrange for quick admission to a unit from the emergency department.

Coordinate inpatient and community-based care. Rationale The case manager is a member of the interdisciplinary (ID) team and is expected to coordinate inpatient and community-based care for the patient before the latter gets discharged from a facility. Tasks such as delegating nursing duties for the patient, arranging for quick admission to the emergency department, or providing discharge teaching to the patient and family are not the responsibilities of the case manager. p. 3

A nurse manager tasks a special committee with revising a set of standardized patient forms. This is an example of which process? Delegation Supervision Collaboration Quality improvement

Delegation Rationale Delegation is the process of transferring the authority to perform a selected nursing task to a competent person, in this case, the task of revising documentation forms. Supervision is guidance or evaluation, and follow-up by the nurse to ensure that the task or activity is performed appropriately; in this scenario, the nurse manager will supervise the committee by reviewing the revisions. Collaboration is planning, implementing, and evaluating patient care together using an interdisciplinary (ID) plan of care. Quality improvement is ensuring whether the patient and staff require further changes to enhance safety and efficacy; the revision of forms may be done for quality improvement purposes, but the action of assigning the task to other team members is delegation. p. 6

The nurse instructs unlicensed personnel to help the postoperative patient in turning and positioning. Which leadership action does this constitute? Delegation Supervision Collaboration Quality improvement

Delegation Rationale Delegation is the process of transferring the authority to perform a selected task or activity to a competent person, like assigning unlicensed assistive personnel the task of helping a patient turn. Supervision is guidance or direction, evaluation, and follow-up to ensure the task or activity assigned to the nursing assistive personnel is appropriately performed. Collaboration entails planning, implementing, and evaluating patient care together using an interdisciplinary plan of care. Quality improvement is achieved using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. p. 6

Patient-centered care is about sharing the management of an illness between the patient and the health care provider. What is an example of knowledge needed to develop the Institute of Medicine (IOM)/Quality and Safety Education for Nurses (QSEN) initiative's Patient-Centered Care competency? Recognize your own attitudes about working with different ethnic, cultural, and social backgrounds. Describe how diverse backgrounds function as sources of patient, family, and community values. Provide care with sensitivity and respect for the diversity of human experience. Respect and encourage expression of the patient's values, preferences, and expressed needs for care.

Describe how diverse backgrounds function as sources of patient, family, and community values. Rationale Describing how diverse backgrounds function as sources of patient, family, and community values is an example of the knowledge needed to develop the IOM/QSEN Patient-Centered Care competency. Knowledge is what the nurse knows; it is a sum total of the learning. Recognizing personally held attitudes about working with different ethnic, cultural, and social backgrounds is an attitude, as well as respecting and encouraging individual expression of the patient's values, preferences, and expressed needs. Attitude is how the nurse comes across to others while carrying out his or her tasks. Providing patient-centered care to the patient with sensitivity and respect for the diversity of human experience is a skill, which is how well the nurse performs his or her tasks. p.2

Which term describes the act of integrating current research and statistical information to make decisions about patient care? Informatics Supervision Collaboration Evidence-based practice

Evidence-based practice Rationale Evidence-based practice is the integration of the best current evidence to make decisions about patient care. Using technology and information to communicate, reduce the occurrence of errors, and support decision making is called informatics. Guidance, evaluation, and follow-up by the nurse to ensure that the assigned task is performed appropriately are called supervision. Collaboration includes planning, implementing, and evaluating patient care using an interdisciplinary (ID) plan of care. p. 6

Evidence-based practice is one of the core competencies of nurses. What best describes evidence-based practice? Nursing care based on traditional beliefs and practices. Care provided as per resources available at the health care facility. Practice embodied in nursing and biomedical literature and books. Problem-solving approach to clinical practice derived from facts.

Problem-solving approach to clinical practice derived from facts. Rationale Evidence-based practice is a problem-solving approach that integrates the best current evidence or facts to make decisions about the patient's care. It is not based on traditional beliefs and practices, but is based on current evidence and facts. It is not provided as per resources available at the health care facility, but based on verified evidence. It is not necessarily the practice embodied in literature and books, but based on the most current evidence. p.6

What competency did the QSEN Institute add to the Institute of Medicine's (IOM) competencies? Safety Informatics Patient-centered care Evidence-based practice

Safety Rationale Several years after the IOM established five core competencies for health care professionals, the QSEN Institute added safety as a sixth competency. Informatics, patient-centered care, and evidence-based practice were existing IOM competencies. P.2

Which is a formal method of communication between two or more members of a health care team? Code blue Electronic health record (EHR) Quality and Safety Education for Nurses (QSEN) Situation, Background, Assessment, Recommendation (SBAR)

Situation, Background, Assessment, Recommendation (SBAR) Rationale Situation, Background, Assessment, Recommendation (SBAR) is a formal method of communication between two or more members of a health care team. Code blue is used to indicate a patient who requires resuscitation. The electronic health record (EHR) is the digital version of a patient's health information. Quality and Safety Education for Nurses (QSEN) is an initiative that created specific knowledge, skills, and attitudes needed to develop core competencies. p. 5

When assigning a task to unlicensed assistive personnel, which process will the nurse undertake to ensure the task is performed appropriately? Delegation Supervision Collaboration Quality improvement

Supervision Rationale Supervision is guidance or direction, evaluation, and follow-up to ensure the task or activity assigned to the unlicensed assistive personnel is performed appropriately. Delegation is the process of making that assignment. Collaboration entails planning, implementing, and evaluating patient care together using an interdisciplinary plan of care. Quality improvement is achieved by using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. p. 6

The nurse observes a new graduate nurse caring for patients in an intensive care unit. The nurse should intervene when the new graduate takes which action? The new graduate arranges for a translator for Spanish-speaking patients. The new graduate acts as an advocate for patients with low self-determination. The new graduate refers a patient with spiritual distress to a spiritual advisor. The new graduate provides special care to patients who have extensive insurance coverage.

The new graduate provides special care to patients who have extensive insurance coverage. Rationale The nurse should follow the principle of social justice and provide equal care to all patients irrespective of their financial status. The nurse should arrange for a translator for non-English-speaking patients, as it helps the nurse communicate with the patients and provide effective care. The nurse should act as an advocate for patients with low self-determination to provide effective care. Patients with terminal illnesses may experience spiritual distress. To enhance coping, the nurse should refer the patients to spiritual leaders. p.9

A nurse in the intensive care unit (ICU) is concerned that a patient's hydration levels aren't being properly managed. According to the SBAR method of communication, which nursing intervention is fulfills the "R" step? The nurse records and reports the the patient's fluid and electrolyte levels and urinary output. The nurse describes the patient's current condition and the patient's fluid intake and output during the ICU stay. The nurse notes which fluid and electrolyte levels are cause for concern, explaining that these are outside of the patient's baseline. The nurse states what the fluid and electrolyte values should be and suggests that the physician order fluids to be given to the patient intravenously.

The nurse states what the fluid and electrolyte values should be and suggests that the physician order fluids to be given to the patient intravenously. Rationale Stating what the fluid and electrolyte values should be and suggesting that the physician order fluids to be given to the patient intravenously is part of the "recommendation" step of the SBAR method of communication. Recording and reporting the patient's fluid and electrolyte levels and urinary output is part of the "situation" step of the SBAR method of communication. Describing the patient's condition and fluid intake and output during the ICU stay is part of the "background" step of the SBAR method of communication. Noting which fluid and electrolyte levels are cause for concern and explaining that these are outside of the patient's baseline is part of the "assessment" step of the SBAR method of communication. p. 5