Murray Chapter 5

11. A nurse leader is explaining the process of appreciative inquiry to a group of nurses who hope to use this process in bringing change to their nursing unit. The leader shares that what are stages of appreciative inquiry? Select all that apply. 1. Discovery 2. Dreaming 3. Dramatics 4. Design 5. Destiny

1,2,4,5 Discovery is the first stage, and its goal is to identify what works best. Dreaming is the second stage or envisioning and encourages staff members to imagine a future based on the positives identified during discovery. Design is the third stage, and the focus is to design the ideal and identify the structure and processes necessary to make the dream a reality. Destiny is the last stage, and it is used to determine how to create the identified characteristics. Dramatics is not a stage found in any part of critical thinking, decision making, or appreciative inquiry.

10. The nurse manager has determined that patient care on the nursing unit would be more efficient if a different nursing model was used and plans to use what tool for decision making that gives the manager the opportunity to look at more than one feasible alternative? 1. Decision-making grid 2. DECIDE model 3. SWOT analysis 4. Shared decision making

1. A decision-making grid analysis is one of the simplest tools a nurse manager can use especially if the decision involves more than one feasible alternative. The DECIDE model helps the nurse manager avoid jumping to conclusions before all information is collected and analyzed. A SWOT analysis helps the nurse manager identify strengths and weaknesses of the staff and helps identifies areas of improvement and opportunities for facilitating positive change. The shared decision-making model is not an actual tool for decision making but an actual decision-making process.

9. The nurse leaders of a large acute care facility have decided to implement shared decision making on each nursing unit and expect to see what result? 1. Improved retention of nurses 2. More nurses applying for leadership positions 3. Decreased nurse-to-patient ratio 4. Elimination of medication errors

1. Shared decision making has shown to have a positive effect on nurse recruitment and retention. There is no evidence that shared decision making leads to an increased number of nurses applying for leadership positions. Shared decision making does not increase staffing, which would lead to a decreased nurse-to-patient ratio, but it helps to utilize nursing staff in a better fashion and leads to increased patient satisfaction. Shared decision making leads to a decrease in adverse effects, not an elimination of medication errors.

2. The nurse manager knows that what is the first step in the critical thinking process? 1. Reflection 2. Judgment 3. Evaluation 4. Criticism

1. There are four elements required for critical thinking and sound decisions, and it begins with reflection as the nurse leader thinks back or reflects on the area that needs correction or change. Judgment, evaluation, and criticism are all parts of the critical thinking process, but it begins with reflection.

13. The nurse manager believes that critical thinking when used to make decisions involving patient care is the ability to think in a systematic and logical manner and involves being open to questioning and reflecting on the reasoning process used to ensure safe nursing practice and is basing this definition on what group or individual? 1. Ignatavicius 2. Masters 3. Alfaro-LeFevre 4. AACN

2. Masters believes that critical thinking for clinical decision making is the ability to think in a systematic or logical manner. Ignatavicius states that critical thinking is a purposeful, outcome-directed thinking that is based on a body of scientific knowledge that is derived from research and other courses of evidence. Alfaro-LeFevre states that critical thinking is a deliberate, purposeful, and informed outcome-focused thinking that requires careful identification of key problems, issues, and risks involved. The American Association of Colleges of Nursing (AACN) states that critical thinking underlies decision making and involves the process of questioning, analyzing, synthesizing, interpreting, inferring, using inductive and deductive reasoning, and using intuition and creativity.

5. The nurse manager has decided to begin a shared decision-making model on the nursing unit and knows that individual staff nurses will receive what benefit from this decision? 1. Sense of entitlement 2. Sense of empowerment 3. Sense of inquiry 4. Sense of intellect

2. Shared decision making gives the nurses engaged in this process a sense of empowerment, because the nurses are given the opportunity to assist in making the decisions involving the provision of effective patient care and also in the operation of the unit. It does not provide a sense of entitlement, inquiry, or intellect.

1. The nurse manager has been evaluating the nursing unit's strengths and weaknesses in an effort to ensure that the unit continues to improve its safety practices and is using what cognitive skill of the critical thinking process in this exercise? 1. Interpretation 2. Self-regulation 3. Analysis 4. Evaluation

2. The cognitive skill of self-regulation is the process of examining one's practice for strengths and weaknesses and promoting continuous improvement. Interpretation is clarifying data and circumstances to determine meaning and significance. Analysis is determining a problem or issues based on assessment data, and evaluation is determining whether expected outcomes have or have not been met.

7. The nurse manager has determined that the nursing unit should see a reduction in medication errors by 50% and knows that this decision equates to what part of the nursing process? 1. Assessment 2. Diagnosis 3. Outcomes identification 4. Planning

3. The nurse leader has determined that the nursing unit's medication error rate should be reduced by 50%, which corresponds to the outcomes identification step of the nursing process. Assessment involves data collection, diagnosis is the identification of an issue or problem, and planning is the determination of the steps needed to achieve the intended outcome.

3. The nurse manager knows that which nurse on the medical-surgical unit will be the best at using intuitive thinking? 1. The nurse who graduated from nursing school 6 months ago and has worked on the unit for 3 months. 2. The nurse who just started working on the unit but has worked on a pediatric unit for 2 years. 3. The nurse who worked in the intensive care unit for 1 year and has worked on this unit for 4 months. 4. The nurse who worked in a long-term care facility for 6 years and has worked on this unit for 6 months.

3. Expert nurses use intuitive understanding of a patient's situation based on previous knowledge, experiences, and pattern recognition. The nurse who has a year of intensive care experience has more previous knowledge, experience, or pattern recognition of medical-surgical patients than does the nurse with 2 years of pediatric experience, 6 years of long-term care experience, and especially the new graduate nurse.

4. The nurse leader manages a nursing unit that has a preponderance of nurses who have graduated from nursing school within the last 12 months and knows that what type of thinking will provide the best guidance to the nursing staff? 1. Reactive 2. Intuitive 3. Reflective 4. Automatic

3. Nurse leaders and managers who use reflective thinking provide to staff guidance that creates a sense of trust and safety on the unit. Reactive thinking can also be known as automatic thinking and is a knee-jerk reaction to a situation and leads to poor nursing practice. Nurse leaders use intuitive thinking as they deal with day-to-day unit-level situations. Dealing with many new graduates on a unit requires reflective thinking.

12. The nurse manager is holding a unit meeting and asks each staff member to share one thing that the individual believes works best on the unit. What technique is the nurse manager using in this meeting? 1. Critical thinking 2. Shared decision making 3. Appreciative inquiry 4. Reflective thinking

3. The nurse manager is using appreciative inquiry, which is a collaborative process that engages staff in a healthy exchange of knowledge to solve problems, which avoids focusing on the negatives and shifts the perspective to what works best for the organization. It is not strictly a critical thinking or shared decision-making model, and reflective thinking is the use of one's own personal experiences and knowledge to help with self-improvement.

8. The staff nurses from an orthopedic surgery unit are dissatisfied with the admission process of a patient following surgery. The nurses state that there may be four to five admissions within a 1-hour period as they are discharged from the postanesthesia recovery unit. With many patients arriving at the same time, the staff does not feel able to give the patients the close assessment they deserve and complete the admission process. The director of nursing suggests that these nurses observe the system that the women's health unit uses for the multiple admissions that happen at the same time due to deliveries and female surgeries. What problem-solving technique is the director of nursing using? 1. Critical thinking 2. Shared decision making 3. DECIDE model 4. Appreciative inquiry

4. Appreciative inquiry is a problem-solving strategy that capitalizes on the positive characteristics of an outcome by valuing and building on them. It is a collaborative process that engages a healthy exchange of knowledge to solve problems and innovate change. Critical thinking is a directed thinking process that imposes intellectual standards on the elements of thought. Appreciative inquiry is a comparison and collaborative process that allows one unit to look to what another unit is doing and learn from that unit. Shared decision making is the inclusion of staff nurses in decision making related to patient care and work methods at the unit and organizational level. Appreciative inquiry is problem solving by investigating something within the organization that works the way you are seeking. The DECIDE model is a decision-making model that helps to ensure that all steps of decision making are addressed. It is not the same as appreciative inquiry.

6. The nurse manager is planning to use the DECIDE model to assist in improving nursing staff self-scheduling and is explaining the use of this tool by comparing it to the nursing process and knows that the ECI of the model corresponds to what parts of the nursing process? Select all that apply. 1. Assessment 2. Diagnosis 3. Identification of outcomes 4. Planning 5. Evaluation

all In the DECIDE model, E stands for establish the criteria, C is for consider the alternatives, I is for identify the best alternatives, and these correspond to diagnosis and identification of outcomes in the nursing process.