NS 415 Test 1 Objectives (Ch 1,2,3,4,17,18,23,25)
Norming
"Norming is the stage when emotions have begun to cool down, and practical rules of behavior become established. The group has weathered some conflicts and seeks now to develop norms conducive to group cohesion and working together effectively.:p. 35 In norming "team members need to learn how to 1) change the team leader's role, 2) clarify the way they make decisions, and 3) clarify documentation and communication." pg.
Ending
"This is the time for celebration, rituals, and closure. There may be some resistance to ending (a stage sometimes referred to as mourning). Loose ends and unfinished business must be cleared up. Optimistic discussion of future challenges take place." p.35
Storming
"This stage involves a period of tension and conflict: subgroups begin to form based on mutual interests or similarity in points of view. Subgroups "nitpick" challenge, and clash with one another. Th issues relate to who controls the group. If this stage is skipped and underlying differences have not been addressed, these conflicts could emerge later perhaps to sabotage the groups's effectiveness in performing." p.35
IOM Recommendations for Future Nursing
- 80/20 guessing 80% bachelors and 20% associates - Lifelong learning - Nurses leading change - Remove scope of practice barriers - Double number of nurses with doctorates by 2020
Kurt Lewin's 3 Leadership Styles
- Authoritarian - Democratic - Lazzirefare
Manger Traits
- Emphasizes organizing, coordinating, and controlling resources (space, supplies, equipment, people) - Attends to short-term objectives/goals - Maximizes results form existing resources - Interprets established policy, procedures, and mandates - Moves cautiously; dislikes uncertainty - Enforces policy mandates, contracts, etc. (acts as gatekeeper)
Reports by IOM
- In 2010, IOM recommended that by 2020 at least 80% of RNs should be educated at Baccalaureate level.
Characteristics of Innovation Adopters
- Innovators - Early adopters - Early majority - Late majority - Laggards
5 Competencies of Health Professionals
- Patient-centered care - Evidence-Based Practice - Quality Assurance - Interdisciplinary teams - Informatics
Follower Traits
- Perceives the needs of both the leader and other staff - Demonstrates cooperative and collaborative behaviors - Exerts the power to communicate through various channels - Remains fully accountable for actions while relinquishing some autonomy and conceding certain authority to the leader - Exhibits willingness to both lead and follow peers, as the situation warrants, allowing for competency-based leadership. - Assumes responsibility to understand what risks are acceptable for organization and what risks are unacceptable.
To Err is Human
- Safety and quality is currently emphasis on nursing - Public became aware of 48,000 to 96,000 deaths per year in hospitals due to errors.
Leadership Traits
- Values commitments, relationships with others, and espirt de corps in the organization - Provides a vision that can be communicated and has a long-term effect on the organization that moves it in new directions - Communicates the rationale for changing paths; charts new paths that lead to progress - Endorses and thrives on taking risks that bring about change - Demonstrates a positive feeling in the workplace and relates the importance of workers.
Patient Safety: Lecture
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Yoder-Wise Chapter 17: Leading Change
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Yoder-Wise Chapter 1: Leading, Managing, and Following
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Yoder-Wise Chapter 23: Conflict: The Cutting Edge of Change
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Yoder-Wise Chapter 3: Developing the Role of Leader
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Yoder-Wise Chapter 18: Building Teams Through Communication and Partnerships
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Yoder-Wise Chapter 2: Safe Care: The Core of Leading and Managing
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The Emerging Workforce: Generation Y's
= Born 1977-1995 = AKA Generation Net, Nexter, or Millenniums = Don't have confidence in leaders and institutions = They tend to change jobs more frequently = Their focus is on work-life balance and they seek feedback about their performance = No brand loyalty and blatant disregard for status symbol = Highly skilled in technology and seek to figure out how something works rather than read manual
Baby Boomer: 1946-1965
= Born after WWII = They tend to mistrust authority and are very comfortable with the process of getting to a goal = They find the journey of getting to the goal almost as important as reaching the goal. = They are tolerant of, even depend on, meeting and ongoing discussions that the younger generation finds tedious and wasteful = Expect their leaders to be professional and supportive and have high integrity
Mentorship
= Coach and confidante = 2 way street = Leads by example
Standards for Creating and Maintaining Healthy Working Environments
= Collaboration = Communication = Decision Making = Staffing = Recognition = Leadership = Accountability = Self-actualization
Barriers to Leadership
= False Assumptions = Time constraints
Five Rules of Leaders
= Maintain balance = Generate self-motivation = Build self-confidence = Listen to constituents = Maintain a positive attitude
Nursing Care Needs to Be
= Scientific, Evidence Based = Respectful treatment of others' values and beliefs = Cultural competent = Health Literacy = Safe clinical care, free of medical errors, and sentinel events.
Leadership Development
= Select a Mentor = Lead by Example = Accept Responsibility = Share the Rewards = Have a Clear Vision = Be Willing to Grow
Leadership Role's
= Works with others toward a specific goal/visions and achieves results = Vision- the goal in the future; the one thing that leader wants to accomplish = Inspires, encourages, leads, empowers others to accomplish the vision = Incrementally over time
Highest # of Nonfatal Occupational Illnesses & Injuries
A BLS report in 2012 indicated healthcare workers, especially nurses, experience high rates of violence compared to workers in most other industries.
Clinical Processes
A defined sequence of steps needed to ensure that basic functions are fulfilled in a standardized manner, ensuring safety and quality, such as medication procurement and administration.
Conflict
A disagreement in values or beliefs within oneself or between people that has the potential to cause harm if unresolved or stimulates change for a more favorable outcome if effectively addressed. Also Conflicts arise form discrepancies in four areas: facts, goals, approaches, and values. Catalyst for change; inherent in human relationships; potential to develop/deepen relationships
Role theory
A framework used to understand how individuals perform within organizations.
Advanced Practice Registered Nurses (APRN)
A group of nurses, prepared at the graduate level, with defined roles and scopes who function in expanded nursing roles. Those roles are: certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners.
National Quality Forum (NQF)
A membership-based organization that sets priorities and goals for performance improvement and endorses standards for measurement.
American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)
A multidisciplinary professional organization that focuses on those providers in roles related to quality assurance and utilization review.
Group
A number of individuals assembled together or having a unifying relationship.
Team
A number of people associated together in specific work or activities.
Case management
A person-oriented service that reflects multidisciplinary cooperation and coordination.
Synergy
A phenomenon in which teamwork produces extraordinary results that could not have been achieved by any one individual.
Quantum Theory
A physics theory stating that energy is not a smooth flowing continuum but, rather, bursts of energy that are related.
Bullying
A practice closely related to later or horizontal violence, but a real or perceived power differential between the instigator and recipient must be present in bullying
Effective Communication
A process that leads to positive outcomes for senders and receivers in terms of clarity, usefulness, and efficiency.
Mediation
A process using a trained third party to assist with conflict resolution.
Triple Aim
A shortcut for describing contemporary healthcare reform: to improve access, improve quality, and decrease or control health care costs.
Commitment
A state of being emotionally impelled; feeling passionate about and dedicated to a project or event.
TeamSTEPPS (an AHRQ strategy to promote patient safety)
A teamwork systems designed to increase patient safety.
Innovators
Active in seeking new information. Organization's visionaries.
Lateral violence
Aggressive and destructive behavior OR psychological harassment of nurses against each other.
Lateral Aggression
Aggressive and destructive behavior of co-workers against each other.
Dualism
An "either/or" way of conceptualizing reality in terms of two opposing sides or parts (right or wrong, yes or no), limiting the broad spectrum of possibilities that exists between.
Transformational leadership
An act of encouraging followers to follow the leader's style and change their interests into a group interest with concern for a broader goal. Leader Behaviors: + Charismatic + Inspirational and motivational + Intellectual stimulation + Individualized consideration
Institute for Healthcare Improvement (IHI)
An independent organization devoted to improving patient safety and health care globally.
Toxic Workplace
An organization in which people feel devalued or dehumanized and in which disruptive behavior often flourishes.
The Joint Commission
An organization that accredits healthcare organizations and is deemed by the Center for Medicare & Medicaid Services (CMS) as holding healthcare facilities to CMS standards.
Institute of Medicine (IOM)
An organization that works outside of the federal government to provide independent, scientific advice.
Avoiding
An unassertive, uncooperative approach to conflict in which the avoider neither pursues his or her own needs, goals, and concerns nor helps others to do so. Unassertive Uncooperative
Laissez-Faire Leadership
Are characterized as involved with their followers and members; in fact, laissez-faire leadership is an absence of leadership style. Leaders of this tyle make no polices or group-related decisions. Instead, group members are responsible for all goals, decisions, and problem solving. The functions of laissez-faire leadership include trusting their members or followers to make appropriate decisions and bringing in highly trained and reliable members into the group organization.
Competing
Assertive, uncooperative approach to conflict in which the individual pursues own needs at the expense of others. Assertive Uncooperative
Mcgregor's Theory Y
Assumption: People are more content when they have self-discipline and autonomy at work Implications: People aim to satisfy through higher level accomplishments to achieve self-actualization.
Mcgregor's Theory X
Assumption: People basically do not like their work and must be coerced to perform\ Implications: Lower level basic needs are important, e.g., safety, security
Refreezing
At this level you are now sustaining the change over time: this is where you try not to revert back to old ways. So basically it focuses on sustaining the change over a longer period of time.
Modes of Conflict Resolution
Avoiding Accommodating Competing Compromising Collaborating
Action
Behavioral response: do nothing, deal with it, escalate, increase anger, hostility, engaging in dialog. A behavioral response to a conflict follows the conceptualization. This may include seeking clarification about how another person views the conflict, collecting additional information that informs the issue, or engaging in dialog about the issue.
Managed Care
Care purchased through a public or private healthcare organization whose goal is to promote quality healthcare outcomes for patients at the lowest cost possible through planning, directing, and coordinating care delivered by healthcare organizaitons that it may own, have contractual agreements with, or have authority over by virtue of the fact that it reimburses the organization for services provided its patients. This model rewards providers for low utilization of care that is relatively low in cost; also, a system of care in which designated person determines the services the patient uses.
Planned, First Order Change:
Change expected and deliberately prepared beforehand by using systematic directional processes to develop and carry out activities to accomplish a desired outcome. Evolutionary change that occurs in planned and small steps. Three steps to planned change (Kurt Lewin's model of change 1951) - Unfreezing - Moving - Refreezing
Authoritarian Leadership
Characterized as domineering. The functions of authoritarian leadership include unilateral rule-making, task-assignment, and problem solving while the roles of authoritarian followers include adhering to the leader's instructions without question or comment.
Negotiating
Conferring with others to bring about a settlement of differences.
Interpersonal Conflict:
Conflict that occurs between or among people. This is the most common type of conflict and transpires between and among patients, family members, nurses, physicians, and members of other departments.
Organizational Conflict:
Conflict that occurs when a person confronts an organization's policies and procedures for patient care and personnel and its accepted norms of behavior and communication. This arises when discord exists about policies and procedures, personnel codes of conduct, or accepted norms of behavior and patterns of communication.
Intrapersonal Conflict:
Conflict that occurs within an individual. This occurs within a person when confronted with the need to think or act in a way that seems at odds with one's sense of self. Questions often arise that create a conflict over priorities, ethical, standards, and values.
Outcomes
Degree to which mutual goals were achieved and subsequent relationships among participants. Tangible and intangible consequences result form the actions taken and have significant implications for the work setting. Consequences include (1) the conflict being resolved with a revised approach, (2) stagnation of any current movement, or (3) no future movement. '
Diffusion of Innovation
Describes how innovations spread through society, occurring in stages: knowledge, persuasion, decision, implementation, and confirmation.
Det Norske Vertias (DNV)
Diagnostic related group
Conceptualization
Different interpretations of situation. arises when different interpretations of a situation occur, including a different emphasis on what is important and what is not, and different thoughts about what should occur next.
Unplanned change
Disconcerting, unanticipated, adaptive change. AKA Second Order Change: Change that is revolutionary, episodic, and that requires radical differences form what exists.
Entrenched workforce
Employed persons older than 35 years who are thought of as the Baby Boomer generation.
Role
Expected or actual behavior, determined by a person's position or status in a group.
Barriers
Factors, internal or external to the change situation, that interfere with movement toward a desirable outcome.
Facilitators
Factors, internal or external to the change situation, that promote movement towards a desired outcome.
Active listening
Focusing completely on the speaker and listening without judgment to the essence of the conversation; an active listener should be able to repeat accurately at least 95% of the speaker's intended meaning.
Follower
Followers collaborate and communicate to translate that direction into action and share perceptions about facilitators and barriers to achieving the vision. Person who contributes to a group's outcome by implementing activities and providing appropriate feedback.
National Integrated Accreditation for Healthcare Organizations (NIAHO)
Formely Det Norske Veritas. An internationally based organization that accredits many fields, including health care.
Five Stages of Group Development
Forming Storming Norming Performing Ending
Forming
Forming "Form is the stage or occasion when the team first come together. People are usually very polite and agreeable and tend to make rather vague statements. The interpersonal issues in forming are wanting to find a place in the group and getting to know the members and seeking leadership and direction. The task issues are initially vague and then begin to focus on defining the purpose of the group and it's goals and identifying who has the knowledge ad information that are necessary." p. 35
The 4 Stages of Conflict:
Frustration Conceptualization Action Outcomes
Two-Factor Theory (Motivation/Hygiene)
Herzberg is credited with developing a two-factor theory of motivation first published in 1968. Hygiene factors, such as working conditions, salary, status, and security, motivate workers by meeting safety and security needs and avoiding job dissatisfaction. Motivator factors such as achievement, recognition, and the satisfaction of the work itself, promote job enrichment by creating job satisfaction. In short workers both need hygiene factors and motivation factors to have job satisfaction.
Expectancy Theory
Individual's perceived needs influence their behavior. In the work setting, this motivated behavior. In the work setting, this motivated behavior is increased if a person perceives a positive relationship between effort and performance. Motivated behavior is further increased if a positive relationship exists between good performance and outcomes or rewards, particularly when these are valued.
Change Agents
Individuals with formal or informal legitimate power whose purpose is to initiate, champion, and direct or guide change.
Change agent
Individuals with formal or informal legitimate power whose purpose is to initiate, champion, and direct or guide change.
Values
Inner forces that influence decision making and priority setting.
The Three Types of Conflict
Intrapersonal Conflict Interpersonal Conflict Organizational Conflict
Horizontal violence
Involves conflictual behaviors and among individuals who consider themselves peers with equal power but with litter power within the system. Describes aggressive and destructive behavior of co-workers against each other.
Collaborating
It is both assertive and cooperative because people work creatively and openly to find the solution that most fully satisfies all important concerns and goals to be achieved. Involves a group of people working together to achieve a common goal. This is the closets thing to a win-win situation.
Decision
Key Idea: Commitment to adoption
Persuation
Key Idea: Development of attitudes about an innovation through psychological involvement and selective perception
Confirmation
Key Idea: Evaluating the innovation
Knowledge
Key Idea: Exposure to an innovation and how it functions
Implementation
Key Idea: Putting the innovation into practice
Leaders
Leaders build a culture of teamwork, set a direction, develop a vision, and communicate that direction to staff. Person who demonstrates and exercises influence and power over others.
Patient Protection and Affordable Care Act
Legislation aimed at increasing access to uninsured Americans to quality, affordable care while reducing costs of unnecessary services. The PPACA was upheld as constitutional by the Supreme Court.
Management
Management is the generic function that includes focusing on completing the work that must be done. Mangers address complex issues by organizing, planning, budgeting, and setting target goals.
Quality indicators
Measurable elements of quality that specify the focus of evaluation and documentation.
Compromising
Moderately assertive, cooperative approach to conflict in which the individual's ability to negotiate and willingness to give and take result in conflict resolution and fulfillment of priorities for all involved. This one is considered a lose-lose Blend of booth assertive and cooperative behaviors.
Emotional Intelligence
Monitoring emotions in a situation to guide actions and inform thought processes.
Laggards
Most secure in holding on the past. Most comfortable when an idea cannot fail.
Moving
Moving or changing phase is the actual change with facilitators and barriers. Basically at this stage you use facilitators to help bring about change. Also you identify barriers and see what can be done from that interfering wit the change.
Early Adopters
Organization's opinion leaders who learn about an innovation and apply it to their practice. Can be effective in communicating the value of an innovation
Reported Violence
Our knowledge of the scale of workplace violence remains incomplete because no consistent system of data collection exists. Data regarding the less severe forms of workplace violence are particularly sparse.
Hierarchy of Needs (Maslow)
People are motivated by a hierarchy of human needs, beginning with physiologic needs and then progressing to safety, social, esteem, and self-actualizing needs. In this theory, when the need for food, water, air, and other life-sustaining elements is met, the human spirit reaches out to achieve affiliation with others, which promotes the development of self-esteem, competence, achievement, and creativity. Lower-level needs will always drive behavior before higher-level needs will be addressed.
Frustration
Perception of goals being blocked. When people or groups perceive that their goals may be blocked, frustration results. This frustration may escalate into stronger emotions, such as anger and deep resignation.
Performing
Performing is the high point of the project stage in which members have taken responsibility for their individual and collective goals. There is a strong agreement on the task and decisions are made by consensus." p. 35
Two Types of Change
Planned Change Unplanned Change
Acknowledgement
Recognition that an employee is valued and respected for what he or she has to offer to the workplace, team, or group; acknowledgments may be verbal or written, public or private.
Complexity Theory
Requires leaders to expand and respond to engaging dynamic change and focus on relationships rather than on prescribing and approaching change as a lock-step, pre-prescribed method. Traditional organizational hierarchy plays a less significant role as the "keeper of high level knowledge" and replaces it with the idea that knowledge applied to complex problems is better distributed among the human assets within an organization, without regard to hierarchy. Leaders try less to control the future and spend more time influencing, innovating, and responding to the many factors that influence health care.
Complexity theories
Requires leaders to expand and respond to engaging dynamic change and focus on relationships rather than on prescribing and approaching change as a lock-step, pre-prescribed method. Traditional organizational hierarchy plays a less significant role as the "keeper" of high level knowledge and replaces it with the idea that knowledge applied to complex problems is better distributed among the human assets within an organization, without regard to hierarchy. Leaders try less to control the future and spend more time influencing, innovating, and responding to the many factors that influence health care.
Evidence-Based Organizational Practice
Scientifically derived approaches to delivering care that optimizes professional roles, practices, and coordination of activities.
Late Majority
Skeptics who do not adopt something unless there is pressure. Feel safe when there is limited uncertainty
Mentor
Someone who models behavior, offers advice and criticism, and coaches the novice to develop a personal leadership style. An experienced person who helps a less experienced person navigate into expertise.
Unfreezing
Sometimes unfreezing involves overcoming inertia, the desire to keep things the same. So its basically overcoming the dire to keep things the same. First you need to recognize the need to change (so this is basically planting the seed of thought).
Style Theory
Style theories focus on what leaders do in relational and contextual terms. The achievement of satisfactory performance measures requires supervisors to purse effective relationships with their subordinates while comprehending the factors in the work environment that influence outcomes.
Leadership
The ability to elicit a vision from people and to inspire and empower those people to do what it takes to bring the vision into reality. The use of personal traits to constructively and ethically influence patients, families, and staff through a process in which clinical and organizational outcomes are achieved through collective efforts.
Transactional leadership
The act of using rewards and punishments as part of daily oversight of employees in seeking to get the group to accomplish a task. Leadership Behaviors: + Contingent reward (quid pro quo) + Punitive + Management by exception (active-monitors performance and takes action to correct + Management by exception (passive)-intervenes only when problems exist
Management
The activities needed to plan, organize, motivate, and control the human and material resources needed to achieve outcomes consistent with the organization's mission and purpose.
Management
The activities needed to plan, organize, motivate, and control the human and material resources needed to achieve outcomes consistent with the organizations's mission and purpose.
Organizational culture
The attitudes, behaviors, and policies and procedures for patient care and personnel and its accepted norms of behavior and communication.
Incivility
The condition of acting in a rude or disruptive manner. Incivility includes a wide range of behaviors form ignoring others, to rolling one's eyes, to yelling, and eventually to personal attacks, both physical and psychological.
Learning organization
The designation of a type of organization in which continual learning as an expectation permeates all levels to promote adequate responses required by dynamic, accelerated change.
Vision
The desired future state.
Process of Care
The desired sequence of steps that have designed to achieved clinical standardization.
Motivation
The instigation of action based on various factors, both intrinsic and extrinsic.
Magnet Recognition Program
The only national designation built on and evolving through nursing research that is designed to recognize nursing excellence of healthcare organizations through a self-nominating, appraisal process.
Manager
The person who accountability for a group of people.
Agency for Healthcare Research and Quality (AHRQ)
The primary federal agency devoted to improving quality, safety, efficiency, and effectiveness of healthcare.
Change Process
The series of ongoing efforts applied to managing a change.
Emerging workforce
The so-called 20-something generation, who were born between the years of 1965 and 1985
Management Theory
The theory related to the activities described in Management.
Leadership
The use of personal traits to constructively and ethically influence patients, families, and staff through a process in which clinical and organizational outcomes are achieved through collective efforts.
Social Networking
The use of technology and other mechanisms to create a web of relationships with common involvement in an area of focus or concern.
Chaos theory
Theoretical construct defining the random-appearing yet deterministic characteristics of complex organizations.
Conflict Resolution Outcomes
There are two general outcomes are consididerd when assessing the degree to which a conflict has been resolved: 1) the degree to which important goals were achiaved and 2) the nature of the subsequent relationships among those involved. So basically the quality of decisions and the quality of the relationships.
Democratic Leadership
They are characterized by collective decision-making, camaraderie, active member or follower involvement, fair praise, and restrained criticism; they facilitate collective decision-making. Democratic leaders offer their followers choices and support.
Quality and Safety Education for Nurses (QSEN)
This acronym refers to the Quality and Safety Education for Nurses, which is an institute devoted to providing resources related to the QSEN Competencies for both undergraduate and graduate practitioners. The knowledge, skills, and attitudes are defined to reflect the necessary abilities one must have to practice safely and to strive for quality. The six competencies are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.
Change Leaders
Those who create the vision and foster major organizational transformation.
Followership
Those with whom a leader interacts; involves assertive use of personal behaviors in contributing toward organizational outcomes while still acquiescing certain tasks to the leader or other team members.
Situational-Contingency Theories
Three factors are critical 1) the degree of trust and respect between leaders and followers, 2) the task structure denoting the clarity of goals and the complexity of problems faced, and 3) the position power in terms of where the leader was able to reward followers and exert influence. Consequently, leaders were viewed as able to adapt their style according to the presenting situation.
Trait-Theory (Great Man Theory)
Trait theories were first studied from 1900 to 1950. These theories are sometimes referred to as the Great Man theory, from Aristotle's philosophy extolling the virtue of being "born" with leadership traits. Stogdill is usually credited as the pioneer in the school of thought. Leaders have a certain set of physical and emotional characteristics that are crucial for inspiring others toward a common goal. Some theorists believe that traits are innate and cannot be learned; others believe that leadership traits can be developed in each individual.
Transformational Theories:
Transformational leadership refers to a process whereby the leader attends to the needs and motives of followers so that the interaction raises each to high levels of motivation and morality. The leader is a role model who inspires followers through displayed optimism, provides intellectual stimulation, and encourages follower creativity.
Accommodating
When accommodating, people neglect their own needs, goals, and concerns (unassertive) while trying to satisfy those of others (cooperative). This approach has an element of being self-sacrificing and simply obeying orders or serving other people. Unassertive Cooperative
Early Majority
Will not bring forth an innovation but will readily adopt it when brought forth by others.
