Nursing Leadership Exam 2

model of change leadership

Acknowledge thoughts and feelings; Align with purpose and values; create Agency with genuine choices; Adjust your attitude

one nurse provides total care for one patient during the entire work period

Case (Total Pt Care)

Essay/Short Answer 6 types of care delivery, when best to use (examples) and why

Case (Total Pt Care) Functional Nursing Team Nursing Primary Nursing Practice partnership Patient-focused care

Importance of political astuteness

For leaders it brings self-awareness, self-control, and influence. Also, they have the ability to negotiate, to stand up to pressures from others, and achieve constructive outcomes from conflict

providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of people

Functional Nursing

most common type of conflict and transpires between and among patients , family members, nurses, physicians, and members of other departments; conflict occurs that focuses on a difference of opinion, priority, or approach with others

Interpersonal

goals include improving p/t satisfaction and outcomes, improving working job satisfaction, and increase efficiencies and decreasing costs; involves both p/t and healthcare providers, including nurses arriving at at some form of conclusion about the care of the p/ts condition; interprofessional collaborative care

Patient-focused care

an RN is paired with an assistant ; the partner works with the RN consistently; if partner is unlicensed the RN allows the assistant to perform basic nursing functions consistent with the state delegation rules

Practice partnership

a method for organizing patient care delivery in which one RN functions autonomously as the patient's primary nurse throughout the hospital stay; 24 hr accountability and responsibility of patient care from admission to discharge

Primary Nursing

devised to improve patient satisfaction; a team leader who is an RN is responsible for coordinating a group of licensed and unlicensed personnel to provide patient care to a small group of patients.

Team Nursing

Essay/Short Answer System level thinking (define)

The development of frameworks that see the organization as a complex entity whose many part affect outcomes

What best describes evidence-based practice? a. Applying best research evidence to care of patients b. Using research-based information to develop practice guidelines c. Conducting a randomized control trial to determine effectiveness of handwashing techniques d. Developing standards for practice

a. Applying best research evidence to care of patients Evidence-based medicine is derived from evidence-based medicine and involves integration of the best research evidence with clinical expertise and the patient's unique values and circumstances in making decisions about the care of individual patients. It is focused on searching for, appraising, and synthesizing the best evidence to address a specific clinical practice problem.

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method b. Team nursing c. Functional nursing d. Nurse case management

a. Case method The case method may involve total patient care provided by a registered nurse, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This method would be justifiable delivery in the pediatric intensive care unit, where the status of patients can change rapidly and where complex functions of care involve both patients and families.

Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to: a. consciously evaluate invisible mental models. b. allow for individual outcomes. c. encourage cooperative activities. d. operate between order and disorder.

a. consciously evaluate invisible mental models. Senge theory on change suggests that each individual or organization bases activities on a set of assumptions, or a set of beliefs, or mental pictures about the way that the world should work. When these invisible models are uncovered and consciously evaluated, it is possible to determine their influences on work accomplishment.

What is the first step to gather evidence for guiding practice? a. Develop the clinical question. b. Identify the databases to be used. c. Appraise the evidence. d. Integrate available evidence with unit expertise.

a. Develop the clinical question. Identifying the question may be the most challenging part of the process. Once the clinical question has been identified, writing it down will help in moving on to the next step of gathering evidence.

Importance of understanding change theories as leader

useful for low level low complexity change

As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? a. Unfreezing b. Experiencing the change c. Moving d. Refreezing

a. Unfreezing. Although you may be at a higher level of change in relation to your individual practice and knowledge of the use of change, in this situation, you are recognizing the need for change in relation to practice on the unit that you are managing. This phase is the initial phase in first-order change and will involve listening to staff to see if they perceive a similar problem.

An RN on the dementia unit, is discussing the treatment of a paitnet who can be agitated and combative at bedtime. The physician orders a strong sedative to "knock the patient out". The nurse questions the order, based on her knowledge of the patient's history and of other medications that the patient has been given. The physician reiterates the order and the nurse refuses to comply. In this instance, the nurse is demonstrating: a. autonomy. b. accountability. c. authority. d. best practice.

a. autonomy. Participation in decision making regarding one's practice is an appropriate expectation for professional nurses, provides for greater autonomy and authority over practice decisions, contributes to supporting the professional nurse, and is a major component of job satisfaction. Autonomy is encouraged through supportive management and through unit-level support of changes without the need for complex, multilevel approval of changes that can be made locally.In this situation, the nurse is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. Key to the concept of autonomy is decision making and the level of independence that is given. Accountability refers to achievement of outcomes, and authority refers to the capacity to make decisions.

Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back pain. He shows the clinic nurse a webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted 5 years earlier and was last updated 3 years before. The clinic nurse advises Mr. Cruiser to: a. avoid this site. b. check with his primary healthcare provider. c. continue with the exercises. d. contact the author for additional exercise and feedback.

a. avoid this site. Patients need coaching as to how to use and decipher information that is available through the Internet. In this situation, the provider on the site lacks credibility because no credentials are listed, and the information is not current.

Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to: a. consciously evaluate invisible mental models. b. allow for individual outcomes. c. encourage cooperative activities. d. operate between order and disorder.

a. consciously evaluate invisible mental models. Senge theory on change suggests that each individual or organization bases activities on a set of assumptions, or a set of beliefs, or mental pictures about the way that the world should work. When these invisible models are uncovered and consciously evaluated, it is possible to determine their influences on work accomplishment.Senge theory on change has 5 organizational disciplines (box, og 329):shared vision - the process of creating a common view about where the organization is going mental models - the practice of helping individuals become aware of how they think, what they value, and how that affects organizational performancepersonal mastery - the fostering of openness in the face of change by managing self-awareness and using reflectionteam learning - the promotion of teams thinking together, collaborating, and sharing ideas, knowledge and perspectivesystems thinking - the development of frameworks that see the oganization as a complex entity whose many parts affect outcomes

What are the positive factors influencing healthcare consumers and their relationship with healthcare organizations? a. increased engagement of patients with their healthcare b. inadequate healthcare professionals discussing legislation bills related to healthcare c. healthcare professionals are held more accountable for patient outcomes d. delivery of cost effective quality care is achieved by preparing nurses with a higher level of education in the ever-chaning healthcare environment e. giving people a voice for changes they desire to achieive in healthcare f. patients use non-professional websites to researh pathology and treatments g. mangagement may place gaining approval and certification by deeming authorities above staff needs h. recognition and certification privdes status and feedback for healthcare institutions on needed improvements and maintenance

a. increased engagement of patients with their healthcare c. healthcare professionals are held more accountable for patient outcomes e. giving people a voice for changes they desire to achieive in healthcare h. recognition and certification privdes status and feedback for healthcare institutions on needed improvements and maintenance

Which of the following would be most effective in implementing the findings to staff nurses regarding a new clinical treatment for an indentified problem? a. Presentation by physician b. An interactive in-service for the nurses that involves discussion of sample case studies and application of evidence c. Presentation of the findings on a poster in the staff break room/lounge d. Discussing the evidence presented in the studies with the informal leaders of each unit

b. An interactive in-service for the nurses that involves discussion of sample case studies and application of evidence Current research suggests that translation of research into practice is best facilitated through interactive learning such as workshops. Least effective strategies included didactic learning and distribution of learning materials.

Workplace Advocacy is designed to assist nurses working in an emergency department by: a. creating professional practice climates in their institutions. b. equipping them to practice in a rapidly changing environment. c. negotiating employment contracts. d. representing them in labor-management disputes.

b. equipping them to practice in a rapidly changing environment. Workplace advocacy encompasses a number of activities that enable nurses to control the practice of nursing and to address challenges that they face in the practice setting. These activities include career development, employment rights, employment opportunities, and the labor-management relationship. The aim of workplace advocacy is to proactively equip nurses to practice within a rapidly changing environment, rather than to negotiate contracts or provide representation in employment disputes.

Data, information, and knowledg are core concepts in: a. database b. informatics c. biomedical technology d. communication technology

b. informatics Informatics is the application of technology to all fields of nursing to facilitate and extend nurses' decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care. THe three core concepts are data, informaiton and knowledge.

When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: a. unfreezing. b. nonlinear. c. cybernetic. d. linear.

b. nonlinear. While Lewin theory was designed to describe planned or first-order changes, many scholars think the theory is too simplistic to address how unplanned or second-order change occurs. In complex situations with an uncertain change environment, a nonlinear approach that involves flexibility improves overall outcomes. Linear change is appropriate to stable, less complex, and more predictable situations.

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the: a. procedure manual. b. nursing care standards. c. litigation rate of unsafe practice. d. job descriptions of the organization.

b. nursing care standards. Standards establish the minimal safety level of care. Procedure manuals provide information about how standards are to be achieved.

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: a. explaining to the staff that disciplinary action will be taken in cases of additional errors. b. recommending that a multidisciplinary team should assess the root cause of errors in medication. c. suggesting that the pharmacy department should explore its role in the problem. d. changing the unit policy to allow a certain number of medication errors per year without penalty.

b. recommending that a multidisciplinary team should assess the root cause of errors in medication. Quality management stresses improving the system, and the detection of staff errors is not stressed. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.Leadership must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks. One method of doing this is to invite all staff into a discussion related to solutions to an identified concern. This approach encourages teamwork.

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to: a. repeat the benefits of the change. b. share change experiences early in the process. c. initiate frequent interactions among staff. d. provide select information to the staff.

b. share change experiences early in the process. Connecting innovators and early adopters to new ideas and with new peers keeps them at the cutting edge.

Which of the following is the most effective method an organisation to ensuring that EBP is incorporated into nursing care? a. Formation of nursing-only implementation teams b. Restriction of evidence to RCTs c. Formation of a network of individuals doing research and/or interested in research utilization d. Avoidance of partnership with experienced researchers

c. Formation of a network of individuals doing research and/or interested in research utilization Collaboration, partnerships, and consideration of a variety of evidence appropriate to the clinical questions are important in ensuring translation of evidence into practice. Collaboration is considered particularly critical and can occur through practice-based networks.Journal clubs provide opportunities for engagement in reading research and considering how it might be applied to clinical practice problems, which is considered very effective in behavioral change.

Despite the implementation of bar-code medication administration (BCMA) on your busy medical unit, you notice that the number of medication errors has not significantly decreased. Which of the following reasons might explain the lack of change in errors? a. A number of new medications have been introduced into the hospital pharmacy that are not yet recognized in the CDS. b. There have been an unusually high number of patients on the unit who have been unable to confirm their identity at the time of medication administration. c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times. d. Clinical data that have been entered into the system to guide administration of the medications are outdated.

c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times. Most errors related to technology involve mislabeled bar codes on medications, mistakes at order entry because of confusing computer screens, or issues with management of information. Errors also are related to dispensing devices and human factors, such as failure to scan bar codes or overrides of bar-code warnings.

What is the primary purpose of QI programs? a. Evaluation the performance of staff b. Determination if standards are appropriate c. Patient outcome improvement d. National accreditation preparation

c. Patient outcome improvement The primary purpose of QI is improvement of patient outcomes, which relates to prevention of error, quality patient care, and patient satisfaction.

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to: a. select one of the change models. b. use Lewin's model and principles of change. c. apply both planned and complexity theory approaches. d. form a task force of nursing staff and wound care specialists.

c. apply both planned and complexity theory approaches. In the second stage, the moving or changing stage of Lewin theory, planned interventions and strategies, such as education, vision building, and incremental steps towards the change, are executed to support the implementation of the change. This situation potentially also involves complexity theories that recognize that change involves engagement of individuals and subsystems throughout the unit and organization.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. be able to effectively communicate with patients. b. build relationships with physicians. c. be able to adapt to daily changes in staffing. d. adapt in communicating information to her supervisor.

c. be able to adapt to daily changes in staffing. A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages.Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of: a. competencies for knowledge technology b. competencies for data knowledge c. competencies for informatics d. competencies for evidence based practice

c. competencies for informatics The Quality and Safety Education for Nurses (QSEN) project identified informatics competency as a necessary component of the knowledge, skills, and attitudes for quality patient care. Nurses are anticipated to be able to use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a. breadth of nursing knowledge and expertise required. b. intention to provide holistic nursing. c. degree of task orientation. d. levels and types of assessment.

c. degree of task orientation. Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from time of admission to discharge and 24 hours a day.

A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. differentiated practice. b. team nursing. c. functional nursing. d. case management.

c. functional nursing Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress.Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

The oncology clinical manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is: a. developing awareness. b. experiencing the change. c. integrating the change. d. perceiving awareness.

c. integrating the change. This particular initiative assesses the success with which the change has been integrated into everyday practice after it has been experienced, or the degree to which staff members have accepted using the new infusion equipment.

One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of: a. mentorship. b. politics. c. networking. d. empowerment.

c. networking. Meeting individuals outside the normal work group to share ideas and gain support and encouragement is an example of networking.

A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least 2 weeks and then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. distance learning. b. knowledge software. c. telecommunications. d. biomedical technology.

c. telecommunications. Telecommunications and systems technology facilitate clinical oversight of health care via telephone or cable lines, remote monitoring, information links, and the Internet. Patients sitting in front of the teleconferencing camera can be diagnosed, treated, monitored, and educated by nurses and physicians. EKGs and radiographs can be viewed and transmitted.

IOM urged organizational change that improves...

care and reduces costs by creating learning healthcare systems in America. Learning healthcare systems strive to use the data generated from an electronic record of p/t encounters to constantly improve and determine the evidence for what works best

Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah's suggestion would be: a. "That is a great suggestion, but we have no resources for such an expensive undertaking right now." b. "Perhaps you can keep that in mind as we redesign our charting system." c. "We have too many seniors as patients, and you know that they don't use technology." d. "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

d. "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further." Involving Sarah with others who enjoy new ideas and who are able to try out new ideas in pilot projects enables her to remain on the cutting edge and to try out innovative solutions with the least amount of disruption.

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes concerning translation of research into practice (TRIP). What best describes TRIP? a. Conducting an integrative review of the literature b. Searching the literature for a systematic review c. Providing the results of research studies to practitioners d. Applying strategies that aid in adoption of research in practice

d. Applying strategies that aid in adoption of research in practice The science of how research is adopted is known as translation science, the science of translating research into practice (TRIP). The primary aim of research utilization is to activate the change process to move research findings into practice to improve patient outcomes.The National Institutes of Health identified translational research or getting research into the hands of practitioners to improve patient care, as a priority.

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse's district, as well as the name of the representative in Washington, DC. This nurse exemplifies which of the following? a. Power sharing b. Empowerment c. Collaboration d. Political astuteness

d. Political astuteness Political involvement/astutenss is a professional responsibility and nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership. This nurse exemplifies several of the skills associated with political astuteness.Collaboration refers to working with others for a common goal; while this collaboration can and does occur when working in professioanl organizations and committees, the example is specifically referring to being involved politically within and on behalf of the nursing profession. The same refers to power sharing and empowerment.

A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Why is it important for nurses to be involved in shaping public policy? a. Involvement will enable nurses to take over the healthcare system at some point in the future. b. Other healthcare professions are less concerned about the essential needs of clients. c. Such activities are important career builders for nurses who seek top-level executive positions. d. They are closest to the front line of health care and see how it affects clients and families.

d. They are closest to the front line of health care and see how it affects clients and families. Nurses can no longer be passive observers of the political world. Political involvement is a professional responsibility. Nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership.

As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time consuming than traditional manual charting approaches. On the basis of this feedback, you: a. assume that the system is doing what it needs to do. b. provide reassurance to staff that the unit has achieved its goals in implementation of the system. c. ask some of the staff if they have had similar experiences with the system. d. consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

d. consult chart audit data and end user consultation reports to determine if errors and problems are occurring. In Kotter eight-step change model, removing obstacles means keeping alert for barriers in structure and processes that limit the ability to change and then removing those barriers once they have been found.

The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: a. coordination. b. resistance. c. anticipation. d. participation.

d. participation. Successful change means persistence and advancement of the change, which requires the undivided focus of all team members. Early involvement and participation are critical to capturing the undivided focus of team members.

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. department b.unit c.staff d. patient

d. patient The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients. In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

To effectively achieve a change goal/outcome in a change situation, the wound care specialist will: a. preserve the status quo. b. diminish facilitators and reinforce barriers. c. weigh the strength of forces. d. strengthen facilitating forces.

d. strengthen facilitating forces. For change to be effective, the facilitators must exceed the force of the barriers; thus, strengthening the facilitating forces would achieve this aim.

Resistance is most likely when change: a. is not well understood. b. involves many layers in an organization. c. involves nonprofessional workers. d. threatens personal security.

d. threatens personal security. Resistance and reluctance commonly occur when personal security is threatened and may involve loss of confidence in abilities or loss of job or financial security.

occurs within a person when confronted with the need to think or act in a way that seems at odds with oneself of self

intrapersonal

Essay/Short Answer Conflict, types, and potential outcomes in workplace

intrapersonal interpersonal organizational

arises when discord exists about policies and procedures, personnel codes of conducts, or accepted norms of behavior and patterns of communication

organizational

Essay/Short Answer Political Astuteness

recognized as a set of skills, knowledge, and judgments about the interests, goals, and values of stakeholders.

Nurses must understand this drive to constantly improve outcomes and reduce costs so they can...

work with the interprofessional healthcare team to change practices based on p/t and organizational assessments and evaluations.

6 phase of change (Havelock

▪ 1) building a relationship ▪ 2) diagnosing the problem ▪ 3) acquiring relevant resources ▪ 4) choosing the solution ▪ 5) gaining acceptance ▪ 6) stabilizing the innovation and generating self-renewal

Examples of system level thinking

● When organizations are open to change and evolution ● The need for nurses and healthcare systems to continuously learn and remain open to changes that improve care has never been greater