Prioritizing Client Care: Leadership, Delegation, and Emergency Response Planning
Purpose of the primary assessment
Identify any client problem that poses an *immediate* or potential *threat to life* - ABCs
Function of management
Planning Organizing Directing Controlling
Team nursing
RN team leader *delegates* - Each staff member is accountable
Functional nursing
Task-oriented - Focus on delegated task rather than whole client - Risk for lack of accountability
Accountability
Process in which individuals have a duty to act and are answerable for their actions - Assume responsibilities only in scope - Responsibility to patient in accordance to standards of nursing practice and adherence to ethical codes
Case manager
Professional nurse who assumes responsibility for coordinating client care *at admission and after discharge* - Plan of care made with patient - Coordinate interdisciplinary care + referrals - Facilitates discharge - Knowledgeable in health insurance
Affordable Care Act
Reduce uncompensated care the average U.S. family pays by requiring everyone to have health insurance or pay a tax penalty - Protect against arbitrary actions by insurance companies
Five rights of delegation
Right task Right circumstance Right person Right direction/communication Right supervision
Modular nursing
Similar to team nursing, but takes into account the structure of the unit - Unit is divided into modules -> nurses can care for a group of clients who are geographically close by
Middle manager
Supervise staff, budget, schedule, write + implementing policies that guide client care + unit, maintain quality of care (ex. unit manager and supervisor)
LPN can
- Administer oral/IM meds - Reinforce teaching by RN - Routine data collection, dressing changed, urinary catheter insertion, naso-oral suctioning
American Red Cross (ARC)
- Given authority by fed gov to provide disaster relief - Free, located across U.S. - Participates in Community disaster plans - Identifies and trains personnel - Works with businesses and labor organizations to identify resources and individuals for disaster work - Public education on disaster prevention - Operates shelters to meet emergency needs, crisis counseling - Inquiries from family - Coordinate relief with other agencies
RN cannot delegate
- Handling invasive line or sterile equipment - Nursing process (ADPIE) - Patient education - Pre-op and post-op assessment - Triage, care for unstable clients
With the ARC, the nurse
- Helps with first aid - Participate in emergency response plans + disaster relief programs - Blood drives, immunizations
Level I disaster
Massive disaster - Significant damage - Presidential declaration - Major federal involvement - Full engagement of national resources
Level III disaster
Minor disaster - Could result in presidential declaration of an emergency
Phases of disaster management
Mitigation Preparedness Response Recovery
Secondary assessment
- Life-threatening problems - Health hx - Physical assessment, vitals
Level II disaster
Moderate disaster - Likely to result in presidential declaration of an emergency - Moderate federal involvement
Triage yellow
Non-life threatening - Can't walk - Spontaneous breathing - RR <30 - Radial pulse present, cap refill <2 sec - Obeys commans - Treated within 30 min - 2 hrs
Multicasualty event
Number of casualties can be managed by a hospital
Mass casualty event
Number of casualties exceeds capabilities of hospital
Client problems, ________, interventions, and expected ________________ are documented in the care plan
goals, outcomes
Triage green
Able to walk, minor injuries - Can wait at least 2 hours
Servant leadership theory
Based on desire to serve others - Works on developing skills of individual team members
Case management
Healthcare delivery system strategy that supports managed care - Interprofessional - Comprehensive client care throughout illness - *High-quality + cost-effective care* - Assessment, development of plan of care, coordination of services, referral, follow-up - Critical pathways are used, variation analysis is conducted
The charge nurse is planning the assignment for the day. Which factors should the nurse remain mindful of when planning the assignment? Select all that apply. 1. The acuity level of the clients 2. Specific requests from the staff 3. The clustering of the rooms on the unit 4. The number of anticipated client discharges 5. Client needs and workers' needs and abilities
1, 5
Process for Medication Reconciliation
1. Obtain current med list from client 2. Develop accurate list of new rx 3. Compare new meds and current list 4. Investigate any discrepancies + talk to HCP as needed 5. Communicate final list with client and team members
Lewin's Change Model
1. Unfreezing: problem + rationale for change identified 2. Changing: planned + implemented 3. Refreezing: change is stabilized
Medicaid
Joint federal and state program - Eligible low income adults, children, pregnant women, elderly, + disabled - Fraud + abuse is a concern
The nurse manager is discussing the facility protocol in the event of a tornado with the staff. Which instructions should the nurse manager include in the discussion? Select all that apply. 1. Open doors to client rooms 2. Move beds away from windows 3. Close window shades and curtains 4. Place blankets over clients who are confined to bed 5. Relocate ambulatory clients from the hallways back into their rooms
2, 3, 4
The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an assistive personnel (AP)? 1. A client requiring colostomy care 2. A client receiving continuous tube feedings 3. A client who requires urine specimen collection 4. A client with difficulty swallowing food and fluids
3
A nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on the evening shift. The nurse should assign priority to which client? 1. A client complaining of muscle aches, headache, and history of seizures 2. A client who twisted her ankle when rollerblading and is requesting medication for pain 3. A client with a minor laceration on the index finger sustained while cutting an eggplant 4. A client with chest pain who states that he just ate pizza that was made with a very spicy sauce
4
A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse determines that which scenario is characteristic of the team based model of nursing practice? 1. Each staff member is assigned a specific task for a group of clients 2. A staff member is assigned to determine the client's needs at home and begin discharge planning 3. A single registered nurse (RN) is responsible for providing care to a group of 6 clients with the aid of an assistive personnel (AP) 4. An RN leads 2 licensed practical nurses (LPNs) and 3 APs in providing care to a group of 12 clients
4
Bureaucratic leadership
Leader believes that individuals are motivated by external forces - Relies on organizational policies and procedures for decision making
Triage red
Life-threatening, need immediate attention - Chest pain, amputation, acute neuro deficits, resp or cardiac arrest - Can't walk - Can't breathe with airway positioned - RR >30 - Radial pulse absent, cap refill >2 sec - Doesn't obey commands
Medicare
Federal health insurance program, >65 yo, certain younger people w/ disabilities, ESRD, dialysis renal transplant Part A: covers hospital stays, SNF stays, hospice care, and some home health care Part B: not covered by A Part C: Supplements by Private insurance agency Part D: covers prescription meds
Nurse practitioner
Advanced RN that can dx and tx acute and chronic conditions
Marketplace insurance companies
Aetna Blue Cross Blue Shield Cigna Humana Kaiser United TriCare/Humana
Authoritarian leadership
Focuses and maintains strong control, makes decisions, addresses all problems - Dominates and commands rather than seeking suggestions or input
Front-line manager
Functions in supervision of roles involved with client care (ex. charge nurse, team leader, client care coordinator)
Laissez-faire leadership
Manager assumes a passive, nondirective, and inactive approach - Decisions made by the group
Quantum leadership theory
Based on chaos theory, maintaining a balance between tension and order prevents an unstable environment and promotes creativity
Charismatic leadership theory
Based on personal beliefs and characteristics of influence
What pulse location is used during emergency situations?
Central: carotid or femoral
Critical pathway
Clinical management care plan for providing client-centered care, planning, and monitoring the client's progress within an established time frame - Based on evidence-based practice - Goal: *anticipate and recognize negative variance* - Ensure care is within budget + care for complex clients
Situational leadership
Combination of styles based on circumstances
Relationship-based practice (primary nursing)
Concerned with keeping nurse at bedside, actively involved in client care, planning goal-directed individualized care while in hospital + on discharge - Associate nurse wil primary is off duty
Variation analysis
Continuous process that the case manager and other caregivers conduct by *comparing the specific client outcomes with expected*
Centralization
Decision making by few individuals at the top
Democratic leadership
Decisions based on input from every member - aka participative management
Decentralization
Delegation of decision making closer to client
Mitigation
Disaster prevention and damage reduction (determine community hazards, awareness of available resources)
Triage black
Dying or dead - Apnic - No hope for survival
Change agents
Facilitate change
Client-focused care
Total care or case method - RN assumes total responsibility for planning and delivering care to a client
Discharge planning begins when the client is ___________________
admitted
Shared leadership theory
based on belief that several individuals share the responsibility for achieving the health care agency's goals
Transformational leadership theory
based on individual's commitment to the health care agency's vision, focuses on promoting change - motivating staff members through shared mission
Transactional leadership theory
based on social exchange theory
In addition to the HCP and primary nurse, the ___________ and ____________ are involved in developing the plan of care
client, family