HESI / NCLEX Leadership and Management
The following are phases of negotiation ___. a. readying for negotiation b. establishing the framework for negotiation c. intensive interaction d. bargaining e. closing the interaction f. a and c g. All of the above.
g. All of the above.
True
True or False - The dominant value in American society of individual autonomy and self-determination may be in direct conflict with diverse groups.
False
True or False - The nurse practice acts are an example of civil law.
True of False: Persons declared incompetent have the legal status of a minor?
True- They cannot vote, drive, sue or be sued, make contracts or wills, or hold professional licensure.
Approval or Disapproval
Trying to impose the nurse's own attitudes, values, beliefs, and moral standards on a patient about what is right and wrong.
Expressive Aphasia
Unable to send the desired verbal message
Transcultural Nursing
Understanding these variables and integrating your understanding into all aspects of nursing care is what we term.
what are the there types of torts?
Unintentional quasi-intentional Intentional
15. Areas to include in the mediation process as relationship issues are explored include all of the following except ___. a. mutual respect b. needs versus wants c. compassion and empathy d. blaming others.
d. blaming others.
motivation theories
motivation is a process that occurs internally to influence and direct a person's behavior in order to satisfy his or her needs; but environment can be created to motivated someone
fosters growth and unity between individuals and group members
new science of leadership
strong relationships improve autonomy at all organizational levels
new science of leadership
is a nurse allowed to witness a living will
no because of nurse/client relationship
informal leadership
no organiaation title but can influence others through thoughtful and convincing ideas.
group
number of individuals assembled together and have some unifying relationship
primary nursing
nurse designs, implements, and is accountable for nursing care with delegation oof to associate nurse
accountability
nurse is legally liable for his/her actions and is answerable for the overall nursing care of patients
responsibility
nurse leaders can delegate authority but cannot delegate this __ so must ensure staff works competently
authority
occurs when a person who has been given the right to delegate, based on the state Nurse Practice Act; also has the official power from an agency to delegate
Magnet Status
only national designation built on and evolving through research; this program is designed to acknowledge nursing excellence; designed for healthcare organizations to achieve recognition of excellent nursing care through a self-nominating, self-appraisal process
Chaos Theory (change)
order emerges through fluctuation and chaos; process is cyclical; little time for orderly, linear change; organization must be able to act with speed, adaptability, and intensity; leader act quickly and are flexible
time management
organization skill allow nurse to prioritize client care, decide outcomes and interventions
standing committee
organization; such as recruiting and retention committee
Patient Safety: Principles in Action in an Organization
organizational structure-encourage accountability; maximize communication; communicate and focus priorities at all levels
case management
organizes client care by major diagnoses and focuses on attaining predetermined client outcomes within specific time, interdisciplinary outcomes, and continutity of care
practice based research network
originally formed to address research issues in primary care, PBRNs are increasingly being used in large healthcare organizations having the capability of integrating systems across multiple practice sites; practice-based research networks in nursing exists for primary care, community nursing centers, and school nursing
clinical pathway
outline the expected clinical course and outcomes for a specific patient type; generally outline the normal course of patient care, and the patient's progress is measured against expected outcomes
what is a critical pathway
outlines the actions that all members of a health care team must complete in a timely manner to achieve desired client outcomes and appropriate length of stay
reflective thinking
part of the critical thinking process; referring specifically to the processes of analyzing; making judgments about what has happened; thinking about thinking
based on expectancy theory
path goal model
harm or damages
patient must show financial harm before the courts will allow a finding of liability against the defendant nurse and/or hospital; General-permanent disability, disfigurement, pain, suffering Special-loss/expenses incurred as a result of injury (medical bills, lost wages, etc) Emotional- rare Punitive/exemplary-willful, wanton conduct; conscious disregard
proficient nurse
perceives whole situation rather than series of tasks
autonomy
personal freedom, right to choose: informed consent, progressive discipline with employees, HN decision about unit operations, staff decisions regarding patient care
Hawthorne effect
phenomena of how being observed or studied results in a change in behavior
In Maslow's Hierarchy, what are examples of Safety and security needs?
physical safety, psychological safety. but prioritize physical safety.
injury
physical; must be physical, not merely psychological or transient; some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider
independent practice association
physician maintain individual or group practice but contract with HMO with a fee
staff model
physicians are HMO employees and are paid a salary is this type of HMO
maslow heirarchy of needs first priority
physiological needs - ABC, water, food (O2 therapy, circulatory support, IV hydration, nutrition, crtical lab values, treatment)
change process: implementation (3)
plan goes live; provide information; competency-based education; the benefits stated as positive outcomes actually begin to materialize
Act
plan the next cycle; decide whether the change can be implemented; examine outcomes; consider modifications for initiating the cycle again for refinement of the process; continue seeking improvements
initiating structure
planning, directing others, and establishing deadlines
leadership values
possess high standards and expectation
position power
possessed by virtue of one's position within an organization or status within a group
5 Factors a nurse must assess when making a decision to delegate nursing tasks
potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and level of patient interaction.
organizational characteristics
presence of a cohesive groups formal organization rigid adherence to rules low position power
Scheduling
primary concerns include patient acuity, volume of patients, state licensing standards, needs and experience of the staff, the environmental layout of the unit, the organization's mission, philosophy and policies
acculturation
process by which a person becomes a competent participant in the dominant culture
communication
process by which information is clearly and accurately exchanged among team members
EBC
process further involves the integrating of both clinician-observed evidence and research directed evidence
situation monitoring
process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team
assignment making
process of assigning the duties and all aspects of care for a patient to individual personnel
management
process of coordinating action and allocating resources to achieve organizational goals
Management
process of coordinating actions and allocating resources to achieve organizational goals
check-back
process of employing closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended
transcultural delegation
process of having personnel perform duties with the diversities culture taken into consideration.
leadership
process of influence whereby the leader influences others toward goal achievement
Leadership
process of influence whereby the leader influences others toward goal achievement--leaders motivate and enliven
delegation
process of transferring a selected nursing task in a situation to an individual who is competent to perform that specific task.
clinical ladder
programs encouraging nurses to earn promotion, gain recognition, and to increase pay by meeting specific requirements
beneficence
promote good, doing good to others; consists of mercy, kindness & charity deed; taking actions to benefit & promote the welfare of people; doing good; help prevent or remove harms or improve situation of others: educating community about STD prevention; progressive discipline; encouraging pt to stop smoking
in RACE, what to do in Rescue stage?
protect and evacuate clients in close proximity to the fire
telephone orders should be transcribed directly on
providers order sheet in the medical record
when using restraints, what kind of knot should you use?
quick release knot (as opposed to a square knot)
Chaos Theory (change)
rapidly changing nature of human and world factors underscores how an emphasis on rules and policies is shortsighted, wastes time, and fails to accomplish goals in the long run.
near miss
recognition that an event occurred that might have led to an adverse event
workplace advocacy
refers to acting on or in behalf of another who is unable to act for himself or herself to effect change about workplace conditions; activities aimed at addressing nursing challenges faced by nurses in their practice setting
multiculturalism
refers to maintaining several different cultures simultaneously
cross-culturalism
refers to mediating between two cultures (one's own and another)
responsibility
reliability, dependability, and the obligation to accomplish work; also includes each person's obligation to perform at an acceptable level
ethical issues encountered in practice
technology (when to use, stop using, or who can use); cost containment; Patient's rights; staffing issues; impaired nurses; confidentiality; refusal of treatment...
situational leadership theory "styles
telling selling participating delegating
ad hoc committee
temporary; dissolves once issue is resolved
intrapersonal conflict
tension or stress that exists within an individual as a result of unmet needs, expectations, or goals Example: A nurse wants to move up on the career ladder but is finding that time with her family is subsequently compromised
power
the ability to influence others in the effort to achieve goals; ability to create, get and/or use resources to achieve one's goals
cost
the amount spend on something; national healthcare costs are a function of the price and utilization of healthcare services; a healthcare provider's costs are the expenses involved in providing goods or services
what is an example of assault?
the conduct of one person makes another person fearful and apprehensive (threatening to place an NG tube in a client who is refusing to eat)
under delegate
the delegator does not think team member can perform or complete assignment
when moving a patient in bed, face
the direction of movement
Assignment
the distribution of work that each staff member is responsible for during a given work period. Assignment occurs when a nurse directs an individual to do something the individual is already authorized to do.
error
the failure of a planned action to be completed as intended (error of execution) or the use of the wrong plan to achieve an aim (error in planning); directly related to outcomes
patient acuity
the measure of nursing workload generated for each patient
SWOT analysis
tool for conducting environmental assessments; identifies both strengths and weaknesses in the internal environment and opportunities and threats in the external environment Strengths Weaknesses Opportunities Threats
group model
HMO contracts multispecialty group to provide service with negotiated fee
ABC stands for:
Airway, Breathing, Circulation (sometimes, a major circulation problem may be addressed before a very minor breathing problem) KEEP THIS IN MIND
Organizing
Allocation and configuring of resources
network model
HMO contracts with two or more IPA to provide a monthly fee called capitation
Ethnocentrism
An assumption of cultural superiority and an inability to accept the ways of another culture
An older adult is being started on a new antihypertensive medication. In teaching the client about the medication, the nurse:
Allows the client time to express himself or herself and ask questions
Formal Leadership
When a person is in a position of authority or in a sanctioned role within an organization that connotes influence
Maintaining Silence
Allows time to organize thoughts and formulate an appropriate response; often conveys respect, understanding, caring, and support; allows observation of patient's nonverbal responses.
Silence for Considering
American Indian, Chinese and Japanese.
ROLES
an acronym used to identify the components of a role: responsibilities, opportunities, lines of communication, expectations, and support
Roger's Diffusion of Innovations Theory (change)
1. Knowledge 2. Persuasion 3. Decision 4. Implementation 5. Confirmation
Jewish Women
Impure on period.
Leadership
Inspiring people to accomplish goals through support and confidence building
LEGAL RISK AREAS **Battery
Intentional touching of another without consent
Agressive Communication
Interact with another in an overpowering and forceful manner to meet your own personal needs at the expense of the other.
TELEPHONE PRESCRIPTIONS
*Date & time the entry *Repeat the prescription to the HCP & record *Sign the prescription: begin with "t.o. (telephone order), write the HCP's name & sign *If another nurse witnessed the prescription, that nurses' name follows *The HCP needs to countersign the prescription within a time frame according to agency policy
COMPONENTS OF A MEDICATION PRESCRIPTION
*Date & time written *Medication name *Medication dosage *Route of administration *Frequency of administration *HCP's signature
(auto)cratic leadership
centralized decision making with leader making decisions and using power to command and control others
MENTALLY OR EMOTIONALLY INCOMPETENT CLIENTS **Unable to sign informed consent
*Declared incompetent *Unconscious *Under the influence of chemical agents (alcohol or drugs..even legal ones) *Chronic dementia or other mental deficiency that impairs thought processes and ability to make decisions
transformational theory characteristics
change agents life long learners believe in others courageous value driven able to deal with complexity
budget variance
change in expected revenue or change in expected expense may be due to changes in price, volume, acuity, and wage
Authoritarian/Autocratic (Management Style)
Determines policy and makes all decisions. Ignores subordinates' ideas or suggestions and gives little feedback for work. Tend to make fast decisions and are successful with employees having little training or education.
The assessment phase of the teaching process includes:
Determining learning needs
Root Cause Analysis
Determining the origin of errors with a focus on prevention is known as which of the following?
Stereotyping
Expectation that all people within the same racial, ethnic or cultural group act alike and share the same beliefs and attitudes
motivation
Explain why people act the way they do and how a nurse manager can relate to individuals as human beings and workers
A client needs to learn how to administer a subcutaneous injection. The nurse knows the client is ready to learn when the client:
Expresses the importance of learning the skill
Eye Contact
Extended (longer than 6 sec) Aggression, intimidation, disrespect. Brief but direct (2-6 sec) Interest, respect, caring. Absent of fleeting Shyness, lack of confidence, low self-esteem, disinterest, anxiety, fear, uneasiness, hurriedness, or deference or respect (culture-specific)
243.1 How does your text describe the leading function?
Leading involves harnessing our personal and professional traits to influence others to accomplish the mission.
authority
Legitimate power or official right to act.
in RACE, what to do in Extinguish stage?
Extinguish the fire if possible using an appropriate fire extinguisher Class A- paper, wood, upholstery, rags, or other types of trash fires Class B- flammable liquids and gas Class C- electric fires
Transformational Leader
identifies common values; is committed; inspires others with vision; has long-term vision; looks at effects; empowers others
change process: assessment (1)
identify the problem or the opportunity for change; collect and analyze data--should come from different sources
Human relations
more workers involvement in management; derived from motivation theories
team nursing
most common nursing care delivery system, where rn personnel provides total care to a group
maslows second priority
still primary needs - safety and security needs, prevent falls, re-orient abnormal high or low value, client teaching
call-out
strategy used to communicate important or critical information
initiating structure
style that involves an emphasis on the work to be done a focus on the task and production
LEGAL RISK AREAS **Assault
When a person puts another person in fear of a harmful or offensive contact *The victim fears & believes that harm will result because of the threat
1. Prepare for an influx of patients
At 3 am the emergency department nurse hears that a tornado hit the east side of town. What action does the nurse take first? 1. Prepare for an influx of patients 2. Contract the American Red Cross 3. Determine how to restore essential services 4. Evacuate patients per the disaster plan
intrinsic satisfaction in the work
substitutes for support and encouragement of relationship oriented leader
change process: planning (2)
identify the who, how, and when of change; identify the target date; goals and outcomes clearly determined and stated in measurable terms
226.2 Give an example of each objective of performance management.
Conducting the initial, mid-course, or follow-up performance feedback is an example of the first objective. A completed EPR is an example of the second objective.
in assertive communication, what kind of statements should you use?
"I statements"
234.3 What role might the core values play in effecting change?
"Service Before Self" encourages faith in the system; "Integrity First" encourages responsibility and loyalty; "Excellence In All We Do" encourages a quality effort.
Referent Power
(Leading by Example) Comes from the followers' identification with their leaders. The admired and respected nurse manager for example is able to influence other nurses because of their desire to be like their nurse manager.
INCIDENTS THAT NEED TO BE REPORTED
*Accidental omission of prescribed therapies *Circumstances that lead to injury or a risk for client injury *Client falls *Needle stick injuries *Medication administration errors *Procedure related/equipment related accidents *A visitor injury that occurred in the facility *A visitor who exhibits symptoms of a communicable disease
REPORTING RESPONSIBILITIES
*Certain communicable diseases *Child/elder abuse *Domestic violence *Dog/other animal bite *Gunshot *Stab wounds *Assaults *Homicides *Suicides **Impaired nurse (report to administration)
COMPUTERIZED MEDICAL RECORDS **Protecting client's information
*Employees should have access only to records in the nursing unit or work area *Use of special computer access codes to limit what employees have access to *Use of password/identification code is needed to enter and sign off computer system *Password/identification code should never be shared with another person *Passwords should be changed periodically to prevent unauthorized computer access
NEGLIGENCE
*Conduct that falls below the standard of care *Can include acts of commission and omission *A nurse who does not meet standards of care can be held liable
PROOF OF LIABILITY
*DUTY: At the time of injury, a duty existed between the plaintiff & the defendant *BREACH OF DUTY: The defendant breached duty of care *PROXIMATE CAUSE: The breach of duty was the legal cause of injury to the client *DAMAGE/INJURY: The plaintiff experienced injury or damages or both & can be compensated by law
NEGLIGENT ACTS
*Medication errors that result in injury to the client *IV administration errors: incorrect flow rates; failure to monitor a flow rate that results in injury *Falls that occur as a result of failure to provide safety *Failure to check equipment for proper functioning *Burns sustains as a result of failure to monitor bath temperature or equipment *Failure to monitor client's condition *Failure to report changes in client's condition to HCP *Failure to provide complete end of shift report
MALPRACTICE
*Negligence on the part of a nurse *Determined if the nurse owed a duty to the client & did not carry out the duty and the client was injured
PATIENT'S BILL OF RIGHTS
*Right to considerate & respectful care *Right to be informed about diagnosis, possible treatments, likely outcome, and discussion with HCP *Right to know the names & roles of persons involved in care *Right to consent or refuse a treatment *Right to have an advance directive *Right to privacy *Right to expect that medical records are confidential *Right to review medical record & to have it explained *Right to expect that the hospital will provide necessary health services *Right to know if the hospital has relationships with outside parties that may influence care *Right to consent or refuse to take part in research *Right to be told of realistic care alternatives when hospital care is no longer appropriate *Right to know about hospital rules that affect treatment and charges & payment options
VIOLATIONS OF PRIVACY
*Taking photographs of the client *Release of medical information to unauthorized person *Use of client's name/picture for health care facility's advantage *Intrusion into client's affairs *Publication of information or embarrassing facts about client *Public disclosure of private information *Leaving the curtains/room door open while providing care *Allowing individuals to observe care without consent *Interviewing a client in a room with only a curtain between clients or where conversation can be overheard *Accessing medical records when unauthorized to do so
Do
identifying the steps in a plan; carry out the plan; collect the data; begin analysis of the data--implementation
Delegation: RN ONLY
- Blood Products (2 RNs must check) - Clotting Factors - Sterile dressing changes and procedures - Assessments that require clinical judgment - Ultimately responsible for all delegated duties
Delegation to UAP's. UAPs can
- Non-sterile procedures - Precautions & Room Assignments - Vital signs w/o no assessments - Feedings but not risk for aspiration
What is the RACE sequence?
-Rescue: -Alarm -Contain -Extinguish
12-20 yr = adolescent stage
identity vs. role diffusion aka prob if a kid is DM w/diet compliance b/c want to do what peers are doing
INCIDENT REPORTS
*Used as a means of identifying risk situations & improving care *Follow specific documentation guidelines *Fill out report completely, accurately & factually *Report form should not be copied or placed in client's record *Make no reference to the incident report form in the client's record *The report is not a substitute for a complete entry in the client's record regarding the incident (record the incident and actions taken but not the report itself) *If a client injury or error in care occurred, assess the client frequently
LEGAL RISK AREAS **False Imprisonment
*When a client is not allowed to leave a health care facility when there is no legal justification to detain *When restraining devices are used without an appropriate clinical need (includes meds)
Nursing Process
- Assessment - Diagnosis (Analysis) - Planning - Implementation (treatment) - Evaluation
What are examples of unintentional torts?
-Negligence -Malpractice (professional negligence)
what are the five rights of delegation?
-What tasks should be delegated (right task) -under what circumstances (right circumstance) -to whom (right person) -what information should be communicated (right direction/communication) -how to supervise/evaluate (right supervision/evaluation)
What are the order of steps in post mortem care?
-a specially trained professional should be contacted right away for organ procurement -specimens should be collected before d/c lines and tubes -remove tubes and lines -cleanse body -apply name tag before shrouding (dressing for burial)
as a coordinator of care, what is the nurse responsible for?
-admission, transfer, discharge, and post discharge orders -initiation, revision, and eval of plan of care -report clients status to other nurses and PCP -coordinate discharge plan -facilitate referrals and utilize community resources
death is determined by one of two criteria:
-an irreversible cessation of circulatory and respiratory functions -irreversible cessation of all functions of the entire brain, including the brain stem
what are examples of intentional torts?
-assault -battery -false imprisonment
nurses role in regards to referrals is to
-begin discharge planning upon clients admission -evaluate client/family competencies in relation to home care prior to discharge -involve the client and family in care planning -collaborate with other health care professionals to ensure all health care needs are met and necessary referrals are made -complete referral forms to ensure proper reimibursment for prescribed services
What are examples of Quasi-intentional torts?
-breach of confidentiality -defamation of character
as a case manager, nurse is responsible for?
-coordinating care (esp if complex needs) -facilitating continuity of care -improving efficiency of care and utilize resources -enhance quality of care -limit unnecessary costs and length stays- -advocating for client and fam
step 5 in performance improvement process
-current state of structure and process is analyzed
step 6 in performance improvement process
-data collection methods are determined
step 7 in performance improvement process
-data is collected, analyzed and compared with benchmark
step 10 in performance improvement process
-education or corrective action is implemented
Ethical Decision-Making Framework
-gather data & identify conflicting moral claims -identify key participant -determine moral perspective and phase of moral development of key participants -determine desired outcomes -identify options -act on the choice -evaluate outcomes of the action
What is the provider's role in consent process?
-give a complete description of treatment -describe professionals involved in treatment -describe potential harm, pain and discomfort that may occur -other treatment options -right to refuse treatment
the client's role in consent process?
-give consent voluntarily -be competent -be of legal age, or emancipated minor
discharge planning for a client includes:
-identification of available community resources -providing for continuity of care -verifying that arrangements for medical equipment have been made -coordinate care with other disciplines
step 8 in performance improvement process
-if benchmark not met, determine why
step 4 in performance improvement process
-interdisciplinary team reviews the issue
what does a root cause analysis do?
-investigates the consequence and possible causes of a situation -analyze the possible existing causes and relationships -determines additional influences at each relationship level -determines the root cause(s)
step 11 in performance improvement process
-issue is re-evaluated at a pre-established time to determine efficacy of corrective action
step 9 in performance improvement process
-potential solutions or corrective actions are analyzed and one is selected for implementation
step 3 in performance improvement process
-quality issues are identified by staff, management, or risk management dept.
Step 2 in performance improvement process
-standards are made available to employees via policies and procedures
what is the nurses role in consent process?
-to witness the clients signature -ensure provider gave necessary info -ensure client understood info -notify physician if client has further questions -document reinforcement of info originally given by provider, questions were clarified, and if interpreter was used.
nurses role in discharge
-type of discharge (ordered by physician, AMA) -actual date and time of discharge, who accompanied client, and how client transported -where was the client discharged (home, facility) -a summary of clients condition at discharge -any unresolved difficulties and plans for follow up -dispositions of valuables, meds from home -copy of clients discharge instructions
Predominant Health Belief System
...
in an emergency situation, where a nurse needs to apply restraints, the nurse must obtain an order for restraints within
1 hour
until what age should you use a backward facing car seat?
1 year old and weighs at least 20 pounds
8 Common steps of Quality Improvement
1) Establish a clear and defined aim or purpose 2) Reviewing the literature 3) Examining current resources to facilitate quality improvement 4) Mapping the current processes 5) Analyzing the root causes 6) Selecting appropriate tools for process analysis 7) Selecting measures and metrics (baseline and outcomes) 8) Conducting a rapid cyclical review of the plan, data, interventions, and outcomes
How does the Nurse Practice Act govern a nurses ability to make assignments?
1. Assignments should take into consideration the nurses education and experience level 2. The nurse should supervise the care given by nursing personnel for which they are administratively responsible. 3. Sterile or invasive procedures should be assigned to or supervised by a registered nurse.
Havelock's 6 step change model (change)
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
Lippitt's Phases of Change
1. Diagnosis of the problem 2. assessment of the motivation and capacity for change 3. assessment of the change agent's motivation and resources 4. the selection of progressive change objectives 5. choosing an appropriate role for the change agent 6. maintenance of the change once started 7. termination of the helping relationship
What are the 4 elements necessary to prove negligence or malpractice?
1. Duty 2. Breech of duty 3. Injury/ damages 4. Causation- a connection between the act and the injury
When might a client be restrained?
1. In an emergency 2. For a limited time 3. to protect the client from injury
What are the nursing responsibilities for caring for a restrained patient?
1. Notify the HCP of the restraint immediately 2. Document the facts regarding the rationale for using restraints. 3. Apply restraints only as a last resort 4. Make sure restraints are applied appropriately 5. Check restraints frequently to make sure there is no impairment of circulation or evidence or pressure sores. 6. Remove restraints as soon as possible 7. Document continued need for restraints
What is Maslow's Hierarchy of needs?
1. Physiological needs 2. Safety and Security needs 3. Love and Belonging Needs 4. Self esteem 5. self actualization Pedro Sang Lullaby So Softly
Management Functions
1. Planning 2. Organization 3.Staffing 4.Directing 5. Controlling
What are the 5 rights of delegation?
1. Right task- can it be delegated 2. Right Circumstance- Should it be delegated 3. Right person- can this person do the task 4. Right direction/ communication- is the task being conveyed in a clear manner 5. Right supervision- is the task being followed up on once complete.
Roman Catholic Diet
Fasting excused during hospitalization. No meat on Friday in lent and on ash wednesday.
What are the prioritization principles?
1. Systemic before local (life before limb) 2. Acute before chronic 3. actual problems before potential/future problems 4. listen before assuming (pain after post op might be due to another problem other than expected surgical pain) 5. recognize and respond to TRENDS versus TRANSIENT findings 6. medical emergencies versus expected findings 7. recognize priority action in procedural standards ( antidiabetic med more impt than some other med)
5 Rights of Delegation
1. Task, 2. Circumstance, 3. Person, 4. Direction/Communication, 5. Supervision & Evaluation
Leadership Skills
1. Technical Skills: Clinical expertise and nursing knowledge 2.Human Skills: Ability and judgement to work with people in an effective leadership role. 3.Conceptual skills: ability to understand the complexities of the overall organization and to recognize how and where one's own area of management fits into the overall organization.
5 qualities of leadership
1. Visibility, 2. Flexibility, 3. Authority, 4. Assistance, 5. Feedback
5 Critical tactics in effective change
1. Vision, 2. Skills, 3. Incentives (motivation), 4. Resources and 5. Action plans
When do you use at least 2 patient identifiers?
1. When taking blood samples 2. Administering blood products 3. Administering medications
step 1 in performance improvment process (quality improvement)
1. a standard is developed and approved by facility committee
The conflict process
1. antecedent conditions (latent)-specific preexisting condition 2. Perceived and/or felt conflict-cognition 3. Manifest behavior-visible evidence of conflict 4. Conflict resolution or suppression-leads to developing new attitudes/feelings 5. Resolution aftermath
3 criteria for informed consent
1. consent is given by a person who has legal capacity for giving the consent 2. voluntary action 3. person giving consent must be given sufficient information and comprehend
Components of the Decision making process
1. critical thinking 2. reflective thinking 3. emotional intelligence 4. intuition
Proving malpractice
1. duty of care was owed to the injured party 2. breach of duty owed 3. foreseeability 4. causation 5. injury 6. damages
Eastern Orthodox Diet
Fasting from meat and dairy on Wednesdays of Fridays during lent. Exempt if detrimental to health.
stages of group and team development
1. forming: orientation; team aquaints and establishes team rules 2. storming: conflict; members resist control by group leaders and show hostility 3. norming: cohesion; members work together developing close relationships ad feeling so comaraderie 4. performing: working;team members work toward getting their job done 5. adjourning: termination; team may disband on achieving goals or because members leave; or reforming stage (instead of adjourning)
decision making process
1. identify need for a decision 2. determine goal/outcome desired 3. identify consequences/benefits of alternatives 4. make decision 5. evaluate decision
what are the steps to take in a sexual harassment case?
1. immediately confront the harasser and state that the behavior is unwanted and should be stopped. 2. The incident should then be reported to the supervisor, 3. documented in detail, and maintained in a secure file that is not kept at the place of employment. 4. If behavior does not stop, the nurse should file a formal grievance against the harasser.
Self-actualization:
1. organization meets the needs by development of employee's skills, chance to be creative, achievement & promotions, & to have complete control over their job.
Consent is considered to be informed when client has been provided with, and understands...
1. reason the treatment/procedure is needed 2. how the treatment/procedure will benefit the client 3. the risks involved in treatment 4. other options to treat problem
Lewin's Force-Field Model (change)
1. unfreezing: the awareness of an opportunity, need, or problem for which some action is necessary 2. Moving to a new level of behavior: leads to incorporation of what is new or different into work and interpersonal processes 3. refreezing (stabilize new change): occurs when the participants in the change situation accept and use the new attitude or behavior
Staffing
1.Determine the number and the type of staff needed based on goals and budget 2.Recruit, interview, select, and assign personnel based on job description requirements and performance standards 3.Offer an excellent orientation, training, and socialization program for the new employee 4.Implement an ongoing staff-development program to ensure staff has opportunities to enhance knowledge and skills 5.Implement creative and flexible scheduling based on patient care needs, employee needs, and organizational productivity requirements.
Stages of Change
1.Unfreezing stage:Problem identified and awareness of need to change 2.Moving Stage:Defines goals and plans the change 3.Refreezing Stage: Change integrates into the organization and is recognized as new status quo. *If the refreezing stage does not occur, staff will drift into old habits
Planning
1.defining goals and objectives 2.identify resources 3.determine action steps 4.Establish a timeline for action goals and goal achievement
water heater should be set to no higher than
120 degrees F.
when a client is in restraints, the frequency of client assessment with regard to food, fluids, comfort, and safety should be performed and documented every
15-30 minutes
establishing priorities
1st priority: a life-threatening or potentially life-threatening occurrence 2nd priority: activities essential to safety (life saving medications, assisting others with lifting) 3rd priority: activities essential to the plan of care (symptom management, other medications)
Self-esteem:
2. meet needs through titles, pay raises, recognition, etc.
crib slats should be no more than ___ inches apart
23/8
How many types of torts are there?
3
Social needs (love & belonging)
3. : needs are meet through interaction with others, to be accepted, to have friends, etc
at what angle should an infant car seat be placed?
45 degrees
STEEEP
6 IOM quality aims Safe Timely Effective Efficient Equitable Patient-Centered
Resource Dependence
: emphasizes the need to secure necessary resources and provides reliable and valid data on
Strategic managmeent
: fit or alignment between organizational strategy, external environment, and internal structure and capabilities
Safety
: to meet inflation, safe working conditions, salary increases medical in`rance
1. "Are you thinking of suicide?"
A 34-year old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. Your best response would be which of the following? 1. "Are you thinking of suicide?" 2. "You've been doing a good job raising your children. You can do it!" 3. "Is there someone who can help you?" 4. "You have so much to live for."
leader-member relations
Feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader
1. A safe environment promotes patient activity.
A 62-year old woman is being discharged home with her husband after surgery for a hip fracture from a fall at home. When providing discharge teaching about home safety to his patient and her husband, the nurse knows that: 1. A safe environment promotes patient activity. 2. Assessment focuses on environmental factors only. 3. Teaching home safety is difficult to do in the hospital setting. 4. Most accidents in the older adult are caused by lifestyle factors.
3, 5, 2, 4, 1
A 67-year old patient will be discharged from the hospital in the morning. The health care provider has ordered three new medications for her. Place the following steps of the nursing process in the correct order: 1. The nurse returns to the patient's room and asks her to describe the medications she will be taking at home. 2. The nurse talks with the patient and family about who will be available if the patient has difficulty taking medicines and considers consulting with the health care provider about a home health visit. 3. The nurse asks the patient if she is in pain, feels tired, and is willing to spend the next few minutes learning about her medications. 4. The nurse brings the containers of medicines and information leaflets to the bedside and discusses each medication with her. 5. The nurse considers what she learns from the patient and identifies the patient's nursing diagnosis.
4. Clear the area around the child to protect child from injury.
A child in the hospital starts to have a grand mal seizure while playing in the playroom. What is your most important nursing intervention in this situation? 1. Begin cardiopulmonary respiration. 2. Restrain the child to prevent injury. 3. Place a tongue blade over the tongue to prevent aspiration. 4. Clear the area around the child to protect child from injury.
2. "Tell me what bothers you the most about this experience."
A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress the nurse says: 1. "Tell me who I can call to help you." 2. "Tell me what bothers you the most about this experience." 3. "I'll contact someone who can help get you temporary housing." 4. "I'll sit with you until other family members can come help you get settled."
Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately.
A client who had a "Do Not Resuscitate" order passed away. After verifying there is no pulse or respirations, the nurse should next:
4. Automobile accidents, suicide, and substance abuse
A couple is with their adolescent daughter for a school physical and state they are worried about all the safety risks affecting this age. What is the greatest risk for injury for an adolescent? 1. Home accidents 2. Physiological changes of aging 3. Poisoning and child abduction 4. Automobile accidents, suicide, and substance abuse
3. Basic critical thinking
A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley catheter to be inserted, so the nurse reads the procedural manual for the institution to review how to insert it. The level of critical thinking that the nurse is using is: 1. Commitment 2. Scientific method 3. Basic critical thinking 4. Complex critical thinking
2. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks
A crisis intervention nurse working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her entitlement check while the child is hospitalized can expect the mother to regain the stability after how long? 1. After 2 weeks when the child's pneumonia begins to improve 2. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks 3. After 1 month when the child goes home and the mother gets help from a food pantry 4. After 6 months when the child is back in school
4. Informatics
A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia cause by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics
3. An adventitious crisis
A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of: 1. A situational crisis 2. A maturational crisis 3. An adventitious crisis 4. A developmental crisis
Race
A group of people who share biologic physical characteristics and hereditary factors.
Race
A grouping of people based on biological similarities; members of a racial group have similar physical characteristics, such as blood group; facial features; and color of skin, hair, and eyes
The choices involved do not appear to be clearly right or wrong.
A health care issue often becomes an ethical dilemma because
236.4 As a leader, what two areas must you look at when assessing the organizational environment?
A leader would be looking at resource availability (human, financial, physical and information), as well as leadership actions (establishing direction and priorities, creating policy, making decisions and providing information).
what is an example of negligence ?
A nurse fails to implement safety measures for a client who has been identified as at risk for falls
3. Analyticity 4. Self-Confidence
A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker and states. "I feel funny." The nurse knows how patients often have behavior changes before developing sepsis when they have cancer. The nurse asks the patient questions to assess thinking skills and notices the patient shivering. The nurse goes to the phone, calls the physician, and begins the conversation by saying, "I believe that your patient is developing sepsis. I want to report symptoms I'm seeing." What examples of critical thinking concepts does the nurse show? (Select all that apply.) 1. Experience 2. Ethical 3. Analyticity 4. Self-Confidence 5. Risk taking
2. Advocate
A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with the family. The nurse is acting as the patient's: 1. Educator 2. Advocate 3. Caregiver 4. Case manager
2. Safety
A nurse is caring for an older-adult couple in a community-based assisted living facility. During the family assessment he notes that the couple has many expired medications and multiple medications for their respective chronic illnesses. They note that they go to two different health care providers. The nurse begins to work with the couple to determine what they know about their medications and helps them decide on one care provider rather than two. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork 4. Informatics
3. The patient will perform breast self-examination correctly on herself before the end of the teaching session.
A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? 1. The patient will verbalize the steps involved in breast self-examination within 1 week. 2. The nurse will explain the importance of performing breast self-examination once a month. 3. The patient will perform breast self-examination correctly on herself before the end of the teaching session. 4. The nurse will demonstrate breast self-examination on a breast model provided by American Cancer Society.
2. A learning objective
A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: 1. A teaching plan 2. A learning objective 3. Reinforcement of content 4. Enhancing the children's self-efficacy
1. Cognitive
A nurse is teaching a 27-year old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? 1. Cognitive 2. Affective 3. Adaptation 4. Psychomotor
4. Health promotion and illness prevention
A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? 1. Simulation 2. Restoring health 3. Coping with impaired function 4. Health promotion and illness prevention
1. A nurse explain to the NAP the approach to use in getting the patient up and why the patient has activity limitations. 3. The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patient up early. 4. The nurse is in Patient B's room to check an intravenous (IV) line and collects the urine specimen while in the room.
A nurse is working with a nursing assistive personnel (NAP) on a bust oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting patient A out of bed, collecting a urine sample from patient B, and checking vital signs on patient C, who is scheduled to go home. Which of the following represent(s) successful delegation? (Select all that apply.) 1. A nurse explain to the NAP the approach to use in getting the patient up and why the patient has activity limitations. 2. A nurse is asked by a patient to help her to the bathroom; the nurse leaves the room and directs the NAP to assist the patient instead. 3. The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patient up early. 4. The nurse is in Patient B's room to check an intravenous (IV) line and collects the urine specimen while in the room. 5. The nurse offers to support the NAP when needed but allows her to complete patient care tasks without constant oversight.
1. How to use an inhaler during an asthma attack
A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? 1. How to use an inhaler during an asthma attack 2. The need to avoid people who smoke to prevent asthma attacks 3. Where to purchase a medical alert bracelet that says she has asthma 4. The importance of maintaining a healthy diet and exercising regularly
3. Chronic illness
A nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which of the following while assessing the patient? 1. Posttraumatic stress disorder 2. Rising hormone levels 3. Chronic illness 4. Return of vital signs to normal
2. Think about past experience with patients who develop postoperative complications. 3. Decide which activities can be combined for patient B and C.
A nurse who is working on a surgical unit is caring for four different patients. Patient A will be discharged home and is in need of instruction about wound care. Patients B and C have returned from the operating room within an hour of each other, and both require vital signs and monitoring of their intravenous (IV) lines. Patient D is resting following a visit by physical therapy. Which of the following activities by the nurse represent(s) use of clinical decision making for groups of patients? (Select all that apply.) 1. Consider how to involve patient A in deciding whether to involve the family caregiver in wound care instruction. 2. Think about past experience with patients who develop postoperative complications. 3. Decide which activities can be combined for patient B and C. 4. Carefully gather any assessment information and identify patient problems.
3. Call the poison control center.
A parent calls the pediatrician's office frantic about the bottle of cleaner that her 2-year old son drank. Which of the following is the most important instruction the nurse gives to the parent? 1. Give the child milk. 2. Give the child syrup of ipecac. 3. Call the poison control center. 4. Take the child to the emergency department.
2. Evaluation
A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL of drainage in the surgical drainage collection device for an 8 hour period. The nurse refers to the written plan of care, noting that the health care provider is to be notified when drainage in the device exceeds 100 mL for the day. On entering the room, the nurse looks at the device and carefully notes the amount of drainage currently in it. This is an example of: 1. Planning 2. Evaluation 3. Intervention 4. Diagnosis
4. Implementation
A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice performed? 1. Planning 2. Evaluation 3. Assessment 4. Implementation
2. Expressing the importance of learning the skill correctly
A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? 1. Describing difficulties a family member has had in taking insulin 2. Expressing the importance of learning the skill correctly 3. Being able to see and understand the markings on the syringe 4. Having the dexterity needed to prepare and inject the medication
4. Psychomotor domain
A patient needs to learn to use a walker. Which domain is required for learning this skill? 1. Affective domain 2. Cognitive domain 3. Attentional domain 4. Psychomotor domain
3. Provide only the information that the patient needs to go home
A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? 1. Teach the patient's spouse 2. Focus on knowledge the patient will need in a few weeks 3. Provide only the information that the patient needs to go home 4. Convince the patient that learning about her health is necessary
4. With silence.
A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." The nurse responds: 1. "Let's talk about something cheerful." 2. "Do other members of your family have diabetes?" 3. "I can tell that you feel stressed to learn that you have diabetes." 4. With silence.
3. Conducting reflective practice.
A patient on a surgical unit develops sudden shortness of breath and a drop in blood pressure. The staff respond, but the patient dies 30 minutes later. The manager on the nursing unit calls the staff involved in the emergency response together. The staff discusses what occurred over the 30-minute time frame, the actions taken, and whether other steps should have been implemented. The nurses in this situation are: 1. Problem solving. 2. Showing humility. 3. Conducting reflective practice. 4. Exercising responsibility.
1. Denial.
A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "the hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." The patient is using the defense mechanism: 1. Denial. 2. Conversion. 3. Dissociation. 4. Displacement.
2. Demonstration
A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use? 1. Simulation 2. Demonstration 3. Group instruction 4. One-on-one discussion
1. Telling approach
A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation? 1. Telling approach 2. Selling approach 3. Entrusting approach 4. Participating approach
3. Obtains an interpreter to facilitate communication of medication information
A patient with limited English proficiency is going to be discharged on new medication. How does the nurse complete the discharge teaching? 1. Uses a dictionary to give directions for medication administration 2. Explains the directions to the patient's 14-year old daughter 3. Obtains an interpreter to facilitate communication of medication information 4. Uses a picture board and visual aids to communicate medication administration information
3, 4, 1, 5, 2
A physician writes an order to apply a wrist restraint to a patient who has been pulling out a surgical wound drain. Place the following steps for applying the restraint in the correct order. 1. Explain what you plan to do. 2. Wrap a limb restraint around wrist or ankle with soft part toward skin and secure. 3. Determine that restraint alternatives fail to ensure patient's safety. 4. Identify the patient using proper identifier. 5. Pad the patient's wrist.
229.2 Explain how properly conducting the feedback session strengthens organizational effectiveness.
A properly conducted feedback session will let the subordinate know if they are meeting, exceeding, or failing to meet the standardsthat have been established. The session will also let the subordinate know why it is happening and a plan to continue to modify the behavior will be developed. This gives the subordinate the direction they need in order to be able to fully contribute to organizations preocesses.
4. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.
A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. The supervising nurse recognizes that: 1. Nurses who feel stress usually pass the stress along to their patients. 2. A nurse who feels stress is ineffective as a nurse and should not be working. 3. Nurses who talk about feeling stress are unprofessional and should calm down. 4. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.
Belief
A theory accepted as true by a culture
Organizational Chart
A visual picture of the organization that identifies lines of communication and authority.
Clinical Pathway
A written plan that identifies key incidents, which must occur at set times to achieve client outcomes within an appropriate time frame (such as length of stay in hospital). These case management tools reflect research, experience, & consensus priorities of a multidisciplinary group of providers actively engaged in providing care to the target population.
237.3 What AFI states that NCOs are delegated authority necessary to exercise leadership commensurate with their rank and responsibility?
AFI 36-2618, The Enlisted Force Structure.
What is the legal significance of a nurse's action when the nurse threatens a demanding client with restraints? A. The nurse can be charged with assault. B. The nurse can be charged with negligence. C. The nurse can be charged with malpractice. D. The nurse can be charged with beneficence.
ANS: A Assault is an act that results in a person's genuine fear and apprehension that he or she will be touched without consent.
A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? A. Allow the client to decline the medication and document. B. Tell the client that if the medication is refused, hospitalization will occur. C. Arrange with a relative to add medication to the client's morning orange juice. D. Call for help to hold the client down while the injection is administered.
ANS: A It is ethically appropriate for the nurse to allow the client to decline the medication and provide accurate documentation. The client's right to refuse treatment should be upheld unless the refusal puts the client or others in harm's way.
An inpatient client, whom the treatment team has determined to be a danger to self, gives notice of intention to leave the hospital. What information should the nurse recognize as having an impact on the treatment team's next action? A. State law determines how long a psychiatric facility can hold a client. B. Federal law determines if the client is competent. C. The client's family involvement will determine if discharge is possible. D. Hospital policies will determine treatment team actions.
ANS: A Most states commonly cite that in an emergency a client who is dangerous to self or others may be involuntarily hospitalized.
A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care? A. Northern European Americans B. Native Americans C. Latino Americans D. African Americans
ANS: A The community health nurse should anticipate that Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related to this group's educational level and financial capability. Many members of the Native American, Latino American, and African American subgroups value folk medicine practices.
Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworker's lack of involvement? A. Taking no action is still considered an unethical action by the coworker. B. Taking no action releases the coworker from ethical responsibility. C. Taking no action is advised when potential adverse consequences are foreseen. D. Taking no action is acceptable because the coworker is only a bystander.
ANS: A The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. The coworker has a responsibility to report any observed unethical actions.
A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? A. Refusing to give any information to the caller, citing rules of confidentiality B. Refusing to give any information to the caller by hanging up C. Affirming that the person has been seen at the facility but providing no further information D. Suggesting that the caller speak to the client's therapist
ANS: A The most appropriate action by the nurse is to refuse to give any information to the caller. Admission to the facility would be considered protected health information (PHI) and should not be disclosed by the nurse without prior client consent.
A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate? A. Try to locate a shaman that will agree to come to the ED. B. Explain to the client that "voodoo" medicine will not heal the ulcerated toe. C. Ask the client to explain what the shaman can do that the physician cannot. D. Inform the client that refusing treatment is a client's right.
ANS: A The most appropriate nursing intervention would be to try to locate a shaman who will agree to come to the ED. The nurse should understand that in the Native American culture, religion and health-care practices are often intertwined. The shaman, a medicine man, may confer with physicians regarding the care of a client. Research supports the importance of both health-care systems in the overall wellness of Native American clients.
A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief should a nurse associate with this client's behavior? A. Families are male dominated with clear male-female role distinctions. B. Religious tenets support the use of violence in a marital context. C. The nuclear family is female dominated and the mother possesses ultimate authority. D. Marriage dynamics are controlled by dominant females in the family.
ANS: A The nurse should associate the cultural belief that families are male dominated with clear male-female role distinctions with the client's abusive behavior. The father in the Latin American family usually possesses the ultimate authority.
In what probable way should a nurse expect an Asian American client to view mental illness? A. Mental illness relates to uncontrolled behaviors that bring shame to the family. B. Mental illness is a curse from God related to immoral behaviors. C. Mental illness is cured by home remedies based on superstitions. D. Mental illness is cured by "hot and cold" herbal remedies.
ANS: A The nurse should expect that many Asian Americans are most likely to view mental illness as uncontrolled behavior that brings shame to the family. It is often more acceptable for mental distress to be expressed as physical ailments.
Which cultural considerations should a nurse identify with Western European Americans? A. They are present-time oriented and perceive the future as God's will. B. They value youth, and older adults are commonly placed in nursing homes. C. They are at high risk for alcoholism due to a genetic predisposition. D. They are future oriented and practice preventive health care.
ANS: A The nurse should identify that most Western European Americans are present oriented and perceive the future as God's will. Older adults are held in positions of respect and are often cared for in the home instead of nursing homes.
A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? A. Autonomy B. Beneficence C. Nonmaleficence D. Justice
ANS: A The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian or representative would be asked to give consent.
During the first interview with a man from Syria who has just lost his son in a car accident, in sympathy for the man's loss, the female nurse reaches out and hugs him. Which is an accurate evaluation of the nurse's action? A. The nurse's action should be evaluated as unacceptable due to breech of cultural norms. B. The nurse's action should be evaluated as empathetic; encouraging expressions of feelings. C. The nurse's action should be evaluated as the technique of offering self. D. The nurse's action should be evaluated as inappropriate due to poor timing.
ANS: A The nurse's action should be evaluated as unacceptable due to breech of cultural norms. During communication, Arab Americans stand close together, maintain steady eye contact, and may touch the other's hand or shoulder but only between members of the same sex.
A female nurse is caring for an Arab American male client. When planning effective care for this client, the nurse should be aware of which of the following cultural considerations? (Select all that apply.) A. Limited touch is acceptable only between members of the same sex. B. Conversing individuals of this culture stand far apart and do not make eye contact. C. Devout Muslim men may not shake hands with women. D. The man is the head of the household and women take on a subordinate role. E. Men of this culture are responsible for the education of their children.
ANS: A, C, D When planning effective care for this client, the nurse should be aware that limited touch within this culture is acceptable only between members of the same sex, that devout Muslim men may not shake hands with women, and that women are subordinate to the man, who is the head of household. Conversing individuals of this culture stand close together and maintain eye contact. Arab American women are responsible for the education of the children.
After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department by police. The client threatens suicide. Which criteria would enable a physician to consider involuntary commitment? (Select all that apply.) A. Being dangerous to others B. Being homeless C. Being disruptive to the community D. Being gravely disabled and unable to meet basic needs E. Being suicidal
ANS: A, D, E The physician could consider involuntary commitment when a client is being dangerous to others, is gravely disabled, or is suicidal. If the client is determined to be mentally incompetent, consent should be obtained from the legal guardian or court-approved guardian or conservator. A hospital administrator may give permission for involuntary commitment when time does not permit court intervention.
negotiating
Conferring with others to bring about a settlement of differences; high level of discussion with permanent solution; requires highly developed skills & careful communication-make party feel satisfied with the outcome; can not return to conflict-union contract, change in policy
Which is an example of an intentional tort? A. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome. B. A nurse physically places an irritating client in four-point restraints. C. A nurse makes a medication error and does not report the incident. D. A nurse gives patient information to an unauthorized person.
ANS: B A tort is a violation of civil law in which an individual has been wronged and can be intentional or unintentional. A nurse who physically places an irritating client in restraints has touched the client without consent and has committed an intentional tort.
A nursing instructor is teaching about cultural characteristics. Which statement by the student indicates the need for further instruction? A. "All cultures communicate freely within their group." B. "All cultures embrace light therapeutic touch." C. "All cultures view the importance of timeliness differently." D. "All cultures display biological variations."
ANS: B All cultures do not embrace light therapeutic touch. In the Native American culture, if a hand is offered to another it may be accepted with a light touch; however, in the Asian culture, touching during communication has been historically considered unacceptable. This student statement indicates the need for further instruction.
In the situation presented, which nursing intervention constitutes false imprisonment? A. The client is combative and will not redirect stating, "No one can stop me from leaving." The nurse seeks the physician's order after the client is restrained. B. The client has been consistently seeking the attention of the nurse much of the day. The nurse institutes seclusion. C. A psychotic client, admitted in an involuntary status, runs off the psychiatric unit. The nurse runs after the client and the client agrees to return. D. A client hospitalized as an involuntary admission attempts to leave the unit. The nurse calls the security team and they prevent the client from leaving.
ANS: B False imprisonment is the deliberate and unauthorized commitment of a person within fixed limits by the use of verbal or physical means. Seclusion should only be used in an emergency situation to prevent harm after least restrictive means have been unsuccessfully attempted.
The experience of being physically restrained can be traumatic. Which nursing intervention would best help the client deal with this experience? A. Administering a tranquilizing medication before applying the restraints B. Talking to the client at brief but regular intervals while the client is restrained C. Decreasing stimuli by leaving the client alone most of the time D. Checking on the client infrequently, in order to meet documentation requirements
ANS: B Restraints are never to be used as punishment or for the convenience of the staff. Connecting with the client by maintaining communication during the period of restraint will help the client recognize this intervention as a therapeutic treatment versus a punishment.
During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework? A. "I would want to be treated in a caring manner if I were mentally ill." B. "This job will pay the bills, and the workload is light enough for me." C. "I will be happy caring for the mentally ill. Working in Med/Surg kills my back." D. "It is my duty in life to be a psychiatric nurse. It is the right thing to do."
ANS: B The applicant's comment reflects an ethical egoism framework. This framework promotes the idea that decisions are made based on what is good for the individual and may not take the needs of others into account.
In response to a student's question regarding choosing a psychiatric specialty, a charge nurse states, "Mentally ill clients need special care. If I were in that position, I'd want a caring nurse also." From which ethical framework is the charge nurse operating? A. Kantianism B. Christian ethics C. Ethical egoism D. Utilitarianism
ANS: B The charge nurse is operating from a Christian ethics framework. The imperative demand of Christian ethics is to treat others as moral equals by permitting them to act as we do when they occupy a position similar to ours. Kantianism states that decisions should be made based on moral law and that actions are bound by a sense of moral duty. Utilitarianism holds that decisions should be made focusing on the end result being happiness. Ethical egoism promotes the idea that what is right is good for the individual.
Which situation exemplifies both assault and battery? A. The nurse becomes angry, calls the client offensive names, and withholds treatment. B. The nurse threatens to "tie down" the client and then does so against the client's wishes. C. The nurse hides the client's clothes and medicates the client to prevent elopement. D. The nurse restrains the client without just cause and communicates this to family.
ANS: B The nurse in this situation has committed both assault and battery. Assault refers to an action that results in fear and apprehension that the person will be touched without consent. Battery is the touching of another person without consent.
When working with clients of a particular culture, which action should a nurse avoid? A. Maintaining eye contact based on cultural norms B. Assuming that all individuals who share a culture or ethnic group are similar C. Supporting the client in participating in cultural and spiritual rituals D. Using an interpreter to clarify communication
ANS: B The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals.
An African American youth, growing up in an impoverished neighborhood, seeks affiliation with a black gang. Soon he is engaging in theft and assault. What cultural consideration should a nurse identify as playing a role in this youth's choices? A. Most African American homes are headed by strong, dominant father figures. B. Most African Americans choose to remain within their own social organization. C. Most African Americans are uncomfortable expressing emotions and need group affiliations. D. Most African Americans have limited religious beliefs which contribute to criminal activity.
ANS: B The nurse should identify that a tendency to remain within one's own social organization may have played a role in this youth's choice to join a black gang. African Americans who have assimilated into the dominant culture are likely to be well educated and future focused. Those who have not assimilated may be unemployed or have low-paying jobs, and view the future as hopeless given their previous encounters with racism and discrimination.
3. Assessment
An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, auscultates her lung sounds, listens to her heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed? 1. Diagnosis 2. Evaluation 3. Assessment 4. Implementation
Which client should a nurse identify as a potential candidate for involuntary commitment? A. A client living under a bridge in a cardboard box B. A client threatening to commit suicide C. A client who never bathes and wears a wool hat in the summer D. A client who eats waste out of a garbage can
ANS: B The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatment is a danger to self and requires emergency treatment.
Group therapy is strongly encouraged, but not mandatory, on an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy preserve? A. Justice B. Autonomy C. Veracity D. Beneficence
ANS: B The unit manager's policy regarding voluntary client participation in group therapy preserves the ethical principle of autonomy. The principle of autonomy presumes that individuals are capable of making independent decisions for themselves and that health-care workers must respect these decisions.
To effectively care for Asian American clients, a nurse should be aware of which cultural norm? A. Obesity and alcoholism are common problems. B. Older people maintain positions of authority within the culture. C. "Tai" and "chi" are the fundamental concepts of Asian health practices. D. Asian Americans are likely to seek psychiatric help.
ANS: B To effectively care for clients of the Asian American culture, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. The balance of "yin" and "yang," not "tai" and "chi," is the fundamental concept of Asian health practices. In the Asian culture, psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families.
When interviewing a client of a different culture, which of the following questions should a nurse consider asking? (Select all that apply.) A. Would using perfume products be acceptable? B. Who may be expected to be present during the client interview? C. Should communication patterns be modified to accommodate this client? D. How much eye contact should be made with the client? E. Would hand shaking be acceptable?
ANS: B, C, D, E When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview, modifications of communication patterns, amount of eye contact, and hand-shaking acceptability. Given that cultural influences affect human behavior, its interpretation, and another person's response, it is important for nurses to understand the effects of these cultural influences to work effectively with diverse populations.
Because of cultural characteristics, in which of the following cultural groups would a nurse's assessment of mood and affect be most challenging? (Select all that apply.) A. Arab Americans B. Native Americans C. Latino Americans D. Western European Americans E. Asian Americans
ANS: B, E The nurse should expect that both Native Americans and Asian Americans might be difficult to assess for mood and affect. In both cultures, expressing emotions is difficult. Native Americans are encouraged to not communicate private thoughts. Asian Americans may have a reserved public demeanor and may be perceived as shy or uninterested.
The nursing staff is discussing the concept of competency. Which information about competency should a nurse recognize as true? A. Competency is determined with a client's compliance with treatment. B. Refusal of medication can initiate an incompetency hearing leading to forced medications. C. A competent client has the ability to make reasonable judgments and decisions. D. Competency is a medical determination made by the client's physician.
ANS: C A competent individual's cognition is not impaired to an extent that would interfere with decision making.
Which cultural group is correctly matched with the disease process for which this group is most susceptible? A. African Americans are susceptible to lactose intolerance. B. Western European Americans are susceptible to malaria. C. Arab Americans are susceptible to sickle cell disease. D. Jewish Americans are susceptible to thalassemia.
ANS: C A number of genetic diseases are more common in the Arab American population, including sickle cell disease, tuberculosis, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, parasitic infestations, thalassemia, and cardiovascular disease.
A client is concerned that information given to the nurse remains confidential. Which is the nurse's best response? A. "Your information is confidential. It will be kept just between you and I." B. "I will share the information with staff members only with your approval." C. "If the information impacts your care, I will need to share it with the treatment team." D. "You can make the decision whether your physician needs this information or not."
ANS: C Basic to the psychiatric client's hospitalization is his or her right to confidentiality and privacy. When admitted to an inpatient psychiatric facility, a client gives implied consent for information to be shared with health-care workers specifically involved in the client's care.
A nurse is preparing to establish a therapeutic relationship with a grieving family from China. Which nursing intervention would be considered most appropriate? A. Touch each member lightly as this enhances the communication process. B. Direct questions to the young males of the family as they maintain positions of authority. C. Avoid direct eye contact as it implies rudeness. D. Remain objective and empathetic as Asians express feelings freely.
ANS: C In the Asian culture, eye contact is often avoided as it connotes rudeness and lack of respect.
There is one bed available on an inpatient psychiatric unit. For which client should a nurse advocate emergency commitment? A. An individual who is persistently mentally ill and evicted from an apartment B. An individual treated in the emergency department (ED) for generalized anxiety disorder C. An individual who is delusional and has a plan to kill his wife D. An individual who rates mood 4/10 and is participating in a no-harm safety plan
ANS: C The criteria for involuntary emergency commitment include danger to self and/or others. Of the four clients considered, the client who is delusional and has a plan to kill his wife meets this criterion as a danger to others.
3. "Would you like for me to sit down with you for a few minutes so you can talk about this?"
After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. The nurse's first response is which of the following? 1. "Don't be sad. People live with cancer every day." 2. "Have you thought about how you are going to tell your family?" 3. "Would you like for me to sit down with you for a few minutes so you can talk about this?" 4. "I know another patient whose colon cancer was cured by surgery."
A brother calls to speak to his sister who has been admitted to the psychiatric unit. The nurse connects him to the community phone and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law has the nurse broken? A. The National Alliance for the Mentally Ill Act B. The Tarasoff Ruling C. The Health Insurance Portability and Accountability Act D. The Good Samaritan Law
ANS: C The nurse has violated the Health Insurance Portability and Accountability Act (HIPAA) by revealing that the client had been admitted to the psychiatric unit. The nurse should not have provided any information without proper consent from the client.
A nursing instructor is presenting content on the provisions of the nurse practice act as it relates to their state. Which student statement indicates a need for further instruction? A. "The nurse practice act provides a list of definitions of important terms including the definition of nursing." B. "The nurse practice act lists education requirements for licensure and reciprocity." C. "The nurse practice act contains detailed statements that describe the scope of practice for registered nurses (RNs)." D. "The nurse practice act lists the general authority and powers of the state board of nursing."
ANS: C The nurse practice act contains broad, not detailed, statements that describe the scope of practice for various levels of nursing (APN, RN, LPN), not just for the RN. This student statement indicates a need for further instruction.
Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of psychopathology? A. Dissociative disorders B. Alzheimer's dementia C. Stress-related disorders D. Schizophrenia-spectrum disorders
ANS: C The nurse should correlate Northern European American values, such as punctuality, hard work, and acquisition of material possessions, with stress-related disorders. Psychopathology may occur when individuals fail to meet the expectations of the culture.
A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this client's decision? A. Future orientation causes the client to devalue assertiveness skills. B. Decreased emotional expression makes it difficult to be assertive. C. Assertiveness techniques may not be aligned with the client's definition of the female role. D. Religious prohibitions prevent the client's participation in assertiveness training.
ANS: C The nurse should identify that the Latin American woman's refusal to participate in an assertiveness training group may be influenced by the Latin American cultural definition of the female role. Latin Americans place a high value on the family which is male dominated. The father usually possesses the ultimate authority.
A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent? A. The client is paranoid. B. The client is 87 years old. C. The client incorrectly reports his or her spouse's name, date, and time of day. D. The client relies on his or her spouse to interpret the information.
ANS: C The nurse should question the validity of informed consent when the client incorrectly reports the spouse's name, date, and time of day. This indicates that this client is disoriented and may not be competent to make informed choices.
A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to come from which cultural group? A. African Americans B. Asian Americans C. Native Americans D. Jewish Americans
ANS: C The nurse should recognize that Native American clients might have a history of missed or late medical appointments. Many Native Americans are not ruled by the clock. The concept of time is casual and focused on the present.
Which situation reflects the ethical principle of veracity? A. A nurse provides a client with outpatient resources to benefit recovery. B. A nurse refuses to give information to a physician who is not responsible for the client's care. C. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. D. A nurse treats all of the clients equally regardless of illness severity.
ANS: C The nurse who tricks a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients.
A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? A. When the client makes inappropriate sexual innuendos to a staff member B. When the client constantly demands inappropriate attention from the nurse C. When the client physically attacks another client after being confronted in group therapy D. When the client refuses to bathe or perform hygienic activities
ANS: C The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making rational choices. The client's refusal to accept treatment can be challenged because the client is endangering the safety of others.
Which is an accurate description of a common law? A. A common law would be invoked to deal with a nurse who, without justification, threatens a client with restraints. B. A common law would be invoked to deal with a nurse who touches a client without the client's consent. C. A common law would be invoked to deal with a hospital employee who steals drugs, hospital equipment, or both. D. A common law would be invoked to deal with a nurse's refusal to provide care for a specific client.
ANS: D Common laws apply to a body of principles that evolve from court decisions resolving various controversies. Common law may vary from state to state. Assault (threats) and battery (touch) are governed by civil law. Stealing is governed by criminal law.
A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client? A. The client is placed in seclusion. B. The client is placed in a geriatric chair with tray. C. The client is placed in soft Posey restraints. D. The client is monitored by an ankle bracelet.
ANS: D The least restrictive alternative for this client would be monitoring by an ankle bracelet. The client does not pose a direct dangerous threat to self or others, so neither physical restraints nor seclusion would be justified.
Variations
Age, Religion, Dialect, Gender identity, Socioeconomic, Geographic location, Amount and type of interaction, and Degree to which values in current country are adopted.
An involuntarily committed client is verbally abusive to the staff and repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit? A. Verbally redirect the client, and then limit one-on-one interaction. B. Involve the hospital's security division as soon as possible. C. Notify the client that documenting personal staff information is against hospital policy. D. Continue professional attempts to establish a positive working relationship with the client.
ANS: D The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client. The involuntarily committed client should be respected and has the right to assert grievances if rights are infringed.
An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which violation of an ethical principle should a nurse recognize in this situation? A. Autonomy B. Beneficence C. Nonmaleficence D. Justice
ANS: D The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief.
Which statement should a nurse identify as correct regarding a client's right to refuse treatment? A. Clients can refuse pharmacological but not psychological treatment. B. Clients can refuse any treatment at any time. C. Clients can refuse only electroconvulsive therapy (ECT). D. Professionals can override treatment refusal if the client is actively suicidal or homicidal.
ANS: D The nurse should understand that health-care professionals can override treatment refusal when a client is actively suicidal or homicidal. A suicidal or homicidal client who refuses treatment may be a danger to self or others. This situation should be treated as an emergency, and treatment may be performed without informed consent.
When planning client care for a Latino American, the nurse should be aware of which cultural influence that may impact access to health care? A. The root doctor may be the first contact made when illness is encountered. B. The "yin" and "yang" practitioner may be the first contact made when illness is encountered. C. The shaman may be the first contact made when illness is encountered. D. The curandero may be the first contact made when illness is encountered.
ANS: D The nurse should understand that some Latin Americans may initially contact a curandero when illness is encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatural rituals, prayers, magic, practical advice, and indigenous herbs.
Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture? A. Extremes of emotional expression prevent accurate assessment of this culture. B. Suspicion of Western civilization has resulted in minimal cultural research. C. The small size of this subpopulation makes research virtually impossible. D. The Asian American culture includes individuals from many different countries.
ANS: D The nursing instructor's best explanation is that the Asian American culture is difficult to classify globally due to the number of countries that identify with this culture. The Asian American culture includes peoples and descendents from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Within this culture there are vast differences in values, religious practices, languages, and attitudes.
Assertive Communication
Ability to confidently and comfortable express thoughts and feelings while still respecting the legitimate rights of the patient.
Roman Catholic Eucharist
Abstinence from solid food and alcohol is required for 15 minutes before.
Roman Catholic Organ Donation
Acceptable as long as no harm to donor.
236.1 According to Hersey, Blanchard and Johnson, what three skills are requisite to leading?
According to Hersey, Blanchard and Johnson diagnosing, adapting and communicating are the three skills indicated as being requisite to leadership.
Cultural competence
Acquisition of knowledge, understanding, and appreciation of a culture that facilitates provision of culturally appropriate health care
Consideration
Activities that focus on the employee and emphasize relating and getting along with people
1. Function independently
Advanced practice registered nurses generally: 1. Function independently 2. Function as unit directors 3. Work in acute care settings 4. Work in the university setting.
Unassertive Communication
Agrees to do what the patient requests, even though doing so will create additional problems for themselves.
Ethnicity
An individual's identification of self as part of an ethnic group
accommodating
An unassertive, cooperative approach to conflict in which the individual neglects personal needs, goals, and concerns in favor of satisfying those of others.
avoiding/ignore
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 s
240.3 What are the five steps in the planning process?
Analyze the mission; establish goals; identify alternatives; select the best alternative; implement the plan.
What is a tort?
And act involving injury to another resulting in civil rather than criminal liability
4. Allows the patient time to express himself or herself and ask questions
And older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse: 1. Speaks loudly 2. Presents the information once 3. Expects the patient to understand the information quickly 4. Allows the patient time to express himself or herself and ask questions
Health Care Organization
Any business, company, institution, or facility engaged in providing health care services or products.
Eye Contact = Hostility
Appalachian
Assertive Nurse
Appears self-confident and composed. Maintains eye contact. Uses clear, concise speech. Speaks firmly and positively. Speaks genuinely, without sarcasm. Is unapologetic. Takes initiative to guide situations. Gives teh same message verbally and nonverbally.
New admissions
Are priorities Only RNs should assess the newly admitted client
Delegation to LPN's/LVN's. LPNs can
Are technical doer's -Can give PO's meds -Sterile procedures such as foley cath -IV's but can not give IV meds
Jewish Birth Control
Artificial methods no encouraged. Vasectomy is not allowed. Abortion is permitted only to save the mother's life.
Eye Contact = Invasion of Privacy
Asian cultures and American Indians.
Asking for explanations
Asks the patient to explain her or his actions, beliefs, or feelings with "why" questions.
What are the intentional torts?
Assault and Battery False imprisonment Exposure of a person Defamation Fraud Presenting false credentials Describing a myth regarding treatment
competing
Assertive, uncooperative approach to conflict in which the individual pursues own needs at the expense of others.
Partially Fluent in English
Assess the patient's nonverbal as well as verbal communication. Keep your eyes at the same level as patient's and assess if they are comfortable with the eye contact. Speak slowly and never loudly. Use pictures when possible. Avoid using technical terms. Ask for feedback and provide patient with paper and pencil. Patient understands more than they can express and give them time to think in their own language. Street interferes with the patient's ability to think and speak in English.
Reflecting
Assists the patient to reflect on inner feelings and thoughts rather than seeking answers and advice from another. Promotes independent decision making; allows the patient to see that her or his ideas and thoughts are important.
232.2 Explain why organizational change is a challenge for a manager/supervisor.
At this level, you are responsible for effecting changes in a multitude of people. One major hurdle will involve changing the "But we've always done it this way! mindset. Change at this level will generally be more difficult and therefore take more time than each of the other levels.
informed consent
Authorization by patient or patient's legal representative to do something to the patient;
Style theories
Autocratic: dictator Democratic: majority will be listened to but may not rule Laissez-Faire: hands-off
Cultural Competence
Aware of your own cultural beliefs and practices and how they relate to those of others, which will be different.
Eastern Orthodox Birth
Baptized within 40 days. Done by ordained priest or deacon.
Connection Power
Based on a person's relationship or affiliation with other people who are perceived as being powerful.
Legitimate Power
Based on an official position in the organization. the manager has the right to influence staff members, and staff members have an obligation to accept that influence.
Expert Power
Based on knowledge, skills, and information. For example, the nurse who has expertise in an area will gain respect and compliance from others.
Leadership Trait Theory
Based on the assumption that leaders are born with certain traits and characteristics that make them ideal leaders.
Jewish Shaving
Beard is piteous, with scissors or electric razor.
When teaching older adults, the nurse should:
Begin and end with the most important information.
provides framework to facilitate professional development
Benners Novice to expert model
In Maslow's Hierarchy, what are examples of physiological needs?
Body temperature, elimination, fluids, nutrition, oxygen, sex, shelter But prioritize ABC (we are talking about any body process- start with ABC..and then you will remember the rest)
235.3 In Step 3 of the six-step problem solving process, which two techniques are used to generate a list of possible solutions?
Brainstorming is a very effective technique used to generate many possible solutions to a problem in a very short period of time. Creative thinking, like brainstorming, promotes freethinking of ideas by changing or recombining old ideas into new possible solutions to problems. These activities provide the problem solvers with material to work with.
235.7 Explain how your use of the six-step approach to problem solving can impact you as a supervisor.
By properly utilizing the problem solving process, you will be better able to resolve problems with your subordinates. This will result in your credibility being reinforced and open lines of communication between you and your subordinates. Using this process will also give you more experience that will help you to accept and handle increased levels of responsibility.
Hispanic American
COMMUNICATION: Avoids eye contact with authority as a sign of respect; may arrive late to event because relationships are valued more than being on time; comfortable when in close proximity with other people HEALTH & ILLNESS: Results from a balance of "hot & cold" "wet & dry" forces HEALTH RISKS: Diabetes mellitus, parasites INTERVENTIONS: Protect privacy(except moms and husbands)
African Amrerican
COMMUNICATION: Eye contact and personal questions asked on initial contact is considered rude/intrusive HEALTH & ILLNESS: Religious beliefs profoundly affect ideas about health and illness HEALTH RISKS: HTN, Heart Disease, Diabetes Mellitus
European-Origin(White) American
COMMUNICATION: Eye contact is viewed trustworthiness; future oriented; time is valued tend to avoid close physical contact HEALTH & ILLNESS: Have a tendency to be social when expressing physical concerns HEALTH RISKS: Cancer, Postpartum depression, injury INTERVENTION: Monitor body language; respect personal place
Native Americans
COMMUNICATION: Silence and avoidance of eye contact is a sign of respect; message is used to bond mother and baby; touching a dead body is prohibited in some tribes SOCIAL ROLES: Very family oriented; elders are honored HEALTH & ILLNESS: Natural and religious folk medicine tradition may come into play INTERVENTION: Encourage personalization of personal space
Asian American
COMMUNICATION: Silence is valued; eye contact and the word "no" may be considered disrespectful; head nodding does not always mean yes; no touching during convo; opposite sex do not touch; touching the head is disrespectful HEALTH & ILLNESS: believe in yin(cold) and yang(hot); cold illnesses call for hot foods and vice versa (can lead to dietary issue if nutritional needs aren't met) HEALTH RISKS: osteoporosis, cancer, thalassemia(blood disorder)
Use of Humor
Can enhance feelings of well-being, reduce anxiety, and encourage a sense of hope. Use it with caution and discretion. It is never apporpriate to laugh at - only with - a person.
Autocratic Leadership
Centralized decision-making style with the leader making decisions and using power to command and control others
Arguing
Challenging or arguing against the patient's statements or perceptions.
Lippitt's Phase of Change
Change can be planned, implemented, and evaluated in seven sequential phases. Ongoing sensitivity to forces in the change process is essential. useful for low level, low complexity change
Havelock's 6 step change model
Change can be planned, implemented, and evaluated in six sequential stages. The model is advocated for the development of effective change agents and used as a rational problem-solving process. useful for low level, low complexity change
Roger's Diffusion of Innovations Theory (change)
Change for an individual occurs over five phases when choosing to accept or reject an innovation/idea. Decisions to not accept the new idea may occur at any of the five stages. The change agent can promote acceptance by providing information about benefits and disadvantages and encouragement; useful for individual change
Hearing Impairment
Check for hearing aids and glasses, reduce environmental noise, get patient's attention before speaking, face patient with your mouth visible, do not chew gum, speak at a normal volume do not shout, rephrase rather than repeat, and provide a sign language interpreter if indicated.
Reward Power
Comes from the ability to reward others for complying and may include rewards such as money, desired assignments, or acknowledgment of accomplishments.
Space and Territoriality
Comfort zone, intangible personal space (18inches - 4 feet in western culture). Intimate zone, nurses often are in this zone because of duties they carry out (0-18 inches). Social zone, appropriate when speaking to a small group of people (4 - 12 feet). Public Zone, for public speaking (12 feet or more).
Denotative Meaning
Commonly accepted definition of a particular word.
Jargon
Commonplace "language" or terminology unique to people in a particular work setting.
Minimal Encouragement
Communicates to the patient that the nurse is interested and wants to hear more.
224.2 Distinguish between the Situational Leadership concepts of competence and commitment.
Competence is the degree of knowledge or skills possessed by the subordinate. It is gained from education, training and/or experience. IT should also include any transferable skills the subordinate may have such as abilities developed in other jobs which apply to the particular task at hand. Commitment is a combination of both confidence and motivation. Confidence is a person's self-assurance that leads to the feeling or opinion that, "I can do a task well and without supervision!" Motivation is a person's interest and enthusiasm for doing a task.
Emotional Intelligence
Component of leadership and refers to the capacity for recognizing your own feelings and those of others, for motivating yourself, and for managing emotions well in yourself and in your relationships.
foreseeability
Concept that certain events may reasonably be expected to cause specific consequences; third element of negligence/malpractice. concern medication errors, patient falls, and failure to adhere to physician orders.
Summarizing
Concise review of main ideas from a discussion. Focuses on key issues and allows for additional information that was perhaps omitted; particularly useful when interaction has been lengthy or has covered several topics.
Cultural Assessment
Consists of cultural affiliation, health and care beliefs and practices, illness beliefs and customs, interpersonal relations, spiritual practices, world view, and other social structure features.
in RACE, what to do in Contain stage?
Contain the fire by closing doors and windows as well as turning off any sources of oxygen. clients who are on life support are ventilated with a bag-valve mask
1. Caregiver 2. Autonomy and accountability 3. Patient advocate 4. Health promotion
Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.) 1. Caregiver 2. Autonomy and accountability 3. Patient advocate 4. Health promotion 5. Lobbyist
Ten C's for evaluation of internet sources
Content Credibility Critical thinking Copyright Citation Continuity Censorship Connectivity Comparability Context
Active Listening
Conveys interest and caring; gives patient full attention; allows feedback to verify understanding of the message.
Management
Coordination of resources, such as time, people, and supplies, to achieve outcomes; involves problem-solving and decision-making process
Criminal Law
Deals with the rights of individuals and society
position power
Degree of formal authority and influence associated with the leaders
LEGAL RISK AREAS **Fraud
Deliberate deception to produce unlawful gains
Conveying Acceptance
Demonstrates acceptance of patient's rights to current beliefs and practices without condoning them; nonjudgemental, therefore encourages honesty and openness on the part of the patient; provides an opportunity to bring about change in health behaviors while still maintaining the patient's personal integrity.
Which of the following is an example of an appropriately stated learning objective?
Demonstrates correct finger placement and counts the beats correctly
What is a negative outcome for a preschooler?
Demonstrates fearful pessimistic behaviors; lacks self confidence
A client who is hospitalized has just been diagnosed with diabetes. He is going
Demonstration
quality improvement
systematic process to improve outcomes; based on customer needs; proactive approach; responsibility of all; "doing the right thing;" continuous process
228.3 Why should you monitor over a period of time long enough to determine your subordinates typical performance?
Determining the subordinates typical behavior will give the evaluator a more accurate picture to make decsions on. It also makes it easier to provide effective feedback because the supervisor will kno the behavior and performance levels of the subordinate.
The school nurse is about to teach a freshman-level health class about nutrition. To achieve the best learning outcomes, the nurse:
Develops topics for discussion that require problem solving
DRG
Diagnosis-Related Groups: created by Medicare in 1983 as an attempt to contain health care costs. A hospital receives a set amount of money for a patient with a certain diagnosis.
Cultural diversity
Differences among groups of people that result from ethnic, racial and cultural variables
Health disparities
Differences in the incidence, prevalence, mortality, & burden of disease and other adverse health conditions that exist in specific U.S. populations.
human relations theory of management
Differs from earlier approaches because it demonstrates improved performance through participative management.
224.1 Describe directive behavior.
Directing refers to the extent to which a leader engages in one-way communication. The supervisor spells out the follower's role and clearly tells subordinate what to do, where to do it, how to do it, and when to do it, and closely supervises the subordinate's performance. This doesn't mean the supervisor has to be short tempered or have a nasty attitude. Directive behaviors are those a leader will take to accomplish the task. In other words, they are task-oriented behaviors.
Racism
Discrimination directed toward individuals or groups who are perceived to be inferior
Gestures
Distinct movements of hands, head, body. Emphasis, clarification, pleasure, helpfulness, anger, threat, disrespect.
Turnover rate
Dividing the total number of nurses who left a unit in 1 year by the total number of nurses employed on that unit
Laissez-Faire (Management Style)
Does not provide guidance or direction and is unable/unwilling to make decisions. Does not provides feedback and imitates little change. Tends to communicate using memos or email instead of personal interaction. May work well with professional people.
Open-Ended Questioning
Does not require a specific answer and cannot be answered by "yes", "no" or a one-word response; usually begins with words like "how", "what", "can you tell me about", "in what way". Allows the patient know if the nurse heard what was said; encourages the patient to offer additional information.
Don't delegate what you can not _____
Don't delegate what you can not eat. E-evaluate A-assess T-teach
How are leaders different from non leaders
Drive desire to lead honesty and integrity self confidence cognitive ability knowledge of the business
1. "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax."
During a home health visit the nurse prepares to instruct a patient in how to perform range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took an analgesic 30 minutes before arrival at the patient's home. After discussing the purpose for the exercises and demonstrating each one, the nurse has the patient perform them. After two attempts with only the second of three exercises, the patient stops and says, "This hurts too much. I don't see why I have to do this so many times." The nurse applies the critical thinking attitude of integrity in which of the following actions? 1. "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax." 2. "I see that you're uncomfortable. I'll call your doctor to decide the next step." 3. "Show me exactly where your pain is and rate it for me on a scale of 0 to 10." 4. "Is anything else bothering you? Other than the pain, is there any other reason you might not want to do the exercises?"
2. Since your husband has died, what have you been doing in the evening when you feel lonely?
During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions? 1. How is this flood affecting your life? 2. Since your husband has died, what have you been doing in the evening when you feel lonely? 3. How is having diabetes affecting your life? 4. I know this must be hard for you. Let me tell you what might help.
234.1 Identify each of the roles in a change process and describe the responsibility of each.
During the change process, people usually fill three roles. The change sponsor is the individual responsible for initiating the change and supervising it through each of the three processes. The change agent is the individual responsible for implementing change within a specific group. The change target is the individual undergoing the change.
Culture
Dynamic network of knowledge, beliefs, patterns of behavior, ideas, attitudes, values and norms that are unique to a particular group of people
Improves outcomes affecting health
EBC
employment law
EEO-prohibits discrimination-gender, age, race, religion, handicap, pregnancy, national origin; Civil Right Act 1991-sexual harassment; investigate, conciliation, and litigation Age Discrimination in Employment 1967 Americans with Disabilities Act 1990 Affirmative Action-protected groups Equal Pay Act 1963 Family & Medical Leave Act 1993-balance family and work; job security fro unpaid leave Employment-at-Will and Wrongful Discharge
Eye Contact = Class
East Indian
230.3 How does effective counseling strengthen organizational effectiveness?
Effective counseling is the vehicle that provides guidance and direction for the subordinate resulting in them becoming a more well rounded and fully developed member of the Air Force. Counseling fosters teamwork and opens the lines of communication necessary for a solid supervisor-subordinate relationship.
motivation factors
Elements such as achievement, recognition, responsibility, advancement, and the opportunity for development that contribute to job satisfaction
maintenance or hygiene factors
Elements such as salary, job security, working conditions, status, quality of supervision, and relationships with others that prevent job dissatisfaction
Democratic/Participative (Management Style)
Encourages staff participation in decision making and involves staff in planning and developing new ideas and programs. Communicates effectively and provides regular feedback thus building responsibility in people. Works best with highly motivated people.
Patient Safety: Management Functions
Establish a clear-cut measurable standards of care and determine the most appropriate method for measuring if those standards have been met; keeps abreast of current government and licensing regulations that affect QI; determines discrepancies between care provided and hospital/unit standards and seeks further information regarding why standards were not met
242.2 What are the four steps in the controlling process?
Establish standards of performance; measure actual performance; compare performance standards; evaluate performance and take action.
American Nurses Association's (ANA's) Code of Ethics
Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the:
Minority group
Ethnic, cultural, racial, or religious group that constitutes less than a numerical majority of the population
Jewish Death
Euthanasia is forbidden. Family visits before death. Body untouched for 8 to 30 minutes. Some do not approve of autopsies. Buried within 24 hrs for orthodox. 7 day mourning period. All of the body must be returned to the earth.
3. A problem-solving approach that integrates best current evidence with clinical practice
Evidence-based practice is defined as: 1. Nursing care based on tradition 2. Scholarly inquiry of nursing and biomedical research literature 3. A problem-solving approach that integrates best current evidence with clinical practice 4. Quality nursing provided in an efficient and economically sound manager
Factor Evaluation System
FES is the most popular patient classification sytem in use because of it's ability to project needs for individual patients and groups of patients; used to determine each patient's acuity rating, depending on hospital policy, several times through out the day; uses units of measure that equate to nursing time
235.2 Why is it important to gather data at the right point during the six-step problem solving process?
Facts are known truths (concrete information) used to make sound decisions. By gathering these facts and data early in the process, you are better equipped to make these sound decisions regarding possible solutions. You are also better equipped to be more objective and empathetic towards the situation and the individual involved. The data you collect may also be needed, should your supervisor or commander need information about the problem.
malpractice
Failure of a PROFESSIONAL person to act in accordance with the prevalent professional standards or failure to foresee potential consequences that a professional person, having the necessary skills and expertise to act in a professional manner, should foresee.
negligence
Failure to exercise the degree of care that a person of ordinary prudence, based on the reasonable person standard, would exercise under the same or similar circumstances; also known as ordinary negligence; carelessness--nonprofessional
Nursing malpractice
Failure to use that degree of care the a reasonable nurse would use under the same or similar circumstances.
True or False: The patient room number may be used as identification?
False
LEGAL RISK AREAS **Defamation
False communication that causes damage to someone's reputation *In writing: libel *Verbal: slander
What intentional tort does misusing restraints fall under?
False imprisonment
228.1 Explain the limitations of a job description.
First job descriptions are actively oriented rather than result oriented. This is a limitation because something else, feedback, must be used to address the results expected. The other limitation is subordinates may see the job description as defining the limits of their job often refusing to do anything not listed in the description.
Ethnic Stereotype
Fixed concept of how all members of an ethnic group act or think.
Closed Questioning
Focused and seeks a particular answer; usually requires and elicits only a "yes" or "no" or one- to two-word answer. Provides a very specific answer to a very specific question.
1. Scientific management
Focuses on goals and productivity/organization is a machine to run efficiently to increase production. Uses time & motion studies to make work efficient.
Negotiation
Form of conflict resolution that uses bargaining and mediation strategies.
Jewish Sabbath
Friday sunset to Saturday sunset. Cannot turn lights or tv on or off.
management process
Function of planning, organizing, coordinating, and controlling
Trust
Gain a patient's trust before expecting to have a meaningful or therapeutic interaction. Without trust interaction will not progress past superficial social interaction.
Stereotype
Generalized expectation about forms of behavior, an individual, or a group.
Roman Catholic Anointing Sick
Given before death or immediately after.
Dominant culture
Group whose values prevail within a society
The management process
Gulick and urwick POSDCORB
1. Moving from an acute illness to a health promotion, illness prevention model
Health care reform will bring changes in the emphasis of care. Which of following models is expecting from health care reform? 1. Moving from an acute illness to a health promotion, illness prevention model 2. Moving from illness prevention to a health promotion model 3. Moving from an acute illness to a disease management model 4, Moving from a chronic care to an illness prevention model
Bureaucratic Organization
Hierarchy with clear superior-subordinate communication and relationships, based on positional authority, in which orders from the top are transmitted down through the organization via a clear chain of command
One-way Communication
Highly structured; the sender is in control and expects and gets very little response from the receiver.
1. Completing incident reports when appropriate 2. Completing incident reports for a near miss 3. Communicating product concerns to an immediate supervisor
How does the nurse support a culture of society? (Select all that apply.) 1. Completing incident reports when appropriate 2. Completing incident reports for a near miss 3. Communicating product concerns to an immediate supervisor 4. Identifying the person responsible for an incident
Hertzberg's Two Factor
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.
CUS
I am Concerned I am Uncomfortable This is a Safety issue
1. Answer the call light promptly. 4. Answer questions honesty. 5. Demonstrate competence when doing treatments.
Identify behaviors that foster the development of trust. (Select all that apply.) 1. Answer the call light promptly. 2. Call the patient by first name unless requested otherwise. 3. Do all the care as quickly as possible and leave the room as the patient can rest. 4. Answer questions honesty. 5. Demonstrate competence when doing treatments.
235.4 How do you know if a possible solution is feasible?
If resources such as time, money, and material are available, a solution may be feasible. You must also ensure you have the authority to implement a solution in order for it to be a feasible proposal.
233.3 What are some advantages/disadvantages of each of the change cycles.
If you choose the wrong change cycle, it can tend to demotivate your subordinates. In a highly-motivated, well-educated and task-oriented work section comprising seasoned hard-chargers, directive change may not be the best approach. In like fashion, participative change might never be realized among a work section staffed by one-stripers.
235.5 What should you do if you have more than one feasible and acceptable solution to choose from after performing Step 4?
If you have more than one solution once you reach Step 5, you may want to get input from others to help choose the best solution. You can also consider combining the ideas to find the best solution.
243.4 What does effective controlling require?
In order for controlling to be effective, it requires an understanding of performance standards as they pertain to mission accomplishment and an ability to see what kind of controlling mechanisms are best. There is a balance between over-control and under-control. That balance is based on the dynamic relationship between people, mission, and the situation at hand.
243.3 How would you describe effective organizing?
In order for organizing to be effective, it requires, first, an understanding of the organizational structure and second, an ability to convince your people that cross utilization is best for them and the Air Force.
243.2 What is effective planning?
In order for planning to be effective, it requires vision and the ability to communicate that vision to other people.
242.1 What is the main purpose of the controlling function?
In the controlling function, organizational activities are regulated so that the elements of performance remain within acceptable limits.
4. The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.
In which of the following examples is the nurse not applying critical thinking skills in practice? 1. The nurse considers personnel experience in performing intravenous (IV) line insertion and ways to improve performance. 2. The nurse uses a fall risk inventory scale to determine a patient's fall risk. 3. The nurse observes a change in a patient's behavior and considers which problem is likely developing. 4. The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.
Receptive Aphasia
Inability to recognize or interpret the verbal message being received.
Changing the Subject
Inappropriately focusing the discussion on something other than the patient's concern.
Receiver
Individual or individuals to whom the message is conveyed.
informal leader
Individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group rather than as the head or leader of the group
Roman Catholic Birth
Infant baptism mandatory.
Complex Adaptive systems:
Interrelated unpredictable elements Constantly interacts with its environment Encourages staff to look at their activities on one unit as part of a larger picture they may affect other units Innovation and rapid information sharing
collaborating
Involves a group of people working together to achieve a common goal; win-win; can be time consuming but worth it
task structure
Involves the degree that work is defined, with specific procedures, explicit directions and goals
Information Power
Is based on a person's possession of information that is needed by others. An example would be a nursing instructor.
Civil Law
Is concerned with the protection of the client's private rights
Organization
Is necessary to establish a formal structure that defines the lines of authority, communication, and decision making within an organization. It involves developing policies and procedures to help outline how work will be done and establishing position qualifications and job descriptions to define who will do the work.
225.1 How does the subordinate benefit when Situational Leadership is practiced?
It cultivates overall positive behavior--Subordinates react to their supervisor's behavior. If provided specific goals and proper direction and support, they'll respond positively. Development--By taking people through the Situational Leadership development process, you'll develop both their competence and their commitment.
According to Maslow, when does motivation occur
It results if needs are not met
241.5 Briefly describe job enlargement.
Job enlargement is the allocation of a wider variety of similar tasks to a job in order to make it more challenging.
241.4 Briefly describe job enrichment.
Job enrichment is the process of upgrading the job-task mix in order to increase the potential for growth, achievement, responsibility and recognition.
231.2 How does job rotation contribute to the development of the improvement plan?
Job rotation is helpful because it prevents complacency and boredom. It also helps you to make full use of your subordinates because they are able to learn about more areas within the work center and their career field.
241.3 Briefly describe job rotation.
Job rotation is the practice of periodically shifting workers through a set of jobs in a planned sequence.
227.1 How does knowing yourself contribute to performance management?
Knowing yourself will help you to deal with your subordinates because you know ho you are going to respond to likely situations in your work center.
Jewish Diet
Kosher, no mixing of milk and meat. Slaughtered specially. Passover, no leavened products. 24-hr fast. Pray over meal.
What are Nurse Practice Acts?
Laws that control the practice of nursing in each state.
transformational leader
Leader who is committed to a vision that empowers others
Transformational Leader
Leader who is committed to organizational goals, has a vision, and is able to empower others with that vision. They are admired and mentor individual staff members based on need.
Transactional Leader
Leader who is concerned with the day-to-day operations of a facility. They wait until problems occur and then deal with them. They often reward staff for desired work in a trade-off type of way (I'll do X if you do Y).
Fielder's contingency theory
Leadership effectiveness dependent on interaction of personality of leader and needs of situation
Aphasia
Listen and wait, do not shout or speak loudly, short questions, facial gestures, speak of things familiar, ask yes or no questions, offer picture board, give patient time, avoid patronizing and childish, collaborate with a speech pathologist, encourage speaking, and use communication aids.
Giving Advice or Personal Opinions
Making a decision for a client; offering personal opinions; telling a patient what to do with phrases such as "should do," "ought to".
False Assumptions
Making an assumption without validation; jumping to conclusions.
motivation theories
Maslow heirarchy of needs alderfers growth relatedness existence theory herzberg two factor theory mcclelland manifest needs theory
227.2 In regards to knowing your people, why is it important to match personal interests with jobs?
Matching interests with jobs can help to prevent problems such as boredom or complacency, by putting the right people into the right job. Along with interests, special skills or aptitudes should be considered before any job assignment is made.
Jewish Head Covering
Men wear skullcaps at all times. Women cover their hair after marriage.
238.2 What term is used to describe a supportive relationship, where a senior member of an organization counsels, coaches, teaches, and provides feedback to a junior member? What is the term used to describe the subordinate in this relationship?
Mentoring; proteges.
Nonverbal Communication
Messages transmitted without the use of words. Include tone and rate of voice, volume of speech, eye contact, physical appearance, and use of touch.
Silence to Disagree
Mexicans
233.2 Provide an example of when you would implement each of the change cycles.
Military managers would use directive change in most cases. However, participative change should be used whenever possible. In a work section comprising achievement-oriented individuals with a high degree of knowledge, the preferred method would be participative. Depending upon the situation and mix of people in your individual shops, you may have the opportunity to use both.
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
Emotional Intelligence
Monitoring emotions in a situation to guide actions and inform thought processes
accountability
Moral concept that involves acceptance by a professional nurse of the consequences of a decision or action.
Space
Most comfortable when they can maintain 3 to 6 feet between them.
Ethnocentrism
Most people look at the world from their own cultural viewpoint They often believe that the beliefs and practices of their particular culture are best.
Posture and Positioning
Most therapeutic is to the same position and level as the patient, or as close to it as feasible.
GANTT chart
table of project tasks information and a bar chart that graphically displays the project schedule (outlines how you will approach a large project)
3. Deflect your eyes downward to show respect
Mr. Sakda emigrated from Thailand. When taking care of him, you note that he looks relaxed and smiles but seldom looks at you directly. How do you respond? 1. Use therapeutic communication to assess for increased anxiety 2. Sit down and position yourself closer so you are at eye level 3. Deflect your eyes downward to show respect 4. Continue to maintain eye contact
2. Coach her to give herself positive messages about her ability to do this
Mrs. Jones states that she gets anxious when she thinks about giving herself insulin. How do you use your understanding of intrapersonal communication to help with this? 1. Provide her the opportunity to practice drawing up insulin 2. Coach her to give herself positive messages about her ability to do this 3. Bring her written material that clearly describes the steps of insulin administration 4. Use therapeutic communication to help her express her feeling about giving herself an injection
Should the RN delegate assessment?
NO The LPN can assist the RN in data collection, but that is not assessment in the NCLEX world
Jewish Birth
Named by father. Circumsized.
What are the 2 unintentional torts?
Negligence and malpractice
How do negligence and malpractice differ?
Negligence is performing an act that a reasonible and prudent person would not perform while malpractice is negligence in a professional context, that is to say, professional misconduct
Are complex chronic diagnoses unstable?
No, if there are no changes, then they are considered stable A client can be complex and stable Don't let a complex chronic diagnosis make you think the client is unstable and has to be seen only by the RN
235.6 Describe the impact that not following-up on the implementation of solution to a problem (Step 6) would have on a workcenter.
Not following-up on the implementation of the solution could result in not ever determining if the solution chose in Step 5 actually worked. It may also result in the loss of opportunities to learn from mistakes made because of a poorly chosen solution or a needlessly costly implementation. Follow-up provides the definitive information you are looking for and expecting to see.
Jewish Organ Transplant
Not permitted, but sometimes with rabbinical consent.
Eastern Orthodox
Not permitted.
Span of control
Number of staff reporting directly to a single manager (affects functions of planning, organizing & leading)
Theory X
Nurse prefer job security and need direction
Offering Information
Nurse provides the patient with relevant data and asks for feedback to determine the patient's level of understanding. Useful for patient teaching; promotes informed decision making.
Assess the client's point of view and prepare to articulate this point of view.
Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to:
3. In-service education
Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education? 1. Continuing education 2. Graduate education 3. In-service education 4. Professional Registered Nurse Education
Touch
Often conveys warmth, caring, comfort, support, and understanding.
Therapeutic Nurse-Patient Interaction
One in which nurse demonstrates caring, sincerity, empathy, and trustworthiness.
Posture
Open (relaxed stance, facing receiver, uncrossed arms and legs, slight shift toward receiver, direct eye contact, smile) Warmth, acceptance, caring. Closed (formal, distant stance, arms and possibly legs tightly crossed) Disinterest, coldness, nonacceptance, authority control, intimidation, condescension.
240.2 Which planning category will most commonly be used by NCOs on a daily basis?
Operational planning, since it will be used most often by NCOs on a day-to-day basis.
Coercive Power
Opposite of Reward Power, is based on fear and punishment for failure to comply.
223.1 Define organizational effectiveness.
Organizational Effectiveness is the attaining or surpassing of objectives and tasks dealing with mission accomplishment.
241.1 Define organizing as it pertains to the functions of management.
Organizing is the process of dividing work into manageable sections and coordinating the results to serve a purpose.
Physiologic Factors
Pain (difficult to communicate about anything except the pain) Altered cognition (because of stroke, medication, dementia and developmental delays)
laissez-faire leadership
Passive and permissive style in which the leader defers decision making
the rights of individuals in health care settings is outlined in
Patient Care Partnership
Psychosocial Factors
Patient feels vulnerable, defensive, angry, verbally abusive, depressed and withdrawn.
Asking the right question: PICOT format
Patient population Intervention/interest area Comparison Outcome Time
Maslow's hierarchy
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.
External Customers
People in need of services from an organization who are not employed by the organization(including patients, family members, doctors, students, payers, discharge planners, and other groups that are a source of patient referrals)
Internal Customers
People who are employed by the organization to provide services to various groups an individuals across the organization (Nurses, social workers, administrators, dieticians, therapists, housekeeping, and clerical support staff)
Ethnic group
People within a culture who share characteristics based on race, religion, color, national origin or language
228.2 What elements should be addressed in order to write an effective performance standard?
Performace standards need to be specific, observable, and measureable.
230.1 What is the difference between performance feedback and counseling?
Performance feedback's main focus is how well the person is doing in regards to assigned tasks and fulfilling the elements defined in the job description. Counseling serves to address job performance as well as items such as personal issues, discipline problems, and career decisions.
What is most complex behavior in the psychomotor learning domain?
Performing activities of daily living after acquiring left-sided paralysis due to a brain injury
Sender
Person conveying the message.
Resources
Personnel, time, and supplies needed to accomplish the goals of the organization.
228.4 How do common evaluation pitfalls impact your evaluations?
Pitfalls bring bias, closed mindedness, and logical errors into the actual evaluation. These pitfalls essentially result in an unclear, inaccurate evaluation of the subordinate's performance.
PDSA/PDCSA
Plan Do Study Act/Plan Do Check Study Act
240.1 Into what two categories is planning usually divided?
Planning is commonly divided into two categories, strategic and operational.
4 steps of the Management Process
Planning, Organizing, Coordinating (Directing) and Controlling
229.1 How does preventative feedback helps your subordinate?
Preventative feedback helps to start a new relationship off right. It provides the expectations and standards in which the subordinate will be measured by. This type of feedback sets the subordinate up for success by helping him adjust to his new environment.
Values
Principles and standards that have meaning and worth to an individual, family, group, community or culture
Cultural assimilation
Process in which individuals from a minority group are absorbed by the dominant culture and take on the characteristics of the dominant culture
management
Process of coordinating actions and allocating resources to achieve organizational goals
leadership
Process of influence whereby the leader influences other toward goal achievement
Acculturations
Process of learning norms, beliefs & behavioral expectations of a group other than one's own group
research utilization
Process of synthesizing, discriminating, and using research-generated knowledge to make an impact or change in existing practices
Roman Catholic Birth Control
Prohibited except through abstinence or natural family planning. Sterilization prohibited except for overriding medical reason.
What does the Good Samaritan Act do?
Protects healthcare providers against malpractice claims for care provided in an emergency situation.
A client newly diagnosed with cervical cancer is going home. The client is avoiding discussion of her illness and postoperative orders. In teaching the client about discharge instructions, the nurse:
Provides only the information the client needs to go home
A client needs to learn to use a walker. Acquisition of this skill will require learning in the:
Psychomotor domain
To use a fire extinguisher, follow PASS sequence. what is that?
Pull Aim Squeeze Sweep
PLEASED
Purpose for which the site was created Links and their accuracy and reliability Editorial or site content: accuracy, bias, comprehensiveness, currency Author: credentials, expertise Site: design, navigability, ease of use Ethics: disclosure of author, sponsor, site purpose Date: is information current, updated regularly
What MUST a nurse do when taking a verbal order?
Read back the order
Cognitively Impaired
Reduce environmental distractions, get patient's attention before speaking, use simple sentences and avoid long explanations, ask one questions at a time, allow time for patient to respond, be an attentive listener, and include family and friends in conversations, especially in subjects known to patient.
237.4 Name and describe the three types of personal power.
Referent power--it is determined by how your followers feel about interacting with you. This power depends on your charisma, character, self-concept and interpersonal skills. Information power--access to or possession of useful information and your ability to provide and explain the information at the time it's needed. Expert power--based on your education and experience displayed through your technical and professional expertise.
Ethnicity
Refers to a group of people who share a common social and cultural heritage based on shared traditions, national origin, and physical and biologic characteristics.
Change Agent
Refers to the changing health care environment, and that change is an unavoidable occurrence in health care organizations.
The nurse is demonstrating the proper technique for using a glucometer to a group of clients newly diagnosed with diabetes. The nurse smiles and praises one of the clients when she correctly performs a finger stick. This teaching approach is referred to as:
Reinforcing
Restating
Repeating to the patient what the nurse believes to be the main paint that the patient is trying to communicate; tone of voice rises slightly at the end of the phrase as if asking a question. Let the patient know if the nurse heard what was said; encourages the patient to offer additional information.
in RACE, what to do in Alarm stage?
Report the fire by sounding the alarm
Jewish Prayer
Required
Two-way Communication
Requires both the sender and the receiver participate in the interaction.
Controlling
Requires the nurse manager to establish performance or outcome standards, determine action plans to improve performance, and to evaluate employee performance through appraisals and feedback. The goal is to ensure that employees accomplish goals while maintaining a high quality of performance.
Defensiveness
Responding negatively to criticism; often in response to feelings of anger or hurt on your part; usually involves making excuses.
Paraphrasing
Restatement of the patient's message in the nurse's own words. Verifies that the nurse's interpretation of the message is correct.
5 Rights of Delegation
Right Task Right Circumstances Right Person Right Direction Right Supervision and Evaluation
The nurse is teaching a parenting class to a group of pregnant adolescents and has given the adolescents baby dolls to bathe and talk to. This is an example of:
Role play
Role transition Process
Role preview Role Acceptance Role Discrepancy Role Development Role Internalization Unexpected Role Transition
Roman Catholic Religious Objects
Rosary, medals, relics, statues.
Silence as Consensus
Russians, French, Spanish.
IOM 6 Aims STEEEP
Safe healthcare Timely healthcare Effective healthcare Efficient healthcare Equitable healthcare Patient-centered healthcare
Client education should include
Safety, empowerment, compliance
Clarifying
Seeks to understand the patient's message by asking for more information or for elaboration on a point; expressed as a question or statement or paraphrasing of part of the patient's message. Allows the patient to verify that the message received is accurate; particularly useful when the message is ambiguous or not easily understood.
Culture
Set of learned values, beliefs, customs, and practices that are shared by a group and are passed from one generation to another.
Subculture
Shares many characteristics with the primary culture, but has characteristic patterns of behavior and ideals that distinguish it from the rest of a cultural group.
Roman Catholic Death
Shrouded after sacraments. Anointing and eucharist. Buried or cremated whole body.
Age and Gender
Significant age differences between you and your patients will, in some cases, raise a barrier to communication. Male and female patterns of communication are often closely related to cultural familial and lifestyle patterns developed over a lifetime.
Physical Appearance
Size, color of skin, dress grooming, body carriage, age, sex. Professional or nonprofessional, trust or distrust, respect or disrespect, comfort or intimidation, interest or disinterest, competence or incompetence.
Subculture
Social group within a culture that has distinctive characteristics, such as patterns of behavior or beliefs
Chaos Theory
States that variation is a normal part of managing health care systems. Attempts to account for the complexity and randomness in organizations. It suggests that a degree of order can be attained by viewing complicated behaviors and situations as predictable (expect the unexpected).
STEP
Status of the patient Team members Environment Progress toward goal
Automatic Responses
Stereotyped or superficial comments that do not focus on what the client is feeling or trying to say.
Novice nurse
task oriented focus on rules and direction form telling style leader
Democratic Leadership
Style in which participation is encouraged and authority is delegated to others
Contingency Theory
Style that acknowledges that other factors in the environment influence outcomes as much as leadership style and that leader effectiveness is contingent upon or depends upon something other than the leader's behavior
job-centered leaders
Style that focuses on schedules, cost, and efficiency with less attention to developing work groups and high-performance groups
Employee-Centered Leadership
Style with a focus on the human needs of subordinates
Connotative Meaning
Subjective and reflects the individual's perception or interpretation.
227.3 Explain how supervisors can get to know their subordinates.
Supervisors can acquire biographical information by communicating with the subordinate and asking them about interests, past experiences, previosu employment, needs and values, and their own expectation of the job and work center.
Capitation
System of payment used by managed care plans in which MDs and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan.
taxonomy
System that orders principles into a grouping or classification
A client who is having chest pain is going for an emergency cardiac catheterization. The most appropriate teaching approach in this situation is the:
Telling approach
Cultural imposition
Tendency to impose one's own beliefs, values, and patterns of behavior on individuals from another culture
Hawthorne effect
Term coined to reflect the findings of a research study that demonstrated that change in employee behavior occurs as a result of being observed
236.5 What type of leader exhibits a high task, low relationship style?
The Authoritarian leader exhibits a high task, low relationship style. This type of leader tends to be autocratic and rigid, allowing for little deviation from the schedule.
236.8 What type of leader exhibits a low task, high relationship style?
The Country Club leader exhibits a low task, high relationship style. This type of leader uses reward power as a motivating force.
236.7 What type of leader exhibits a low task, low relationship style?
The Impoverished leader exhibits a low task, low relationship style. This type of leader is notorious for delegating, then disappearing, leaving subordinates to fend for themselves.
236.3 What four categories are used by the U.S. Marine Corps to gain a complete picture of the status of its people?
The Marines list morale, esprit de corps, discipline and profiency as being good indicators of its peoples' status.
reverse delegation
team member request that nurse leader complete task because of inability or unwilling
240.4 As an Air Force supervisor, you will manage budgets at different organizational levels and with varying degrees of control. Identify and describe the two areas mentioned in the text.
The Responsibility Center, an organizational department under the direct supervision of a single individual solely responsible for its activities, the Cost Center, the lowest level where supplies are used, is usually the flight or work center in an organization.
236.6 What type of leader exhibits a high task, high relationship style?
The Team leader exhibits a high task, high relationship style. This type of leader is not afraid to dive right in and usually leads by example.
Leadership
The act of guiding people to achieve desired outcomes. Occurs anytime a person attempts to influence the beliefs, opinions, or behaviors of an individual or group.
Productivity
The amt of output of work produced by a specific amount of input or resources.
A nurse is going to teach a client how to perform a breast self-examination. The behavioral objective that best measures the client's ability to perform the examination is:
The client will perform breast self-examination correctly on herself before the end of the teaching session
What is an example of an appropriately stated learning objective?
The client will state three factors that affect cholesterol by the end of the teaching session.
Civil
The client's right to refuse treatment is an example of _________ laws.
American Nursing Association
The code of ethics for nurses is composed and published by
Nursing management
The coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives
239.1 Technical proficiency, as a leadership tenet, is most closely related to which AF Core Value?
The core values "Excellence in all we do" is most closely related to the technical proficiency tenet.
Culture
The effect of culture on communication is immense.
4. Provides a minimal standard of knowledge for a registered nurse in practice
The examination for registered nurse licensure is exactly the same in every state in the United States. The examination: 1. Guarantees safe nursing care for all patients 2. Ensures standard nursing care for all patients 3. Ensures that honest and ethical care is provided 4. Provides a minimal standard of knowledge for a registered nurse in practice
Validity
The extent & effectiveness of an evaluation tool in measuring the construct (ie, behaviors, outcomes, etc.) that is under evaluation. The extent to which a test measures or predicts what it is supposed to.
3. Ask the family to stay with the patient if possible. 4. Inform the family of the risks associated with side rail use. 6. Discuss alternatives with the family that are appropriate for this patient.
The family of a patient who is confused and ambulatory insists that all four side rails be up when the patient is alone. What is the best action to take in this situation? (Select all that apply.) 1. Contact the nursing supervisor. 2. Restrict the family's visiting privileges. 3. Ask the family to stay with the patient if possible. 4. Inform the family of the risks associated with side rail use. 5. Thank the family for being conscientious and put the four rails up. 6. Discuss alternatives with the family that are appropriate for this patient.
226.1 What are the two objectives of performance management?
The first objective is to provide appropriate and effective performance feedback. The second objective is to provide a long term record of subordinate performance for use in making personnel management decisions.
237.2 Name and describe the four types of position power?
The first, coercive power is founded in your authority to use sanctions in response to poor performance. Connection power, the second type is based on your association with influential people or organizations. Your ability to provide things people like is the third type of position power; it is referred to as reward power. The fourth type is legitimate power. It is based on the perception that you should make certain decisions based on your title, role or position.
230.2 Explain why the non directive counseling approach is often the preferred method of counseling.
The nondirective approach is often preferred because it puts the responsibility for a solution on the shoulders of the subordinate. This is effective because if conducted properly, this approach usually results into a higher level of open, honest communication. The commitment of the subordinate is greatly increased because they often take pride in ownership of the solution that was developed.
3. knowledge application
The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion the nurse reviewed the description of loss and grief and therapeutic communication principles in his textbook. The critical thinking component involved in the nurse's review of the literature is: 1. experience 2. problem solving 3. knowledge application 4. clinical decision making
4. nurse researcher
The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? 1. clinical nurse specialist 2. nurse administer 3. nurse educator 4. nurse researcher
2. Description of the efforts to restore the child's blood pressure, what was used, ad questions about the child's response 3. The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death 4. A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently in the future
The nurse cared for a 14-year old with renal failure who dies near the end of the work shift. The health care team tried for 45 minutes to resuscitate the child with no success. The family was devastated by the loss, and, when the nurse tried to talk with them, the mother said, "You can't make me feel better; you don't know what it's like to lose a child." Which of the following examples of journal entries might best help the nurse reflect and think about this critical experience? (Select all that apply.) 1. Data entry of time of day, who was present, and condition of the child 2. Description of the efforts to restore the child's blood pressure, what was used, ad questions about the child's response 3. The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death 4. A description of what the nurse said to the mother, the mother's response, and how the nurse might approach the situation differently in the future
Focusing
The nurse encourages the patient to select one topic over another as the primary focus of discussion. Allows the nurse to gather more specific information when the patient's message is too vague; focuses on specific data.
2. Leave a night light on in the bathroom. 6. Provide scheduled toileting during the night shift. 7. Keep the pathway from the bed to the bedroom clear.
The nurse found a 68-year old female patient wandering in the hall. The patient says she is looking for the bathroom. Which interventions are appropriate to ensure the safety of the patient? (Select all that apply.) 1. Insert a urinary catheter. 2. Leave a night light on in the bathroom. 3. Ask the physician to order a restraint. 4. Keep the bed in low position with upper and lower side rails up. 5. Assign a staff member to stay with the patient. 6. Provide scheduled toileting during the night shift. 7. Keep the pathway from the bed to the bedroom clear.
3. The patient is short of breath.
The nurse has a patient who is short of breath and calls the health care provider using SBAR (situation-background-assessment-recommendation) to help with the communication. What does the nurse first address? 1. The respiratory rate is 28. 2. The patient has a history of lung cancer. 3. The patient is short of breath. 4. He or she requests an order for a breathing treatment.
4. "I'm going to attend a support group to learn more about multiple sclerosis."
The nurse is evaluating the coping success if a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says: 1. "I'm going to learn to drive a car so I can be more independent." 2. "My sister says she feels better when she foes shopping, so I'll go shopping." 3. "I've always felt better when I go for a long walk. I'll do that when I get home." 4. "I'm going to attend a support group to learn more about multiple sclerosis."
2. When the patient's pain medications are working 3. Just before lunch, when the patient is most awake and alert
The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.) 1. When there are visitors in the room 2. When the patient's pain medications are working 3. Just before lunch, when the patient is most awake and alert 4. When the patient is talking about current stressors in his or her life
1. Role play
The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? 1. Role play 2. Discovery 3. An analogy 4. A demonstration
Collecting all available information about the situation
The nurse is working with parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. In helping the parents resolve this ethical conflict, the nurse knows that the first step is
Stating Observations
The nurse makes observations of the patient during an interaction and communicates these observations back to the patient. Allows for clarification of the intended message when verbal cues do not match nonverbal cues; allows for more accurate interpretation of patient concerns.
4. Search for identity with peer groups and separating from family
The nurse plans care for a 16-year old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following? 1. Loss of autonomy caused by health problems 2. Physical appearance, family, friends, and school 3. Self-esteem issues, changing family structure 4. Search for identity with peer groups and separating from family
1. Diagnostic reasoning.
The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient reports she is unable to sleep, feels very fatigued during the day, and is having trouble at work. The nurse asks her to clarify the type of trouble. The patient explains she can't concentrate or even solve simple problems. The nurse records the results of the assessment, describing the patient as having ineffective coping. This is an example of: 1. Diagnostic reasoning. 2. Competency. 3. Inference. 4. Problem solving.
2. Clarifying
The nurse states, "When you tell me that you're having a hard time living up to expectations, are you talking about your family's expectations?" The nurse is using which therapeutic communication technique? 1. Providing information 2. Clarifying 3. Focusing 4. Paraphrasing
4. Feedback
The nurse summarizes the conversation with the patient to determine if the patient has understood him or her. This is what element of the communication process? 1. Referent 2. Channel 3. Environment 4. Feedback
3. Remove all patients in immediate danger
The nurse's first action after discovering an electrical fire in a patient's room is to: 1. Activate the fire alarm 2. Confine the fire by closing all doors and windows 3. Remove all patients in immediate danger 4. Extinguish the fire by using the nearest fire extinguisher
1. Place a bed alarm device on the bed.
The nursing assessment of an 80-year old patient who demonstrates some confusion but no anxiety reveals that the patient is a fall risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to prevent falls for this patient is to: 1. Place a bed alarm device on the bed. 2. Place the patient in a belt restraint. 3. Provide one-on-one observation of the patient. 4. Apply wrist restraints.
4. Risk for falls
The nursing assessment on a 78-year old woman reveals shuffling gait, decreased balance, and instability. On the basis of the patients data, which of the following nurses diagnoses indicates an understanding of the assessment findings? 1. Activity intolerance 2. Impaired bed mobility 3. Acute pain 4. Risk for falls
Relationships
The philosophy sometimes called the code of ethics of care suggests that ethical dilemmas can best be solved by attention to
240.7 What are the primary professional development programs for enlisted people?
The primary professional development programs for enlisted people are the Professional Military Education (PME) Courses.
235.1 In Step 1 of the six-step problem solving process, how does recognizing the problem contribute to work center effectiveness?
The proper completion of Step 1 is very important because it breaks down the element of the individual, goal, and obstacle, and identifies the problem that needs to be solved. By knowing what the problem is, those involved can begin to find a workable, permanent solution. As the problem is solved, work center personnel are able to focus on the job and mission accomplishment rather than the problem.
Communication
The reciprocal process in which messages are sent and received between people. Verbal and nonverbal forms.
When teaching is viewed as communication, then a specific learning objective can be said to be developed from:
The referent
Authority
The right to direct others given to a person by the employer through an authorized position such as a manager or administrator
3. Develop topics for discussion that require problem solving
The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? 1. Provide information using a lecture 2. Use simple words to promote understanding 3. Develop topics for discussion that require problem solving 4. Complete an extensive literature search focusing on eating disorders
4. The professional nurse works with colleagues and the patient's family to provide combined expertise in planning care.
The statement that best explains the role of collaboration with others for the patient's plan of care is which of the following? 1. The professional nurse consults the health care provider for direction in establishing goals for patients. 2. The professional nurse depends on the latest literature to complete an excellent plan of care for patients. 3. The professional nurse works independently to plan and deliver care and does not depend on other staff for assistance. 4. The professional nurse works with colleagues and the patient's family to provide combined expertise in planning care.
3. Consistent
The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to see the pain scores recorded for a patient over the last 24 hours. Use of the pain scale is an example of which intellectual standard? 1. Deep 2. Relevant 3. Consistent 4. Significant
241.2 What three approaches to job design are discussed in your text?
The three approaches to job design are: job rotation, job enlargement and job enrichment.
238.1 What are three key attributes of a role model?
The three key attributes that are essential to the Air Force are integrity and commitment (character traits) and mentoring (a supportive relationship).
237.1 What are the two categories of leadership power?
The two categories of leadership power are personal and position.
232.1 Briefly describe each of the change levels.
There are four levels of change: knowledge, attitudinal, behavioral, and group/organizational. A process as simple as reading a publication, manual or AFI can effect change at the knowledge level. Attitudes, because they are normally emotionally charged, and more challenging. Attitudinal change involves the adoption of a positive feeling for the task at hand. Behavior is more difficult to change than either knowledge or attitude. Both of these must change first in order for behavioral change to occur. Change at the behavioral level is demonstrated through observable behavior. Group or organizational performance change is the most difficult, since it often involves the alteration of long-standing and deeply engrained customs and traditions.
234.2 What are the organizational norms? What comprises each?
There are four orgaznizational norms. The technology norm includes computers, test equipment, weapons systems, etc.; the task norm includes general procedures, job steps, checklists, etc.; the structure norm includes administrative procedures, evaluation systems, etc.; and the people norm includes technical or leadership training, new jobs, etc.
234.4 What are the stages of the change process? Briefly, describe each.
There are three stages in the change process: unfreezing, changing and refreezing. The unfreezing stage involves creating a need for the change; the changing stage involves moving the four organizational norms from the old state to the new; the refreezing stage completes the process by locking-in the expected outcomes.
233.1 Briefly describe each of the change cycles.
There are two change cycles--directive and participative. The directive change cycle is the "from the top down" approach, while the participative change cycle works "from the bottom up".
240.6 What does the Unit Manning Document (UMD) tell you?
This document tells you the number of people authorized, the Air Force Specialty Codes (AFSCs), position numbers and total number assigned to your work center.
what is nonmaleficence
to do no harm and protect patients when they cannot protect themselves
1. Smoking is prohibited around oxygen. 3. Do not use electrical equipment around oxygen. 4. Special precautions may be required when traveling with oxygen.
To ensure the safe use of oxygen in the home by a patient, which of the following teaching points does the nurse include? (Select all that apply.) 1. Smoking is prohibited around oxygen. 2. Demonstrate how to adjust the oxygen flow rate based on patient symptoms. 3. Do not use electrical equipment around oxygen. 4. Special precautions may be required when traveling with oxygen.
Voice
Tone, volume, pitch, rate of speech. Fear, excitement, enthusiasm, stress, anger, comfort, concern, confidence calmness.
Nursing Hours Per Patient Day
Total nursing hours worked by nursing staff in a 24 hour period divided by the patient census at the end of that 24 hour period.
225.2 How does the organizational benefit when the Situational Leadership model is followed?
Training and development of subordinates will be more organized. Production will be easier to manage because everyone will know the goals, understand what they need to do to reach those goals, and when they reach the D3 and D4 levels, will contribute more effectively and enhance mission accomplishment. Fulfillment of NCO responsibilities is easier making management of the work-center more efficient.
Delegation in Nursing
Transferring the authority to perform a selected nursing task in a selected situation to a competent individual
Biomedical
Treatment focuses on the use of physical and chemical interventions.
Holistic
Treatment is designed to restore balance with physical, social, and metaphysical worlds. It may extend beyond treating the person to treating the environment to decrease pollution or prevent hunger, homelessness, etc.
Folk "Third-World"
Treatment is done by carrying out rituals, repentance, or giving in to the supernatural force's wishes.
Non-English Speaking w/o Interpreter
Use a translator, determine if there is a 3rd language that can be used, nonverbal communication is more important than verbal communication, be attentive to both your own and the patient's nonverbal messages, pantomime simple words and actions, and use pictures.
Non-English Speaking w/Interpreter
Use dialect-specific interpreters, give patient and interpreter time alone together, build time for translation and interpretation, avoid using children and relatives as interpreters, select same-age and same-sex interpreters, and address your questions to patient, not interpreter.
Verbal Communication
Use of spoken or written words or symbols. Words can have different meanings, or connotations, for different people.
224.6 Describe situations in which the coaching style is appropriate.
Use the coaching style when dealing with a D2, a person with some competence, but not all the skills, knowledge or information needed, and who is also unmotivated and/or unsure of their ability. A subordinate has some skills and experience to contribute, but may not have all the information or perspective you have. Working with a D3 who is slipping or regressing because his skills are rusty, his attitude is poor or he's lost sight of the goal. You want to verify a person's skills or attitudes toward a new task.
224.8 Describe situations in which the delegating style is appropriate.
Use the delegating style with D4s--motivated, confident, educated, experience, self-directing, self-supporting persons--subordinates with high competence and high commitment. Other appropriate situations are with D3s, who have all the skills for the task at hand, when you have long timelines, low stakes and built-in reinforcement and you think they're ready to be let go.
224.5 Describe situations in which the directing style is appropriate.
Use the directing style when you have a D1, someone who is low in competence, but motivated. You could also use Style 1 when: You're in an emergency situation. There is a short timeline and your follower is a D2 or D3. A D2 is working on a complicated and very important task. There is a major organizational change. When Style 2 is no longer effective.
224.7 Describe situations in which the supporting style is appropriate.
Use the supporting style when the person has the skills needed to do a task, but is a little insecure or lacks confidence. It could also be used with someone who has the skills relevant to doing the task, but doesn't care.
False Reassurance
Using falsely comforting phrases in an attempt to offer reassurance.
substitutes for leadership
Variable that may influence or have an effect on followers to the same extent as the leader's behavior
Theory Z
View of collective decision making and a focus on long term employment that involves less direct supervision
Theory X
View that in bureaucratic organizations, employees prefer security, direction, and minimal responsibility; coercion, threats, or punishment are necessary because people do not like the work to be done
Theory Y
View that in the context of the right conditions, people enjoy their work, they can show self-control and discipline, are able to contribute creatively and are motivated by ties to the group, the organization, and the work itself; belief that people are intrinsically motivated by their work
Systems Theory
Views the organization as a set of interdependent parts that together form a whole. If something affects on factor in the system, the entire system will also be affected.
LEGAL RISK AREAS **Invasion of Privacy
Violating confidentiality *Intruding on private client/family matters *Sharing client information with unauthorized persons
The client who is most ready to begin a client teaching session is the client who has:
Voiced a concern about how insulin injections will affect her lifestyle
Eye Contact = Openness
Western
motivation
Whatever influences our choices and creates direction, intensity, and persistence in our behavior
2. Analogy
When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? 1. Telling 2. Analogy 3. Demonstration 4. Simulation
3. A thorough physical assessment
When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments include which of the following? 1. The amount of family support 2. A 3-day diet recall 3. A thorough physical assessment 4. Threats to safety in her home
239.2 When should you understand the capabilities and limitation of your organization?
When developing objectives, creating priorities and assigning tasks.
236.2 What two key aspects should you focus on when you are diagnosing an organization?
When diagnosing an organization, the two key aspects are; the status of the people and the status of the environment.
posttraumatic stress disorder (PTSD)
When doing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. The nurse recognizes this as ___________________.
The sequencing of stages of grief may occur in order, they may be skipped, or they may reoccur
When helping a person through grief work, the nurse knows
Current health standards should determine the acceptability of cultural practices.
When providing care to clients with varied cultural backgrounds, it is imperative for the nurse to recognize that:
1. Results in neurophysiological response.
When teaching a patient about the negative feedback response to stress, the nurse indicates which of the following to describe the benefits of this stress response? 1. Results in neurophysiological response. 2. Reduces body temperature 3. Causes a person to be hypervigilant 4. Reduces level of consciousness to conserve energy.
The nurse plans to teach a client about the importance of exercise:
When the client's pain medications are working
3. 18 inches to 4 feet from the patient.
When the nurse takes the patient's history, he or she sits: 1. Next to the patient. 2. 4 to 12 feet from the patient. 3. 18 inches to 4 feet from the patient. 4. 12 inches to 3 feet from the patient.
3. Shifting quickly from subject to subject.
When working with an older adult, the nurse remembers to avoid: 1. Touching the patient. 2. Allowing the patient to reminisce. 3. Shifting quickly from subject to subject. 4. Asking the patient how he or she feels.
229.3 When should you refer your subordinate to other people or other agencies for follow-up feedback?
When you determine the problem is too much for you to handle or you do not know enough about the issue to help the subordinate make a solid informed decision, you should refer the person to the agency best able to help.
Bio-cultural needs
Which factor is least significant during assessment when gathering information about cultural practices?
4. Anticipated when to make choices without others' assistance.
Which of the following is unique to the commitment level of critical thinking? 1. Weighs benefits and risks when making a decision. 2. Analyzes and examine choices more independently. 3. Concrete thinking. 4. Anticipated when to make choices without others' assistance.
2. Nurse practitioner 3. Certified clinical nurse specialist
Which of the following nursing roles may have prescriptive authority in their practice? (Select all that apply.) 1. Critical care nurse 2. Nurse practitioner 3. Certified clinical nurse specialist 4. Charge nurse
2. "Why do you always put so much salt on your food?"
Which of the following statements would be most likely to block communication? 1. "You look kind of tired today." 2. "Why do you always put so much salt on your food?" 3. "It sounds like this has been a hard time for you." 4. "If you use your oxygen when you walk, you may be able to walk farther."
240.5 Describe the purpose of the Unit Personnel Management Roster (UPMR).
Which organizational document lists the people assigned, projected losses and gains, and should accurately reflect the Unit Manning Document (UMD).
4. Problem solving.
While assessing a patient, the nurse observes that the patient's intravenous (IV) line is not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator on the tubing, looks to see if the patient is lying on the tubing, checks the point of connection between the tubing and the IV catheter, and then checks the condition of the site where the intravenous catheter enters the patient's skin. After the nurse readjusts the flow rate, the infusion begins at the correct rate. This is an example of: 1. Inference. 2. Diagnostic reasoning. 3. Competency. 4. Problem solving.
Amish Society
Women are not allowed to hold position of authority; outside marriages are not allowed; unmarried women remain under the authority of their fathers; wives are submissive to their husbands; physically and socially detached from from the world; Believe that health is a gift from God; do not have health insurance(self pay); have lower risk factors than the general population; funerals are conducted at home without: flowers, eulogy or any other display; women are buried in their wedding dresses; believe in after life
2. Theory Y
Workers have self control & self-discipline-workers reward is their involvement & opportunity to be creative.
McGregor's X & Y
X-workers have to be constantly supervised Y-workers see work as equal to rest and extra curricular activities
3. Takes antihypertensive and diuretics 4. History of recent fall 5. Neglect, spatial and perceptual abilities, impulsive 6. Requires assistance with activity, unsteady gait 7. IV line, urinary catheter
You are admitting Mr. Jones, a 64-year old patient who had a right hemisphere stroke and a recent fall. The wife stated that he has a history of high blood pressure, which is controlled by an antihypertensive and a diuretic. Currently he exhibits left sided neglect and problems with spatial and perceptual abilities and is impulsive. He has moderate left-sided weakness that requires the assistance of two and the use of a gait belt to transfer to a chair. He currently has an intravenous (IV) line and a urinary catheter in place. What factors increase his fall risk at this time? (Select all that apply.) 1. Smokes a pack a day 2. Used a cane to walk at home 3. Takes antihypertensive and diuretics 4. History of recent fall 5. Neglect, spatial and perceptual abilities, impulsive 6. Requires assistance with activity, unsteady gait 7. IV line, urinary catheter
4. Talk with him about his favorite hobbies
You are caring for Mr. Smith, who is facing amputation of his leg. During the orientation phase of the relationship, what would you do? 1. Summarize what you have talked about in the previous sessions 2. Review his medical record and talk to other nurses about how he is reacting 3. Explore his feelings about losing his leg 4. Talk with him about his favorite hobbies
3. Move to her bedside, get her attention, and repeat the question while facing her
You are caring for an 80-year old woman, and you ask her a question while you are across the room washing your hands. She does not answer. What is your next action? 1. Leave the room quietly since she evidently does not want to be bothered right now 2. Repeat the question in a loud voice, speaking very slowly 3. Move to her bedside, get her attention, and repeat the question while facing her 4. Bring her a communication board so she can express her needs
4. Defines the principles of right and wrong to provide patient care.
You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A nonnursing colleague asks about this code. Which of the following statements best describes this code? 1. Improves self-health care 2. Protects the patient's confidentiality 3. Ensures identical care to all patients 4. Defines the principles of right and wrong to provide patient care.
2. "When you brush me off like that, it takes me even longer to do my job."
You ask another nurse how to collect a laboratory specimen. The nurse raises her eyebrows and asks, "Why don't you figure it out?" what would be the best response? 1. Say nothing and walk away. Find a different nurse to help you. 2. "When you brush me off like that, it takes me even longer to do my job." 3. "Why do you always put me down like that?" 4. "I guess I just enjoy having you make fun of me."
231.1 Explain how you can improve your subordinate when developing an improvement plan.
You can improve your subordinate by building on their strengths to develop a good foundation of motivation. Building on strengths helps to minimize and elminate weaknesses in the subordinate.
quality management (QM)
a corporate culture emphasizing customer satisfaction, innovation, and employee involvement in quality improvement activities; often used interchangeably with total quality management, continuous quality management, quality improvement, and performance improvement
234.5 Explain the responsibility an NCO has to each subordinate during the change process.
You have a responsibility to create a positive atmosphere through which each of your subordinates will feel that change is needed and will be supportive of the process. Concurrently, as NCO supervisors, managers and leaders, you must anticipate and deal with any resistance to change. In so doing, you must gain familiarity with and be able to identify each of the following six groups of personalities in your orgaznization: the innovators, early adopters, early majority, late majority, late adopters, and the diehards. You must realize that people are your single greatest asset, and concentrate your efforts upon those who are willing to "get with the program".
231.3 What are some things to consider as a supervisor to improve the situation while developing an improvement plan?
You should make sure you are not over or under supervising; also you should maintain good situational awareness of the happenings with your subordinates and your work center.
2. Pulling the curtain to provide privacy 3. Offering to discuss information about her condition 5. Sitting quietly by her bed and hold her hand
Your patient has just been told that she has cancer, and she is crying. Which actions facilitate therapeutic communication? (Select all that apply.) 1. Turning on the television to her favorite show 2. Pulling the curtain to provide privacy 3. Offering to discuss information about her condition 4. Asking her why she is crying 5. Sitting quietly by her bed and hold her hand
culture of safety
a blame free environment in which staff can practice & openly discuss potential errors or near-misses as well as actual errors---just culture: No shame No Blame
clinical information system (CIS)
a collection of software programs and associated hardware that supports the entry, retrieval, update, and analysis of patient care information and associated clinical information related to patient care; primarily a computer system
critical path/critical pathway
a component of care MAP that is specific to diagnosis-related group reimbursement; the purpose is to ensure patients are discharged before insurance reimbursement is eliminated
operating budget
a financial plan for day to day activities of an organization
Mission Statement of organization
a formal expression of the purpose or reason for existence of the organization
role discrepancy
a gap between role expectations and role performance
flowcharts
a graphical representation of a process, depicting inputs, outputs and units of activity; represents the entire process, allowing analysis and optimization of workflow
emergency response plan
a health care agency's preparedness and response plan in the event of a disaster
managed care
a health care plan that brings finance and delivery of care into one entity, to enhance cost, and quality of care
collective action
a mechanism for achieving professional practice through group decision making; activities undertaken by a group of people with a common interest
functional nursing model
a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients (may be seen during a mass casualty event)
Failure Mode & Effect Analysis (FMEA)
a method to analyze reliability problems proactively to avoid negative outcomes; risk management tool; proactive identification and risk reduction
primary nursing
a model of patient care delivery whereby one registered nurse functions autonomously as the patient's main nurse throughout the entire hospital stay
what is an example of malpractice?
a nurse administers a large dose of medication due to a calculation error. the client has a cardiac arrest and dies
what is an example of breach of confidentiality?
a nurse releases the medical diagnosis of a client to the press
What is an example of defamation of character?
a nurse tells a coworker that she things a client has been unfaithful to a spouse
What is an example of false imprisonment?
a person is confined or restrained against his will
cash budget
a plan for an organization's cash receipts and disbursement, how bills are paid month to month
Strategic Planning Process
a process by which the guiding members of the organization envision their future and develop the necessary and appropriate procedures and operations to actualize that future
benchmarking
a process for measuring products, practices, and services against best performing organizations; allows nurse managers to compare staffing and plans across like units or organizations
360 Degree Feedback
a process in which an individual is assessed by a variety of people in order to provide a broader perspective; nurses asked to evaluate their peers need orientation to the process and to the specific tool being used
politics
a process of human interaction within organizations; predominantly a process by which people use a variety of methods to achieve their goals; involves some level of competition, negotiation, and/or collaboration
quality assurance
a process that focuses on the clinical aspects of a provider's care, often in response to an identified problem; inspection approach to ensure that minimum standards of care existed in health care institutions
safe harbor act
a process that protects a nurse from employer retaliation & licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in violation of the NPA or Board rules; must be invoked prior to engaging in conduct or assignment
capitation
a reimbursement method in which healthcare providers are paid a per-person-per-year (or month) fee for providing specified services over a period of time
time management
a set of related common-sense skills that helps you use your time in the most effective and productive way possible; the use of tools, techniques, strategies, and follow-up systems to control wasted time and to ensure that the time invested in activities leads toward achieving a desired, high priority goal
team nursing model
a small group of licensed and unlicensed personnel, with a team leader, responsible for providing patient care to a group of patients
role stress
a social condition in which role demands are conflicting irritating, or impossible to fulfill
moral distress
a type of distress that occurs when faced with situations in which two ethical principles compete, such as when the nurse is balancing the patient's autonomy issues with attempting to do what the nurse knows is in the patient's best interest
Philosophy of organization
a value statement of the principles and beliefs that direct the organization's behavior
Tort law
a wrongful act committed against another person, organization, or their property that causes harm by invading a legally protected right for which the court will provide a remedy in the form of an action for damages
Autonomy is ___. a. The right to self-determination b. the duty to do good c. a problem that confronts one, with a choice of solutions that seem or are equally unfavorable d. duty to keep one's promise
a. The right to self-determination
224.4 Explain each of the four Situational Leadership styles of leadership. a. Directing b. Coaching c. Supporting d. Delegating
a. "Directing" implies that the manager will exhibit more directive behavior; provide specific instructions, control task accomplishment, make most of the decisions and closely supervise workers. Using the SI style assumes the leaders/managers/supervisors, solve problems generally by themselves. b. "Coaching" implies that the manager still decides what the game plan will be and directs task accomplishment, but may consult with subordinates or ask for their ideas. The manager/leader/supervisor will be the one who identifies problems, sets goals and evaluates the work accomplished. c. "Supporting" implies an increase in Supportive Behavior and a decrease in Directive Behavior. The leader/manager/supervisor using this style act toward subordinates with more two-way communication involving subordinates in problem solving, process improvement and decision-making. In addition, using this style involves discussing with the subordinate what needs to be done and allowing the individual to decide how, when, where, etc. to accomplish the job. d. "Delegating" implies that the leader/manager/supervisor assigns responsibility to the subordinate and then backs off. Many refer to this as "Empowerment-It's not the case that low direction and support means no direction and support."
All of the following are true about accountability except ___. a. Accountability can be delegated. b. Accountability is invested in individuals, not group. c. Accountability is about the products of work, not the processes of work. d. Accountability implies change.
a. Accountability can be delegated.
Critical influences that are creating shifts in health care include all of the following except ___. a. Change forces are usually just seen on a local level. b. The financial model now reflects a strong emphasis on value rather than the volume. c. Focus on healthcare system structures, processes, and evidence is reflected in dynamics that clearly demonstrate impact, effectiveness, and significant measures of the levels of health. d. Evidentiary dynamics and improvement science now guide mechanisms of advancing practice within the context of a strongly interfaced digital information infrastructure.
a. Change forces are usually just seen on a local level.
Examples of poor communication in fully sharing personal views, insights, or opinion include all of the following except ___. a. Staff vocalizes affirmatively. b. You see people nodding their heads or sitting in silence in response to a statement or question raised. c. You notice people stop questioning or raising issues because they fear being labeled as not being team players.
a. Staff vocalizes affirmatively.
An essential characteristic of negotiation is ___. a. Win-lose b. Win-win c. Lose-lose d. None of the above.
a. Win-lose
224.3 Explain each of the four Situational Leadership development levels. a. D1 b. D2 c. D3 d. D4
a. D1 - low competence/high commitment: the D1 lacks or has little skill and knowledge to do the task, but is eager to try it anyway. For example, a subordinate diagnosed as a D1 could be compared to an individual who recently arrived at his first duty station. The person has a lot of enthusiasm for entering a new lifestyle and being part of the US military forces, but has none of the job skills necessary to be successful. b.D2 - some competence/low commitment: At this point, the subordinate has some knowledge or training, but confidence may still be low for a number of reason. The subordinate may not be able to perform as much as he thought he could, or he could be overwhelmed by the scope of the task, thus limiting his own potential. For example, a subordinate diagnosed as a D2 is the follower who is beginning to "learn the ropes." The newly assigned subordinate described above is introduced to computer software he's not familiar with, but he has an understanding of using a computer system. After some time on the task, he gains more competence at manipulating the software, but will come across problems in trying to maximize the software's power. This can definitely influence his willingness to progress further. He may have to consult the user's manuals or seek assistance often. c. D3 - high competence/variable commitment: The D3 is a skilled individual but whose commitment may vary due to low self-confidence, personal problems, lack of valued recognition (or support). In some cases the person may simply not care (apathy). For example, a D3 has become quite proficient in using the software program by following the guidelines of the tutorial or user guide. She's quite skilled at using the program, but as yet isn't excited by its capabilities. She's not sure the software is useful for the duties assigned. d. D4 - high competence/high commitment: The D4 has all the technical and team skills to do the task and is motivated, self-directed, self-supporting. For example, our software specialist has now become the peak performer in using the program. She's competent in using the software and has much confidence in her ability to master it. She's identified and developed several uses for the program and is looked to by co-workers and supervisors as the expert in using that particular program.
All of the following are true about negotiation except ___. a. Effective negotiation is a skill one is born with. b. Negotiation is learned through the process of discipline and application. c. Much of the skill and talent necessary to negotiate well can be improved through continuous and effective use and refinements of skill development and learning. d. In all negotiation it is important to be able to develop and utilize good listening skills.
a. Effective negotiation is a skill one is born with.
223.2 Describe each of the following situational factors: a. Interpersonal b. Structure of the job or organization c. Time d. Outside influences e. Awareness of self
a. Interpersonal factors include personal relationships among supervisors and subordinates, supervisors and superiors, and supervisors and other supervisors. They affect and influence leadership under the following conditions: 1) a strong personality encounters a weak personality, 2) someone with ambition deals with another who seems to lack ambition, 3) expectations of each for the other, 4) physical stature is unequal (larger person versus smaller person), and 5) when an aggressive person interacts with a passive person b. Some organizations such as fire departments require much more directive styles of leadership. More highly technical or research jobs may require more delegating or empowering. c. The time an individual has to act can have a major impact on situational leadership. In an emergency situation, the supervisor would likely revert to more directive styles in order to save lives and resources. A supervisor with an urgent mission in a base exercise might be more demanding than someone planning next year's company picnic. d. Outside influence include social issues and movements that will affect attitudes of subordinates and supervisors alike, environmental conditions, social unrest, and current world. e. Awareness of self involves your leadership inclinations and tendencies? How you prefer to lead subordinates?
Of the following statements ____ is true. a. Optimization in the system is a reflection of the strong goodness of fit between the human organizational dynamics and the technological functional processes that comprise the overall structure of the work environment. b. Complex thinking that focuses on either social or technical processes increases the predictable. c. Health care contains little interaction between social and technical forces.
a. Optimization in the system is a reflection of the strong goodness of fit between the human organizational dynamics and the technological functional processes that comprise the overall structure of the work environment.
The novice to expert skill acquisition model for nursing was developed by ___. a. Pat Benner b. Florence Nightingale c. Madeline Leininger d. Dorothea Orem
a. Pat Benner
The following is true__. a. Physicians cannot delegate physician work to nurses. b. Physicians can delegate physician work to nurses. c. If the activity or task is not within the nurse's scope of practice, it can be delegated by the nurse. d. Delegation is necessary even if the particular activity or task is already within the legally recognized scope of practice of the individual who is to perform the activity or task.
a. Physicians cannot delegate physician work to nurses.
Dashboards are ___. a. a combination of graphics and numbers to quickly display important data elements. b. a discrepancy between needs and resources. c. financial statements that include information about revenue sources. d. a way to chart medications given.
a. a combination of graphics and numbers to quickly display important data elements.
A balance sheet is ___. a. a financial statement that includes assets, liabilities, and equity. b. a financial statement that includes information about revenue sources and expenses at a specific point in time. c. a financial report that shows the cash inflow and outflow activities of financial stability of the organization.
a. a financial statement that includes assets, liabilities, and equity.
The delegator is responsible for all of the following except ____. a. accepting only those tasks or assignments for which he or she is qualified. b. assessment of the situation. c. ascertaining the competence of the delegate. d. follow-up supervision. e. management of results.
a. accepting only those tasks or assignments for which he or she is qualified.
For professionals ____ is the definitive foundation for work. a. accountability b. responsibility c. competence d. functionalism
a. accountability
Variance management is____. a. analysis of the difference between actual hours of staff and required hours of care and then using this information to create effective workload management systems. b. using multiple indicators to evaluate staffing effectiveness. c. assisting less-experienced staff in organizing and providing care. d. eliminating non-value-added work.
a. analysis of the difference between actual hours of staff and required hours of care and then using this information to create effective workload management systems.
When a health care professional performs favors for a patient that are outside the therapeutic relationship, this is called _____. a. boundary violation b. boundary crossing c. ethical fading d. whistle-blowing
a. boundary violation
Practice breakdown is ____. a. disruption or absence of any of the aspects of good practice b. brief excursions from an established boundary for a therapeutic purpose c. a process that obscures the ethical dimensions of a decision d. when a person knows what is right and doesn't want to do it
a. disruption or absence of any of the aspects of good practice
what is the purpose of filling out an incidence report?
to identify factors that contribute to the occurrence of the problem
One of the problems with patient classification systems has been low validity. This problem includes the following: a. failing to account for the full scope of nursing practice. b. belief that patient classification systems are a vehicle to increase or decrease staffing levels inappropriately. c. wrongly projecting patient care needs for the next shift or time period. d. failing to use the data that is generated.
a. failing to account for the full scope of nursing practice.
Setting the table means ___. a. knowing how all the decisions need to be served b. making all of the decisions for the team c. selecting team members based solely on how well they work together d. limiting the diversity of the group
a. knowing how all the decisions need to be served
The historical usage approach to staffing involves___. a. looking at usage from the year before. b. the assumption that all patients are similar in needs. c. identifying nurse-to-patient ratios based on experiences and perceptions of nurses. d. use of a patient classification system.
a. looking at usage from the year before.
Care at the end of life for which there is little hope of benefit is an example of ____. a. medical futility b. organizational integrity c. nonmaleficence d. rationalization
a. medical futility
Underdelegation is when __. a. not enough work is delegated. b. the workload is beyond what the delegate can reasonably do in the assigned time. c. the delegator is constantly looking over the shoulders of those asked to do the work. d. any of the five rights are violated.
a. not enough work is delegated.
Social policy is ___. a. policy intended to enhance public welfare b. laws passed by the legislature c. policies that are authoritative rulings related to those decisions made by government d. policy directed toward promoting the health of citizens
a. policy intended to enhance public welfare
quality improvement
also known as performance improvement, focuses on processed or systems that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor outcomes of care and to determine the need for change to improve the quality of care.
Reasons to introduce change
to solve a problem to improve efficiency to reduce the unnecessary workload for some group
All of the following are team fables except ____. a. team members are not always committed to implementing a good team process b. all team members are created equal c. team members generally use good critical thinking to resolve their questions and issues d. team members will set aside their emotional issues in the interest of effective team decision making
a. team members are not always committed to implementing a good team process
All of the following are team fables except ____. a. team members usually do not use good critical thinking to resolve their questions and issues b. each team member fully understands why they act the way they do c. people always want to work with others d. building trust is an important role of the team leader
a. team members usually do not use good critical thinking to resolve their questions and issues
<p>The agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care in the U.S. is ___.</p> <p>a. the Agency for Healthcare Research and Quality</p> <p>b. the Commonwealth Fund</p> <p>c. the Institute of Medicine</p> <p>d. the Organization of Nurse Executives</p>
a. the Agency for Healthcare Research and Quality
<p>The federal statute enacted in March 2010 that was designed to ensure that all Americans have access to health care is ___.</p> <p>a. the Patient Protection and Affordable Care Act</p> <p>b. the Future of Nursing: Leading Change, Advancing Health</p> <p>c. the Transition of Care Program</p> <p>d. the Patient Self-Determination Act</p>
a. the Patient Protection and Affordable Care Act
Accountability is ___. a. the cornerstone of professional expression b. the same as responsibility c. to be avoided by professionals d. All of the above are true.
a. the cornerstone of professional expression
mutual support
ability to anticipate and support other team members' need through accurate knowledge about their responsibilities and workload
leadership
ability to coordinate the activities of team members by ensuring team actions are understood, changes in information are shared, and that team members have the necessary resources
Management
about controlling complexity to bring order and consistency
Leadership
about creating change and involves establishing direction and aligning people through empowerment
management
accomplishment of tasks or goals by oneself or by directing others.
delegation
achieving performance of care outcomes for which you are accountable and responsible by sharing activities with other individuals who have the appropriate authority to accomplish the work
contingency approach
acknowledges that (other) environmental factors influence outcomes as much as leadership style
policy and procedures
activities governed by agency such as restraints, scheduled meds or dressings, checking code carts
maslow third priority
activities that care support, love and belonging, self esteem(self-care), self-actualizaion, teaching and psychosocial support
huddle
ad hoc planning to reestablish situation awareness; reinforcing plans already in place; and assessing the need to adjust the plan
contemporary approaches
address leadership functions necessary to develop learning organizations and lead process of transforming change
situational leadership theory
addresses followers readiness as factor in determining leadership style
5. Physiological:
adequate salary, breaks and working conditions.
demonstrate marginally acceptable independent performance
advanced beginner nurse
Scientific Management
all about production; based on the idea that there is one best way to accomplish as task
paternalism
allowing a person to make a decision for another; deliberate overriding of patient's opportunity to exercise autonomy b/c of perceived obligation of beneficence: mandatory flu vaccine, not giving bad information about a terminal diagnosis
nominal group technique
allows group members the opportunity to provide input into the decision-making process; no discussion initially
sentinel event
an event that had a negative patient outcome (unexpected death, serious physical or psychological injury, or serious risk)
profit
an excess of revenues over expenses and obligations;
What is a negative outcome for infancy?
an inability to trust; withdrawal, isolation
informal leader
an individual who demonstrates leadership outside the scope of a formal leadership role, such as a member of a group rather then the head or leader of the group.
adverse event
an injury resulting from medical intervention; not due to the patient's underlying condition
disaster
any human-made or natural event that causes destruction and devastation that cannot be alleviated without assistance; internal disasters are events that occur within a health care agency, whereas external disasters are events that occur outside the health care agency.
variance
anything that alters a patient's progress through a normal care path
if two nurses are talking about patient information publicly,
approach them right away to avoid further release of information
evidence-based practice
approach to client care in which the nurse integrates the client's preferences, clinical expertise, and the best research evidence to deliver quality care
translating research into practice (TRIP)
approaches that integrate the use of evidence into patient care; the science of how research is best translated into practice
where do you secure baby's harness?
at baby's armpits to ensure proper placement of safety straps
behavioral theories*****
autocratic leadership democratic leadership laissez-faire leadership
informed consent is based on the ethical principle of
autonomy
1 yr -3 yr = Toddler stage
autonomy vs. shame and doubt (if no contact)
misuse
avoidable complications that prevent patients from receiving full potential benefit of a service (patient receives a med that is not prescribed & conflicts w/his allergies causing anaphylaxis)
The following is not true about change ___. a. Learning how to thrive in the presence of continual change requires both art and science in the healthcare environment. b. All change is urgent. c. Not all change is value laden. d. Some good ideas just don't need to happen unless there is evidence and rationale for the change.
b. All change is urgent.
All of the following are essentials that evidence a good fit between supporting infrastructure and the capacity for sustainable professional practice except ___. a. Professionals organize around decisions, not positions. b. Decisions are never driven from the point of service. c. A grid of accountability demonstrates the locus of control for all decisions in the system and clearly identifies where decisions should be made and by whom. d. Clarification and distinction of decisions that are a priori management driven and owned and those that are staff owned is an important distinction of accountability in professional organizations.
b. Decisions are never driven from the point of service.
The following is not true ___. a. The nurse is accountable for selection and delegation of tasks to the delegate. b. The delegator is responsible for the actual work of the delegate. c. The delegate is fully responsible for his or her work. d. The delegator is responsible for the process.
b. The delegator is responsible for the actual work of the delegate.
<p>The Institute of Medicine is ___.</p> <p>a. an organization that serves to promote health care that emphasizes access, quality, and greater efficiency, particularly for society's most vulnerable people</p> <p>b. a non-profit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public</p> <p>c. the U.S. government's principal agency for protecting the health and well-being of all Americans through the provision of essential human services, especially for those who are most needy</p> <p>d. None of the above are true.</p>
b. a non-profit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public
Creating a context of trust is the essential framework for ____. a. a place where the employee can share with you all of their problems. b. a truly safe place where conflict can be dealt with as easily and effectively as any other function, process, or relationship. c. quicker discovery of mistakes, allowing the proper punishments to be delivered more quickly. d. None of these is true.
b. a truly safe place where conflict can be dealt with as easily and effectively as any other function, process, or relationship.
All of the following are examples of elements of a professional nurse portfolio except ____. a. continuing education records b. attendance record c. committee contributions d. contributions to the community
b. attendance record
In complex adaptive systems, power is ____. a. located in the formal structure. b. closely-aligned with the point-of-care decision making. c. Both of the above are true. d. Neither of the above is true.
b. closely-aligned with the point-of-care decision making.
Times and motion studies involve _____. a. sampling activities at systematic or random intervals. b. continuous timed observations of a single person during a typical time period or shift of work. c. asking the individual to log the work performed using a data collection tool with start and stop times of each activity recorded. d. using time standards developed from past experiences.
b. continuous timed observations of a single person during a typical time period or shift of work.
A problem that confronts one, with a choice of solutions that seem or are equally unfavorable is a (n) ___. a. ethical erosion b. ethical dilemma c. ethical fading d. boundary crossing
b. ethical dilemma
All of the following are true about the ethics of care moral theory except ____. a. it is based on the insights of Carol Gilligan b. it is a process that obscures the ethical dimension of a decision c. it rejects the traditional male-centered ethics that focused on rationality, individuality, and abstract principles d. it is based on emotion, caring relationships, and concrete situation
b. it is a process that obscures the ethical dimension of a decision
All of the following are true about nursing staff skill mix except ____. a. it consists of the numbers of licensed and nonlicensed staff. b. it is determined based on who is available to work. c. it is determined based on the work that needs to be done. d. it is difficult and challenging to determine due to the multifaceted nature of patients and caregivers.
b. it is determined based on who is available to work.
All of the following fall within the realm of complexity science except ___. a. behavioral economics b. linguistics c. gaming theory d. nonlinear dynamics
b. linguistics
You have just witnessed an incident where a patient could have been harmed by the care of another nurse. The type of ethical dilemma you are facing is a ____. a. boundary crossing b. nurse-nurse ethical dilemma c. whistle-blowing d. nurse-patient ethical dilemma
b. nurse-nurse ethical dilemma
<p>The provision of tangible recognition of professional achievement in a defined functional or clinical area of nursing is ___.</p> <p>a. the state nurse practice act</p> <p>b. nursing certification</p> <p>c. nursing licensure</p> <p>d. none of the above</p>
b. nursing certification
A coach is ___. a. a wise and trusted advisor who guides others on a particular journey. b. one who assists others to develop viable solutions, prioritize them, and then act on them. c. a unit manager or leader. d. None of the above.
b. one who assists others to develop viable solutions, prioritize them, and then act on them.
<p> The law passed in 1996 which focused on the patient's right to confidentiality and the improvement of the portability and continuity of health insurance coverage is ___.</p> <p>a. the Good Samaritan Law</p> <p>b. the Health Insurance Portability and Accountability Act c. Informed Consent</p> <p>d. the Patient Self-Determination Act</p>
b. the Health Insurance Portability and Accountability Act
confronting
immediate and obvious move to stop conflict; powerful; conflict does not take root/issues clarified; leaves impression conflict not tolerated; can make something big out of nothing
The Federal Register is ___. a. a policy that refers to rules that govern the workplace b. the official daily publication for rules, proposed rules, and notices of the federal government and an unbiased source of information c. a document that regulates nursing practice d. the overarching federal administrative agency concerned with quality healthcare in the United States
b. the official daily publication for rules, proposed rules, and notices of the federal government and an unbiased source of information
The obligation for social accountability represents the social contract between the society that licenses the profession and ___. a. those who practice a profession b. the persons who act in the best interests of the society c. employees of a healthcare institution d. None of the above.
b. the persons who act in the best interests of the society
<p>Autonomy is all of the following except ____.</p> <p>a. the power to do a job.</p> <p>b. the right to do a job.</p> <p>c. embedded in a job description.</p> <p>d. is identified within the expectation for specific work.</p>
b. the right to do a job.
Conflict is all of the above except ______. a. normative b. to be avoided at all costs c. a metaphor for difference d. often ideological e. due to intellectual differences
b. to be avoided at all costs
personal power
based on one's reputation and credibility
market justice
based on the principle that the benefits & burdens of a society should be distributed among its members according to the members' individual efforts & abilities
What is a positive outcome for a preschooler?
begins to evaluate own behavior; learns limits on influence in the environment
leadership theories
behavioral contingency contemporary
emotional intelligence
being able to evaluate and control emotions as well as assess their co-workers' emotion; those with higher levels of EI are more satisfied with and dedicated to their jobs; allows nurses to function optimally
beureaucratic leader
belief people are motivated by external forces, trust followers or self for decisions. relies of policies.
democratic leader
belief people are motivated by internal drives and impulses, active participation in decisios, desire to get it done
laissez faire leader
belief people are motivated by internal forces, need to be left alone, and gives no direction.
autocratic leader
belief people are motivated by power, authority, and need for approval, uses coercion and punishment
interpersonal conflict
between two or more people who disagree in regards to an issue or belief
causation
breach of duty caused injury; means that the nurse's actions or lack of actions directly caused the patient's harm; the patient did not merely experience some type of harm. There must be a direct relationship between the failure to meet the standard of care and the patient's injury.
capital budget
budget for purchasing major capital items, such as equipment or a physical plant, with a useful life greater than 1 year and exceeding a minimum cost set by the organization
Normative-reeducative
change strategy; focuses on the relationship needs of workers, peer pressure; assumes employees are interested in preserving relationships; assumes people respond to social norms and values
All of the following are true except _____. a. Challenges that differences in personalities create need to be addressed. b. Values must have a voice, and that voice must be honored, respected, and included. c. All problems can be solved. d. Challenges that exist in matching demand to available resources need expression if conflict about them is to be allayed.
c. All problems can be solved.
Complex adaptive systems theory ____. a. is grounded in work generating out of biology, mathematics, physics, and complexity science b. as applied to human behavior is represented in the study of a number of different approaches to understanding the relationship among behavior, organizations, and the larger systems that form the context. c. Both are true. d. Neither is true.
c. Both are true.
The problems with prospective versus retrospective prediction of patient care needs includes___. a. the amount of staff and skill mix has been nearly impossible to determine without an acceptable error range without using a computerized solution. b. it is nearly impossible to accurately predict patient condition changes, new admissions, and discharges. c. a and b d. Neither is true.
c. a and b
The following is not true about material resources ___. a. Material resources include those resources needed for the environment and supplies and equipment to provide the required patient care. b. There is significant variation in material resources and continuing demand for new and improved material resources. c. Material resources comprise a small percentage of the cost of health care. d. All of the above are true.
c. Material resources comprise a small percentage of the cost of health care.
All of the following are true about evolution of interdisciplinary teams except ____. a. Digital technology has helped to create the demand for interdisciplinary teams. b. The complexity-based biopsychosocial model lends itself to health along a continuum, and therefore a role for a wide variety of clinical members. c. The physician is always the team leader and therefore guides the team. d. In this increasingly complex health environment no one discipline has all of the information, skills, and resources necessary to address the many intersecting needs of individual patients and patient populations.
c. The physician is always the team leader and therefore guides the team.
All of the following are true about price except ____. a. It is based on available dollars and the need for a good or service. b. Prices are considered from the perspective of actual costs of services. c. The seller of goods does not determine the price for the goods. d. Prices are considered from the perspective of overall expenditure of dollars.
c. The seller of goods does not determine the price for the goods.
Cash flow operating activities is ______. a. a financial statement that includes assets, liabilities, and equity. b. a financial statement that includes information about revenue sources and expenses at a specific point in time. c. a financial report that shows the cash inflow and outflow activities of financial stability of the organization.
c. a financial report that shows the cash inflow and outflow activities of financial stability of the organization.
All of the following are principles of delegation from the ANA or NCSBN website except ___. a. delegation to competent individuals. b. care coordination and the use of assistants in providing patient care. c. ensuring the integrity of the physical plant. d. the essence of professional responsibility and accountability.
c. ensuring the integrity of the physical plant.
The following is a major element of the role of dialogue ___. a. have limited breaks b. negative language is acceptable c. establish rules of speaking without interruption d. remind the parties of prior failures
c. establish rules of speaking without interruption
An American school of philosophy that rejects the esoteric metaphysics of traditional European academic philosophy in favor of more down-to-earth, concrete questions and answers is ____. a. morality b. utilitarianism c. pragmatism d. bioethics
c. pragmatism
Inappropriate communication with patients could involve all of the following ethical issues except ____. a. autonomy b. betrayal c. pragmatism d. nonmaleficense
c. pragmatism
<p>Policies that are authoritative rulings relating to those decisions made by government are ___.</p> <p>a. social policy</p> <p>b. organizational policy</p> <p>c. public policy</p> <p>d. institutional policies</p>
c. public policy
Terms of engagement contain all of the following elements except ____. a. each member of the team will have an opportunity to speak b. avoid the use of judgment terms, such as "I agree" or "I disagree" c. team members should never use "I" statements d. the use of appreciative strategies in conversation should be encouraged and stimulated
c. team members should never use "I" statements
Ethics is ____. a. the elimination of arbitrary distinctions and the establishment of a structure of practice with a proper share, balance, or equilibrium among competing claims b. duty to keep one's promise c. the philosophical study of right and wrong action d. duty to do no harm
c. the philosophical study of right and wrong action
Power-coercive
change strategy; force used to change behavior; based on power, authority, and control; little effort for employee participation; little concern for employee acceptance/resistance; resistance accepted but not important to authorities
Flat structure
characterized by decentralization of decision making to the level of the personnel carrying out the work; removal of hierarchal layers; delegation of decision making to the professionals doing the work
contemporary approaches
charismatic leadership transformational leadership knowledge workers wheatley's new science of leadership
at what age do you use booster seats?
children who are less than 4 feet 9 inches and weight less than 40 pounds (4-8yr olds)
role development
choosing to change role expectations and/or role performance
public law
citizen's relationship with government
triage
classifying procedure that ranks clients according to their need for medical care
Patient Safety: Leadership Roles
clearly communicate expected standards of care; encourage followers to be actively involved in the QI process
when communicating with a patient, nurse should always address _____ first
clients feelings
9 success characteristics
clinical microsystem leadership, culture, organizational support process improvement; performance patterns patient focus, staff focus, interdependence of care team information and information technology
what kind of behavioral technique is journaling?
cognitive behavioral
mesosystem
collection of interrelated microsystem (linked clinical and supporting microsystems); collaboration to achieve desired patient outcomes; information flows forward and backward; regulatory systems
1. Theory Z
collective decision making, long-term employment, mentoring, holistic concern, this is a humanistic style of motivation based on Japanese organizations.
leadership values
communicates openly
can view own actions as part of long range goals set for patients
competent
Study
complete the analysis of the data; check: compare data to predictions; summarize what was learned
Matrix Organizational Structure
complex and designed to reflect both function and service in an integrated organizational structure, includes both bureaucratic and flat structure
macrosystem
comprised of interdependent micro- and mesosystems; ex: hospitals, integrated healthcare systems
latent error
condition involves problems within the system; may lie dormant within the system for a long time; pose the greatest threat to safety in a complex system
Veterans (66+yrs)
conservative, loyal to the organization and authority, reluctant to use technology
focusing on employees and creating trusting relationships
consideration
Prototype Evaluation System
considered subjective and descriptive and is based on diagnostic related groups (DRGs-a grouping of similar patients with similar diseases or conditions); used less frequently than FES Advantage: reduction of the RN's duty of completing the acuity rating on each patient throughout the day Disadvantages: DRGs do not capture all of the patient's needs because the medical diagnosis alone does not adjust for differences in patients; there is a lack of ongoing measure of the actual nursing work required by individual patients; and there is a lack of ongoing data to monitor the accuracy of the pre-assigned nursing care requirements;
impact of EBP (positive)
constraining healthcare costs; reducing geographic variability; improving quality; promoting consumer-directed healthcare; making health coverage decision
DESC script
constructive approach for managing and resolving conflict Describe the specific situation or behavior; provide concrete data Express how the situation makes you feel/what your concerns are Suggest other alternatives and seek agreement Consequences should be stated in terms of impact on established team goals; strive for consensus
How can nurses develop leadership and management skills
continuing education increasing expertise in patient care
managers
continuously seek information constantly engage in interactions with others who need information
what is/are the name(s) of the tool used by various health care team members to direct and focus a clients care?
critical pathway, clinical pathway, or care map
just culture
culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action
Nurses are encouraged to avoid relationships in which individuals are known to have the following characteristics ____. a. bully and harass others b. engage in routine gossip c. be unreliable and need constant reminders to complete work d. All of the above should be avoided.
d. All of the above should be avoided.
<p>Considerations in being "media ready" include ___.</p> <p>a. practicing with internal public relations staff</p> <p>b. avoiding off-the-record comments</p> <p>c. defining key messages and staying on message</p> <p>d. All of the above.</p>
d. All of the above.
Step one of the basic actions in delegation is assessing the patient or client, the situation, and the appropriateness for delegation. Important considerations within this step are ___. a. Knowing your personal delegation strengths and weaknesses as well as those of the members of your team. b. Base decisions on the needs of clients, the stability of client conditions, the complexity of the task, the predictability of the outcome, and the available resources to meet those needs and the judgment of the nurse. c. Be sure to understand the importance and expectations of the state nurse practice act, practice limitations, and job requirements. d. All of the above are considerations.
d. All of the above are considerations.
<p>Delegation is ___.</p> <p>a. required whenever there is a hierarchal order of individuals working together to accomplish goals.</p> <p>b. both a management and a legal concept.</p> <p>c. discussed in terms of authority, responsibility, and accountability.</p> <p>d. All of the above are true.</p>
d. All of the above are true.
<p>The following is true about the APRN role ___.</p> <p>a. there is currently no uniform model of regulation across the states</p> <p>b. each state independently determines the APRN legal scope of practice</p> <p>c. education, accreditation, certification, and licensure of APRNs needs to be effectively aligned to continue to ensure patient safety</p> <p>d. All of the above are true.</p>
d. All of the above are true.
A patient care delivery model ___. a. is the method or system of organizing and delivering nursing care. b. includes work delegation and resource utilization. c. emerges from the organizational mission, vision, values and structures. d. All of the above are true.
d. All of the above are true.
All of the following are examples situations that could lead to nurse-patient ethical dilemmas except ____. a. pain management b. patient restraint c. patient privacy d. All of the above are true.
d. All of the above are true.
Bargaining is ___. a. the phase of negotiation that emphasizes the give and take related to the variety of positions at the table b. the work of exchange c. initiates the serious give and take necessary to determine which legitimate positions emerge and the degree of support for any particular position or view d. All of the above are true.
d. All of the above are true.
Challenges with technology include ____. a. computer and technology competency b. identification of the boundaries between employer and personal electronic products c. use of social media d. All of the above are true.
d. All of the above are true.
Core skills that must be developed and refines in order to assure successful negotiation include(s) ___. a. It is important that the individual can discern, identify, and declare specific goals for which the risk of negotiation is worth undertaking. b. There must be a certain level of flexibility and fluidity with regard to wants and needs. c. Good negotiators are well informed, clearly prepared, and understand as much about the matter under negotiation as possible. d. All of the above are true.
d. All of the above are true.
Critical elements of professional ownership include ___. a. The individual nurse values his or her specific gifts, talents, and skills and agrees to commit to the full application of them in undertaking the work of the profession. b. The individual professional member of the staff recognizes that his or her competence depends on continuous and dynamic lifelong learning. c. Competency and skill enhancement depends on the individual's commitment to membership. d. All of the above are true.
d. All of the above are true.
Decision making ___. a. is a complex cognitive process. b. involves choosing a particular course of actions from among alternatives. c. is an essential component of the problem-solving process. d. All of the above are true.
d. All of the above are true.
Establishing the framework for the negotiation and the terms of the engagement satisfies the goals of ___. a. providing a structured and positive environment as the negotiation requires b. allowing the parties to more clearly establish expectations with regard to the process c. allowing the parties to operate within the context of fairly formal rules of dialogue d. All of the above are true.
d. All of the above are true.
Examples of productivity metrics include___. a. registered nurse hours/day b. admissions, discharges, and transfers/shift c. new staff orientation hours/ total worked hours d. All of the above are true.
d. All of the above are true.
Examples of resources for ethical decision making would include ____. a. ethics committees b. ethics textbooks c. ethics journals d. All of the above are true.
d. All of the above are true.
Issues related to the development of professionalism in the 20th century include ___. a. political equity of women b. changes in women's role expectations c. advances in women's educational opportunities d. All of the above are true.
d. All of the above are true.
The following is true about negotiation sessions ___. a. each session stands on its own merits and reflects only the activities that occurred within that session b. subsequent sessions always build on previous sessions c. early agreements on particular issues of conflict can provide the floor for subsequent clarity and agreement on more difficult issues (called chunking) d. All of the above were true.
d. All of the above were true.
Leadership must create an organizational context that doesn't impede membership and ownership of the work. For this to happen, the following circumstances and conditions need to be present: ___. a. Professional ownership implies that the ownership of the work belongs to the profession, not to the workplace. b. Contemporary research on the orientation of the professional/knowledge worker suggests that the traditional incentives often seen in employee-driven models do not succeed to motivate the action of this worker. c. Leaders must on-board new professionals through the use of well-identified professional processes, such as granting privileges instead of hiring, and peer-based selections of incoming members instead of management hiring practices. d. All of the above are true.
d. All of the above are true.
Performance evaluations review the worker within the context of the capacity to function and ___. a. the ability to do the work b. the ability to get the job done c. the ability to get along with others who are doing their jobs d. All of the above are true.
d. All of the above are true.
Reasons why shared governance organizational structure operates effectively in complex adaptive systems like the healthcare environment include ___. a. The sustainability of healthcare services fully depends on how the point-of-service professionals function individually and collectively. b. The emergence of knowledge organizations demonstrates that knowledge is not fixed or finite and does not operate simply as a capacity. c. In a continuum of care approach, no one healthcare organization can own, control, or unilaterally mandate all of the service linkages and connections necessary to fully serve a specific population. d. All of the above are true.
d. All of the above are true.
Sources of ethical dilemmas include ____. a. values b. diversity c. political views d. All of the above are true.
d. All of the above are true.
Team progress related response strategies that the team leader could initiate within the team process are all of the following except ____. a. reaffirm specific goals and activities that were identified as essential to the team's progress toward fulfillment of the purpose of the team b. place the problem, barrier, or challenge specifically within the context of particular stages or elements of change management. c. when the context of the issue has been delineated, help break the problem down into smaller issues d. All of the above are true.
d. All of the above are true.
The central characteristics of accountability that are nonnegotiable for the profession represent the following principles ___. a. Accountability generally reflects the individual professional commitment to performance and to action. b. Accountability demands a dynamic convergence between ownership, action, impact, and outcome. c. Individual accountability cannot be sustained if the system structure does not allow it to be legitimately expressed by those who own it. d. All of the above are true.
d. All of the above are true.
The following are strategies for assessing one's time management ___. a. Determine what your personal abilities are in managing your work across s span of time. b. Take into consideration both your own personal assessment and the feedback from others on your team. c. Personal reflection specific to meeting deadlines, feeling stressed or overwhelmed, and managing interruptions are areas that should be considered. d. All of the above are true.
d. All of the above are true.
The following are true about productivity ____. a. It is a ratio comparing what is produced to what is required to produce it. b. It is a measure of output from a production process, per unit of input. c. Aggregate productivity ratios are helpful in determining the overall efficiency of processes and individuals at a macro level. d. All of the above are true.
d. All of the above are true.
The following is information to be gathered by the team leader prior to assigning roles _____. a. discerning the character of the work b. discerning the distribution of the work c. determining the best way to break down elements of the work into meaningful components. d. All of the above are true.
d. All of the above are true.
The following is true ---. a. The relationship between the individual and the workplace unfolds through the lens of job categorization. b. The job is the contextual framework for the relationship between the individual and the workplace. c. Creating a job context for work cannot produce professional outcomes. d. All of the above are true.
d. All of the above are true.
The impact of technology on the team process means that ____. a. communications become available to team members more quickly b. communication may be more succinct c. body language and emotions are not available to factor in with electronic communication d. All of the above are true.
d. All of the above are true.
The process of recruiting nurses ___. a. involves identifying and selecting individuals who closely match the needs of the unit and organization b. involves defining or anticipating needs for services c. includes advertising, interviewing, selecting, and hiring d. All of the above are true.
d. All of the above are true.
The role of the leader in an era of change is ___. a. helping the staff to anticipate change b. translate change into a language that colleagues can understand c. actively engage in change d. All of the above are true.
d. All of the above are true.
The sense of lack of justice comes from what is considered ___. a. unfair work conditions b. unfair procedures c. unfair relationships d. All of the above are true.
d. All of the above are true.
The study of healthcare policies includes ___. a. national or state legislation initiatives and processes b. organizational policies necessary for order and progress c. external agencies d. All of the above are true.
d. All of the above are true.
Value is about ___. a. doing the right work rather than doing a good job b. work that is informed by purpose c. the product of a measured and defined relationship between effective process and meaningful outcome d. All of the above are true.
d. All of the above are true.
Effective delegation ___. a. distributes the workload equitably b. distributes the workload effectively c. enhances collaboration with other healthcare providers d. All of the above is true.
d. All of the above is true.
<p>Policies are generated from ___.</p> <p>a. state legislatures</p> <p>b. state agencies authorized by legislation</p> <p>c. state professional associations</p> <p>d. All of the above.</p>
d. All of the above.
Patient workforce management includes five highly interconnected and interrelated components, which include all of the following except ____. a. Establishment of a patient care delivery model. b. Patient needs and nurse interventions identification. c. Creation of a core staffing schedule to support patient needs. d. Daily staffing process that is consistent each day. e. Evaluate value and outcome.
d. Daily staffing process that is consistent each day.
<p>All of the following are true about accountability except___.</p> <p>a. It is being answerable for actions or inactions of self or others.</p> <p>b. It is the obligation to account for or explain the events.</p> <p>c. There is individual accountability and organizational accountability for delegation.</p> <p>d. It describes the distribution of work that each staff member is to accomplish in a given period of time.</p>
d. It describes the distribution of work that each staff member is to accomplish in a given period of time.
All of the following are true about a shift to the health model except ___. a. The health model requires a network. b. A preventive health service structure is key. c. Patients must access services earlier. d. Patients are seen only when ill.
d. Patients are seen only when ill.
14. Values conflicts ______. a. are the easiest to address in the workplace b. are difficult to resolve because they relate to who people are c. are difficult to resolve because they relate to what people believe d. b and c are true
d. b and c are true
All of the following are true about the team leader and their role except ___. a. It is the role of the team leader to both monitor and moderate the effect of progress and challenges to an effective team dynamic. b. The team leader must not be overwhelmed by the seesaw between small successes as they intertwine with moments of challenge. c. The team's small successes should be celebrated by members as they progress. d. The leader should never point out signs of progress until a goal is totally achieved.
d. The leader should never point out signs of progress until a goal is totally achieved.
The purpose for creating teams is all of the following except ___. a. to provide a general framework for care delivery b. to advance the capacity of professionals to fully engage particular planning activities c. to guide problem solving in a way that addresses patient care and improves team effectiveness d. To make staffing ratios easier to calculate
d. To make staffing ratios easier to calculate
<p>The committee of Future of Nursing: Leading Change, Advancing Health developed the following key messages ___.</p> <p>a. Nurses should practice to the full extent of their education and training.</p> <p>b. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.</p> <p>c. The diploma model for nurses training should be revived.</p> <p>d. a and b</p>
d. a and b
Healthcare economics is ___. a. a branch of economics focused on efficiency, effectiveness, and behavior in production and consumption of healthcare goods and services. b. the study and science of how human needs are perceived in relationship to what supply is available. c. a topic that only managers need to be aware of. d. a and b
d. a and b
Individuals at the point of service will need to be ___. a. more self-directed b. more collaborative c. more reliant on management d. a and b
d. a and b
Job descriptions ___. a. have been used historically as a vehicle for delineating role functions, tasks, and activities of the nurse. b. do not always match the dynamic nature of the work of nursing. c. are written so that they fit all possibilities in the work environment. d. a and b e. All of the above are true.
d. a and b
Responsibility ___. a. is embedded in work b. sees the individual from the perspective of the work c. assumes some level of intensity of the individual and any investment and ownership of the role, tasks, and activities d. a and b e. All of the above are true.
d. a and b
Supervision ___. a. is the provision of guidance or direction, evaluation, and follow-up by the delegator for accomplishment of a task delegated to another. b. is to watch over a particular activity or task being carried out by people and ensure that it is carried out correctly. c. is the transfer of responsibility for the performance of a selected nursing activity or task from a licensed nurse authorized to perform the activity or task to someone who does not have the authority. d. a and b
d. a and b
The following are included in the guidelines for interaction in negotiation ___. a. never say "never" b. make many concessions early in the negotiations c. do listen carefully to all parties d. a and c e. All of the above are true.
d. a and c
12. Steps in handling conflict include ___. a. identifying the problem b. immediately reporting the problem to hospital administration c. making sure issues are expressed d. a and c are true.
d. a and c are true.
Bioethics is__. a. the sum total of individual and collective experience, knowledge, and good sense b. guidelines for behavior specific to a moral framework for professional practice c. supporting and promoting patients' healthcare rights and enhancing community health and policy initiatives that focus on the availability, safety, and quality of care d. a subdiscipline of applied ethics that studies questions surrounding biology, medicine, and the health profession
d. a subdiscipline of applied ethics that studies questions surrounding biology, medicine, and the health profession
8. Validity measures___. a. the extent to which data is reproducible. b. the extent to which a workforce management system measures what it is designed to measure. c. the ability to quantify and/or predict patient needs for nursing care. d. b and c e. All of the above are true.
d. b and c
The primary point of accountability is ___. a. to be responsible for a stated task. b. to be able to demonstrate impact and results. c. to achieve long-term viability. d. b and c
d. b and c
cultural blindness
do not see or acknowledge the culture of others
Nursing career management includes all of the following except ___. a. maintaining a current license b. maintaining continuing competence c. participating in professional organizations d. exploring alternative careers
d. exploring alternative careers
<p>Collective bargaining agreements include all of the following except ___.</p> <p>a. salaries</p> <p>b. benefits</p> <p>c. working conditions</p> <p>d. health care costs</p>
d. health care costs
what is patient care partnership?
document writte in in plain language and translated to several languges about rights of individuals
centralized scheduling
done by staffing coordination
Gen Y (16-31yrs)
dynamic, confident, straight-forward and opinionated, "Linked" generation
prioritizing
deciding which needs or problems require immediate action and which ones could tolerate a delay in action until a later time because they are not urgent
decentralized
decisions made at or close to the patient care level
centralized
decisions made at the top; often delegate responsibility without authority
Plan
define the objective, questions, and predictions; plan data collection to answer the questions: who? what? where? when?; devise a plant to address the problem
over delegation
delegator becomes overwhelmed by situation and loses control by delegating authority and responsiblity to delegatee
team structure
delineates fundamentals such as team size, membership, leadership, composition, identification and distribution
high initiating structure, high consideration
delivers better performance and satisfaction outcomes develops clear assignments and works considerately with employees to achieve quality outcomes
participative leadership is the same as
democratic leadership
formal leadership
demonstrated in assigned role within organization
What is a negative outcome for young adulthood?
demonstrates an avoidance of intimacy and vocational career commitments
What is a negative outcome for a toddler?
demonstrates defiance and negativism
What is a negative outcome for late adulthood?
demonstrates fear of death' life lacks meaning
What is a negative outcome for a school age child?
demonstrates feelings of inadequacy, mediocrity, and self-doubt
What is a negative outcome for adolescence?
demonstrates inability to develop personal and vocational identity
What is a negative outcome for middle adulthood?
demonstrates lack of interests, commitments; preoccupation w/self-centered concerns
leadership values
demonstrates organizational power and status
Consequences of horizontal violence in nursing
demoralization, feelings of vulnerability, a changed-to-negative attitude to work, loss of confidence, impaired work performance, reduced patient satisfaction
transculturalism
denotes bridging significant differences in cultural practices
caring, responsibility, trustworthiness, and flexibility
desirable traits of leadership
what do outcome, or clinical indicators reflect? (quality improvement)
desired client outcomes related to standard under review
budget
detailed financial plan, stated in dollar, for carrying out the activities of an organization wants to accomplish within a specific period
what is outcome audit? (data collection methods--step 6)
determine what results, if any, occurred as a result of nurse care provided
What is a positive outcome for adolescence?
develops a coherent sense of self; plans for a future of work/education
What is a positive outcome for a school age child?
develops a sense of confidence thro achievement & accomplishments; uses creative energies to influence the environment
What is a positive outcome for young adulthood?
develops connections to work and intimate relationships
breach of duty
deviated from standard of care or falling below the standard of care; omission-nothing was done when something should have been done commission-something done that should not have been done
how does an autocratic leader function?
direct and issue commands necessary to promulgate a successful response to a situation
what are the leadership styles according to the path-goal theory
directive supportive participative achievement-oriented
Conflict
disagreement about something of importance to each person involved; ability to resolve conflict is important part of change management; conflict not bad-actually healthy; allows for healthy discussion of differences
non-maleficence
do no harm; correlates to beneficence; obligated not to harm anyone-intentionally refraining from actions that harm a patient; principle most helpful when balanced against beneficence--risk of treatment (harm) must be understood in light of the potential benefits, benefits outweigh burdens: stopping ineffective treatment
The following elements need to be included in the assignment of work ___. a. individuals charged with responsibility for a particular goal need to be clear about the specifics and the expectations. b. members working on an activity need to be clear about the time and resources needed to undertake the work. c. the work timetable is generally not as important as the resource utilization. d. measures of success must be incorporated into the team member work. e. A, b, and d are correct. f. All of the above are correct.
e. A, b, and d are correct.
The following is true about goals _____. a. they give the team clear and specific direction b. they create a point of reference where teams can evaluate their progress and determine movement toward completion c. they are generally frowned upon by hospital administration d. they involve both the team and individual members in defining the performance expectation of the team e. A, b, and d are correct. f. All of the above are correct.
e. A, b, and d are correct.
Strategies to enhance personal balance include ____. a. minimizing negative thoughts b. specific time for reflection and planning for the future c. being mindful of self within or after professional practice situations d. stress management e. All of the above are helpful.
e. All of the above are helpful.
Step three in the delegation process is planning for the work to occur. The following are steps which provide guidelines for preparing with the delegate ____. a. Clearly identify the work that needs to be done. b. Clearly identify the importance of requesting assistance when needed. c. Create a plan for daily feedback between the delegator and delegate specific to delegation principle performance. d. Discuss strategies to increase effectiveness of delegation and supervision activities, including frequency of supervision and potential for additional delegation. e. All of the above are steps.
e. All of the above are steps.
10. Alienation____. a. is encouraged by permitting the reflective work of the profession to be sacrificed by unrelenting work expectations. b. is encouraged when team members are kept busy doing without the opportunity to think about what they're doing. c. that flourishes prevents individuals from ever arriving at that unique fellowship and strong sense of professional relationship that is a sign of a committed team. d. causes members of the team to give up participating. e. All of the above are true.
e. All of the above are true.
<p>Activities which all nurses should embrace as they become more involved in the profession include ___.</p> <p> </p> <p>a. becoming competent in the processed of policy development and the differing approaches that are effective at the local, state, and national levels</p> <p>b. developing focused partnerships with stakeholders who know and understand the evidentiary support for policy making or changing</p> <p>c. taking a risk and proposing a new policy that is of great personal interest</p> <p>d. examining a current policy to identify its effectiveness</p> <p>e. All of the above are true.</p>
e. All of the above are true.
All of the following are true about accountability in shared governance except ___. a. Accountability drives the work of professionals. b. Accountability is the foundation for all knowledge work performance. c. Every member of a complex adaptive system has both rights and obligations that generate from the full participation in the life and activities of the system. d. Every member of the system must fully contribute to the extent of his or her capacity in a way that ensures that the system thrives and fulfills its essential value. e. All of the above are true.
e. All of the above are true.
Applying for a new position leads to the following changes ___. a. It changes the individuals you socialize with. b. It changes your abilities to manage policies and practices. c. It changes your salary and benefits. d. It changes your work location. e. All of the above are true.
e. All of the above are true.
Approaches to staffing decisions include ___. a. nurse-patient ratios b. patient classification systems c. legislative requirements d. different skill levels e. All of the above are true.
e. All of the above are true.
Collaboration ___. a. is the essential central methodology through which the diverse team stakeholders work b. advances the interactions that define the team's response to patient needs c. advances the team's competence in serving their population well d. implies the capacity to have team members work well together e. All of the above are true.
e. All of the above are true.
Embedded in the fear of conflict are issues of all of the following except ____. a. personal security b. identity c. safety d. relational integrity e. All of the above are true.
e. All of the above are true.
Examples of interventions to address the gap between needs and actual staffing are the following ___. a. reevaluating patient acuity ratings. b. postponing admissions. c. postponing nonemergent patient care, d. floating existing staff to the unit of need. e. All of the above are true.
e. All of the above are true.
For a system to be effective the following considerations must be addressed ___. a. Complex adaptive system providers are integrated in a collaborative and linked relationship that synthesizes well around the needs of the user. b. The primary driving point of decision making in a complex clinical delivery system is the place where the provider and the user meet. c. Data must be available at point-of-service to support caregivers in decision making, in clinical activities, and in evaluation of impact and value. d. a and b e. All of the above are true.
e. All of the above are true.
Issues that impact ethics in health care include ___. a. the values of the patient b. the values of the caregivers c. errors in the clinical setting d. moral courage e. All of the above are true.
e. All of the above are true.
Knowledge workers (professionals) ___. a. a need a very specific organizational context in order to facilitate good practice and positive outcomes b. are intrinsically motivated c. see their work as more than simply a job d. a and b e. All of the above are true.
e. All of the above are true.
Mentors and coaches address ___ with the mentored nurse. a. professional role behaviors b. appearance c. attitude d. conflict management e. All of the above are true.
e. All of the above are true.
Nonverbal signs the leader must be able to read include ___. a. body language b. gestures c. eye movements d. facial expressions e. All of the above are true.
e. All of the above are true.
Nursing is ____. a. a scientific process founded on a professional body of knowledge. b. a learned profession based on an understanding of the human condition across the lifespan. c. an art dedicated to caring for others. d. a dynamic discipline that increasingly involves more sophisticated knowledge, technologies, and client care activities. e. All of the above are true.
e. All of the above are true.
Settings where nursing opportunities may be found include all of the following except ___. a. healthcare organizations b. community centers c. outpatient settings d. insurance industry e. All of the above are true.
e. All of the above are true.
Significant shifts underway in health care include ___. a. Tertiary care is slowly being deconstructed. b. Digital technology is making it possible to create an increasingly portable diagnostic, therapeutic, and interventional environment making it increasingly mobile, fluid, flexible, and portable. c. Systems compete for value and quality. d. The fundamental value of practice is no longer embedded in volume measures related to how much an individual has done but in what difference and impact action had. e. All of the above are true.
e. All of the above are true.
Structure in the healthcare system that best supports healthcare leadership is ____. a. resource-effective b. timely c. value-based d. works to advance the mission and vision of the healthcare system e. All of the above are true.
e. All of the above are true.
The early identification of conflict is important to help prevent escalation. Many stressors are manifested in particular modes of ______. a. communication b. relationships c. interactions d. expression of personal emotions e. All of the above are true.
e. All of the above are true.
The following are important considerations in constructing the basic core schedule: a. anticipated patient needs volume. b. shift length. c. experience. d. available research evidence for staffing effectiveness. e. All of the above are true.
e. All of the above are true.
The following is true about conflict and conflict management ___. a. Principles of conflict management are essential to navigating the landscape of transformation and change. b. Conflict is a normative dynamic. c. A good conflict process includes identifying conflict in its earliest stages. d. Conflict resolution and mediation is a learned and developed skill that comes with practice and application. e. All of the above are true.
e. All of the above are true.
The leader needs to be comfortable with conflict. Factors which are important to this occurring are the following: a. The leader must be comfortable with self-expression of feelings, personal insights, and challenges to prevailing views and circumstances. b. The leader needs an environment that is not constraining or controlling or creates structural barriers that make it difficult to express personal feelings. c. The good leader embraces his or her own feelings regardless of intensity. d. The leader must assess their level of comfort and self-expression in the presence of conflict or conflict situations. e. All of the above are true.
e. All of the above are true.
The role of advanced practice nurse providers and clinical experts includes___. a. writing orders. b. providing general patient care oversight. c. providing care. d. assisting staff in the care of more complex patients using the latest evidence in a cost-effective approach. e. All of the above are true.
e. All of the above are true.
Transition to nursing practice is sometimes difficult because ____. a. an adequate support system for new graduates may not be in place. b. subtle hazing may occur to a new employee. c. new ideas they present are quickly dismissed and discouraged. d. a and b are true. e. all of the above are true.
e. All of the above are true.
Criteria for assessing and monitoring meaningful measures includes ____. a. Prioritize consumer and purchaser needs. b. Focus measurement on areas where there is a potential for improvement in outcome quality. c. Require that all patients fitting clinical criteria be included in analysis. d. Measure provider performance at all levels. e. All of the above is true.
e. All of the above is true.
Nurses should know ___. a. the source of healthcare policies b. the content of healthcare policies c. the consequences of healthcare policies d. the role of the professional in providing feedback to policy makers when policies are no longer effective e. All of the above are true.
e. All of the above is true.
Policy making takes place ___. a. at the national level. b. at the state level c. at the local level d. within agencies e. All of the above is true.
e. All of the above is true.
Major resources in a healthcare organization include ____. a. fiscal support b. physical setting c. supplies d. technology e. All of the above.
e. All of the above.
The multistate licensure ___. a. allows a nurse to have one license in a primary state of residence and be able to practice in other states with multistate statutes. b. increases the cost of licensure fees when nurses practice in more than one state. c. is available in 24 states. d. is available in all states. e. a and c are true. f. b and d are true.
e. a and c are true.
At the closure of negotiations the following should have occurred ___. a. new positions should be clarified and well-defined b. trade-offs noted c. bargaining trades clearly articulated d. both sides dissatisfied with the results e. a, b, and c f. All of the above are true.
e. a, b, and c
Healthcare reform involves ___. a. move from a volume service framework to a value-driven model b. a change to user-driven healthcare service c. increasing the use of digital technology d. decreasing the number of people on Medicare e. a, b, and c f. All of the above are true.
e. a, b, and c
Insured individuals include ____. a. those with employer-sponsored health plans b. older citizens c. military d. illegal aliens e. a, b, and c
e. a, b, and c
Maintaining one's competence as a professional nurse includes ___. a. role b. licensure c. technology d. completing a graduate degree e. a, b, and c f. All of the above is true.
e. a, b, and c
The next stage of conflict is seen with _____. a. verbalizations b. snide remarks c. statements of discomfort d. cynicism e. negative assessments f. b, c, and d are true. g. All of the above are true.
g. All of the above are true.
<p>Critical thinking takes ___ into consideration when deciding what to believe or do.</p> <p>a. focus</p> <p>b. reasoning</p> <p>c. assignments</p> <p>d. implications</p> <p>e. a, b, and d</p> <p>f. All of the above are true.</p>
e. a, b, and d
Risk is ___. a. a sign of the continuous and dynamic reach of the human experience in new directions in new ways b. exploring new territory in a way that advances the human experience and improves it in important ways c. to be avoided in the healthcare arena d. present at some level with all meaningful change e. a, b, and d f. All of the above are true.
e. a, b, and d
The underlying reasons for advancing to management and leadership positions are ____. a. the desire to advance quality practices b. to advance excellence c. because of a dislike for the clinical role d. to introduce new ideas for a better work environment e. a, b, and d f. All of the above are true.
e. a, b, and d
Major factors that are critical to the effectiveness of the team leader's role relate specifically to ____. a. the adequate structuring of the team b. the type of health care setting c. the use of good process d. the progress of the team toward its goals or in fulfillment of its purpose e. a, c, and d f. All of the above are true.
e. a, c, and d
Material supply levels are impacted by ___. a. types of services provided b. available staff c. access to supplies d. cost of supplies e. a, c, and d f. All of the above
e. a, c, and d
The leader completely orchestrates and manages ____ associated with the negotiation. a. the atmosphere b. the discussions c. the space d. the processes e. a, c, and d f. All of the above are true.
e. a, c, and d
Informatics and related technology include ___. a. researching new medications b. designing complex documentation and monitoring systems c. electronic monitoring of patients from remote locations d. a and b e. b and c f. All of the above are true.
e. b and c
<p>The following are strategies to support effective delegation ___.</p> <p>a. Clearly identify the importance of requesting assistance when needed.</p> <p>b. Gain an understanding of personal delegation competence.</p> <p>c. Provide feedback on tasks according to the guidelines specified by the delegator.</p> <p>d. Access evidence-based resources for delegation and supervision.</p> <p>e. b and d</p>
e. b and d
All of the following are elements of readying for negotiation except ___. a. understanding the issues at the table b. determining the personal bottom line c. understanding the bottom line of each participant d. practicing the approach to the interaction e. determining how to defeat the opponent
e. determining how to defeat the opponent
change process: evaluation (4)
effectiveness of change is evaluated according to the outcomes identified during the planning and implementation steps; most overlooked step; time intervals for evaluation should be identified and allowed to elapse before modifications and declarations of failure are asserted
cultural destructiveness
eliminates the cultures of others
Learning Organization Theory (change)
emphasis on interrelationships of all part of the organization; respond quickly to improve relationships; organizations respond to changes using learning approach; focus on communication, education and cooperation among all parts of organization; concept of continuous learning
Weber's Theory of Bureaucracy
emphasized rules instead of individuals and competency instead of favoritism as being important for effective organizations. His ideas revolve around the role of authority.
what is a structure audit? (Data collection methods--step 6)
evaluates the influence of elements that exist separate from or outside of the client-staff interaction
how often does the provider need to rewrite the prescription for restraints?
every 24 hours
evidenced based care
evidenced based care and your experience as an RN are invaluable for quality patient care
social justice
evolves from values of impartiality and objectivity at a systems or governmental level and founded on principles of fairness, equity, respect for self and human dignity, and tolerance; fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation; values are reflected in policies--fairness in policy implementation Fair distribution of benefits and burdens among members of a society
What is a positive outcome for a toddler?
exercises self-control and directly influences the environment, they want to do things themselves
Population ecology:
external environment pressures are primary determinants
5. Patient care needs categories include___. a. cognitive needs. b. pain and comfort needs. c. family information and support needs. d. treatments and interventions. e. a and c f. All of the above are true.
f. All of the above are true.
Areas of focus necessary to get the work done in healthcare settings include a system that requires ____. a. clear delineation and assignment of work based on skills. b. licensure and competence. c. recruitment and retention of competent caregivers. d. assurance of value-based outcomes. e. integration of the work of all caregivers into a whole that meets the needs of patients. f. All of the above are true.
f. All of the above are true.
The debate related to nursing as a profession relates to ___. a. the predominant level of minimum education of the majority of the profession b. its dependency role in relationship to other disciplines c. its lack of clarity with regard to its specific contribution to the health of society d. an ongoing lack of a disciplined profession e. a and c f. All of the above are true.
f. All of the above are true.
Supply of healthcare goods and services includes ___. a. people b. supplies c. technology d. time f. funds to pay for services g. All of the above.
g. All of the above.
The expert opinion or expert panel technique to measure work _____. a. identifies time requirements for certain work. b. is a consensus approach. c. uses professional judgment to determine staff required. d. provides a flexibile approach that focuses on a critical review of nursing practice. e. a and d f. All of the above are true.
f. All of the above are true.
The following is true about teams ___. a. Teams can't be constructed simply because people want to meet or work together. b. Teams are purposeful. c. Accountable teams are relational bodies. d. The work of teams is the sum total of its members contributions. e. a, b, and c f. All of the above are true.
f. All of the above are true.
<p>Organizations providing healthcare services are required to have policies specific to ___.</p> <p>a. provider roles</p> <p>b. patient care procedures</p> <p>c. safety practices</p> <p>d. equipment management</p> <p>e. staffing and scheduling</p> <p>f. All of the above.</p>
f. All of the above.
The delegation can be improper if any of the five rights are violated. These include ___. a. right task b. right patient c. right circumstance d. right directions e. right supervision f. All of these are rights.
f. All of these are rights.
Accountability needs ____ for it to be expressed. a. autonomy b. responsibility c. authority d. competence e. a, b, and c f. a, c, and d
f. a, c, and d
Legislative issues could impact the following ethical issues ___. a. boundary violations b. betrayal c. code of ethics d. rationalization e. a, b, and c f. a, c, and d
f. a, c, and d
The role of management in shared governance is ___. a. stewardship b. unilateral decision making c. servant leadership d. assure seamless interface between the system's purpose and resources e. a and c f. a, c, and d
f. a, c, and d
Collective bargaining is protected by ___. a. the Department of Commerce b. the Nation al Labor Relations Act c. the Taft-Hartley Act d. Public Law 93-360 e. a and b f. b, c, and d g. All of the above.
f. b, c, and d
For complex adaptive systems to thrive, the following principles must operate ___. a. The whole is never greater than the parts. b. A problem in one part of the system ultimately affects the whole system. c. All disciplines serve the user and/or serve someone who serves the user. d. In complex adaptive systems, form and function interact with each other, otherwise they are not a dependent relationship. e. a, b, and d f. b, c, and d g. All of the above are true.
f. b, c, and d
decision-making grid
facilitate the visualization of the option under consideration and allow comparison of options using common criteria
justice
fairness, treating people equally and without prejudice
what is the Patient Self Determination Act?
federal legislation that requres all clients admitted to a health care facility to be asked if they have advance directives
powerful tool to assist managers in motivating behavior
feedback
contingency approach theories
fielders contingency hersey and blanchard situational leadership pathgoal substitute for leadership
shared governance
flat type of organizational structure with decision making decentralized; democratic, egalitarian; shared decision making and accountability
what can be used to ensure proper fit of car seat?
foam rolls
job centered leadership
focused on schedules costs efficiency
employee centered leadership
focuses on human needs of subordinates
transactional leader
focuses on management tasks; is a caretaker; uses trade-offs to meet goals; does not identify shared values; examines causes; uses contingency reward
variables that may influence followers to same extent as leader behavior
followers characteristics organizational characteristics
delegating
for high maturity groups who are able and need little direction
telling
for low maturity groups who need direction
participating
for moderate maturity groups who are able , but unsure and need support
selling
for moderate maturity groups who are unable but willing and need direction
a person is in a position of authority or in a sanctioned, assigned role within an organization that connotes influence, such as clinical nurse specialist
formal leadership
what is a referral?
formal request for a special service by another care provider
secondary group
formal; held together with formal rules and regulations; has procedures for maintenance of the group and association policies; meets fro an organized purpose, for a specific project for a specific time frame
staff model, independant practice association, group model, network model
four types of HMO's
safety
freedom from accidental injury (patient stay free of complications and expected outcomes reached)
Elements essential for viable team construction are___. a. purpose b. goals c. roles d. relationships e. activities and functions f. a, b, and d g. All of the above are true.
g. All of the above are true.
The five types of conflicts are ___. a. relationship conflicts b. information conflicts c. interest conflicts d. organizational conflicts e. values-based conflicts f. conflicts with administration g. a through e are true h. All of the above are true.
g. a through e are true
11. Five personal barriers that have a dramatic impact on the individual leader's ability to understand, engage, and manage conflict include ____. a. willingness to confront conflict b. uncertainty about the capacity to handle the conflict emotionally and personally c. recognizing that most people's attitude toward conflict is a negative one d. lack of skill e. lack of exposure and experience f. previous family conflicts experienced g. a, b, c, d, and e are true. h. All of the above are true.
g. a, b, c, d, and e are true.
The foundations of shared governance include ___. a. ownership b. accountability c. vertical structures d. partnership e. equity f. a, b, and c g. a, b, d, and e
g. a, b, d, and e
connection power
gained by association with people who have links to powerful people
35-64 = middle adulthood stage
generativity vs stagnation (want to leave a legacy)
environment
geography, market, political jurisdiction, regulatory and legislative requirements, biomedical knowledge and technology
how does a transformational leader function?
gives group members responsibilities that will enhance their professional development
what are benchmark goals in quality improvement?
goals that are set that determine at what level the outcome indicators should be met
Civil law
governs how individuals relate to each other in everyday matters ei: contract law-transaction between individuals &/or legal entities
ethical committees
groups of persons who provide structure and guidelines for potential healthcare problems, serve as an open forum for discussion, and function as patient advocates; provide education, policy and guideline recommendations, and case review
new science of leadership functions
guiding organization using vision make choices based on mutual values Engage in culture to provide meaning and coherence
leadership characteristics
guiding vision passion integrity
focus of nursing informatics
handling information in nursing practice; making sure nurses' needs are taken into consideration when automated systems are designed and purchased; developing processes to help bedside nurses manage patient data at the bedside; teaching other nurses about information resources & tools; testing information systems
In Triage or emergency situations, priority is given to those who
have the highest chance of living
HMO health maintenance organization
health care agency provide basic health and trx to voluntary enrollees who prepay a fee for in or out patient on a agreed on package.
case management
health care delivery strategy that supports managed care; it is an interdisciplinary health care delivery approach that provides comprehensive client care using available resources to promote quality and cost-effective care.
knowledge workers
health care professionals who are well educated and technologically savvy and see themselves as owning their intellectual capital
country club leader
high people concern and low production concern
Team leader
high production and people concern
authority compliance leader
high production concern and low people concern
respect for others
highest ethical principle; acknowledges rights of the individual to make decisions and live by the decisions; patient centered focus
what do process indicators reflect? (quality improvement)
how client care is provided and are established by policies and procedures (clinical practice guidelines)
Boomers (47-65 yrs)
idealistic, hard-working, dedicated, value promotions, position & title; see Gen X as the "wild generation" without a sense of social commitment
What is a positive outcome for late adulthood?
identification of life as meaningful
The performance improvement process begins with
identification of standards and outcome indicators based on evidence
advanced directive
includes living will, durable power of attorney, DNR; specific hospital policy; if pt has AD, ask for a copy of the document and post to pt records; if pt revokes AD, document pt decision and notify MD; nurse should not be a witness
cultural competence
including values, beliefs, and attitudes that are new or different from your culture to render effective nursing care
cultural precompetence
increasing awareness of what you do, do not know about working in diverse settings
6-12 = school age stage
industry vs. inferiority
leadership
influences or inspires actions and goals or others
debrief
informal information exchange session designed to improve team performance and effectiveness; after action review
primary group
informal; consists of people who share a common bond; evolves naturally from social interactions; usually has no written rules for membership; can begin or end at any point
management roles
information processing Interpersonal decision making
feedback
information provided for the purpose of improving team performance; should be timely, respectful, specific, directed towards improvement, and considerate
3-6 = preschool stage
initiative vs. guilt
evidence-based practice
integration of individual clinical expertise, built from practice, with the best available evidence from systematic research applied to practice
> 65 = late adulthood stage
integrity vs. despair
Leadership desirable traits
intelligence, self-confidence, determination, integrity, and sociability
what is an example of Battery?
intentional and wrongful physical contact with a person that involves an injury or offensive contact (restraining a client and administering an injection against wishes)
leadership
interpersonal process that involves influencing others (followers) to achieve goals
20-35 = young adulthood stage
intimacy vs. isolation
What is a positive outcome for middle adulthood?
involved w/est family; expands personal creativity and productivity
duty owed patient
involves both the existence of the duty and the nature of the duty; ex: failure to monitor a patient's response to treatment.
Directing
involves issuing assignments and instructions that allow workers to clearly understand what is expected and to additionally coach workers to achieve planned goals
Delphi technique
involves systematically collecting and summarizing opinions and judgments from respondents, such as expert panels, on a particular issue through interviews, surveys, or questionnaires
formal leadership
job described as legitmate leader, power of position and ability to reward and punish
fidelity
keeping one's promise: maintaining staff vacation request, keeping promise made to patient/family
situation awareness
knowing what is going on around you
serves as leadership substitute
knowledge
barriers to cultural competence
lack of diversity in healthcare's leadership and workforce; systems of care poorly designed to meet the needs of diverse patient populations; poor communication between providers and patient of different racial, ethnic, or cultural backgrounds; lack of education regarding cultural proficiency; lack of evaluation regarding cultural proficiency
Statutory Law
law enacted and approved by US Congress or state legislature, or local government
Contingency (Situational) theories
leader adjusts based on situation and individual
contingency approaches
leader effectiveness contingent on something other than leaders behavior
supportive
leader provides encouragement and attention
achievement oriented
leader provides high structure and high support
directive
leader provides structure through direction, focusing on task to be done
what does needs of the situation involve
leader-member relationships degree of task structure leaders position of power
transformational theory
leaders and followers raise one another to higher levels of motivation and morality
trait theory of
leaders have a certain set of physical and emotional characteristics that are crucial for inspiring others toward a common goal; some theorist believe that traits are innate and cannot be learned others believe they can be developed
path- goal theory
leaders motivate followers and influences goal accomplishment
transformational theory
leaders motivate others to behave in accordance with mutual values and empower others to contribute
1. Theory X
leaders must direct control, as motivation results from reward & punishment. Employees need coercion & threats to get the job done
Do the right thing
leadership
doesnot require position of authority
leadership
includes vision and goals for what the organization can become then getting cooperation and teamwork from others to achieve goals
leadership
part of management-not a substitute
leadership
process of interaction in which leader influences others toward goal and achievement
leadership
if a nurse suspects child abuse, he/she is
legally mandate to report it to appropriate legal authority (police, etc)
cultural proficiency
lifelong learning of cultural groups to create a socially just democracy
Responsibilities of risk management
loss prevention and reduction, claims management, financial risk, risk regulatory and accreditation compliance
impoverished leader
low production and people concern
Involves planning, budgeting, organizing, staffing, solving problems,and controlling complexity
management
do things right
management
has range of importance and urgency
management
five leadership styles are apart of the
managerial grid
Values of organization
may be formally stated and explicit, or may be implicit and part of the organizational culture
if a preschooler is apprehensive when other children cry,
may be suggestive of physical abuse
patient classification system (PCS)
measurement tool used to determine the nursing workload for a specific patient or group of patients over a specific period
Hartman Value Profile
measures patterns of decision making used when processing information about the world & self; profile places emphasis upon thinking, not behaving
full-time equivalent
measures the work commitment of a full time employee; the unit's forecasted workload is used to calculate the number of FTEs needed for the unit's staffing plan wich may comprise full-time and part-time employees; a conversion of hours to a standard base of one person working so many hours per day, so many days per week, and so many weeks per year
regulatory requirements
measuring organizational performance against standards from regulatory/accrediting organizations
collective bargaining
mechanism for settling labor disputes by negotiation between the employer and representatives of the employees; process which organized employees participate w/their employers in decisions about their pay, hours of work, & other terms and conditions of employment
storyboard
method for sharing work with others; takes the major steps in the improvement methodology and visually outlines the progression of each step; can be displayed on a chart in a high traffic area of the organization to inform other staff of the improvement efforts underway
nursing care delivery model
method used to provide care to patients Goals: 1)Deliver nursing care effectively and efficiently to patients 2)Nurse manager must ensure to achieve both patient and nurse satisfaction as an outcome measure 3)Should enhance communication between staff and the inter-professional healthcare team 4)Must meet the mission, vision, values, and goals of the hospital or healthcare organization
case method/total patient care model
model of care delivery in which one nurse provides total care for an individual patient during an entire work period; oldest model commonly seen on hospital units where the nurse will provide patient centered, comprehensive, continuous, and holistic care to several assigned patients during his/her shift (ICU setting)
Shared Governance
model of organizational decision making premised on a decentralized organizational structure in which staff nurses are empowered through autonomy and accountability
middle of the road leader
moderate concern in both directions
revenue
money earned by an organization for providing goods or services (before expenses are deducted)
outcome orientation (time management)
more is achieved than with an emphasis on task completion; determine long-term goals, then break them down into achievable outcomes that are the steps toward those goals; flexibility
role negotiation
resolving conflicting expectations about personal management performance through communication
perceived power
results from one's reputation as a powerful person
expert power
results from the knowledge and skills one possesses that are needed by others
what is process audit? (data collection methods--step 6)
review how care was provided and assume relationship exists between nurses and quality of care provided
5 rights of delegation
right task, right circumstances, right person, right direction/communication, right supervision
Bureaucratic management
rules and policies to abide by, specific roles, hierarchy, top=boss; bottom=workers
administrative law proceedings
rules and regulations adopted by federal or state agencies to implement statutory law adopted by US Congress or state legislature
Gen X (32-48yrs)
seek balance between work and family, realistic, team-oriented, advanced technology skills, work independently & seek work experiences where they apply their ability & expertise; see Boomers as domineering
what are the five basic competencies of emotional intelligence
self awareness self regulation motivation empathy social skills
characteristics of charismatic theory
self confidence strength in conviction communication of high expectations confidence in others
servant leadership
serves the workers and uses that to get job done; undying loyalty of their workers
risk management
serves to provide a safe and effective environment for patients, visitors & employees while averting/decreasing loss to the organization Focus: identification, analysis, treatment, and evaluation of actual or potential hazards
regulatory organization
set standards for the operation of healthcare organizations, ensure compliance with federal and state regulations developed by governmental administrative agencies, and investigate and make judgements regarding complaints brought by consumers of the services and the public
empowerment
sharing of power and control with the expectation that people are responsible for themselves; also, the process by which we facilitate the participation of others in decision making within an environment in which power is equally distributed
brief
short session prior to start to discuss team formation; assign essential roles; establish expectations and climate; anticipate outcomes and likely contingencies
feedback
should be valuable frequent timely useable consistent correct diverse
role exploration
similar to honeymoon phase
SBAR
situation background assessment recommendation (by you)
considers task and relationship behaviors
situational leadership theory
hersey and blanchard
situational leadership theory
team
small number of people with complementary skills who are committed to a common purpose or goal; have a set of performance goals and approaches for which they hold themselves mutually accountable; membership is based on specific skills required to accomplish the task
Clinical Microsystem
smallest system; building blocks of healthcare; patient + caregivers; produce quality, safety, & costs outcomes; ex: medicine unit, surgical unit, oncology unit, OR, cardiac cath lab, pharmacy, radiology dept.
role internalization
stage at which a person has learned behaviors that maintain a role so thoroughly that the person performs them without consciously considering them; energy once spent on establishing these behaviors can be redirected to other goals
clinical practice guidelines
statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options
information power
stems from one's possession of selected information that is needed by others
safety culture
the outgrowth of the larger organization culture and emphasizes the deeper assumptions and values of the organization toward safety
overuse
the potential for harm from the provision of a service that exceeds the possible benefit
nursing case management
the process of a nurse coordinating health care by planning, facilitating, and evaluating interventions across levels of care to achieve measurable cost and quality outcomes; patient focused and outcome oriented
role transition
the process of unlearning an old role and learning a new role; transforming one's identity from being an individual contributor as a staff nurse to being a leader as a nurse manager
root cause analysis
the process used to identify all possible causes of a sentinel event and all appropriate risk-reduction strategies; an in-depth analysis of an error to asses the event & identify causes & possible solutions
Supervision
the provision of guidance or oversight of a delegated nursing task. The availability of the supervising nurse occurs through various means of written and verbal communication.
main time management concepts
the relative effectiveness of the effort (20% effort for 80% outcome results); the importance of outcome vs process orientation; the value of organizing how time is currently being used
what do structure indicators reflect (quality improvement)
the setting in which care is being provided and the available human and material resources
safety climate
the shared perception of employes about the importance of safety within the organization
role strain
the subjective feeling of discomfort experienced as a result of role stress, may manifest through increased frustration, heightened emotional awareness, or emotional fragility to situations
biomedical technology
the technological devices and systems that relate to biologic and medical sciences; involves the equipment in the clinical for diagnosis, physiologic monitoring, testing, or administering therapies to patients
information technology
the use of computer hardware and software to process data into information to solve problems
knowledge technology
the use of expert and decision support systems to assist in making decisions about patient care delivery; provide clinical decision support
informatics
the use of knowledge technology; nursing science, computer science and information science; identifying, collecting, processing, and managing data and information; supporting nursing practice, administration, education, research, and the expansion of nursing knowledge
organizational culture
the values and behaviors that contribute to the unique social and psychological environment of an organization; a shared value system developed over time that guides members to problem solve, adapt to the external environment, and manage relationships; the values and behaviors that contribute t the unique social and psychological environment of an organization
Cultural Care Theory
theory explicitly focused on the close relationships of culture and care on well-being, health, illness, and death; it is holistic and multidimensional, generic (emic, folk) and professional (etic) care has a specifically designed research method (ethnonursing); care is the essence of nursing, and culturally based care is essential for well-being, health, growth, and survival and for facing handicaps or death
structured routine task
theory suggests that nurses and other professional with significant experience do not need direction and supervision
board of nursing
this authority defines delegation as transferreg to a competent person a selected nursing task
dashboards
time series data; allows a quality improvement team to see change in quality over time; time series chart used to look for trends, shifts, and unusual data
program evaluation and review technique (PERT)
tool to assist in complex projects that require a series of activities some of which must be performed and other that can be performed in parallel to other activities (outlines how you will approach a large project)
transactional leader
traditional manager concerned with day-to-day operations
effective communication
transfer of information and understanding from one person to another; timely, accurate, complete, unambiguous, & understood by the recipient: reduces error, and results in improved patient safety
cultural incapacity
trivialize other cultures and make other cultures appear to be wrong
What is a positive outcome for infancy?
trust self and others (need to meet infants basic needs)
Birth - 1 year = infancy stage
trust vs. mistrust
veracity
truth: informing family of sentinel event or error; completing incident report for a near miss
active error
type of incident that is non-compliant with procedure, or making a mistake such as not assuring the correct identification of the patient before administering the medication
what is paternalism?
type of relationship between clients and healthcare providers in which the healthcare provider believes they know what is best for the clients
active participants in needs of the group
valuable followers
good communicators
valuable followers
skilled, self directed employees
valuable followers
work well with others
valuable followers
leadership values
values education and professional development
substitute for leadership
variables that may influence followers to same extent as leader behavior
leadership values
visible and responsive
leadership values
visionary enthusiastic supportive knowledgeable
assessment, rn judgement, diagnoses, care goals and progress plans, teaching
what are 6 nursing diagnoses that can not be delegated to UAP
right task, circumstance, person, direction, supervision or evaluation
what are the 5 board of nursing rights of delegation
ABC's, maslow herarchy of needs, policies
what are the top three priorities of care
fragmentation of care
what is one disadvantage of functional nursing where RN, LPN and UAP are coordinated by charge nurse
inter-role conflict
when an individual is associated with more than one group role and these roles are incompatible
when is there a good leader member relationship
when followers have trust, respect, and confidence in leader.
decentralized scheduling
when the nurse manager develops the schedule separate from other units within the hospital
the goal of negotiation is to create a
win-win situation in which all parties are satisfied
when taking a telephone order, provider must sign the order
within 24 hours
management
work driven in random order
committee
work group with a specific task or goal to accomplish s defined by the organization; a group formed to assist an organization with communication and decision making
Equity Theory
work has to be equitable to motivate; inequity will lead to job dissatisfaction
Rational-empircal
workers understand organizational need for change or meaning of change for individuals and organization; people are rational & use knowledge to embrace change; used when little resistance is expected
is a nurse permitted to witness a clients signature on a living will?
yes
a client says they want to see their medical chart. what is nurses best response?
you could do soo with the guidance of the health team member designated by hospital policy
What should you purchase for being a nurse?
your own malpractice insurance
information required for informed consent
• An explanation of the treatment/procedure to be performed and the expected results of the treatment/procedure • Description of the risks involved Benefits that are likely to result because of the treatment/procedure • Options to this course of action, including absence of treatment • Name of the person(s) performing the treatment/procedure • Statement that the patient may withdraw his or her consent at any time
