Leadership Ch 11 & 20

17. Jenna, a registered nurse (RN), has been accused of gossiping and bullying a new graduate RN on her unit. This type of workplace violence is called _____ violence. a. horizontal b. co-worker c. threatening d. nurse-to-nurse

ANS: A A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker's performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload

10. According to the National Healthcare Quality and Disparities Report, which group has worse access to health care in America, compared with Whites? a. Hispanics b. Asians c. Blacks d. American Indians

ANS: A According to the 2014 National Healthcare Quality and Disparities Report (Agency for Healthcare Research and Quality [AHRQ], 2015), "Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, and residence location." This study found that Blacks had worse access to health care than Whites for about half of measures of access, Hispanics had worse access to care than Whites for two-thirds of access measures, and Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

16. The agency that oversees the safety and health of health care workers is: a. The Joint Commission (TJC). b. the Department of Public Health (DPH). c. OSHA. d. CMS.

ANS: C OSHA is the agency that provides health and safety programs for health care workers, through the U.S. Department of Labor.

6. Equity is the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Which group formulated this definition? a. World Health Organization b. Affordable Care Act c. Centers for Disease Control d. Agency for Healthcare Research and Quality

ANS: A According to the World Health Organization (2016), "Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically."

1. What percentage of assaults in the workplace are committed against health care workers? a. 50% b. 20% c. 15% d. 40%

ANS: A Although health care workers incur less than 20% of all workplace injuries, health care workers nevertheless suffer 50% of all assaults in the workplace.

3. Cultural diversity refers to the: a. variety of cultural or ethnic groups within a society. b. belief that one's own culture is similar to another's culture. c. realization that all people in a particular culture have the same beliefs. d. view that individuals living in a country should speak the native language.

ANS: A Cultural diversity is defined by the Oxford Dictionary ("Cultural diversity," 2016) as "The existence of a variety of cultural or ethnic groups within a society."

2. A long-standing mental health nursing tool may be used in an aggressive or violent situation. The use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting is known as: a. de-escalation. b. chemical restraint. c. stress management. d. emergency assistance programs.

ANS: A De-escalation is a long-standing mental health nursing tool. De-escalation is defined as "a gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance and non-confrontational limit setting that is based on respect"

19. _____ may be useful in preventing loss caused by domestic violence that extends to the workplace. a. Employee assistance programs b. Stress leave for up to 6 weeks c. Termination of the perpetrator d. Arrest and conviction of the perpetrator

ANS: A Employee assistance programs can be very useful in preventing or mitigating loss caused by domestic violence that extends to the workplace

13. An integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits is called _____ management. a. risk b. threat c. total quality d. human resources

ANS: A Risk management is an integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits.

15. This generational cohort currently dominates the U.S. workforce. They have grown up with little economic competition. Efficiency, teamwork, quality, and service have thrived under their leadership. This generational cohort is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: A The baby boomers, born between 1946 and 1964, currently dominate the U.S. workforce. They have grown up with little economic competition outside the United States. Efficiency, teamwork, quality, and service have thrived under their leadership.

8. One of the several legal issues surrounding workplace violence is: a. an employer may be subject to liability claims. b. maintaining mandatory security ratios. c. Department of Labor laws requiring employers to report each incidence of workplace violence. d. the patient's right to unrestricted visitation.

ANS: A To date, 29 states have introduced legislation related to workplace bullying, often referred to as the Healthy Workplace Bill (HWB) or some version thereof (HWB, 2016; Mao, 2013). Basic provisions of the model HWB legislation, developed and introduced by Yamada in 2000, include a clear definition of an "abusive work environment," a legal right for those harmed by workplace bullying to seek recourse, and decreased employer liability when prevention and corrective policies and plans are implemented

14. A White nurse from the United States is assigned to care for a Vietnamese woman who speaks little English, had a baby 2 months ago, and is 1 day postoperative after fibroid removal. The nurse knows that traditional Vietnamese women will avoid drinking or eating "sour" foods such as lime Jell-O or other citrus types of liquids after surgery. She confirms her patient's values and beliefs. The nurse is exhibiting characteristics of: a. cultural competence. b. ethnic sensitivity. c. stereotyping. d. nonjudgmental behavior.

ANS: A To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences.

11. A common-sense look at the workplace to find existing or potential hazards for workplace violence is: a. worksite analysis. b. risk management. c. administrative rounds. d. hazard prevention and control.

ANS: A Worksite analysis is a common-sense look at the workplace to find existing or potential hazards for workplace violence.

5. Which of these are true regarding millennials in the work environment? (Select all that apply.) a. They need clear definitions of outcomes. b. They thrive on deadlines. c. Most enjoy working on their own. d. They struggle with multitasking. e. They lack problem-solving skills.

ANS: A, B, C Millennials have astonishing multitasking skills. They are problem solvers who grew up in a flourishing economy. Most enjoy the liberty of working on their own in a style that favors their work ethic. Millennials have learned that their presence is in demand. To thrive, they need clear definitions of outcomes, resources to do what needs to be done, and a deadline

1. Administrative controls that may affect workplace violence include: (Select all that apply.) a. adequate staffing levels. b. controlled access. c. development of systems to alert security personnel to threats of violence. d. conflict resolution. e. architectural modifications.

ANS: A, B, C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Administrative controls include (1) adequate staffing patterns to prevent personnel from working alone and to reduce waiting times, (2) controlled access, and (3) development of systems to alert security personnel when violence is threatened.

3. There are three major issues in cross-cultural communication. They are: (Select all that apply.) a. ambiguity. b. ethnocentrism. c. inflexible attitude. d. collectivism. e. negotiation.

ANS: A, B, C Research shows that there are three major issues in cross-cultural communication: ambiguity, inflexible attitude, and ethnocentrism.

1. Culturally competent organizations benefit from meeting the diverse health care needs of the population it serves. What are the social benefits to the organization? (Select all that apply.) a. Increases mutual respect. b. Increases community participation. c. Meets regulatory guidelines. d. Assists patient and families in their care. e. Increases cost savings.

ANS: A, B, D Becoming culturally competent has social, health, and business benefits for health care organizations, according to a report from the Equity of Care initiative and the American Hospital Association's Health Research & Educational Trust and Hospitals in Pursuit of Excellence. Becoming a Culturally Competent Health Care Organization (Health Research & Educational Trust, 2013) outlined 16 benefits of organizations' ability to meet the health care needs of patients with diverse backgrounds, grouped into three broad categories of social, health, and business benefits. Social benefits include increases mutual respect and understanding between patient and organization, increases trust, promotes inclusion of all community members, increases community participation and involvement in health issues, assists patients and families in their care, and promotes patient and families responsibilities for health.

4. In order to make a positive contribution to care of patients, it is critical that nurses recognize which of the following aspects of culture? (Select all that apply.) a. Culture of the clinician b. Culture of the patient and family c. Spiritual beliefs of the clinician d. Culture of co-workers e. Spiritual beliefs of the patient

ANS: A, B, D In order to make a positive contribution to the effective treatment of patients, it is critical that nurses or clinicians first recognize that they are dealing with a multiplicity of cultures. They include the clinician's own culture, the culture of the patient and patient's family, the culture of co-workers, and the health care institution's culture.

6. The nurse manager of a nursing unit is a White, female working with a high percentage of Middle Eastern nursing staff. Which of these statements are true about the communication and leadership style of a low-context culture? (Select all that apply.) a. Rules are clear and tend to be followed. b. Low-context cultures require extensive, detailed explanations. c. Verbal communication is less explicit. d. Decisions are made in face-to-face conversations. e. Decisions are focused around tasks.

ANS: A, B, E From a global perspective, the cultural context of the Western world is low context. In places such as North America and Western Europe, the explicit verbal or written message carries the meaning. Low-context cultures require extensive detailed explanations, information, and contracts because they are making up for the context that may be missing in a given situation. Decisions are focused around tasks and activities that need to be accomplished. Rules are very clear and tend to be followed precisely.

2. The main components in a violence prevention program are: (Select all that apply.) a. a written plan. b. worksite analysis. c. criminal control. d. security staff training. e. record keeping and evaluation of the program.

ANS: A, B, E The main components in a violence prevention program are: (1) management commitment and worker participation, (2) worksite analysis and hazard identification, (3) hazard prevention and control, (4) safety and health training, and (5) record keeping and program evaluation. Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.

3. Examples of environmental designs that can improve worker safety include: (Select all that apply.) a. well-lit parking lots. b. critical incident debriefing. c. de-escalation training for all staff. d. metal detectors at hospital entrances. e. posting security guards in the main lobby.

ANS: A, D, E NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.

15. Posters have been distributed with information about workplace violence such as typical profiles of workplace killers, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. This approach is completed by: a. the FBI. b. threat assessment team. c. human resources. d. senior leadership.

ANS: B A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). Still another procedural approach for the TAT would be to circulate generalized information such as typical profiles of perpetrators of extreme workplace violence, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem.

11. The variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction is known as: a. bias. b. diversity. c. culture d. stereotyping.

ANS: B Culture refers to the variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction.

9. The most prevalent source of violence against nurses is from: a. a current or former employee. b. customers, clients, or patients. c. criminals with no other connection to the workplace but who simply intend to commit a crime. d. someone who is not employed at the workplace but has a personal relationship with an employee.

ANS: B Customers, clients, patients, or students are regarded as the most prevalent source of violence against nurses.

16. This generational cohort was the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. This group is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: B Generation X members, born between 1965 and 1980, were the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life.

8. A nurse believes that she should provide optimal care to all clients, regardless of their cultural background. She is struggling with her emotions when caring for a client with a violent criminal background. What would be the best course of action for this nurse? a. Avoiding the client as much as possible but providing care b. Identifying her biases but providing care c. Requesting another patient assignment d. Taking sick days while the patient is hospitalized

ANS: B The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences. The problem is that many Americans are afraid to ask people about their culture because oNf theRideIa that "we don't want to offend anyone." The challenge with this thinking is that if nurses do not ask about people's differences, then the only option is to make assumptions.

2. A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. "I don't blame you. I don't like lime Jell-O either." b. "Tell me about your cultural beliefs to best help you." c. "Why don't you want to eat the lime Jell-O?" d. "It is important for you to eat sSo that you will heal."

ANS: B The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that "we don't want to offend anyone." The challenge with this thinking is that if nurses do not ask about people's differences, then the only option is to make assumptions.

7. Recognizing one's own prejudices and learning about other people's differences is the first step toward: a. cultural diversity. b. multicultural competence. c. social change. d. valuing.

ANS: B To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences.

2. When communicating health information with diverse populations, miscommunication and misunderstanding can lead to: (Select all that apply.) a. cultural competence. b. malpractice claims. c. informed consent. d. errors. e. increased cost.

ANS: B, C, D, E The literature illustrates the vital role communication plays in avoiding cases of malpractice due to diagnostic and treatment errors. When communicating with culturally and linguistically diverse populations, the opportunity for miscommunication and misunderstanding increases, which subsequently increases the likelihood of errors. These errors, in turn, can cost millions of dollars in liability or malpractice claims.

5. Which of the following ethnic populations has seen the fastest growth? a. African Americans b. Iranians c. Hispanics d. Vietnamese

ANS: C

4. A nurse executive is a member of a collaborative committee assigned to revise the violence prevention program. After reviewing the program, the committee has determined that the following components already were included in the existing program: a written plan available to all employees, a system for tracking work-related assaults, and specific strategies for reducing the severity of violent injuries. A primary revision recommended by the committee should be the inclusion of a: a. detailed description of last year's injuries. b. list of preferred work injury health care providers. c. method for evaluating the effectiveness of the program. d. way to determine whether an employee is at fault.

ANS: C According to the Occupational Safety and Health Administration (OSHA), the main components in a violence prevention program are a written plan, a worksite analysis, hazard prevention and control, safety and health training, and record keeping and evaluation of the program.

10. Jeff, the manager of security at Methodist Hospital, has required that all of his security guards attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is: a. hazard prevention. b. environmental designs. c. behavior modification. d. administrative control.

ANS: C Behavior modifications provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness

1. Which of these statements are true about culture? a. Culture remains consistent. b. Individuals identify with one culture during their lifetime. c. Culture is complex. d. Culture excludes religion.

ANS: C Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes. There is a complex nature to culture, which has been defined and studied across many disciplines.

6. Employee assistance programs: a. allow employers to place staff into anger management programs designed to help control potentially violent behavior. b. encourage employees to provide assistance to co-workers experiencing workplace violence. c. provide services to help employees cope with stressors that occur at home or work. d. train employees to deescalate violent situations.

ANS: C Employee assistance programs provide a range of services to help employees cope with stressors that occur at home and at work.

13. When nurses portray an attitude that their cultural group is superior to another, it is known as practicing the concept of cultural: a. diversity. b. egocentrism. c. ethnocentrism. d. prejudice.

ANS: C Ethnocentrism is characterized or based on an attitude that one's own cultural group is superior to another.

12. What is the most modifiable factor in the provision of equitable health care? a. Availability of services b. Socioeconomic status c. Care that is responsive to cultural needs d. Education level

ANS: C Health inequities are directly related to the existence of historical and current discrimination and social injustice, and one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals.

7. An important role of the human resources department in limiting workplace violence is: a. allowing the local police force to control violence within the facility. b. delegating the control of workplace violence to individual unit managers. c. developing comprehensive violence prevention policies and procedures. d. empowering each nurse to assess each situation and react accordingly.

ANS: C Human resource management policies addressing hiring, discipline, counseling, training, threat assessment, threat management, and reporting are essential for the prevention and/or mitigation of violence from current or former workers in health care organizations.

14. County Hospital has purchased a computerized reporting system for reporting incidents, including acts of violence. Violence reports are aggregated, trended, and used to mitigate future incidences of workplace violence. This type of management framework is _____ management. a. risk b. threat c. total quality d. human resources

ANS: C In a systems approach, organizational culture is also considered an aspect of environment. A worksite analysis conducted by a TAT or similar task force is among the recommendations by OSHA and is consistent with a total quality management approach. Such an effort analyzes records, trends, workplace security, physical characteristics, operating policies, and screening surveys of staff to provide an overview of the work environment.

3. The chief operations officer of a local hospital has issued a memorandum indicating that the modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence? a. Administrative controls b. Behavior modification c. Environmental design d. Fixture adaptation

ANS: C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.

18. Eliminating ___________ can be accomplished through access to high-quality care, promoting patient-centered care and maintaining accurate data to monitor the quality of care provided. a. diversity b. cultural incompetence c. health disparities d. miscommunication

ANS: C Principles of eliminating racial and health disparities include providing insurance coverage and access to high-quality care, promoting a diverse health care workforce, delivering patient-centered care, maintaining accurate, complete race and ethnicity data to monitor disparities in care, and setting measurable goals for improvement of quality of care.

9. Which of the following supports successful workplace diversity? a. Being a "devil's advocate" b. Holding tight to one's cultural values c. Respect for differences d. Withholding judgment of others

ANS: C To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences.

17. A patient from the Philippines has been admitted to the ICU after a motor vehicle accident. The patient has a very large group of family and friends wanting to visit, hold vigils, and provide meals to the visitors and staff. This is an example of: a. inflexible attitude b. ambiguity c. ethnocentrism d. collectivism

ANS: D Collectivism is a tightly knit societal framework where people are integrated into cohesive and strong in-groups, often extended families, to look after them in exchange for unquestioning loyalty. Nurses from collectivist cultures tend to look to the team before taking action. The most collectivist culture on Hofstede's scale is Guatemala at 6, China is 20, and the Philippines is 32. It's not unusual with patients from collectivist cultures to have large groups of relatives and friends visit at the same time, which can create challenges for nursing staff to accommodate, especially in crowded shared rooms.

19. Members of a generation who are linked through shared life experiences in their formative years are known as: a. baby boomers. b. generational markers. c. generation gaps. d. cohorts.

ANS: D Generational groups are categorized into cohorts. These cohorts are members of a generation who are linked through shared life experiences in their formative years.

5. Staff nurses may be able to avoid bullying behavior through: a. increasing time spent with patients at the bedside. b. ignoring the assaults. c. filing a grievance. d. cognitive rehearsal training.

ANS: D On an individual level, cognitive rehearsal training can help nurses avoid bullying behavior. It can also teach nurses how to intervene in situations where they see others bullying

20. A 17-year-old male has presented to the emergency department with appendicitis. He speaks English, but his mother speaks Spanish. The mother needs to consent for the surgery since the patient is a minor. The doctor determines that the consent is not needed due to the emergent nature of the case. If the doctor proceeds with out obtaining consent, he may face: a. cultural competence. b. linguistic competence. c. miscommunication concerns. d. liability claims.

ANS: D The National Center for Cultural Competence (n.d.a) noted that health professionals who lack cultural and linguistic competency can be found liable under tort principles in several areas such as treatment in the absence of informed consent. In addition, providers may be presumed negligent if an individual is unable to follow guidelines because they conflict with his or her beliefs and the provider neglected to identify and try to accommodate the beliefs. Additionally, if a provider proceeds with treatment or an intervention based on miscommunication due to poor quality language assistance, he or she and his or her organization may face increased civil liability exposure.

4. Which of these is the fastest growing minority group in the United States? a. Asians b. Caucasians c. Blacks d. Hispanics

ANS: D The U.S. Census Bureau (2014) estimates that minorities (anyone who is not a single-race non-Hispanic White) will be the majority in America by 2044 as a result of both immigration and growth rate. The nation's racial and ethnic minority groups, especially Hispanics, are growing more rapidly than the non-Hispanic White population, fueled by both immigration and births.

12. Employee assistance programs can be especially useful when mitigating which source of violence? a. Patients b. Current or former workers c. Criminals with no connection to the employer d. Someone who has a personal relationship with an employee

ANS: D The implications for management of the threat of workplace violence vary depending somewhat on the source of violence. In dealing with someone who has a personal relationship with an employee, employee assistance programs can be especially useful.

18. What is the primary component of a violence prevention program? a. Regulatory guidelines b. Employee commitment c. Financial commitment d. Management commitment

ANS: D Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.