leadership test 3

ch 12 case managed care During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method b. Team nursing c. Functional nursing d. Nurse case management

ANS: A -The case method may involve total patient care provided by a registered nurse, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.

ch8 Four stages of conflict

1. frustration- when people perceive that their goals may be blocked, frustration results. 2. conceptualization- conflict arises when different interpretations of a situation occur. what is/ what is not. individual interpretations. 3. action- seeking clarification, collecting info, engaging in dialogue 4. outcomes- can be tangible or intangible consequences that result.

ch 12 In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. Can be effective in recognizing individual strengths and backgrounds of staff. b. Promotes autonomy and independence for the RN. c. Avoids conflict because of role clarity. d. Is efficient in delivering care to a large group of patients, utilizing a staffing mix.

ANS: A -Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

ch19 The nurse educator was giving a workshop on team building. She noted that effective communication is essential for team building. One of the key questions in the workshop was, "What is the best way to check to see if what you have communicated to a team member is understood the way you meant it to be understood?" The correct response is which of the following options? a. Active listening and feedback b. Cues from nonverbal communications c. Content and context clues d. Reliance on paralanguage

A. -Active listening is a skill in listening in which one listens with the full intention of understanding what is being communicated, listening to the degree that you are able to repeat exactly what was said. Feedback helps to verify that the message you received was the one that was sent. Paraphrasing and restating the message are important feedback skills ("What you meant was....").

ch25 clinical incompetence Clinical incompetence is a problem facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? a."It is a nurse's professional responsibility to maintain quality control." b."All instances of clinical incompetence are to be reported." c."It is not considered being disloyal when one nurse reports another for poor care." d."Patient care is the number one concern. Meeting standards is mandatory and necessary."

A. "It is a nurse's professional responsibility to... B. "All instances of clinical incompetence... C. "It is not considered being disloyal when... D. "Patient care is the number one concern...

CH 8 avoidance avoiding

AKA withdrawing Very unassertive/uncooperative Never pursue needs, goals, or concerns immediately nor assist others to pursue them. conflict is postponed or ignored.

ch25 absenteeism The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? a. Employee morale is at a high level. b. Care will suffer and standards will be lowered. c. Existing staff have experienced little effect from the absenteeism. d. Replacement staff usually needs little supervision. e. Unit costs have increased because of staff replacements and overtime.

ANS: B. Care will suffer and standards will be lowered. E. Unit costs have increased because of staff replacements and overtime.

Ch 7 "Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except: a. Distancing oneself from work. b. Using cognitive reframing to change irrational thoughts. c. Refusing a request to sit on a committee to evaluate scheduling software. d. Exercising regularly.

ANS: A -Achieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout.

ch7 "Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except: a. Distancing oneself from work. b. Using cognitive reframing to change irrational thoughts. c. Refusing a request to sit on a committee to evaluate scheduling software. d. Exercising regularly.

ANS: A -Achieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout. ch 7

ch 12 For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. Rotation of task assignments. b. Frequent opportunities for in-service education. c. Orientation to job responsibilities and performance expectations. d. Team social events in off hours.

ANS: A -Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

ch 14 Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient's discharge. This action exemplifies which of the four historical concepts identified by Lewis and Batey? a. Authority b. Responsibility c. Communication of conflict d. Autonomy

ANS: A -Authority refers to the use of professional status and power to act in the patient's best interests. In this example, Sarah is using her professional status and power to set up a conference in which her patient, the prescribing physician, and she can discuss what is not working for the patient and potential options.

Ch 14 A Magnet hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and autonomy, is linked with: a. Client satisfaction with the healthcare organization. b. Organizations with a limited number of nurse managers. c. Private, specialty organizations in urban areas. d. Sophisticated academic health sciences universities.

ANS: A -Autonomy and authority in decision making that is consistent with scope of practice are linked both to higher job satisfaction and to higher patient satisfaction with care. Job satisfaction is an important indicator of the quality of patient care.

ch 14 A Magnet hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and autonomy, is linked with: a. Client satisfaction with the healthcare organization. b. Organizations with a limited number of nurse managers. c. Private, specialty organizations in urban areas. d. Sophisticated academic health sciences universities.

ANS: A -Autonomy and authority in decision making that is consistent with scope of practice are linked both to higher job satisfaction and to higher patient satisfaction with care. Job satisfaction is an important indicator of the quality of patient care.

ch 14 Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the patient's history and of other medications that the patient has been given. The physician reiterates the order and Sandra refuses to give it. In this instance, Sandra is demonstrating: a. Autonomy. b. Accountability. c. Authority. d. Best practice.

ANS: A -In this situation, Sandra is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. This is analogous to the example in the text where the workers on the manufacturing floor have the independence to say "Stop the line" when something is wrong. Key to the concept of autonomy is decision making and the level of independence that is given. Accountability refers to achievement of outcomes, and authority refers to the capacity to make decisions.

ch 26 mentoring The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs. The main purpose of mentoring is: a. Promoting staff retention. b. Promoting staff attrition. c. Developing new role expectations. d. Promoting staff supervision.

ANS: A -Mentoring has been identified as important to staff retention.

high performing teams ch19 From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams: a. Can create a form of synergism in which the outcome is greater than the sum of the individual performances. b. Do not necessarily need goals, objectives, vision, and a clearly stated purpose. c. Do not always have effective communication patterns. d. May or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.

ANS: A -Research on team-building over many years has established that high-functioning teams are characterized by synergy that takes the team from a collection of individuals to an outcome that is greater than the sum of the parts.

ch 14 labor- mgmt. partnerships Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to mission statement, goals, and objectives. For true shared governance to be seen as part of this approach: a. It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions. b. Stakeholders must be assured of the value of their input even though final decisions rest with senior executives. c. Publications must clearly outline how staff input was solicited and obtained. d. Staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.

ANS: A -Shared governance demands participation in decision making rather than provides for participation. When partnership, equity, and ownership are not involved, then shared governance has not occurred, and publication and expressions of appreciation for input will not be seen as representative of shared governance.

ch 14 shared governance Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to mission statement, goals, and objectives. For true shared governance to be seen as part of this approach: a. It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions. b. Stakeholders must be assured of the value of their input even though final decisions rest with senior executives. c. Publications must clearly outline how staff input was solicited and obtained. d. Staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.

ANS: A -Shared governance demands participation in decision making rather than provides for participation. When partnership, equity, and ownership are not involved, then shared governance has not occurred, and publication and expressions of appreciation for input will not be seen as representative of shared governance. -is an organizational strategy that supports nurses to have ownership, autonomy and input in their professional practice.

ch 25 documentation In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a.Include a plan to correct them and to prevent future occurrences. b.State a detailed history of past problems that are related to the current one. c. Be written at the convenience of the manager. d. Accumulate until the evaluation period begins

ANS: A Include a plan to correct them and to prevent future occurrences.

ch 7 Select all- work related stress affect High levels of work-related stress affect all but which of the following? (Select all that apply.)

ANS: A, B, C, D a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare -Many writers and researchers have found that these work-related areas are adversely affected by stress. ch 7

ch 12 select all- strategies to implement TCAB Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.

ANS: A, B, E a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. e. Present ideas based on best practices and ask staff for advice on implementation -Transforming care at the bedside (TCAB) relies on active involvement of staff in the generation of innovative ideas to improve patient care. Staff are actively engaged in selecting innovation, planning, and evaluation of the innovations. Critical to practice changes, rapid cycle change is a process that encourages testing creative change on a small scale while determining potential impact.

CH 25 absenteeism Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: a. Not all absenteeism is voluntary. b. High personal control contributes to absenteeism. c. Direct discussions with employees who have high levels of absenteeism are not recommended. d. All absenteeism is related to personal issues and needs.

ANS: A. Not all absenteeism is voluntary.

CH 25 absenteeism Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? a. Increased absenteeism over the past month b. Increased attempts to discuss his concerns with his colleagues c. Testing of workplace guidelines d. Frequent defensiveness

ANS: A. Increased absenteeism over the past month

ch 14 accountability Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin's follow-up to complaints from the community is: a. Appropriate and indicates that he has assumed accountability for the actions of his staff. b. Indicative that he does not clearly understand the concept of accountability. c. Indicative of strong support for his staff and their autonomy. d. Important in clarifying the difference between his accountability and that of the community in patient care.

ANS: B -Accountability refers to the achievement of desired outcomes. If community agencies are noticing that limited or no change in patient behavior has occurred despite teaching on the unit, then the staff has not achieved accountability, and he is not holding his unit responsible for the outcomes. Martin is also demonstrating lack of accountability.

ch 12 The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method

ANS: B -Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable utilization of various types of healthcare providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost-effective in patient care settings because it maintains quality care while streamlining costs for high-risk, high-volume, high-cost patient populations and seeks the active involvement of the patient, the family, and diverse healthcare professionals.

ch 12 functional When interviewing an applicant for a position, the nurse manager describes the unit's care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. The case method. b. Functional nursing. c. Primary nursing. d. Nurse case management.

ANS: B -The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients.

ch 14 The emergency department staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management: a. Disregards due process when disciplining a nurse. b. Delays responding to repeated efforts to provide safe care. c. Hires nurses who are not a part of the union during a strike. d. Refuses to bargain in good faith with the elected bargaining agent. BWhistle-blowing is often a result of organizational failure, including failure of the organization in responding to serious danger or wrongdoing created within the environment, which, in this instance, involves conditions that put the patient at risk.

ANS: B -Whistle-blowing is often a result of organizational failure, including failure of the organization in responding to serious danger or wrongdoing created within the environment, which, in this instance, involves conditions that put the patient at risk.

ch 14 The chief nursing officer utilizes the hospital's Workplace Advocacy to help the overwhelmed emergency department staff. Workplace Advocacy is designed to assist nurses by: a. Creating professional practice climates in their institutions. b. Equipping them to practice in a rapidly changing environment. c. Negotiating employment contracts. d. Representing them in labor-management disputes.

ANS: B -Workplace advocacy encompasses a number of activities that enable nurses to control the practice of nursing and to address challenges that they face in the practice setting. These activities include career development, employment rights, employment opportunities, and the labor-management relationship.

ch 14 The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. The senior nurse executive is named in the suit: a. As a global respondent. b. Under the doctrine of respondeat superior. c. As a frivolous action. d. Under the element of causation.

ANS: B Known as vicarious liability, the doctrine of respondeat superior makes employers accountable for the negligence of their employees, using the rationale that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer. Ch 14

CH 25 documentation A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? a. Use of the performance appraisal on an annual basis b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up c. A tally sheet of medication errors and other specific problems that will be used at annual review d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

ANS: B Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up

CH 25 documentation The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation: a. Cannot be left to memory. A notation must be placed in the personnel file. b. Should avoid discussion of the problem. c. Should include what was done about the problem when it occurred. d. Needs to include date, time, and place.

ANS: B Should avoid discussion of the problem.

ch 12 team nursing challenges To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. Be able to effectively communicate with patients. b. Build relationships with physicians. c. Be able to adapt to daily changes in staffing. d. Adapt in communicating information to her supervisor.

ANS: C -A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages.

ch 14 In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary children. This is an example of: a. Community development. b. Collective bargaining. c. Collective action. d. Shared governance.

ANS: C -Collective action refers to activities undertaken by a group of people with common interests and, in this example, by a group of nurses who are interested in the welfare of children in their community.

ch 12 functional patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. Differentiated practice. b. Team nursing. c. Functional nursing. d. Case management.

ANS: C -Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress.

ch 26 role discrepancy The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of: a. Acceptance. b. Negotiation. c. Discrepancy. d. Internalization.

ANS: C -Role discrepancy is an experience that includes a gap between what is expected and what is occurring and can lead to disillusionment, discomfort, and frustration. If the unit manager values the relationship and sees the differences between performance and expectations as correctable, then the manager is likely to stay in the role.

ch22 patient satisfaction survey and health literacy In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? a. Providing instructional materials at appropriate reading levels b. Facilitating access to translators for persons with language barriers c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made d. Knowing that most people have limited health literacy skills

ANS: C -The definition of health literacy used by the federal government is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (U.S. Department of Health and Human Services, 2010).

CH 25 documentation A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting

ANS: C Having adequate written documentation to support the action

ch25 clinical incompetence The chief nursing officer understands that clinical incompetence is best prevented by a: a. Flexible protocol for evaluating competency skills. b. Standardized clinical skills checklist. c. Administration of personality tests and competency assessments at point of hire. d. Formalized competency program with established standards for practice.

ANS: D

ch 12 A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." This nursing care delivery model employed in this situation might be particularly effective in: a. Promoting communication among diverse team members. b. Facilitating multiple perspectives on the total care of a patient. c. Avoiding patient-provider conflict. d. Developing competence and confidence in unskilled workers.

ANS: D -An advantage of functional nursing is that both unskilled assistive personnel and skilled staff are involved in performance of specific tasks, and the repeated performance of tasks enables staff to become very efficient in specific functions. Disadvantages of the model include difficulty in being able to assess the patient's nonphysical needs effectively and the potential for ineffective communication because of the focus on specific tasks.

ch 12 In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. Department. b. Unit. c. Staff. d. Patient.

ANS: D -In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

CH 14 Collective action is effective in: a. Ensuring that needs of nurses are placed ahead of other disciplines. b. Defining nursing as a profession. c. Advising patients of the needs of nurses. d. Amplifying the influence of individuals. efine and sustain individuals in achieving the desired purposes.

ANS: D -Individuals may have limited influence in achieving various purposes such as advancement of quality care or of the profession, whereas collective action helps to d

ch 14 To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except: a. Notifying staff of changes to policies related to medication administration. b. Scheduling and staffing to ensure safe care. c. Delegating in accordance with practice acts. d. Supervising the practice of the physician.

ANS: D -Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures. Ch 14

ch 14 In a nurse managers' meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is: a. Accepting the practice of "going along to get along." b. Attending as many workshops as practical. c. Spending as much time as possible in clinical settings. d. Taking the opportunity to work with a mentor.

ANS: D -Mentoring facilitates development and adoption of positive interaction and other skills that facilitate good decision making. Optimism, trust, and decision making are important in collective action and shared decision making and contribute to job satisfaction and lower turnover in staff.

ch 14 Awareness and use of power have been challenging for nurses in general because of: a. Incidences of punishment by authority figures. b. Too little time in the workplace to collectively develop power strategies. c. Lack of cohesiveness and unity among nurses. d. A tradition of obedience to authority.

ANS: D -Rituals and traditions such as the Nightingale Pledge have emphasized the need for the "good nurse" to be obedient to authority. This prevailing attitude has made it difficult for nurses, who typically spend considerable time in the workplace and who have opportunity through their work in teams to develop cohesiveness and unity, to develop awareness and use of power.

ch 12 The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization is to: a. Implement the care pathway on admission. b. Provide direct nursing care throughout the hospitalization. c. Supervise the nursing staff members who implement the care map. d. Prevent additional hospitalizations resulting from complications of the client's disease.

ANS: D -The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

ch 12 case mgmt.. goals for pt The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization is to: a. Implement the care pathway on admission. b. Provide direct nursing care throughout the hospitalization. c. Supervise the nursing staff members who implement the care map. d. Prevent additional hospitalizations resulting from complications of the client's disease.

ANS: D -The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

CH 25 absenteeism The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a.Using replacement personnel with new ideas may be beneficial. b.Salary costs are lower because personnel are fewer, and outcome is favorable. c.Absence on the part of the rest of the staff is decreased. d.Unacceptable patient care may result.

ANS: D. Unacceptable patient care may result.

ch 25 incivility Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would NOT be an appropriate first step? a. Suspending the staff member from work b. Providing written admonishment that is discussed and placed in the employee's file c. Providing verbal admonishment d. Terminating the staff member

ANS: d. Terminating the staff member

synergy and active listening ch 19 By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members:

Actively listen to each other. -Active listening in a group creates synergy in that team members really hear one another's ideas and share in decision making.

team vs group ch 19 A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning:

As a group. -A group is a collection of interconnected individuals working together for the same purpose. A team is a unified group that is committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. The conflict indicates that the staff may not be united in a common purpose.

ch7 identifying possible solutions to stress As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to:

Ask the nurse to meet with you for a few minutes before she leaves for the day. -Stress can lead to emotional symptoms such as depression and a variety of ailments. Meeting with the nurse privately may assist in identifying stress and possible solutions. ch7

ch 14 Which ethical principle is primarily involved in informed consent?

Autonomy -Autonomy refers to the right to choose freely, which is inherent in informed consent. ch 14

SBAR ch 19 The SBAR system of communications is one of the most used communication systems in health care because: a. It deals with all aspects of communications in patient care except with the physician. b. The nurse is on the same communication level as administration c. It focuses on a system in which information is provided and gleaned in an honorable way. d. It honors an unstructured transfer of information.

C. The SBAR system was developed by professionals in the Colorado Kaiser Permanente System and involves direct, respectful communication skills among professionals with the aim of quality patient care.

ch19 From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams:

Can create a form of synergism in which the outcome is greater than the sum of the individual performances. -Research on team-building over many years has established that high-functioning teams are characterized by synergy that takes the team from a collection of individuals to an outcome that is greater than the sum of the parts.

ch 7 Psychological hardiness The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individual's ability to deal with stress is moderated by psychological hardiness. Psychological hardiness is a composite of: a. Commitment, control, and challenge. b. Commitment, powerlessness, and passivity. c. Commitment, control, and passivity. d. Decreased isolation, challenge, and passivity.

Commitment, control, and challenge. -Some people have the capacity to accept changes in life with good humor and resilience, which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to manage time and stress, to reframe situations positively, and to commit. ch7

ch19 The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is:

Commitment. -Team-building involves moving toward a common vision, which requires commitment. Conflict and clarification of tasks are components in the development of this commitment.

communication ch 19 The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication:

Consists of thoughts, ideas, opinions, emotions, and feelings. -Communication involves both senders and receivers and may or may not be a reflection of self-analysis and thoughtful consideration. It always, however, involves thoughts, ideas, opinions, emotions, and feelings.

active listening ch19 The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?

Cultivate a desire to learn about the other person. -Active listening means suspending judgment about what is about to be said and listening to all that is said (and not just the first or last words). It is motivated by a genuine desire to learn about the other person.

ch7 Depersonalization After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two elderly patients. You are concerned that Rama is evidencing which state?

Depersonalization -A characteristic of burnout is depersonalization, a state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general (Greenglass et al., 2001). Depersonalization is commonly described as a feeling of being outside one's body, feeling as if one is a machine or robot, an "unreal" feeling that one is in a dream or that one "is on automatic pilot." Generally, subjective symptoms of unreality make the nurse uneasy and anxious. Nurses pushed to do too much in too little time may distance themselves from patients as a means of dealing with emotional exhaustion. ch7

ch 7 knowing self Many writers and researchers have found that these work-related areas are adversely affected by stress.

Determine her personal and professional goals. -Personal time management refers, in part, to "the knowing of self." Self-awareness is a critical leadership skill, and being self-aware and setting goals helps managers determine how their time is best spent. ch7

ch7 Managing information overload The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff. What is a strategy that would assist the manager to manage the information overload effectively? a. Ignore messages unless they are labeled as important. b. Determine who is most likely to send useful or important information or requests. c. Check e-mail messages once a day. d. Encourage face-to-face meetings rather than e-mail.

Determine who is most likely to send useful or important information or requests. -Reduction of stress related to information overload requires the development of information-receiving and information-sending skills. Information-sending skills include determining most common sources of useful data, labeling files and folders to which e-mail messages can be directed, deletion of e-mails, and focusing on the most important pieces. Information-sending skills include keeping e-mail messages short (and calling if the message needs to be long) and considering the most appropriate medium for messages (telephone, fax, face-to-face). ch7

Functional nursing positives

Each person becomes efficient at specific task, and much work can be done in a short time. Unskilled workers can be trained to perform one or two specific task very well. The organization benefit financially from this model because care can be delivered to a large number of patients by mixing staff with a fixed number of our ends in a larger number of UAPs

ch 14 A staff nurse who was fired for reporting patient abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse:

Had previously reported the complaint, in writing, to hospital administration. -An employer is unable to fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law. ch 14

Disadvantages case management nursing

Financial barriers, lack of administrative support, human resource inequalities, turf battles, and the lack of information support systems have been identified as obstacles in the implementation

Functional Nursing negatives

Fragmentation of care, physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift Staff members might become busy and forget to communicate with other staff

ch7 Cognitive reframing The education consultant at St. Joseph's Hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by:

Helping people realize that negative thinking causes emotional distress. -Cognitive reframing is a therapy that aids individuals in discovering that their irrational thoughts can be replaced with responses that are more rational. It enables individuals to gain a sense of control over the situation and can change "I'll never ..." to "I can ..." or "She always ..." to "Sometimes she ... ." It is an approach that allows individuals to replace negative thoughts and statements with others that are more realistic and helpful. ch 7

ch 12 Advantages of nursing case management

Improve care outcome, decreased the length of stay in the hospital, service efficient

Functional nursing role of manager

Must be sensitive to the quality of patient care delivered and institutions budgetary constraints. Patient outcomes becomes the nurse managers responsibility

ch 12 patient-centered A rural, critical access hospital has used a total patient care model to deliver nursing care to patients because of the hospital's commitment to individualized care to patients in the community. Environmental factors such as a nursing shortage in the area and limited profitability of the hospital have forced the nursing administration to consider another, less expensive model of nursing care delivery. They want to continue their commitment to individualized care to the extent possible. Which model of care would be most appropriate in this situation?

Patient-centered care. The patient-centered care model of care maintains the commitment to individualized care; however, it uses less expensive unlicensed assistive personnel to extend the practice of the registered nurse.

ch 14 autonomy

Personal freedom and the right to choose what will happen to one's own person

ch 12 Nursing case management

Process of coordinating healthcare by planning, facilitating, and evaluating interventions across levels of care to achieve measurable cost and quality outcomes

Functional nursing

Providing patient care by which each licensed and unlicensed staff member perform specific tasks for a large group of patients Upgrade to remove ads

ch 12 The most important role of the nurse case manager is to:

Serve as a communication link between all providers of care. The primary role of the case manager, according to the Case Management Society of America, is to increase the involvement of individual and caregivers in the decision-making process.

ch 25 substance use The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would not be included in the discussion?

Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

ch 14 magnet Magnet recognition program

The only national designation built on evolving through nursing research that is designed to recognize nursing excellence of healthcare organizations through a self nominating appraisal process

ch 14 Whistle blowing

The process in which an individual makes public a serious wrongdoing or danger when the organization didn't take action to correct the situation or report the condition.

Functional nursing role of registered nurse

the staff RN become skilled at the task that are usually assigned by the charge nurse. Clearly defined policies and procedures are used to complete the physical aspects of care in an efficient and economical manner

ch 14 whistleblowing

a person who makes public a serious wrongdoing or danger concealed within an organization when internal actions have failed to correct or make public a situation

ch14 collective action

activities that are undertaken by a group of people who have common interest. 4 purposes: 1. promote the practice of professional nursing. 2. establish and maintain standards of care. 3. allocate resources effectively and efficiently. 4. create satisfaction and support in the practice environment. results of collective action: magnet status, 24 hr care in hospital, transfer within specialties without interruption of care..

ch 8 lateral violence

aggressive/destructive behavior or psychological harassment of nurses against each other involves conflictual behaviors among individuals who consider themselves peers with equal power- but with little power within the system.

Ch 22 select all- activities that represent a customer-friendly approach Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) a. Using a local anesthetic before inserting a needle into a child's arm b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma

ans: A, C, D -A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is important.

ch22 diversity A 27-year old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to: a.Explain to the family that the medicine pouch may contain herbs that may bother other patients. b.Ask the family about the significance of the medicine pouch for them. c.Remove the pouch when the family is not present. d.Put the medicine pouch on the shelf beside the bed.

ans: B -Diversity encompasses more than differences in nationality or ethnicity and may include a variety of ways that patients are different from their healthcare providers. Nurses need to recognize the culture of their work setting, realizing that it may differ markedly from the culture of the consumer, and move beyond ethnocentrism to provide culturally competent care. This competence includes cultural knowledge, which involves actively learning about a community; cultural sensitivity, which entails valuing and respecting beliefs, norms, and practices of the people being served; and collaboration within a community (Flaskerud, 2007). In this instance, it is important to understand the meaning of the pouch for the family; removal from the bed without discussion does not demonstrate respect for the values and beliefs of this family.

ch22 During review of a patient's progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are: a.Empowering the patient. b.Avoiding litigation. c.Advocating for the patient. d.Supporting the clinical pathway. CAdvocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as determined by standards utilized in a critical pathway.

ans: C -Advocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as determined by standards utilized in a critical pathway.

ch22 Which of the following actions best exemplifies advocacy? a.Developing a list of agencies that will provide free services for the homeless b.Working in a needle exchange program for individuals in an inner-city environment c.Acting on behalf of a patient to promote end-of-life wishes to an ethics committee d.Working in a free clinic for immigrant workers

ans: C -Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure that advocacy is actually occurring.

ch 25 Emotional problems The most important approach that a nurse manager can take with an emotionally troubled employee is to: a.Act as a therapist for the employee. b.Adjust the standard of care to assist the employee. c.Assist the employee in obtaining professional help. d.Adjust the employee's work schedule to decrease stress

ans: C. Assist the employee in obtaining professional help.

ch22 advocacy the chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: a.Establishing private and professional networking systems. b.Asking social services to handle clients' concerns. c.Identifying community support groups. d.Empowering others by promoting self-determination.

ans: D -Advocacy involves empowering and promoting self-determination in others.

ch22 Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: a.Assessment and admission of patients into care. b.Orientation of patients to services once they are admitted. c.Function of controlling which patients see the physician and which do not. d.Coordination of care, services, advocacy, and access for patients within the healthcare system.

ans: D -As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care.

ch 14 at-will employment

have greater latitude in selecting disciplinary measures of specific infraction.

ch 8 Managing incivility

increase awareness and sensitivity, recognize when you are participate in negative behaviors, understand particular incidences when nurses are most vulnerable and apt to engage in negative behavior (Heavy workloads, short staffing), establishing performance expectations has the potential to reduce lateral violence in the workplace

ch 8 incivility

one or more rude, discourteous, or disrespectful actions and can range from gossiping to refusing to assist a coworker

ch14 authority Deeming authority

power granted by one with power so that the recipient acts in his or her place

bullying

repeated, unwanted harmful action intended to humiliate, offend, and cause distress in the recipient threatens pt safety, nurse safety, and the nursing profession as a whole