Management Chapter 1

The nurse is aware that human factors engineering is utilized to accomplish what goal? 1. Decrease errors in nursing care. 2. Ensure that there is adequate staffing on a nursing unit. 3. Determine if the nursing unit is an optimal healing environment. 4. Design more efficient ways for nurses to provide patient care.

1 Human factors engineering looks at environmental issues, but its main goal is to ultimately decrease errors in nursing care. Human factors engineering studies human capabilities and limitations to determine ways in which errors in nursing care can be decreased. Human factors engineering may look at staffing to determine if there are adequate caregivers to provide safe care, but this is not the goal. Human factors engineering looks at efficiency of actions, but its main goal is to ultimately decrease errors in nursing care.

The nurse manager has encouraged the nurses to provide patients on the unit any toiletries that are needed but to determine if the patient needs these supplies before providing them. Which one of the Institute of Medicine's Six Aims for Health Care in the 21st Century is the nurse manager using? 1. Efficient 2. Equitable 3. Patient-centered 4. Effective

1 The nurse manager is being efficient, which means to avoid waste, in particular, equipment, supplies, energy, and ideas. To be equitable is to not vary in quality because of personal characteristics. Patient-centered is providing care that is respectful of and responds to the unique needs of each patient. Effective is providing services to those for whom it would be beneficial and avoiding provision of services to those not likely to benefit from them.

The nurse manager is working to create a culture of safety and is aware that which characteristics are fundamental to designing processes for high-reliability organizations? Select all that apply. 1. Sensitivity to operations 2. Desire to simplify 3. Preoccupation with failure 4. Creation of expertise 5. Resilience

1 3 5 Sensitivity to operations is a fundamental characteristic to high-reliability organizations because it states that leaders and staff must be constantly aware of risks to patient safety and reduce them. Preoccupation with failure is a fundamental characteristic of high-reliability organizations and states that leaders and staff must view near-misses as evidence that systems should be improved, rather than as proof that the system is working effectively. Resilience is a fundamental characteristic of high-reliability organizations and states that leaders and staff must be educated and prepared to respond when systems failures occur. Reluctance to simplify, not desire to simplify, is the fundamental characteristic. It states that avoiding overly simple explanations of failure is essential to understand the true reasons that patient safety is in jeopardy. Deference rather than creation of expertise is the fundamental characteristic of high-reliability organizations and states that leaders and managers must listen and respond to the insights of frontline staff.

The director of nursing has decided to begin a quality improvement program, and staff members with what skills should be included on the initial committee to ensure the success of this program? Select all that apply. 1. Have experience in working with interdisciplinary teams 2. Have experience in error justification 3. Have experience in providing efficient care 4. Have experience in performing self-assessment 5. Have experience in designing and testing interventions to change a care process

1 4 5 Skills that are necessary to be competent in quality improvement include having been a member of an interdisciplinary team and improving the quality of one's own performance through self-assessment and personal change. It is also important to have had experience in designing and testing interventions to change the process of care with the objective of improving quality. The nurse who works on quality improvement should be able to identify errors and hazards in care and to assess current practices and compare them with relevant better practices, not provide efficient care.

What are the 8 areas of consumer rights and responsibilities that the Advisory Commission came up with?

1) Information disclosure 2) Choice of providers and plan 3) Choice of health care providers that is sufficient to ensure access to appropriate high quality care 4) Access to emergency services 5) participation in treatment decisions 6) Respect and nondiscrimination; confidentiality of health information 7) Complaints and appeals 8) Consumer responsibilities

Ten rules for Crossing the Quality Chasm: Health-care Delivery in the 21st century (don't have to memorize but be familiar with)

1)Care is based on a continuous healing relationship, rather than periodic individual face-to-face visits 2) Care is based on patients' values and needs, rather than variations of care provided by HCPs based on different local and individual styles of practice and/or training -look at the patient not their many doctors 3) The patient is the source of control over care, rather than health-care professionals 4) Knowledge is shared, and information flows freely, rather than requiring the patient to obtain permission. The patient has access to information without restriction, delay, or the need to request permission 5) Decision making is evidence based, rather than based on the education and experience of the health-care professionals 6) Safety is a system property, in that procedures, job designs, equipment, communication, and information technology should be configured to respect human factors, make errors less common, and make errors less harmful when they do occur, rather than safety being an individual person's responsibility 7) There is a need for transparency, rather than a need for secrecy 8) Health care professionals predict and anticipate needs, rather than reacting to problems and underinvesting in prevention 9) Waste is continuously decreased, rather than resorting to budget cuts and rationing services 10) Collaboration and teamwork are the norm, rather than professional prerogatives and roles

The nurse manager is responsible for designing a new pediatric oncology unit and plans to ensure that it is designed with a culture of safety. The nurse manager is aware that this culture of safety requires what necessary principles to accomplish this task? Select all that apply. 1. Patient safety must be the responsibility of the unit leadership team. 2. Work processes are to be simplified. 3. Train all members of the nursing unit to work as a team. 4. Redesign work processes to prevent accidents. 5. Discourage the use of simulation and focus on actual patient care.

2 3 4 Unit jobs are to be designed for safety, and work processes are to be simplified and standardized. All members of the nursing unit are to be trained to work in interprofessional teams. The nursing unit should identify threats to safety before an accident occurs and redesign processes to prevent accidents. Patient safety is to be the responsibility of all team members, not just leadership. Simulations should be used whenever possible to discover possible errors before actually caring for patients.

The nurse manager has decided to use the strategies of the Institute of Medicine (IOM), To Err Is Human, to improve health care on the nursing unit. The nurse has identified that patient safety, practice consistent with current medical knowledge, and what other strategy must be implemented in this endeavor? 1. Work in interdisciplinary teams. 2. Work in intradisciplinary teams. 3. Meet the expectations of the patient. 4. Meet the expectations of the nurses.

3 According to the IOM report, To Err Is Human, there are three domains of quality that must be implemented, and these include patient safety, practice consistent with current medical knowledge, and meeting customer-specific values and expectations. Working with both interdisciplinary and intradisciplinary teams are components to be included in the health profession as education and is also a part of the QSEN competency of Teamwork and Collaboration. Meeting the expectations of the nurses is also a part of the Teamwork and Collaboration QSEN competency.

Nurses are aware that the Quality and Safety Education in Nursing (QSEN) competency, Teamwork and Collaboration, requires what specific type of collaboration? 1. Multidisciplinary 2. Interdisciplinary 3. Interprofessional 4. Customized care

3 Interprofessional refers to members with specific disciplinary training and diverse perspectives working collaboratively in planning and implementing patient-centered care. It is thought to be more inclusive of all members of the health-care team. Multidisciplinary describes a team in which members function independently and then share information with each other. QSEN calls for team members to be collaborative in planning and implementation. Interdisciplinary refers to teams that cooperate, collaborate, communicate, and integrate care, but QSEN calls for team members to be collaborative in the planning and implementation. Customized care refers to the type of care that should be provided to patients, not the way in which the team should function to provide that care.

The nurse understands that improvement of safety in nursing is dependent on evidence-based practice and which element of the safety competency? 1. Resilience 2. Human factors engineering 3. High-reliability organizations 4. Standardized protocols

4 According to the Agency for Healthcare Research and Quality (AHRQ) (2005), evidence-based practice and standardized tools are critical aspects of patient safety improvement. Resilience refers to nurses being educated and prepared to respond to system failure, while important safety improvement is not dependent on it. Human factors engineering helps to determine what environmental factors influence the commission of errors. While very helpful, safety improvement is not dependent on it. High-reliability organizations refers to consistent performance of high levels of safety over time. It is evidence of safety improvement.

The nurse leader as a part of the patient-centered care Quality Safety Education in Nursing (QSEN) competency has encouraged all nurses to be advocates for their patients. The nurse leader knows that this concept is understood when the nurses demonstrate which action? 1. Patients state they believe they have access to information and resources and have the opportunity to learn and grow. 2. Patients state that they have all the supports necessary to manage their own disease. 3. Patients state they have the ability to read, understand, and act on information about their diseases. 4. Patients state that the nursing staff knew about their desires and allowed them to make their own decisions.

4 Advocacy in nursing is defined as a process of analyzing, counseling, and responding to patients' care and self-determination preferences. Empowerment is where patients believe they have access to information, support, and resources that give them opportunities to learn and grow about their own health conditions. Self-management recognizes the patient as the source of control and that the necessary tools and system supports are available for the patient to self-manage his or her own disease. Health literacy is the patients' ability to read, understand, and act on health-care information.

Which report is the one with the six aims?

Crossing the Quality Chasm: A New Health System for the 21st Century

What does effective communication look like?

Effective communication is accurate and timely and enhances quality of care. Additionally, effective communication requires listening actively, encouraging input from others, and respecting opinions of all team members.

an independent nonprofit organization that works outside the federal government to provide unbiased and authoritative advice on health and health care to decision makers and the public brings together experts and stakeholders to provided evidence-based guidance Came up with all the reports

Institute of Medicine (IOM)

7 Levels of Evidence from highest to lowest

Level 1: systematic review or meta-analysis of RCTs Evidence-based Clinical Practice Guidelines Level 2: Evidence from at least one well-designed RCT Level 3: Controlled trials without randomization Level 4: Case-control or Cohort Level 5: systematic review of qualitative studies Level 6: Single descriptive or qualitative study Level 7: Expert opinions

Multidisciplinary vs interprofessional

Multi: describes a team in which members function independently and then share information with each other Interprofessional: refers to members with specific disciplinary training and diverse perspectives working collaboratively in planning and implementing patient-centered care

What are the five core competencies of "Health Professions Education: A Bridge to Quality"?

Provide patient-centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Use Informatics PIEQI

initiative funded by the Robert Wood Johnson Foundation to indoctrinate the fundamentals of patient safety and quality improvement into the professional practice of all nurses, starting with nursing schools

QSEN Quality and Safety Education in Nursing

What are the six aims of "Crossing the Quality Chasm: A New Health System for the 21st Century"?

Safe Effective Patient-centered Timely Efficient Equitable

What is missing from the five competencies in "A Bridge to Quality" that was added into QSEN?

Safety

What are the three fundamental elements of QI?

Structure or care environment Care process Outcomes of care QISOC

What is important to remember about empowering your patient?

The nurse as well as the patient has to feel empowered that care will help. If we as nurses don't believe we can help, than the patient won't either

representing and/or speaking for patients when they cannot speak for themselves

advocacy

what are the six parts of patient centered care?

advocacy empowerment self management health literacy cultural competence optimal healing environment SHOE AC

organizing the components of the plan of care, coordinating the implementation of the plan of care, advocating for the delivery of dignified human care, and documenting the coordination of care

care coordination basically you are taking what the entire interprofessional team suggests and implementing a plan of care. Like PT will come TR, and the doctor will make rounds at 9 every day. Plan of care that includes all the different teams working to help the patient

What are the two fundamental elements of teamwork and collaboration?

care coordination communication

focusing on *how* nursing care is provided, including models of care delivery, critical pathways, standardized clinical guidelines, and actual physical care of patients, including assessment, intervention, patient education, timelines of care, counseling, and leadership and management activities

care process

following and/or developing guidelines that gather, appraise, and combine evidence to address relevant issues while balancing risk and benefits

clinical practice guidelines

communicating verbally and nonverbally with patients, families, and other health care professionals in an effective manner

communication

providing acceptable cultural care and respecting the differences in patient values, preferences, and expressed needs

cultural competence We need to be aware of our own biases. We need to realize that some people don't believe the same things as we do and treat them as we would any other patient regardless of what we think

leaders and managers must listen and respond to the insights of frontline staff

deference to expertise

What is disparity?

disparity occurs when we treat someone differently because of someone's different views when compared to ours basically being racist or biased to what we like

communicating all interactions with patients, including assessments, interventions, evaluations, and outcomes of care, in the patient's health record

documentation

What is the best way to make sure that nurses are effectively using EBP?

educate nurses on it! and encourage them to use the process

One of the six aims of Quality Chasm: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit; avoiding overuse, underuse, and misuse of care

effective

One of the six aims of Quality Chasm: avoiding waste, in particular of equipment, supplies, ideas, and energy

efficient

What type of people have the lowest health literacy abilities in our society?

elderly and low income population Which are usually the people who need health care the most so make sure to advocate for your patient and assist them in understanding the medical terms

providing patients with access to information, support, resources, and opportunities that allow them to optimize their health and take part in decision making

empowerment

One of the six aims of Quality Chasm: providing care that does not vary in quality because of personal characterisitics such as gender, ethnicity, geographic location, and socioeconomic status

equitable

developing management strategies informed by rigorous research based on empirical evidence

evidence-based management so basically you are looking for high levels of research that prove the best management strategies How to best manage How to best make changes in the unit stuff like that

integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare

evidence-based practice

Who was big on advocating for optimal healing environments?

florence nightingale

assisting patients and their families in reading, understanding, and/or acting on health-care information

health literacy

creating processes, systems, and a culture that radically reduces system failures and/or effectively responds when failures do occur

high-reliability organizations

What did the report "To Err Is Human: Building a Safer Health System" state?

identified that *medical errors* were the leading cause of injury and unexpected deaths in health care This one's easy to remember think *Err- medical errors*

What is the number one cause of medication errors?

ineffective communication communication and safety go hand in hand!

Two fundamental elements of informatics

information management documentation

What are acts of commission?

involves doing something wrong or committing an error

What are acts of omission?

involves failing to do the right thing or omitting something that results in an error

What is the relationship between quality improvement and evidence based practice?

monitoring and evaluating workflow and work processes using benchmarks to measure against established standards honestly what does that even mean but ok

answering questions or solving problems by generating, testing, or evaluating knowledge and developing reliable evidence about issues important to the nursing profession

nursing research

creating and maintaining an environment that fosters healing, is safe and clean, guards patient privacy, engages all the human sense, and considers the experience of the body, mind, and spirit

optimal healing environment

focusing on the *results* of the nursing care provided and reflecting on the effectiveness of nursing activities

outcomes of care Most of QI is based on results Ex. length of stay, infection rates, patients' falls, post-procedure complications, failure to rescue

recognition of the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients' preferences, values, and needs

patient centered care

One of the six aims of Quality Chasm: providing care that is respectful or and responsive to individual patients' preferences, needs, and values, and ensuring that patients' values guide all decisions

patient-centered

leaders and staff must view near misses as evidence that systems should be improved, rather than as proof that the system is working effectively

preoccupation with failure

Five principles of safety culture

providing leadership respecting human limits in the design process promoting effective team functioning anticipating the unexpected creating a learning environment FALLL

avoiding overly simple explanations of failures is essential to understand the true reasons that patient safety is in jeopardy

reluctance to simplify

leaders and staff must be educated and prepared to respond when system failures do occur

resilience

One of the six aims of Quality Chasm: avoiding injuries to patients from the care that is intended to help them

safety

goal is to balance accountability with the notion of "no blame" for errors. Transparency is critical and staff must feel comfortable in report errors, near misses, and potential for errors

safety culture

increasing the skills and confidence of patients in managing their health problems

self-management we want the patients to learn how to take care of themselves

leaders and staff must be constantly aware of risks to patient safety and focus on preventing them (high-reliability organizations)

sensitivity to operations

following standard protocols to decrease *preventable* adverse events and medical errors

standardized protocols and practice Be a courageous nurse! Always think: What could go wrong?

focusing on where nursing care is provided, including the physical environment, equipment, staffing, policies and procedures, the organizational culture, and management of the organization essentially means the setting where nursing care is provided

structure or care environment ex. the unit, patient room, surgical suite, outpatient clinic, patient's home

function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care

teamwork and collaboration

One of the six aims of Quality Chasm: reducing waits and sometimes harmful delays for both those who receive and those who give care

timely

Overall goal of QSEN?

to prepare future nurses with *knowledge, skills, and attitudes* (KSA) necessary to continuously improve the quality and safety of health care systems

What is one way that you can involve patients in their care?

write an attainable goal for your patient for that day