N449 Test 1

fidelity

the need to keep promises

-Massage the dilemma -Outline options -Review criteria and resolve -Affirm position and act -Look back- evaluate the decision making

MORAL approach

decision making

a complex, cognitive process of choosing a particular course of action; the thought process of selecting a logical choice from available options

duty-based framework (deontological)

a duty to do something or to refrain from doing something

thought leadership

-refers to any situation whereby one individual convinces another to consider a new idea, product, or way of looking at things -attract followers not by any promise of representation or empowerment but by their risk taking and vision in terms of being innovative

-heuristics *trial and error or rule-of-thumb *practical mental shortcuts and are not expected to provide perfect or optimal problem solving *provide a more immediate solution to the decision at hand

strengths and limitations of using intuition and heuristics as adjuncts to problem solving and decision making

-planning -organizing -staffing -directing -controlling

management functions

veracity

obligation to tell the truth

justice

-seeks fairness -treats "equals" equally -treats "unequals" according to their differences

authoritative leadership

-strong control is maintained over the work group -others are. motivated by coercion -others are directed with commands -communication flows downward -decision making does not involve others -emphasis is on difference in status ("I" and "you") -results in well-defined group actions that are usually predictable, reducing frustration in the work group and giving members a feeling of security -productivity is usually high, but creativity, self-motivation, and autonomy are reduced

administrative law

-an individual is used by a state or federal government agency assigned the responsibility of implementing governmental programs -burden of proof required for guilty verdict: clear and convincing standard -likely consequences of a guilty verdict: suspension or loss of licensure

beneficence

-doing good -the actions one takes should be done in an effort to promote good

agile leadership

-fast, flexible, and adaptable decision making -openness to ideas and innovation -inclusive and democratic approach to followers

transactional leader

-focuses on management tasks -is directive and results oriented -uses trade-offs to meet goals -does not identify shared values -examines causes -uses contingency reward

criminal law

-generally filed by the state or federal attorney general -burden of proof required for guilty verdict: beyond a reasonable doubt -likely consequences of a guilty verdict: incarceration, probation, and fines

transformational leadership

-identifies common values -is a caretaker -inspires others with vision -has long-term vision -looks at effects -empowers others

advocacy

-involves helping others and grow and self-actualize -defined as protecting and defending what one believes in for both self and others

admin man

-knowledge is fragmented -is impossible to accurately predict future consequences -considers multiple alternatives but not all -makes decisions that are good enough -final choice is satisficing

democratic leadership

-less control is maintained -economic and ego awards are used to motivate -others are directed through suggestions and guidance -communications flows up and down -decision making involves others -emphasis is on"we" rather than I and you -criticism is constructive -seek input from their follows and include them in decision making whenever possible

economic man

-makes decisions in rational manner -has complete knowledge of problem or situation -considers all alternatives -has systematic ordering of alternatives -selects maximizing choice

civil law

-one individual sues another for money to compensate for a perceived loss -burden of proof required for guilty verdict: based on a preponderance of the evidence -likely consequences of a guilty verdict: monetary damages -most malpractice cases are tried here

laissez-faire leadership

-takes a hand-off approach -is permissive, with little or no control -motivates by support when requested by the group or individuals -provides little or no direction -uses upward and downward communication between members of the group -disperses decision making throughout the group -places emphasis on the group -does not criticize -can be frustrating: group apathy and disinterest can occur -when all group members are highly motivated and self-directed, this can result in much creativity and productivity

ethics

-the systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment -the justification of what is right or good and the study of what a person's life and relationships should be, not necessarily what they are

1. a standard of care is in place 2. there is a failure to meet the standard of care 3. foreseeability of harm must exist 4. there must be a provable correlation between care and harm 5. actual patient injury must occur

5 elements that must be present for a professional to be held liable for malpractice (SATA)

-they think longer term: they are visionary and futuristic; they consider the effect that their decisions will have years from now as well as their immediate consequences -they look outward, toward the larger organization: they do not become narrowly focused; they are able to understand how their unit or department fits into the bigger picture -they influence others beyond their own group: effective leader-managers rise above an organization's bureaucratic boundaries -they emphasize vision, values, and motivation: they understand intuitively the unconscious and often non-rational aspects that are present in interactions with others; they are very sensitive to others and to differences in each situation -they are politically astute: they are capable of coping with conflicting requirements and expectations from their many constituencies -they think in terms of change and renewal: the traditional manager accepts the structure and processes of the organization, but the leader-manager examines the ever-changing reality of the world and seeks to revise the organization to keep pace

6 distinguishing traits of integrated leader-managers (SATA)

8 principles of rebel leadership 1. seek out the new 2. encourage constructive dissent 3. open conversations- don't close them 4. reveal yourself- and reflect 5. learn everything- then forget everything 6. find freedom in constraints 7. lead from the trenches 8. foster happy accidents (mistakes may unlock a breakthrough)

8 principles of rebel leadership

moral uncertainty

an individual is unsure which moral principles or values apply or may even include uncertainty as to what the moral problem is

moral indifference

an individual questions why morality in practice is even necessary

-managers are expected to be skilled communicators, organizers, and team builders and to be visionary and proactive in preparing for emerging new threats such as domestic terrorism, biological warfare, and global pandemics

analyze how current and future paradigm shifts in health care affect the leadership skills that will be needed by nurses in the coming decade

encompasses both the transformational elements of leadership (that is building trust, acting with principle and integrity, inspiring others, innovating, and developing others), transactional elements (that includes both constructive elements, e.g., contingent reward and corrective elements and management-by-exception) and avoidant or laissez-faire leadership behaviors

analyze why full-range leadership models suggest leaders must have skills in transformational leadership, transactional leadership, and laissez-faire leadership

-decision grids -payoff tables -decision trees -consequence tables -logic models -program evaluation and review technique

appropriate management decision making tools that are helpful

-strengths-based leadership focuses on the development or empowerment of strengths as opposed to weaknesses or areas of needed growth -research suggests that using a strengths-based approach, even at a young age, can have a profound impact on the ability of individuals to self-manage and to regulate their emotions

compare strengths-based leadership, which focuses on the development or empowerment of workers' strengths, with the traditional management practices of identifying problems, improving underperformance, and addressing weaknesses and obstacles

Taylor -scientific management Weber -bureaucratic functions -we still see this today -personified what we do on the nursing units daily Fayol -management organizations Gulick -activities of management Follett -participative management Mayo -Hawthorne effect McGregor -theory X and theory Y Argyris -employee participation

correlate management theorists with their appropriate theoretical contributions

-define objectives clearly -gather data carefully -take the time necessary -generate many alternatives -think logically -choose and active decisively

critical elements of decision making

ethical dilemmas

defined as making a choice between 2 or more equally undesirable alternatives

p.46-47

delineate variables suggested in situational and contingency theories

informed consent -obtained only after the patient receives full disclosure of all pertinent information regarding the surgery or procedure and only if the patient understands the potential benefits and risks associated with doing so express consent -the role of the nurse is to be sure that the patient has received informed consent and to seek remedy if he or she has not -advocate for the patient

describe appropriate nursing actions to ensure informed consent

-refers to the ability to use emotions effectively and is required by leaders/managers in order to enhance their success -emotional intelligence is critical for building a cooperative and effective team 5 components 1. self-awareness: the ability to recognize and understand one's moods, emotions, and drives as well as their effects on others 2. self-regulation: the ability to control or redirect disruptive impulses or moods as well as the propensity to suspend judgment 3. motivation: a passion to work for reasons that go beyond money or status; a propensity to pursue goals with energy and commitment 4. empathy: the ability to understand and accept the emotional makeup of other people 5. social skills: proficiency in handling relationships and building networks; an ability to find common ground

describe components of emotional intelligence, which promote the development of productive work teams

1. care is provided at the scene of the emergency 2. the care is not grossly negligent

describe conditions that must exist to receive liability protection under Good Samaritan laws

principal agent theory -suggests that not all followers (agents) are inherently motivated to act in the best interest of the leader or employer (principal) situation example -followers may have an informational advantage over the leader as well as their own preferences, which may deviate from the principal's preferences

describe situations where followers (agents) might not be inherently motivated to act in the best interest of the principal (leader of employer)

-respect and meet the reporter's deadlines -assume, until proven otherwise, that the reporter will be fair and accurate in his or her reporting -have key facts and figures ready for the interview -limit your key points to two or three and frame them as bullet points -avoid technical or academic jargon -speak confidently but do not be afraid to say when you do not have the expertise to answer a question or when a question is better directed to someone else -avoid being pulled into inflammatory arguments or blame setting and repeat key points if you are pulled off into tangents -provide the reporter with contact information for follow-up and needed clarifications -be prepared -provide the media with clear, concise information -stay on track by sticking to predetermined points

describe strategies nurses can use to successfully interact with the media

-the philosophy of person- and family-centered care suggests that care should be organized first and foremost around the needs of patients and family members -patient and family perspectives are sought out, and their choices are honored -patient and family knowledge, values, beliefs, and cultural backgrounds and incorporated into the planning and delivery of care -health-care providers communicate openly and honestly with patients and families to empower them to be effective partners in health-care decision making -patients and families are encouraged and supported in participating in care and decision making at the level they choose -patients, families, and health care providers collaborate in policy and program development, implementation, and evaluation; in research; in facility design; and in professional education as well as in the delivery of care -the voice of the patient and family is represented at both the organizational and policy levels as well as at the health care system's strategic planning

describe the core concepts of person- and family-centered care

-gender -values -life experience -individual preference -brain hemisphere dominance and thinking styles

describe the importance of individual variations in the decision making process

-they are all held liable

describe the liability nurses, other care providers, and employers share under the concept of joint liability

if a structured approach to problem solving is used, data gathering is adequate, and multiple alternatives are analyzed, even with a poor outcome, the nurse should accept that the best possible decision was made at that time with the information and resources available

describe the limitations of using outcome as the sole criterion for the evaluation of ethical decision making

PSDA -required health-care organizations that received federal funding (Medicare and Medicaid) to provide education for staff and patients on issues concerning treatment and end-of-life issues -includes the use of advance directives, written instruction regarding desired end-of-life care -also likely includes durable power of attorney for health care

describe the need for patient and family education regarding treatment and end-of-life issues as part of the Patient Self-Determination Act

-nurse administrators should advocate for other health care providers (including subordinates) as well as patients, especially when this is related to health and safety creating an environment that promotes subordinate advocacy -invite collaborate decision making -listen to staff needs -get to know staff personally -take time to understand the challenges faced by the staff in delivering care -face challenges and solve problems together -support staff as needed -promote shared governance -empower staff -promote nurse autonomy -provide staff with workable systems

describe ways a manager can advocate for subordinates

-suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity -p.67

describe why quantum leaders need flexibility in responding to the complex relationships that exist between environment and context in work environments

-individual: the aim is to increase the skills, knowledge, and understanding of patients and families about what to expect when receiving care -health-care team: the focus is to promote shared understanding of expectations among patients and providers when seeking care -organization: the objective is to encourage partnerships and integrate the patient and family perspective into all aspects of hospital operations -community: the emphasis is to expand the focus beyond the hospital setting and find opportunities to improve overall community health

identify entry points for user engagement in the health care system as well as strategies for patient and family engagement in health care

-growing elderly population -health-care reform -reductions in reimbursements -new quality imperatives -shift in care to community settings -technological advances -shift to customer-focused care

identify factors that are affecting health-care trends

-helps patients feel comfortable in the system -stresses strong patient-provider relationship -stresses key role patients play in staying healthy

identify how the Patient's Bill of Rights protects patients

-helping others make informed decisions -acting as intermediaries in the environment -directly intervening on behalf of others -advocating for social justice -nurse administrators should advocate for other health care providers (including subordinates) as well as patients, especially when this is related to health and safety -workplace advocacy occurs when the manager assures the work environment is both safe and conducive to professional and personal growth for subordinates -leader-managers also must be advocates for the nursing profession; when nurses find a discrepancy between their perceived role and society's expectations, they have a responsibility to advocate for the profession common areas requiring nurse-patient advocacy -end-of-life decisions -technological advances -health-care reimbursement -access to health care -transitions in health care -provider-patient conflicts regarding expectations and desired outcomes -withholding of information or blatant lying to patients -insurance authorizations, denials, and delays in coverage -medical errors -patient information disclosure (privacy and confidentiality) -patient grievance and appeals processes -cultural and ethnic diversity and sensitivity -respect for patient dignity -inadequate consents -incompetent health care providers -complex social problems including AIDS, teenage pregnancy, violence, and poverty -aging population

differentiate between the manager's responsibility to advocate for patients, for subordinates, for the organization, for the profession, and for self

-powerful people in organizations are more likely to have decisions made that are congruent with their own preferences and values -in addition, not only do the preferences of the powerful influence decisions of the less powerful but the powerful also can inhibit the preferences of the less powerful -this occurs because individuals who remain and advance in organizations are those who feel and express values and beliefs congruent with the organization

discuss the effect of organizational power and values on individual decision making

-Scientific management 1900-1930 -The Human Relations Era 1930-1970 *participatory management *humanistic management *emphasizes people rather than machines *produced the "Hawthorne" effect -Emerging Theories 1970-present

discuss the historical evolution of management theory

-legal controls are generally clear and philosophically impartial -ethical controls are much less clear and individualized -legal counsel to assist in these dilemmas

distinguish between legal and ethical obligations in decision making

no

does the profession code of ethics have the power of law?

intuitionist framework (deontological)

each case is weighed on a case-by-case basis to determine relative goals, duties, and rights

the best possible decisions stem from structured problem solving, adequate data collection, and examination of multiple alternatives- even if outcomes are poor

evaluate the quality of ethical problem solving in terms of both outcome and the process used to make the decision

-human capital represents the capability of the individual *collective skills, knowledge, or other intangible assets of individuals that can be used to create economic value for the individuals, their employers, or their community -social capital represents what a group can accomplish together

explore elements of human and social capital, which impact resource allocation in organizations

-case studies *provide a more interactive learning experience for students than the traditional didactic approach -simulation *provides learners opportunities for problem solving that have little or no risk to patients or to organizational performance -problem-based learning *the learning itself is collaborative as the teacher guides the students to be self-directed in their learning, and many experts suggest that this type of active learning helps to develop critical thinking skills

how can case studies, simulation, and problem-based learning be used to improve the quality of decision making?

-although much of the public wants wrongdoing or corruption to be reported, such behavior is often looked upon with distrust, and whistleblowers are often considered disloyal and experience negative repercussions for their actions -nurses have great potential to educate the public and influence policy through the media as a result of the public's high trust in nurses and because the public wants to hear about health care issues from a nursing perspective -retaliation against nurses who report misconduct is common, as are outcomes of sadness, anxiety, and a pervasive loss of sense of worth in the whistleblower -whistleblowers often feel traumatized by the emotional manipulation many employers routinely use to discredit and punish employees who report misconduct

identify both the risks and potential benefits of becoming a whistleblower

-authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly -followers have to be able to trust their leaders

identify characteristics of authentic (congruent) leadership and discuss the consequences to the leader-follower relationship when leaders are not authentic

-self-aware -courageous -sensitive -energetic -creative

identify characteristics of successful decision making

-authoritarian *very large bureaucracies such as the armed forces -democratic *effective when cooperation and coordination between groups are necessary *appropriate for groups who work together for extended periods, promotes autonomy, and growth in individual workers -laissez-faire *appropriate when problems are poorly defined, and brainstorming is needed to generate alternative solutions

identify common leadership styles and describe situations in which each leadership style could be used appropriately

transformational 1. inspirational motivation 2. idealized influence (attributed) 3. idealized influence (behavior) 4. intellectual stimulation 5. individualized consideration transactional 6. contingent reward 7. active management-by-exception 8. management-by-exception passive laissez-faire 9. nonleadership

identify contextual factors impacting the relationship between leaders and followers based on full-range leadership theory

-level 1: highly capable individual *leader makes high-quality contributions to his or her work, possesses useful levels of knowledge, and has the talent and skills needed to do a good job -level 2: contributing team member *leader uses knowledge and skills to help his or her team succeed and works effectively, productively, and successfully with other people in his or her group -level 3: competent manager *leader is able to organize a group effectively to achieve specific goals and objectives -level 4: effective leader *leader is able to galvanize a department or organization to meet performance objectives and achieve a vision -level 5: great leader *leader has all of the abilities needed for the other four levels, plus a unique blend of humility and will that is required for true greatness -level 5 leadership is characterized by knowledge, team building skills, the ability to help groups achieve goals, humility, and the empowerment of others through servant leadership

identify level 5 leadership skills (as espoused by Jim Collins), which differentiate great companies from good companies

-stare decisis: let the decision stand *use precedents as a guide for decision making -res judicata: "thing or matter settled by judgment" *keeps the same parties in the original lawsuit from retrying the same issues that were involved in the first lawsuit

identify specific doctrines used by the courts to define legal boundaries for nursing practice

-separate legal and ethical issues -collaborate through ethics committees -use institutional review boards appropriately -foster an ethical work environment

identify strategies leader-managers can use to promote ethical behavior as the norm

-practice within the scope of the Nurse Practice Act -Observe agency policy and procedures -model practice after established standards by using evidence-based practice -always put patient rights and welfare first -be aware of relevant law and legal doctrines and combine such with the biological, psychological, and social sciences that form the basis of all rational nursing decisions -practice within the area of individual competence -upgrade technical skills consistently by attending continuing education programs and seeking specialty certification

identify strategies nurses can use to reduce their likelihood of being sued for malpractice

-putting others including employees, customers, and the community as the number one priority -fostering a service inclination in others that promotes collaboration, teamwork, and collective activism -remember that followers are an important part of the leadership equation 10 qualities 1. the ability to listen on a deep level and to truly understand 2. the ability to keep an open mind and hear without judgment 3. the ability to deal with ambiguity, paradoxes, and complex issues 4. the belief that honestly sharing critical challenges with all parties and asking for their input is more important than personally providing solutions 5. being clear on goals and good at pointing the direction toward goal achievement without giving orders 6. the ability to be a servant, helper, and teacher first and then a leader 7. always thinking before reacting 8. choosing words carefully so as not to damage those being led 9. the ability to use foresight and intuition 10. seeing things whole and sensing relationships and connections

identify the characteristics of a servant leader and suggest strategies for encouraging a service inclination in others

-constitution *constitutional law has little direct involvement in the area of malpractice -statutes *before 1970s, very few state or federal laws dealt with malpractice; since the malpractice crisis, many statutes affect malpractice *Nurse Practice Acts -administrative agencies *State Boards of Nursing and agencies, such as the National Labor Relations Board and health and safety boards significantly impact nursing practice -court decisions *most malpractice laws are addressed by the courts

identify the primary sources of law and how each affects nursing practice

-typically, suspension and revocation proceedings are administrative -following a complaint, the BON completes an investigation -most of these investigations reveal no grounds for discipline; however, there are things a nurse should do it he or she becomes aware they are being investigated by the board -state BON makes the final decision

identify the role State Boards of Nursing play in professional licensure and discipline

-assault -battery -false imprisonment -invasion of privacy -defamation -slander

identify types of intentional torts as well as strategies nurses can use to reduce their likelihood

-it is important for the patient advocate to be able to differentiate between controlling patient choices (domination and dependence) and assisting patient choices (allowing freedom)

identify values central to advocacy and differentiate between controlling patient choices and helping patients choose

-write a letter -join political action committees

identify ways individual nurses can become advocates for the profession

rights-based framework (deontological)

individuals have basic inherent rights that should not be interfered with

clinical reasoning

integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at diagnosis

confidentiality

keep privileged information private

interactional leadership theory

leadership behavior is generally determined by the relationship between the leader's personality and the specific situation

-decision maker -communicator -evaluator -facilitator -risk taker -mentor -energizer -priority setter -coach -counselor -teacher -critical thinker -buffer -advocate -visionary -director -forecaster -influencer -creative problem solver -change agent -diplomat -role model -innovator -encourager

leadership roles

leaders -empower others; maximize workforce effectiveness -needed to implement the planned change that is part of system improvement -leadership is the art of getting work done through others willingly -leaders are in the front, moving forward, taking risks, and challenging the status quo -motivate others to do their best -willing to ask "why" -a job title alone does not make a person a leader; only a person's behavior determines if he or she occupies a leadership position -often do not have delegated authority but obtain their power through other means -have a wider variety of roles than managers and may have different personal goals -are frequently not part of the formal organization -focus on group process, information gathering, feedback, and empowering others managers -guide, direct, and motivate others -intervene when goals are threatened -emphasize control, decision making, decision analysis, and results -are always assigned a position within an organization -have a legitimate source of power due to the delegated authority that accompanies their position -are expected to carry out specific functions -manipulate people, the environment, money, time, and other resources to achieve organizational goals -have a greater formal responsibility and accountability for rationality and control than leaders -direct willing and unwilling subordinates

leadership vs management

moral distress

occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action

paternalism

one individual assumes the right to make decisions for another

problem solving

part of decision making; a systematic process focusing on analyzing a difficult situation involving higher order reasoning and evaluation

-nurses need malpractice insurance in basic practice as well as in expanded practice roles -they do incur a greater likelihood of being sued, however, if they have malpractice insurance because injured parties will always seeks damages from as many individuals with financial resources as possible -without personal nursing malpractice insurance, nurses are dependent on the attorney representing the facility and their first priority is to defend the facility

potential risks and benefits of malpractice insurance as a nurse

autonomy

promotes self-determination and freedom of choice

HIPPA

protects the privacy of health information and improves the portability and continuity of health insurance coverage

scientific/industrial age -technical skills -command and control -competition -gaining advantage -gathering facts -what you have (wealth) -hierarchy (top-down) -metaphor for organizations: machine (separate parts) -leadership: position relationship/industrial age -adaptive skills -invitation and interdependence -cooperation -discerning purpose -finding meaning -what you know (information) -circular (egalitarian) -metaphor: organic network (connected parts) -leadership: trusteeship

provide examples of the 21st-century shift from industrial age leadership to relational age leadership

utilitarian framework (telelogical)

provide the greatest good for the greatest number of people

every nurse is a leader and manager at some level, and the nursing roles requires leadership and management skills

recognize that the integration of both leadership and management skills is critical to the long-term viability of today's health-care organizations

direct -lobby in person or by letter indirect -influence and educate the public about nursing and the nursing agenda to reform health care

specify both direct and indirect strategies to influence legislation that promotes advocacy

-implement and evaluate nationally sanctioned clinical practice guidelines -question and challenge nursing traditions and promote a spirit of risk taking -dispel myths and traditions not supported by evidence -collaborate with other nurses locally and globally -interact with other disciplines to bring nursing evidence to the table -keep abreast of the evidence- subscribe to professional journals and read widely -use and encourage use of multiple sources of evidence -use evidence not only to support clinical interventions but also to support teaching strategies -find established sources of evidence in your specialty- do not reinvent the wheel

strategies used to promote EBP as a new nurse

utility

the good of the many outweighs the wants/needs of the individual

critical thinking (reflective thinking)

the mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion

-patient or population -intervention -comparison -outcome

use PICO format to search for current best evidence to address problems