Nursing Management Test #2

A PN ending her shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? A. Complete an incident report. B. Delegate this task to the PN. C. Ask the AP if she needs assistance. D. Notify the nurse manager

C. CORRECT: The nurse should find out what the AP knows about performing the task and provide education for the AP if indicated.

TeamSTEPPS

An evidence-based framework to enhance team performance.

A community experiences an outbreak of meningitis, and hospital beds are urgently needed. Which of the following clients should the nurse recommend for discharge? A. A client newly admitted with angina and a history of myocardial infarction 1 year ago B. A client who has type 2 diabetes mellitus and was admitted for rotator cuff surgery C. A client admitted the day before with pneumonia and dehydration D. A client who has a fractured hip and is scheduled for total hip replacement the next day

B. A client who has type 2 diabetes mellitus and was admitted for rotator cuff surgery

Conflict Resolution Techniques

1. Avoiding 2. Accommodating 3. Competing 4. Compromising 5. Collaborating 6. Negotiating

Research Methods

1. Basic vs. applied 2. Qualitative vs. quantitative 3. Cross-sectional vs. longitudinal 4. Descriptive vs. experimental 5. Retrospective vs. prospective

Structure Measures

The box, of sorts, in which we practice. These indicate the size of our facilities, how many patients we have, what type of patients, and how much time we spend on patient care.

Qualities of a team player

1. Adaptable 2. Collaborative 3. Committed 4. Communicative 5. Competent 6. Dependable 7. Disciplined 8. Enlarging 9. Enthusiastic 10. Intentional 11. Mission Conscious 12. Prepared 13. Relational 14. Self-Improving 15. Selfless 16. Solution-Oriented 17. Tenacious

Nominal group technique

1. Allows group members the opportunity to provide input into the decision-making process. 2. Participants are asked to not talk to each other as they write down their ideas to solve a predefined problem or issue. a. After a period of silent generation, no more than 10 minutes, each member is asked to share an idea, which is displayed on a flip chart. b. Comments and elaboration are not allowed during this phase. 3. During the next step, ideas are clarified and the merits of each idea are discussed. 4. In the final step, each member privately assigns a priority rank to each option.

Guidelines for Effective Communication

1. Approach each interaction as though the other person has no knowledge of effective communication. Assume responsibility for creating the sender-reciever rhythm. 2. Share your thoughts and feelings. Be self-revealing. 3. Use casual conversation which can be important to relationships, particularly when it is light and humorous. 4. Acknowledge, praise and encourage the other person, doing so is supportive and brings life and energy to the relationship. 5. Take responsibility for any problem or issue you have with another, and speak about it as your problem or issue also. 6. Present messages in a way that the other person can receive them. 7. Use language of equality even when position titles are out of the same level.

A nurse discovers that a client was administered an antihypertensive medication in error. Identify the appropriate sequence of steps that the nurse should take using the following actions. A. Call the provider. B. Check vital signs. C. Notify the risk manager. D. Complete an incident report. E. Instruct the client to remain in bed until further notice.

1. B. Check vital signs. 2. E. Instruct the client to remain in bed until further notice. 3. A. Call the provider. 4. D. Complete an incident report. 5. C. Notify the risk manager.

What process of continuous quality improvement is the nurse manager employing when the nurse manager compares the hospital's patient fall rate of 5% against the nation's leading hospital, who has a patient fall rate of less than 1 % ? 1. Benchmarking 2. Evaluating standards of care 3. Developing clinical practice guidelines 4. Creating a storyboard

1. Benchmarking

Total Quality Management (TQM)

1. Benefits: reduces resource strain, reduction in malpractice, increased job satisfaction. 2. Structure a. Facilities b. Equipment c. Staff d. Finances 3. Process a. Nurses' role/EBP 4. Outcome

Effective team

1. Clear understanding of the goal 2. Active listening 3. Treat each other with respect 4. Strong conflict management skills

The RN incorporates research into clinical practice when the RN: 1. Conferences with the physician to try a wound dressing that has been found to decrease cost and accelerate healing time. 2. Administers a cleansing enema to a client in labor because it has always been routinely done. 3. Injects air into a client's g-tube while auscultating the abdomen as this is the most reliable method to determine g-tube placement. 4. Lubricates two inches of the outer aspect of a foley catheter prior to inserting the catheter into a male client.

1. Conferences with the physician to try a wound dressing that has been found to decrease cost and accelerate healing time.

Benchmarking

1. Continual, Collaborative process of measuring and comparing the results of key work processes with those considered the best in their field 2. Measures products, service, and practices against the toughest competitors or those customers recognized as industry leaders

Effective Team Environments

1. Culture of Excellence 2. Managed stress 3. Trust is evident 4. Adequate support and resources 5. Reduction of Communications Barriers including: a. Distractions b. Inadequate knowledge c. Poor planning d. Differences in perception e. Unmanaged emotions and difficult personalities

Variables That Affect Collaboration

1. Decision-making Styles ● DECISIVE: The team uses a minimum amount of data and generates one option. ● FLEXIBLE: The team uses a limited amount of data and generates several options. ● HIERARCHICAL: The team uses a large amount of data and generates one option. ● INTEGRATIVE: The team uses a large amount of data and generates several options. 2. Hierarchical influence on decision‑making 3. Behavioral change strategies ● RATIONAL‑EMPIRICAL: The manager provides factual information to support the change. Used when resistance to change is minimal. ● NORMATIVE‑REEDUCATIVE: The manager focuses on interpersonal relationships to promote change. ● POWER‑COERCIVE: The manager uses rewards to promote change. Used when individuals are highly resistant to change. 4. Stages of team formation ● FORMING: Members of the team get to know each other. The leader defines tasks for the team and offers direction. ● STORMING: Conflict arises, and team members begin to express polarized views. The team establishes rules, and members begin to take on various roles. ● NORMING: The team establishes rules. Members show respect for one another and begin to accomplish some of the tasks. ● PERFORMING: The team focuses on accomplishment of tasks. 5. Generational Differences of Team Members

Evidenced Based Nursing Practice

1. Defined as "the integration of the best research evidence with clinical expertise and the patient's unique values and circumstances in making decision about the care of the individual patients." (2015. Yoder-Wise; pp 385) 2. Not only is it important to improve patient care but it is also important to stop the use of ineffective strategies that may harm patients.

Brainstorming

1. Effective method for generating a large volume of creative options. 2. Hallmark is to list all ideas as stated without critique or discussion. 3. The goal is to generate ideas, no matter how seemingly unrealistic or absurd.

Assignments

1. Effective team a. Clearly stated b. Accepted by all despite disagreements 2. Ineffective team a. Unclear b. Resented by dissenting members

Ability to handle conflict

1. Effective team a. Comfortable with disagreement b. Open discussion of conflicts 2. Ineffective team a. Uncomfortable with disagreement b. Disagreement usually suppressed, or one group aggressively dominates.

Discussion

1. Effective team a. Focused b. Shared by almost everyone 2. Ineffective team a. Frequently unfocused b. Dominated by a few

Feelings

1. Effective team a. Freely expressed; open for discussion 2. Ineffective team a. Hidden; considered "explosive" and inappropriate for discussion

Self-regulation

1. Effective team a. Frequent and ongoing; focused on solutions 2. Ineffective team a. Infrequent, or occurs outside meetings

Criticism

1. Effective team a. Frequent, frank, relatively comfortable, constructive b. Directed toward removing obstacle 2. Ineffective team a. Embarrassing and tension-producing; destructive b. Directed personally at others

Working Environment

1. Effective team a. Informal, comfortable, relaxed 2. Ineffective team a. Indifferent, bored, tense, stiff

Listening

1. Effective team a. Respectful - encourages participation 2. Ineffective team a. Judgmental - much interruption and "grandstanding"

Leadership

1. Effective team a. Shared; shifts from time to time 2. Ineffective team a. Autocratic; remains clearly with committee chairperson

Decision making

1. Effective team a. Usually reached by concensus b. Formal voting kept to a minimum c. General agreement is necessary for action; dissenters are free to voice 2. Ineffective team a. Often occurs prematurely b. Formal voting occurs frequently c. Simple majority is sufficient for action; minority is expected to go along with opinion

Objectives

1. Effective team a. Well understood and accepted 2. Ineffective team a. Unclear, or many personal agendas

RN's Role in Multidisciplinary Teams

1. Embody principles of being a team player 2. Have an understanding of everyone's role and capabilities 3. Remain patient-centric

Never Events

1. Errors in medical care that are clearly identifiable, preventable and serious in their consequences. 2. Defined by the National Quality Forum (NQF) and Center for Medicare and Medicaid Services (CMS) 3. Examples: a. Operating on the wrong body part b. Foreign body left in a patient after surgery c. Mismatched blood transfusion d. Major medication error e. Severe pressure ulcer caused by the hospital f. Preventable post-surgical deaths 4. Payment for that hospitalization will be withheld from CMS and possible other entities.

Conflict Resolution

1. Foster open-communication among team members 2. Identify the conflict 3. Brainstorm and analyze possible solutions to the conflict 4. Selection a solution and implement it 5. Evaluate whether the solution worked.

Communication pitfalls

1. Giving advice 2. Making others wrong 3. Being defensive 4. Judging the other person 5. Patronizing 6. Giving false reassurance 7. Asking "Why" questions 8. Blaming others

QA Process

1. Goal - Improve quality 2. Focus - Discover/correct errors 3. Major tasks - Inspect nurse activities; chart audits 4. Quality team - QA or department personnel 5. Outcomes - Set by QA team without input from staff

QI Process

1. Goal - Improve quality 2. Focus - Prevent errors 3. Major tasks - Review nurse activities; innovation; staff development 4. Quality team - Interprofessional team 5. Outcomes - Set by QI team with input from staff and patients

Positive effects of Conflict

1. Growth occurs 2. Problems are resolved 3. Groups are unified 4. Productivity is increased 5. Commitment is increased

Evidence-Based Practice

1. Guides care but does not replace learning through hands-on delivery of care 2. Outlines practice parameters based on evidence and research 3. Does not outline how to deliver individualized patient care a. This comes through clinical experience that incorporates theoretical knowledge

Steps in the QI Process

1. Identify needs. 2. Assemble interprofessional team. 3. Collect data. 4. Establish outcomes and quality indicators. 5. Select and implement plan. 6. Evaluate.

Which organization released two landmark reports on health care safety and quality, entitled "To Err is Human" and "Crossing the Quality Chasm"? 1. Institute of Medicine 2. The Leapfrog Group 3. Joint Commission 4. Madison College Student Nurses Association

1. Institute of Medicine

Delphi technique

1. Involves systematically collecting and summarizing opinions and judgements on a particular issue from respondents, such as members of expert panels, through interviews, surveys, or questionnaires. 2. Opinions of the respondents are repeatedly reported back to them with a request to provide more refined opinions and rationales on the issue or matter under consideration. 3. The goal is to achieve a consensus.

GRIEVANCES

1. It is a wrong perceived by an employee based on a feeling of unfair treatment that is considered grounds for a formal complaint. ● Ones that cannot be satisfactorily resolved between the parties involved can require management by a third party. ● Facilities have a formal policy that should be followed when a conflict cannot be resolved. ● The steps of an institution's procedure should be outlined in the policy.

Principles of QM and QI

1. Leaders, managers, and followers must be committed to QI. 2. Goal of QM is to improve systems and processes, not to assign blame. 3. Decisions must be based on data.

Quality Assurance

1. Looked back on data 2. Chart audits 3. Incident reports 4. Does performance conform to standards? 5. Strives to improve performance when standard is not met

Negative effects of Conflict

1. Negativity, resistance, and increased frustration inhibit movement 2. Resolutions diminish or are absent 3. Groups divide, and relationships weaken 4. Productivity decreases 5. Satisfaction decreases

Standards of Quality Care

1. Nurse Practice Acts 2. Accreditation Standards (e.g., The Joint Commission, TJC, National Patient Safety Goals (NPSG), Quality and Safety Education for Nurses, QSEN) 3. Governmental bodies (e.g., Agency for Healthcare Research and Quality [AHRQ], National Quality Forum [NQF]; the National Institute for Occupational Safety and Health [NIOSH]) 4. Healthcare advisory groups (e.g., Institute of Medicine [IOM]) 5. Internal or external performance measurements (e.g., patient satisfaction surveys, employee opinion surveys, safety assessment surveys, patient rounds) 6. Institutional Guidelines (e.g., Policies and Procedures, Structure/Process Standards) 7. Research/Evidence-based practice guidelines

Why is new way better?

1. Priority is benefitting patients 2. Everyone expected to participate 3. Focus is on the work process not blaming 4. Decisions to change or improve based on data, research, EBP, EBNP 5. Seen as a continuous process!

National Patient Safety Goals

1. Published each year by the JC 2. Organizations must have these goals in place to promote improvements in care related to patient safety

Focus groups

1. Purpose is to explore issues and generate information. 2. Can be used to identify problems or to evaluate the effects of an intervention. 3. Meet face-to-face to discuss issues.

14 Forces of Magnetism

1. Quality of Nursing Leadership 2. Organizational Structure 3. Management Style 4. Personnel Policies & Programs 5. Professional Models of Care 6. Quality of Care 7. Quality Improvement 8. Consultation and Resources 9. Autonomy 10. Community & Health Care Organization 11. Nurses as Teachers 12. Image of Nursing 13. Interdisciplinary Relationships 14. Professional Development

Who's on the Team?

1. RN a. Primary RN b. RN Case Manager c. RN Manager 2. MD 3. Other providers: APRN, PA-C 4. Rehab: PT, OT, PTA, OTA 5. Registered Dietician 6. Social Worker 7. Pharmacist 8. Don't forget... Patient + Family

What teams compromise of:

1. Teams have defined objectives 2. Team members have a high degree of interdependence

National Patient Safety Goals Focus

1. The 2017 goals focus on the following areas a. Patient Identification b. Communication c. Medication Safety d. Use Alarms Safely e. Prevent Infection f. Identify Patient Safety Risks: Suicide, Falls g. Surgical Errors 2. TJC requires data be collected and reported for the survey

Collaborative problem solving

1. The most time-consuming but most creative stance. 2. Both assertive and cooperative 3. People work creatively and openly to find solution that fully satisfies all important concerns and goals. 4. Involves analyzing situations and defining the conflict at a higher level.

NEGOTIATION

1. The process by which interested parties: ● Resolve ongoing conflicts. ● Agree on steps to take. ● Bargain to protect individual or collective interests. ● Pursue outcomes that benefit mutual interests. 2. Most nurses use this on a daily basis. 3. It can involve the use of several conflict resolution strategies. ● The focus is on a win‑win solution or a win/lose‑win/ lose solution in which both parties win and lose a portion of their original objectives. a. Each party agrees to give up something and the emphasis is on accommodating differences rather than similarities between parties.

Translation of Research into Practice (TRIP)

1. The science of how research is best translated into practice. a. Example: --The best strategies for getting staff members to use a new evidence-based protocol for teaching new mothers about breast-feeding 2. Also known as translation science - scientific investigation of methods, and variables that affect adoption of evident-based healthcare practices by healthcare systems.

The Joint Commission

1. They developed their own standards to guide critical activities to be performed by health care organizations 2. Preparing for accreditation and survey results provide information and data which can be utilized for improvement

Outcomes (Benefits) From Integrating Nursing EBP

1. To organizations: a. Improved recruitment of nurses b. Improved retention of nurses c. Improved employee satisfaction d. Higher percentage of nurses pursing or attaining advanced degrees in nursing 2. To patients: a. Reduced length of stay b. Reduced admissions c. Reduced mortality and morbidity d. Improved satisfaction

Ineffective team

1. Unfocused 2. Autocratic 3. Frequent conflict without resolution 4. Emotions running high

Team attributes

1. Working Environment 2 Discussion 3. Objectives 4. Listening 5. Ability to handle conflict 6. Decision making 7. Criticism 8. Leadership 9. Assignments 10. Feelings 11. Self-regulation

Magnet hospitals foster the philosophy that nurse leaders are needed at all levels of the organization. As a staff nurse and clinical leader on your unit, which of the following activities would not be viewed as supportive of the hospital's philosophy in a magnet facility? 1. Staff nurse serving as the chairperson of the nursing practice council. 2. Medical doctor serving in the role of chairperson of the nursing practice council. 3. Staff nurses conducting breast cancer self-exam classes in the community. 4. Medical practitioners collaborating with nursing personnel on an interdisciplinary task force.

2. Medical doctor serving in the role of chairperson of the nursing practice council.

The RN understands that which of the following is expected in quantitative research design? 1. Interpretation of non-numeric narratives to discover patterns of relationships 2. Statistical presentation of numerical data to describe the magnitude and reliability of their relationships 3. Researcher collects data without introducing an intervention in the study 4. The smaller the size of study population, the stronger the evidence

2. Statistical presentation of numerical data to describe the magnitude and reliability of their relationships

The RN is reading the section of a research article that provides an overview of current research findings as well as existing gaps in research on the subject matter being studied. The RN determines this is what component of the research article? 1. Data analysis 2. The literature review 3. Description of the research design 4. The purpose of the study

2. The literature review

The quality improvement process consists of a structured series of steps. Which of the following is a part of this process? 1. Identify needs most important to the organization 2. Work independently on the process to save time and energy 3. Collect data to measure the current status of the topic involved 4. Pick an implementation plan based on a consensus model

3. Collect data to measure the current status of the topic involved

What source of knowledge is the RN utilizing when the RN adheres to the AHRQ Guidelines for Pressure Ulcer Management by turning a bed-bound client every two hours? 1. Authority 2. Tradition 3. Evidence based research 4. Trial and error

3. Evidence based research

Why is it important for nurses to recognize and value patient-focused outcome indicators? Select the best answer. 1. To achieve safe, quality, cost-effective care for patients in daily practice. 2. To realize that individual nursing practice styles directly affect the rates at which patients recover 3. To prevent development of unnecessary complications and injury 4. All of the above

4. All of the above

The RN is a member of a Quality Improvement Committee which is studying whether skin-to-skin contact between mother and newborn improves day 2 feeding patterns in breastfeeding mother-baby dyads. In their PICO question to guide their study, which of the following is the C (comparison or control) factor? 1. Skin-to-skin contact between mothers and newborns 2. Breastfeeding mother-baby dyads 3. Day 2 feeding breastfeeding patterns 4. Mother-newborn dyads not using skin-to-skin

4. Mother-newborn dyads not using skin-to-skin

Interprofessional Team

A group of health care professionals from various disciplines. ● Collaboration involves discussion of client care issues in making health care decisions, especially for clients who have multiple problems. ● The specialized knowledge and skills of each discipline are used in the development of a plan of care that addresses multiple problems. ● Nurses should recognize that the collaborative efforts of this allows the achievement of results that a team member would be incapable of accomplishing alone.

Definition of a group

A number of individuals assembled together or having some unifying relationships.

Definition of a team

A number of persons associated together in specific work or activity.

STAGE 2: PERCEIVED CONFLICT

A party perceives that a problem is present though an actual conflict might not actually exist. ----Example: A nurse perceives that a nurse manager is unfair with scheduling. The nurse might not be aware that in reality it is only because the nurse manager misunderstood the nurse's scheduling request.

A nurse manager is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following information should the nurse manager include? *(Select all that apply.)* A. A description of the incident should be documented in the client's health care record. B. The client should sign as a witness on the incident report. C. Incident reports include a description of the incident and actions taken. D. A copy of the incident report should be placed in the client's health care record. E. The risk management department investigates the incident

A. A description of the incident should be documented in the client's health care record. C. Incident reports include a description of the incident and actions taken. E. The risk management department investigates the incident

A nurse manager is providing information about the audit process to members of the nursing team. Which of the following information should the nurse manager include? *(Select all that apply.)* A. A structure audit evaluates the setting and resources available to provide care. B. An outcome audit evaluates the results of the nursing care provided. C. A root cause analysis is indicated when a sentinel event occurs. D. Retrospective audits are conducted while the client is receiving care. E. After data collection is completed, it is compared to a benchmark.

A. CORRECT: A structure audit evaluates the setting in which care is provided and includes resources such as equipment and staffing levels. B. CORRECT: An outcome audit evaluates the effectiveness of nursing care. It should include observable data, such as infection rates among clients. C. CORRECT: A root cause analysis is indicated when a sentinel event occurs. A sentinel event is a serious problem such as injury to or death of a client. Immediate investigation of the problem is indicated. The health care team can use root cause analysis to study the problem and take measures to prevent reoccurrence. E. CORRECT: The benchmark is set at the beginning of the process and then it is compared to the data after collection is completed.

An RN on a medical‑surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the PN? A. Obtain vital signs for a client who is 2 hr postprocedure following a cardiac catheterization. B. Administer a unit of packed red blood cells (RBCs) to a client who has cancer. C. Instruct a client who is scheduled for discharge in the performance of wound care. D. Develop a plan of care for a newly admitted client who has pneumonia

A. CORRECT: It is within the scope of practice of the PN to monitor a client who is 2 hr postprocedure for a cardiac catheterization.

A nurse is participating in an interprofessional conference for a client who has a recent C6 spinal cord injury. The client worked as a construction worker prior to his injury. Which of the following members of the interprofessional team should participate in planning care for this client? *(Select all that apply.)* A. Physical therapist B. Speech therapist C. Occupational therapist D. Psychologist E. Vocational counselor

A. CORRECT: The client will need the assistance of a physical therapist to assist with mobility skills and maintain muscle strength. C. CORRECT: The client will need the assistance of an occupational therapist to learn how to perform activities of daily living. D. CORRECT: The client will need the assistance of a psychologist to adapt to the psychosocial impact of the injury. E. CORRECT: The client will need the assistance of a vocational counselor to explore options for re‑employment.

A nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nurse notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following conflict resolution strategies is the unit manager demonstrating? A. Avoidance B. Smoothing C. Cooperating D. Negotiating

A. CORRECT: The goal in resolving conflict is a win‑win situation. The unit manager is using an ineffective strategy, avoidance, to deal with this conflict. She is aware of the conflict but is not attempting to resolve it. B. The goal in resolving conflict is a win‑win solution. When smoothing is used, one person attempts to "smooth" the other party and/or point out areas in which the parties agree. This is typically a lose‑lose solution. C. The goal in resolving a conflict is a win‑win solution. When cooperating is used, one party allows the other party to win. This is a lose‑win solution. D. The goal in resolving a conflict is a win‑win solution. When negotiating is used, each party gives up something. If one party gives up more than the other, this can become a win‑lose solution.

A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following information should the manager include in the plan? *(Select all that apply.)* A. Skill proficiency B. Assignment to a preceptor C. Budgetary principles D. Computerized charting E. Socialization into unit culture F. Facility policies and procedures

A. CORRECT: The purpose of orientation is to assist the newly licensed nurse to transition from the role of student to the role of employee and licensed nurse. The nurse manager should include evaluation of skill proficiency and provide additional instruction as indicated. B. CORRECT: The purpose of orientation is to assist the newly licensed nurse to transition from the role of student to the role of employee and licensed nurse. The nurse manager should include assignment of a preceptor to ease the transition of the newly licensed nurse. D. CORRECT: The purpose of orientation is to assist the newly licensed nurse to transition from the role of student to the role of employee and licensed nurse. The nurse manager should include computerized charting, which is an essential skill for the newly licensed nurse. E. CORRECT: The purpose of orientation is to assist the newly licensed nurse to transition from the role of student to the role of employee and licensed nurse. The nurse manager should include socialization to the unit as a way to ease the transition of the newly licensed nurse. F. CORRECT: The purpose of orientation is to assist the newly licensed nurse to transition from the role of student to the role of employee and licensed nurse. The nurse manager should include information about facility policies and procedures, which is essential information for the newly licensed nurse.

A home health nurse is assessing the safety of a client's home. The nurse should identify which of the following factors as increasing the client's risk for falls? *(Select all that apply.)* A. History of a previous fall B. Reduced vision C. Impaired memory D. Takes rosuvastatin E. Uses a night light F. Kyphosis

A. History of a previous fall B. Reduced vision C. Impaired memory F. Kyphosis

A nurse is caring for a client who has diabetes mellitus and had a morning blood glucose level of 285 mg/dL. An assistive personnel (AP) reports that a client's finger-stick blood glucose reading 30 min before lunch is 58 mg/dL. Which of the following actions should the nurse take? A. Recheck the client's blood glucose. B. Complete a facility incident report. C. Inform the AP to give the client 120 mL of orange juice. D. Administer insulin as prescribed.

A. Recheck the client's blood glucose.

A nurse on an acute care unit is caring for a client following a total hip arthroplasty. The client is confused, is moving his leg into positions that could dislocate the new hip joint, and he repeatedly attempts to get out of bed. After determining that restraint application is indicated, which of the following actions should the nurse take? *(Select all that apply.)* A. Secure the restraint to the frame of the bed. B. Get an prescription for restraints from the provider. C. Have a family member sign the consent for restraints. D. Use a square knot to secure the restraints to the bed. E. Ensure that only one finger can be inserted between the restraint and the client.

A. Secure the restraint to the frame of the bed. B. Get an prescription for restraints from the provider. C. Have a family member sign the consent for restraints.

A nurse who has just assumed the role of unit manager is examining her skills in interprofessional collaboration. Which of the following actions support the nurse's interprofessional collaboration? *(Select all that apply.)* A. Use aggressive communication when addressing the team. B. Recognize the knowledge and skills of each member of the team. C. Ensure that a nurse is assigned to serve as the group facilitator for all interprofessional meetings. D. Encourage the client and family to participate in the team meeting. E. Support team member requests for referral.

B. CORRECT: The nurse should recognize that each member of the team has specific skills to contribute to the collaboration process. D. CORRECT: Collaboration should occur among the client, family, and interprofessional team. E. CORRECT: The nurse should support suggestions for referrals to link clients to appropriate resources.

A nurse is preparing to transfer an older adult client who is 72 hr postoperative to a long‑term care facility. Which of the following information should the nurse include in the transfer report? *(Select all that apply).* A. Type of anesthesia used B. Advance directives status C. Vital signs on day of admission D. Medical diagnosis E. Need for specific equipment

B. CORRECT: The receiving nurse and facility need to know advance directive status in order to provide care and address the client's current needs. D. CORRECT: The receiving nurse and facility need to know the client's medical diagnosis in order to provide care and address the client's current needs. E. CORRECT: The receiving nurse and facility need to know the client's need for specific equipment in order to provide care and address the client's current needs.

A nurse on a telemetry unit is caring for a client who was admitted 2 hr ago and has chest pain. The client becomes angry and tells the nurse that there is nothing wrong with him and that he is going home immediately. Which of the following actions should the nurse take? *(Select all that apply.)* A. Notify the client's family of his intent to leave the facility. B. Document that the client left the facility against medical advice (AMA). C. Explain to the client the risks involved if he chooses to leave. D. Ask the client to sign a form relinquishing responsibility of the facility. E. Prevent the client from leaving the facility until the provider arrives.

B. CORRECT: When documenting a discharge, the nurse should document the type of discharge, including an AMA discharge. C. CORRECT: The nurse is legally responsible to warn the client of the risks involved in leaving the hospital against medical advice. D. CORRECT: Clients who leave the hospital prior to a prescribed discharge are asked to sign a form to provide legal protection for the hospital.

A nurse is discussing disaster planning with the board members of a hospital. Which of the following individuals should the nurse expect to request extra supplies and staffing for the facility? A. Incident commander B. Medical command physician C. Triage officer D. Media liaison

B. Medical command physician

A nurse on a sixth-floor medical surgical unit is advised that a severe weather alert code has been activated. Which of the following actions should the nurse take? *(Select all that apply.)* A. Open window shades or drapes to provide better visibility of the external environment. B. Move beds of nonambulatory clients away from windows. C. Relocate ambulatory clients into the hallways. D. Use the elevators to move clients to lower levels. E. Turn the radio on for severe weather warnings.

B. Move beds of nonambulatory clients away from windows. C. Relocate ambulatory clients into the hallways. E. Turn the radio on for severe weather warnings.

A nurse is observing a newly licensed nurse and an assistive personnel (AP) pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates an understanding of this technique? A. The nurse stands with his feet together. B. The nurse uses his body weight to counter the client's weight. C. The nurse's feet are facing inward, toward the center of the bed. D. The nurse uses the muscles in his back to lift the client off the bed using the drawsheet.

B. The nurse uses his body weight to counter the client's weight.

A nurse enters the room of a client who is on contact precautions and finds the client lying on the floor. Which of the following actions should the nurse take first? A. Call the provider. B. Ask a staff member for assistance getting the client back in bed. C. Inspect the client for injuries. D. Instruct the client to ask for help if he needs to get out of bed.

C. CORRECT: The first action the nurse should take using the nursing process is to assess the client.

A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following information will provide data regarding the efficacy of the procedure? A. Frequency with which procedure is performed B. Client satisfaction with performance of procedure C. Incidence of complications related to procedure D. Accurate documentation of how procedure was performed

C. CORRECT: The incidence of complications related to the procedure is an outcome measure directly related to the efficacy of the procedure

A nurse is reviewing the hospital's fire safety policies and procedures with newly hired assistive personnel. The nurse is describing what to do when there is a fire in a client's trash can. Which of the following information should the nurse include? *(Select all that apply.)* A. The first step is to pull the alarm. B. Use a Class C fire extinguisher to put out the fire. C. Instruct ambulatory clients to evacuate to a safe place. D. Pull the pin on the fire extinguisher prior to use. E. Close all doors.

C. Instruct ambulatory clients to evacuate to a safe place. D. Pull the pin on the fire extinguisher prior to use. E. Close all doors.

Managing Quality and Risk

Comprehensive systematic approach 1. Prevents errors before they occur 2. Identifies and corrects errors a. Adverse events are decreased b. Safety and quality outcomes are maximized 3. Optimizes patient outcomes 4. Prevents patient care problems 5. Mitigates adverse events

STAGE 5: CONFLICT AFTERMATH

Conflict aftermath is the completion of the conflict process and can be positive or negative. ----Example: Positive conflict aftermath: the nurse manager and nurses on a unit are satisfied with the newly revised scheduling system and feel valued for being included in the conflict resolution process. ----Example: Negative conflict aftermath: the nurse manager and nurses are unable to come up with a scheduling solution that meets the needs of both parties. They agree to continue with the current system however tensions still remain increasing the risk of a recurrence of the conflict.

PICO Format

Creating a spirit of inquiry and identifying the problem so that the relevant information can be obtained.

A nurse manager is working with a committee of nurses to update policies for new employee orientation. The nurse manager directs the team to collect as much data as possible and recommend several options. Which of the following decision‑making styles is the nurse manager demonstrating? A. Decisive B. Flexible C. Hierarchical D. Integrative

D. CORRECT: When the integrative decision‑making style is used, the team uses a large amount of data and generates several options.

Evidence Level 6

Evidence from a single descriptive or qualitative study.

Evidence Level 1

Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.

Evidence Level 5

Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).

Evidence Level 7

Evidence from the opinion of authorities and/or reports of expert committees.

Evidence Level 4

Evidence from well-designed case-control or cohort studies.

Evidence Level 2

Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT).

Evidence Level 3

Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).

Magnet Characteristics

High quality patient care Clinical autonomy Participatory decision-making Strong, effective nurse leaders Open communication channels Community involvement Opportunity & encouragement for professional development Effective use of resources High levels of job satisfaction

What brought about this change?

Institute of Medicine 1. To Err is Human: Building a Safer Health System (1999) a. Addressed patient safety, medical errors 2. Crossing the Quality Chasm: A New Health System for the 21st Century (2001) a. Described quality issues b. Identified six aims for improvement c. Health Care should be: Effective, Patient Centered, Timely, Efficient, Equitable

Intergroup Conflict

Occurs between two or more groups of individuals, departments, or organizations and can be caused by a new policy or procedure, a change in leadership, or a change in organizational structure. a. example: there is confusion as to whether it is the responsibility of the nursing unit or dietary department to pass meal trays to clients.

Interpersonal Conflict

Occurs between two or more people with differing values, goals, or beliefs. ●Interpersonal conflict in the health care setting involves disagreement among nurses, clients, family members, and within a health care team. Bullying and incivility in the workplace are forms of interpersonal conflict. ●This is a significant issue in nursing, especially in relation to new nurses, who bring new personalities and perspectives to various health care settings. ●Interpersonal conflict contributes to burnout and work‑related stress. a. example: a new nurse is given a client assignment that is heavier than those of other nurses, and when he asks for help, it is denied.

Intrapersonal Conflict

Occurs within the person and can involve internal struggle related to contradictory values or wants. a. example: a nurse wants to move up on the career ladder but is finding that time with her family is subsequently compromised.

Nurse-Sensitive Outcomes

Outcomes directly related to the quality of nursing care 1. Examples: a. Falls b. Nosocomial infections such as urinary tract infections c. Pressure ulcers

5 Stages of Conflict

STAGE 1: LATENT CONFLICT STAGE 2: PERCEIVED CONFLICT STAGE 3: FELT CONFLICT STAGE 4: MANIFEST CONFLICT STAGE 5: CONFLICT AFTERMATH

SBAR

Situation Background Assessment Recommendation

STAGE 1: LATENT CONFLICT

The actual conflict has not yet developed however factors are present that have a high likelihood of causing conflict to occur. ----Example: A new scheduling policy is implemented within the organization. The nurse manager should recognize that change is a common cause of conflict.

STAGE 4: MANIFEST CONFLICT

The parties involved are aware of the conflict and action is taken. Actions at this stage can be positive and strive towards conflict resolution or they can be negative and include debating, competing, or withdrawal of one or more parties from the situation. ----Example: The nurse manager and nurses on a unit agree that the current scheduling system is causing a conflict and agree to work together to come up with a solution.

2018 NPSG Program

The purpose of this is to improve patient safety. The goals focus on problems in health care safety and how to solve them. The eight areas they look at are: 1. Ambulatory Health Care 2. Behavioral Health Care 3. Critical Access Hospital 4. Home Care 5. Hospital 6. Laboratory Services 7. Nursing Care Center 8. Office-Based Surgery

Conflict

The result of opposing thoughts, ideas, feelings, perceptions, behaviors, values, opinions, or actions between individuals.

Levels of Evidence

These are assigned to studies based on the methodological quality of their design, validity, and applicability to patient care. These decisions gives the "grade (or strength) of recommendation." Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Level 7

Outcome measures

These are reported in hard numbers. They go up or down and there's no doubt about whether it is improving patient care. 1. Hospital-acquired pressure ulcers 2. Hospital-acquired infections 3. Falls with injury 4. Patient satisfaction

Process measures

These reflect things we do in our practice as opposed to the results of what we do. These are usually gathered from patient surveys. 1. Pain management 2. Medication administration

STAGE 3: FELT CONFLICT

Those involved begin to feel an emotional response to the conflict. ----Example: A nurse feels anger towards the nurse manager after finding out that she is scheduled to work two holidays in a row.

O in PICO

What are the results? 1. There might be multiple strategies to measure the results, such as complication rate, satisfaction, a nursing diagnosis, or a nursing quality indicator.

C in PICO

What is a comparison intervention? 1. This what the intervention might be compared with, such as a treatment, or the absence of a risk factor.

I in PICO

What is the intervention? 1. This can be an intervention or a specific area of interest (postoperative complications, the experience of postoperative pain)

P in PICO

What is the patient population or the setting? 1. This could be adults, children or neonates with a certain health problem. 2. Home care versus an acute care setting.

Synergy

When people work together to produce extraordinary results that could not have been achieved by any one individual.

The Nurse's Role in Effective Collaboration

● Coordinate the interprofessional team. ● Have a holistic understanding of the client, the client's health care needs, and the health care system. ● Provide the opportunity for care to be provided with continuity over time and across disciplines. ● Provide the client with the opportunity to be a partner in the development of the plan of care. ● Provide information during rounds and interprofessional team meetings regarding the status of the client's health. ● Provide an avenue for the initiation of a consultation related to a specific health care issue. ● Provide a link to post-discharge resources that might need a referral.

Typical steps of the grievance process

● Formal presentation of the complaint using the proper chain of command ● Formal hearing if the issue is not resolved at a lower level ● Professional mediation if a solution is not reached during a formal hearing

Nurse Qualities for Effective Collaboration

● Good communication skills ● Assertiveness ● Conflict negotiation skills ● Leadership skills ● Professional presence ● Decision-making and critical thinking

Interprofessional Team Collaboration

● Nurse‑provider collaboration should be fostered to create a climate of mutual respect and collaborative practice. ● Collaboration occurs among different levels of nurses and nurses with different areas of expertise. ● Collaboration should also occur between the interprofessional team, the client, and the client's family/significant others when this plan of care is being developed. ● Collaboration is a form of conflict resolution that results in a win‑win solution for both the client and health care team.

Elements of assertive communication

● Selecting an appropriate location for verbal exchange ● Maintenance of eye contact ● Establishing trust ● Being sensitive to cultural needs ● Speaking using "I" statements and including affective elements of the situation ● Avoiding "you" statements that can indicate blame ● Stating concerns using open, honest, direct statements ● Conveying empathy ● Focusing on the behavior or issue of conflict and avoiding personal attacks ● Concluding with a statement that describes a fair solution

ASSERTIVE COMMUNICATION

● Use of this can be necessary during conflict negotiation. ● It allows expression in direct, honest, and nonthreatening ways that do not infringe upon the rights of others. ● It is a communication style that acknowledges and deals with conflict, recognizes others as equals, and provides a direct statement of feelings.

Common causes of conflict

●Ineffective communication ●Unclear expectations of team members in their various roles ●Poorly defined or actualized organizational structure ●Conflicts of interest and variance in standards ●Incompatibility of individuals ●Management or staffing changes ●Diversity related to age, gender, race, or ethnicity