PNC IV - Exam 1

Nurse leaders role

-Coordinate patient care -Advocate for patient -Evaluate options for patient care -Monitor patient care

Which statements or questions would be appropriate in establishing a discharge plan for a patient who has had major abdominal surgery? A."I'll bet you will be so glad to be home in your own bed." B."What are your expectations for recovery from your surgery?" C."Be sure and take your pain medications and change your dressing." D."You will just be fine! Please stop worrying."

B.

A nurse is preparing an infant and his family for a hernia repair to be performed in an ambulatory care facility. What is the primary role of the nurse during the admission process? A.Assist with screening tests. B.Provide patient teaching. C.Assess what has been done and what still needs to be done. D.Assist with hernia repair.

C.

A home health care nurse is scheduled to visit a 38-year-old female client who has been discharged from the hospital with a new colostomy. Which duties would the nurse perform for this patient in the entry phase of the home visit? Select all that apply. A. Collect information about the patient's diagnosis, surgery, and treatments. B. Call the patient to make initial contact and schedule a visit. C.Develop rapport with the patient and her family. D.Assess the patient to identify her needs. E.Assess the physical environment of the home. F.Evaluate safety issues including the neighborhood in which she lives

C. D. E.

rational-empirical approach

Can be used if there is little anticipated resistance, often possible to get your team on board with change by giving rational explanation

Power-Coercive Approach

Compliance through the exercise of power (ie CEO)

A hospital nurse is admitting a patient who sustained a head injury in a motor vehicle accident. Which activities could the nurse delegate to licensed assistive personnel? A.Collecting information for a health history B.Performing a physical assessment C.Contacting the physician for medical orders D.Preparing the bed and collecting needed supplies

D.

A nurse ensures that a hospital room prepared by an aide is ready for a new ambulatory patient. Which condition would the nurse ask the aide to correct? A.The bed linens are folded back. B.A hospital gown is on the bed. C.Equipment for taking vital signs is in the room. D.The bed is in the highest position.

D.

A nurse is counseling an older female patient hospitalized for dehydration secondary to a urinary tract infection. The patient tells the nurse: "I don't like being in the hospital. There are too many bad bugs in here. I'll probably go home sicker than I came in." She also insists that she is going to get dressed and go home. She has the capacity to make these decisions. What is the legal responsibility of the nurse in this situation? A.To inform the patient that only the primary health care provider can authorize discharge from a hospital B.To collect the patient's belongings and prepare the paperwork for the patient's discharge C.To request a psych consult for the patient and inform her primary care provider of the results D.To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form

D.

You are the nurse manager of a medical-surgical unit that is in need of change in staffing rotation patters, which will lead to major changes in how the unit is staffed. According to Lewis change theory, what forces are in play to enact these changes? A. Refreezing forces B. Restraining forces c. Freezing forces D. Driving forces

D. Driving forces

TPAPN supervisión

Direct supervision require supervision Buy a nurse with the same or higher level of licensure who is on the same unit and is immediately available Indirect requires supervision by a nurse with the same or higher level of licensure who is on the premises but does not have to be on the same unit as a nurse

Olson & Eoyangs self-organizing theory

Human nature and surprising effects

preparation stage

Lay groundwork by planning, stage of change in which people are getting ready to make a change

Care Coordination

Mechanism to make sure the patient gets the right care at the right time in the most efficient and cost effective manner, by the right person in the right setting. Aim to link patient with resources in the community to enhance well-being, improve information exchange and reduce fragmentation and duplication of services.

Bureaucracy

Method of applying general rules to specific cases, making the actions of management fair and predictable. Includes system of covering rights and duties of each position

Nurse navigator

Must ID and remove barriers to timely and appropriate tx. Acts as a point of contact for a patient and coordinates all components involved for care (surgery, insurance, etc)

Complex Adaptive Systems Theory

Nonlinear process- no linear process that will lead to success

Vulnerable populations

Not well integrated into health care system because of ethnic, cultural, economic, geographic or health characteristics.

Patient navigator

Nurse, social worker, lay person.

Care Transition

Patient care shifts form care being provided in one setting to another. A poorly managed transition may diminish health and increase cost.

Chaos theory

Pattern-look for solutions by finding underlying order in seemingly random data Moving target- date is constantly changing making it hard to determine a pattern Unpredictability- Change is a nonlinear process, outcomes may not mirror initial proposed change.

Results of increasing costs

patients are having shorter hospital stays, more surgery, diagnostics, and emergency care in ambulatory settings or on a hospital outpatient basis.

Stages of change model

precontemplation, contemplation, preparation, action, maintenance

Advocacy

protection and support of another's rights

contemplation stage

stage of change in which people are considering changing behavior

precontemplation stage

stage of change in which people don't have intention to change their behavior

maintenance stage

stage of change in which people maintain behavioral change, avoid relapse into old patterns.

Governance

system by which a department of nursing control and direct the formulation and the administration of nursing policy

discharge planning

systematic process of preparing the patient to leave the healthcare facility and for maintaining continuity of care

Normative-reeducative approach

use socialization to ignite change. Group acceptance steers the implementation of change of plans. Inspire change vs manipulating it.

Discharge planning (planning for continuity of care)

-Assess strengths and limitations -Assess for family support -Assess pt environment -Assess implementation and coordination of POC -Consider community, family, individual resources - Make appropriate referrals if necessary

Admission process

-patient is given wrist band -Initial interview is performed -Advanced directives, living will, durable power of attorney are established. -Providers explain how health info will be used and disclosed -Privacy statement is signed -consents are signed -Patient bill of rights is given -Health hx and assessment is performed

Stage 1-Unfreezing

1. Gather Data 2. Accurately diagnose problem 3.Decide if change is needed 4. Make other aware of need for change; do not proceed to stage 2 until the status quo has been disrupted and the need for change is perceived by others.

7 things leaders do to help people change

1. Inspire others 2. Noticing Problems 3. Providing a clear goal 4. Challenging standard approaches 5. Build trust in your judgement 6. Having Courage 7. Make changes a priority

What does the interprofessional team member need to understand about role clarity for the team to be successful? A. The role and responsibility of all teammates B. Roles and responsabilites of those outside the team C. Why the roles and responsibilities exist D. Individual role and responsibilities

A

A discharge nurse is evaluating patients and their families to determine the need for a formal discharge plan and/or referrals to another agency. Which patients would most likely be a candidate for these services? Select all that apply. A.An older patient who is diagnosed with dementia in the hospital B.A 45-year-old male who is diagnosed with Parkinson's disease C.A 35-year-old female who is receiving chemotherapy for breast cancer D.A 16-year-old who is being discharged with a cast on his leg E.A new mother who delivered a healthy infant via a cesarean birth F.A 59-year-old male who is diagnosed with end-stage bladder cancer

A, B, F

A patient is being transferred from the ICU to a regular hospital room. What must the ICU nurse be prepared to do as part of this transfer? A.Provide a verbal report to the nurse on the new unit. B.Provide a detailed written report to the unit secretary. C.Delegate the responsibility for providing information. D.Make a copy of the patient's medical record.

A.

A single parent is raising two children and relying on public transportation, is determined to become a registered nurse. What are the restraining forces in this situation? (select all that apply) A. Being a single mother B. Student success center established within the nursing department c. Stress of being away from children D. Relying on public transportation E. An advancement in medicine

A. Being a single mother C. stress of being away from children D. Relying on public transportation

A nurse decides to become a home health care nurse. Which personal qualities are key to being successful as a community-based nurse? Select all that apply. A.Making accurate assessments B.Researching new treatments for chronic diseases C.Communicating effectively D.Delegating tasks appropriately E.Performing clinical skills effectively F.Making independent decisions

A. C. E. F.

What is the best focused response when asked " what does clear and efficient communication mean?". (Select all that apply) A. Giving as much information as possible about everything related to the patient on hand-off B. A through handoff situation, including background, your assessment, and any recommendations. C. Information is presented in language the receiver can understand D. Always presenting information in a concrete manner E. Checking for the receivers understanding before moving on .

B, C, E

In an interprofessional team, what do teammates need to understand in order to have a shared vision? (select all that apply) A. Why certain members are included B. After-care options C. Cost of the implemented services D. Potential challenges to meeting outcomes E. Desired outcomes

B, D, E

What factors contribute to the success of inter-professional teams? (select all that apply) A. Establishing an interpersonal relationship with team members B. Having role clarity C. Enjoying the work experience D. Forming clear and efficient communication E.Acknowledging the shared vision

B, D, E

A nurse who is a discharge planner in a large metropolitan hospital is preparing a discharge plan for a patient after a kidney transplant. Which actions would this nurse typically perform to ensure continuity of care as the patient moves from acute care to home care? Select all that apply. A. Performing an admission health assessment B. Evaluating the nursing plan for effectiveness of care C. Participating in the transfer of the patient to the postoperative care unit D.Making referrals to appropriate agencies E. Maintaining records of patient satisfaction with services F. Assessing the strengths and limitations of the patient and family

B, D, F

What is considered to be the greatest challenge to the implementation of an interpersonal primary health-care team? A. getting nurses to actively participate in the planning of patient care using this model B. overcoming the traditional provider-dominated role of determining patient care C. the cost of implementation of such a varied team D. Assuring patient acceptance of the care model

B.

The unit manager of a medical- surgical unit is transitioning the unit to electronic charting. According to Lewis model, which of the following roles describes you as the change agent? A. The role player B. The refreezer C. The unfreezer D. The mover

C. The Unfreezer

Care coordination cons

Care coordination may be perceived as poor if pt has poor health outcomes or is not in the right place through health system.

Care Coordinator

Case manager, Social worker, or lay person met be able to ID pt health goals and coordinate services to meet those goals. Must have expertise in self-management and patient advocacy, as well as be able o network with a range of people.

why care coordination now?

Increasing # of older adults, Increased chronic illness, increased availability of costly medications and tx.

SBAR

Situation Background Assessment Recommendation

Collective action

activities that are undertaken by a group of people who have a common interest. Responsibility Authority Autonomy Collective barganing

Community-based care

health care that is provided to people who live within a defined geographic region or who have common needs; designed to meet the needs of people as they move between and among health care settings (ie home health)

Stage 2-Movement

1. Develop plan 2. Set goals and objectives 3.ID areas of support and resistance 4. Include everyone who will be affected by the change in its planning. 5. Set target dates 6. Develop appropriate strategies 7. Implement the change 8. Be available to support others and offer encouragement through change 9. Use strategies for overcoming resistance to change 10. Evaluate the change 11. Modify the change, if necessary

Principles of scientific management (Fredrick W Taylor )

1. Rule of thumb is replaced with scientific method; using time, motion studies and expertise of experienced workers can promote greatest efficiency and energy. 2. Establishment of Scientific system to hire, train and promote based on tech competence and abilities. 3. Workers ID how they fit and contribute in organizations that share same gals and mission. Accomplished by financial incentives (money). 4. Cooperative and interdependent relationship between managers and workers. Work should be shared equally. Function is not the same, managers should plan, prepare and supervise.

TPAPN Requirement for employment

1.Approval from TPAPN case manager 2. TPAPN participant must inform prospective employer prior to accepting position 3.Participants must provide employees with a copy of the TPAPN work agreement to be completed and submitted to TPAPN before starting work 4. Supervisor must complete quarterly work evaluations to document the participants job performance and behavior in the workplace 5. Approved positions must include direct supervision

The oncology unit has recently experienced a higher-than-normal patient census, which is requiring that nurses pick up additional patients. The hospital CFO has indicated that there are no additional funds available to hire additional full-time nurses. As such, the unit manager anticipates some behavioral responses by the stakeholders of change (nursing staff) within the unfreezing phase. What are some possible behavioral responses? (Select all that apply) A. Withdrawal B. anger C. Passivity D. Acceptance E. Discontentment

A. Withdrawal B. Anger E. Discontentment

Meeting patient needs during admission process

Nurses must provide holistic care and establish the basis for how patient will respond to and evaluate the remainder of their stay.

continuity of care

Process in which health care providers give appropriate uninterrupted care and facilitate the patients transition between different settings and levels of care. (ie. hospital to home health)

Key points of Classic social strategies of change

Rational- Empirical Normative- Reeducative Power- Coercive

TPAPN

Safeguards patience by providing early identification, support, monitoring, accountability and earned advocacy to Texas nurses who have an identified substance use and or mental health condition or related incidents, so the nurse may return to save nursing practice

action stage

Stage of change in which people are actively changing a negative behavior or adopting a new, healthy behavior

Stage 3- Refreezing

Support others so that the changes continue.

interprofessional collaboration

Under the direction of a professional nurse who has clinical expertise, ability to communicate thoroughly and efficiently, and have the ability to facilitate conflict.