Transitions Exam 2

Assigning →

process of transferring the authority, accountability, and responsibility of client care to another member of the healthcare team Performed in a downward / lateral manner w/ regard to members of the team

Right Circumstance →

Assess the health status and complexity of care required by the client. Match the complexity of care demands to the skill level of the healthcare team member Consider the workload of the team member

SBAR

(situation, background, assessment, recommendations) → a structured communication method that is used to improve team communication. Focuses on critical information of a patient.

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 of that, in reality, it is only because the nurse manager misunderstood the nurse's scheduling request.

Clinical data repository

this is a physical or logical compendium of patient data pertaining to health; an information warehouse used to store data longitudinally, in multiple forms (text, voice, images, etc)

Coding system

this is a set of agreed-upon symbols (frequently numeric or alphanumeric) associated with a concept representation or terms to allow exchange of meaning.

Nurse role in disaster preparedness/management and emergency response plans radiological

Amount of exposure is related to duration of exposure, distance from source, and amount of shielding. The facility where victims are treated should activate interventions to prevent contamination of treatment areas (floors, furniture, air vents, and ducts should be covered; radiation-contaminated waste should be disposed of according to procedural guidelines). Wear water-resistant gowns, double-glove, and fully cover bodies with caps, booties, masks, and goggles. Wear radiation or dosimetry badges to monitor the amount of radiation exposure. Survey clients initially with a radiation meter to determine the amount of contamination. Decontamination with soap and water and disposable towels should occur prior to the client entering the facility. Water runoff will be contaminated and should be contained. After decontamination, resurvey clients for residual contamination, and continue irrigation of the skin until the client is free of all contamination.

Right Person →

Assess and verify the competency of the health care team member. The task must be within the team member's scope of practice and they must have the necessary competence/training Continually review the performance of the team member and determine care competency Assess team member performance based on standards and, when necessary, take steps to remediate a failure to meet standards.

Types / Methods informatics/health information technology are utilized in the delivery of care

Automated Dispensing of Medications and Bar Coding Computerized Monitoring of Adverse Events Electronic Medical/Health Records Clinical Provider Order-Entry System Clinical Decision Support Systems Tablets and Smartphones Computer-Based Reminder Systems Access to Patient Records at the Point of Care Internet Prescriptions Nurse Call Systems Voicemail and Texting Telephone for Advice and Other Services Internet or Virtual Appointments Online Support Groups for Patients and Families

Nurse role in disaster preparedness/management and emergency response plans biological

Be alert to indications of a possible bioterrorism attack because early detection and management is key. Often, the manifestations are similar to other illnesses. Be alert for the appearance of a disease that does not normally occur at a specific time or place, has atypical manifestations, or occurs in a specific community or people group In most instances, infection from biological agents is not spread from one client to another, management of the incident includes directing personal in the proper use of PPE, and, in some situations, decontamination and isolation Use appropriate isolation measures Transport or move clients only if needed for treatment and care Take measures to protect self and others Recognize indications of infection/poisoning and identify appropriate treatment interventions

Ways to Address Incivility Individual strategies

Be assertive and confront the person(s) who is involved in the uncivil behavior. Use "I" language when talking to the involved person(s). If direct conversation about the situation does not work, then staff should report the occurrence as expected in the organization process. Identify critical information such as date, time, who was involved, and what occurred

Collaborating

Both parties set aside their original individual goals and work together to achieve a new common goal. Requires mutual respect, positive communication, and shared decision-making between parties. This is a win-win solution.

Nurse role in disaster preparedness/management and emergency response plans chemical

Can occur as a result of an accident or due to a purposeful action (terrorism) Take measures to protect yourself and avoid contact. Assess and intervene to maintain airway, breathing, and circulation. Administer first aid as needed. Remove the offending chemical by undressing the client and removing all identifiable particulate matter. Provide immediate and prolonged irrigations of contaminated areas. Irrigate skin with running water, except for dry chemicals (lye or white phosphorus). In the case of dry exposure, brush the agent off of clothing and skin. Gather a specific history of the injury, if possible (name and concentration of the chemical, duration of exposure). Know which facilities are open to exposed clients and which are open only to unexposed clients. Follow the facility's emergency response plans (personal protection measures, handling and disposal of wastes, use of space and equipment, reporting).

What to include in the incident report

Client name & hospital number Date, time, & location Factual description Any injuries occurred Name of witnesses Corrective actions that were taken

Nomenclature

this is a system of designations that is elaborated on according to preestablished rules.

Right direction/communication →

Communicate either in writing or orally. Data that needs to be collected. Methods and timeline for reporting, including when to report concerns/findings. Specific tasks to be performed; client-specific instructions. Expected results, timelines, and expectations for follow-up communication

Application of aspects to include in incident reporting and who should complete the report

Completed by the person who identifies that an unexpected event has occurred (might not be the person who is most directly involved) Should be completed within 24 hours (ASAP) Considered confidential / not shared w/ client Not placed / mentioned in client's record BUT a description of the incident should be documented Forwarded to risk management department

Data analysis software

Computer software used to analyze data; used in health care to meet regulatory requirements, performance assessment and quality improvement, accreditation, and research.

Factors to assigning Client factors

Condition of client / level of care needed Specific care needs (cardiac monitoring, ventilation) Need for special precautions (iso, fall, seizure) Procedures requiring significant time commitment

Understand the aspects of conflict and conflict resolution

Conflict is inevitable, what is important is how it is handled. It is natural for misunderstandings to occur among people who work together, such as in teams. Often, causes of conflict relate to whether resources are shared equitably, insufficient explanation of expectations, questioning someone's performance, unexplained changes that disturb routines and process and for which team members are not prepared, and stress resulting from changes that team members do not understand and may see as threatening or ineffective. Each of these causes can be prevented from developing into conflict. Engaging in clear, timely communication and including team members in the process can reduce conflict.There is another cause of conflict that is more difficult to manage: an individual's personal responses and behavior that may increase team conflict. Examples include the team members who do not do expected work, are late to meetings, do not listen to others, complain, are overly critical of others, do not know how to communicate effectively, want to be the star and take all the credit, and so on Conflict resolution requires leadership and participation from team members. When difficult issues or problems arise, it is best to deal with them rather than postpone decisions (which usually means that the problem has time to get worse). Using threats and negativity with little positive feedback can lead to more conflict, so these approaches need to be avoided. Listening can go a long way toward preventing conflict, and if conflict does occur, resolving it. When team members treat one another with respect and communicate clearly, conflict can be decreased. Respect means to recognize another's right to have opinions and listen and discuss these opinions. Nonverbal communication can give important clues as to when conflict is increasing. When teams or individual members experience stress, the risk of conflict increases. Open communication is key to resolution of conflict, and it is key to preventing conflict when possible.

Application of effective communication

Debriefing, assertiveness, listening, mindful communication, SBAR. checklist

Impact on Teams & Care Delivery

Disruptive behavior (which included verbal abuse) negatively affected relationships and created stress, leading to frustration, lack of concentration, poor communication, and inability to effectively collaborate and provide effective information transfer in the workplace Disruptive behavior was adversely affecting patient safety, patient mortality, the quality of care, and patient satisfaction

Understand and apply the EMR/EHR documentation Guidelines

Do not include opinion - only objective info A nurse does not document another staff member's actions. Supervision of care, however, can be documented. Write neatly and legibly. Use of copy and paste features in an EMR/EHR increases risk of errors, particularly perpetuating an error Use correct spelling, grammar, and medical terminology. Use authorized abbreviations. Using unapproved abbreviations increases the risk of errors. Use graphic records to record specified patient data, such as vital signs and medication administration. Record the patient's name on every page (for hard-copy medical records); this should be part of the EMR. Follow HCO policies and procedures about verbal and telephone orders. Transcribe orders carefully; double-check and ask questions if an order is not clear. In computerized systems, orders do not need to be transcribed; however, this does not mean that there is no risk of an error. All orders need careful review, and if they are not clear, they may require follow-up. Document omitted care. Document medications and outcomes. Document patient noncompliance/nonadherence and the reason(s) for it. Document allergies, and use this information to prevent errors and complications. Document sites of injections and other procedures. Record all required information about intravenous therapy and blood administration. Report abnormal laboratory results. Document as soon as possible after care is delivered. If documentation is done late, note this in the record. The nurse should not leave blank areas to come back to for later documentation. When quoting, use quotation marks and note the person who made the statement. When documentation is corrected because of a mistake, follow the HCO policies regarding corrections as per a hard-copy record or electronic record. Medical records are never rewritten or destroyed by staff. Document patient status change. When contacting the physician, document the time, date, name of physician, reason for the call, content, physician response, and steps taken after the call. This note should not include subjective analysis of the response such as the physician's attitude

Compromising

Each party gives something up. To consider this a win/lose-win/lose solution, both parties must give up something equally important. If one party gives up more than the other, it can become a win-lose situation.

Identify barriers to care coordination

Failure of team members to understand the roles and responsibilities of other team members, particularly members from different healthcare professions Lack of a clear interprofessional plan of care Limited leadership Overwork and excessive burden of team member responsibilities Ineffective communication, both oral and written Lack of inclusion of the patient and family/significant others in the care process Competition among team members to control decisions

Impact of generational differences on teams

Generational issues are important because multiple generations are part of the image of nursing and have an impact on nursing practice and management and, consequently, on leadership. How nurses from each generation view nursing can be quite different, and their educational backgrounds vary a great deal, from nurses who entered nursing through diploma programs to nurses who entered through baccalaureate programs and on to graduate degrees. Some of these nurses have seen great changes in health care, and others see the current status as the way it has always been. Technology, for example, is frequently taken for granted by some nurses, whereas others are overwhelmed with technological advances. Some nurses have seen great changes in the roles of nurses, whereas other nurses now take the roles for granted—for example, the APRN role. If one asked a nurse in each generation for the nurse's view of nursing, the answers might be quite different—for example, how nurses practice, settings in which nurses practice, management responsibilities, and so on. If these nurses then tried to explain their views to the public, the perception of nursing would most likely consist of multiple images. In a profession that includes representatives from multiple generations, it is necessary to recognize that age diversity means variations in positive and negative characteristics among staff. Some will pull the profession backward if allowed, and some will push the profession forward. As one generation moves toward retirement, the next generation will undoubtedly have a greater impact on the image of nursing. It is critical to avoid gender role stereotyping, and we need to increase the strength of nurses as one group of professionals, while still recognizing that these differences exist and appreciating how they might affect the profession.

Cooperating

If the nurse decides to accommodate the manager's request, then the pediatric clients can be at risk for incompetent care. Practice liability is another issue for consideration.

Competing

If the nurse truly feels unqualified to work on the pediatric unit, then this approach can be appropriate: the nurse must win and the manager must lose. Although risking termination by refusing the assignment, the nurse should take an assertive approach and inform the manager that pediatric clients would be placed at risk.

Understand the role of an incident report in evidence-based practice and quality improvement to improve processes and decrease errors

Incident report → Records of unexpected / unusual incidents that affected a client, employee, volunteer, or visitor in a healthcare facility Can also be referred to as → unusual occurrence / quality variance reports In most states, as long as proper safeguards are employed, incident reports cannot be subpoenaed by clients / used as evidence in lawsuits

Role of the nurse, including privacy of information

Involved in choosing EMR to ensure that the system meets nursing care documentation requirements and that relevant data can be collected to assist nurses in providing and improving care Guide development and implementation Serve as resources in identifying needs and testing systems to ensure that the systems are nurse-user friendly

Factors to assigning Healthcare Team Factors

Knowledge & skill level Amount of supervision necessary Staffing mix (RN, PN, AP( Nurse-to-client ratio Experience w/ similar clients Familiarity of staff member w/ unit

Identify barriers to evidence-based practice application

Lack of time Lack of value placed on research in practice Lack of knowledge about EBP and research Lack of technological skills to find evidence Lack of resources to access evidence Lack of ability to read research Resistance to change Lack of organizational support for EBP

Recognize the responsibilities of a team leader

Lead the team-at meetings and in the team's work. Represent the team when the organization requires someone from the team to speak for the team and its activities, for example, with management, committee meetings, etc. Determine or clarify the team's purpose and operating rules or guidelines. Some of this may be predetermined by the organization. Select team members. In many cases, someone other than the team leader or the organization's policies determine who will serve on a team; for example, team members may be assigned to a unit or a particular patient. Orient team members to the team, including coaching and training new members. Determine the plan of action with team members' participation. After the team reviews information, discusses issues, and arrives at team decisions, the team leader ensures that there is an effective plan of action. Determine how to make the team more effective given the time constraints. Provide resources and information to the team as needed. Update the team as necessary. Ensure that the team's plan of action is implemented as designed. Recognize the team's work as well as the work of individuals. Resolve conflict when it occurs. Evaluate the team's outcomes; include input from all team members; strive for improvement. This information then feeds into the organization's quality improvement program. Encourage team learning to improve effectiveness. Ensure that required information about team functioning, decisions, and actions implemented is documented. Accept feedback from team members and the team as a whole. Ensure that the team effectively uses collaboration, coordination, communication, and delegation.

Identify and apply indications for completing an incident report

Med errors Procedure / treatment errors Equipment-related injuries / errors Needlestick injuries Client falls / injuries Visitor / volunteer injuries Threat made to client / staff Loss of property (dentures, jewelry, personal wheelchair)

Role of nursing organizations on the use and implementation of informatics

Nurse managers and nurses involved in direct care are accountable for ensuring that documentation meets the expected standards. Documentation meets the needs of clear, effective communication for the team and others who need the information to provide care and meet legal and ethical, accreditation, documentation, and reimbursement and budget requirements Documentation is a source for quality improvement and research data It is a professional responsibility to document planning, actual care provided, and outcomes.

Understand and apply the EMR/EHR documentation Benefits

Quick access to patient information from multiple locations to assist in providing coordinated, efficient care Decision support, clinical alerts, reminders, and medical information Performance-improving tools, real-time quality reporting Legible, complete documentation that facilitates accurate coding and billing Interfaces with labs and other sources of information Safer, more reliable prescribing Reduction in errors when multiple caregivers are involved in the care—care coordination Improvement of care transitions (handoffs) between settings Up-to-date information for emergency care—care coordination

Room Assignments Private rooms

Required for clients w/ airborne precautions Preferred for clients w/ droplet & contact precautions Preferred for: agitated clients, dementia clients/hx of wandering, quiet environment clients, risk for sensory overload, pts near death

Application of delegation in the delivery of care *Five rights of delegation

Right task, right circumstance, right person, right direction/communication, right supervision/evaluation

Application of TeamSTEPPS tools for conflict resolution

SBAR DESC Goal → arrive at consensus & keep the discussion on track Script includes the following elements: Describe the specific conflict situation or behavior using concrete data. Express how the situation made you feel or identify your concerns. Suggest alternatives and seek agreement. State consequences in terms of effects on team goals; strive for consensus Two-Challenge Rule Cross Monitoring

Application of the stages of conflict

Stage 1: Latent Conflict Stage 2: Perceived Conflict Stage 3: Felt Conflict Stage 4: Manifest Conflict Stage 5: Conflict aftermath

Ways to Address Incivility Organization strategies

Support open, safe communication among all staff members Require staff education about the problem of disruptive behavior and how to respect and communicate with one another even during stressful situation Ensure that collaboration, communication, teams and teamwork, and conflict management are part of the culture and also included in staff ongoing education

If given an unsafe assignment,

Tell charge nurse/scheduling nurse to negotiate new assignment If no resolution, go up the chain of command If no resolution, file a written protest w/ admin *failure to accept assignment w/o following proper channels can be considered client abandonment

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.

Right supervision/evaluation →

The delegating nurse must: Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse) Provide clear directions and expectations of the task to be performed (time frames, what to report) Monitor performance/provide feedback Intervene if necessary (unsafe clinical practice) Evaluate the client and determine if client outcomes were met. Evaluate client care tasks and identify needs for quality improvement activities and/or additional resources

Identification and application of team development and roles associated with effective teams

The most common scenario is that team members work in "silos" most of the time and then come together periodically to collaborate and communicate. Unfortunately, this pattern leads to problems and errors, which may then affect team functioning. The development of an effective team is critical to the success of new and innovative methods such as briefings before handoffs, checklists, and time-outs before surgery, such as the Situation-background-assessment-recommendations TeamSTEPPS is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals Roles: Coordinator: Pulls together the work of the team Critic: Keeps an eye on the team's effectiveness Idea person: Encourages the team to be innovative Implementer: Ensures that the team's functioning is effective External contact: Looks after the team's external contacts and relationships Inspector: Ensures that standards are me Team builder: Develops the team spirit

Negotiation

This approach generally minimizes the losses for all involved while making certain each party gains something. Although each party is giving up something (the manager gives in to a different solution and the nurse still has to work on another unit), this sort of compromise can result in a win-win resolution.

Nursing Minimum Data Set:

This data set describes patient problems across healthcare settings, different populations, geographic areas, and time. It provides clinical data to assist in identifying nursing diagnoses, nursing interventions, and nursing-sensitive patient outcomes. In addition, the Nursing Minimum Data Set is useful in assessing resources used in the provision of nursing care. The goal is to link data between HCOs and providers. Data can also be used for research and healthcare policy.

Stage 3: Felt Conflict

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

Uncivil Behaviors

Verbal abuse, negative behavior, physical abuse (for example, profanity, innuendo, demeaning comments) Reprimanding or insulting another person in public and inappropriately Threatening Telling racial or ethnic jokes Undermining team cohesion Scapegoating Silence (not speaking to a team member Assaulting another person, throwing objects, and outbursts of rage

Database

a collection of interrelated data organized according to a scheme to serve one or more applications with data stored so that several programs can use the data without concern for data structures or organization.

Assertiveness →

a communication style that is often confused with aggression, and, therefore, may be viewed negatively. The assertive nurse uses I statements when communicating thoughts and feelings and you statements when persuading others.

Email list

a list of email addresses can be used to send an email to many simultaneously.

Dashboard

a method to provide a quick view of data using key elements of concern.

Encryption

a method used to change information into a code, usually for security reasons as to limit access to that information.

Data bank

a method used to store a large amount of information; may include several databases.

Mindful Communication →

a process by which actively aware individuals engage in communication that is meaningful, is timely, and responds continually as events unfold.

Factors to assigning

client factors, healthcare team factors, room assignments

Application of conflict resolution strategies

compromising, collaborating, cooperating, competing, negotiation

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.

Point of care access

decreases the chance that details may be forgotten, documented incorrectly, or not documented at all. It saves nurses time and eliminated the need to delay documentation

Debriefing →

dialogue between two or more people; its goals are to discuss the actions and thought processes involved in a particular patient care situation, encourage reflection on those actions and thought processes involved in a particular patient care situation, and incorporate improvement into future performance.

Standardized Terminology

is a collection of terms with definitions for use in information systems, databases. This enables comparisons to be made because the same term is used to denote the same condition, and it is necessary for effective documentation in EHRs. Standardized terminologies are needed, but it will be difficult to reach consensus among the healthcare professionals

Meaningful use

focuses on the use of certified EHR technology for the following purposes: improve quality, safety, efficiency, and reduce health disparities, engage patients and family, improve care coordination, and population and public health, and maintain privacy and security of patient health info. Meaningful use identifies specific objectives that eligible professionals and hospitals must achieve to qualify for Centers for Medicare and Medicaid services reimbursements

Right Task →

identify what tasks are appropriate to delegate for each specific client. A right task is repetitive, requires little supervision, and is relatively noninvasive for the client. Delegate tasks to appropriate levels of team members based on standards of practice, legal and facility guidelines, and available resources.

Room Assignments Confused / disoriented

in a room away from noise and exits

Security protections

methods used to ensure that information is not read or taken by unauthorized users.

Computer literacy

specific knowledge and skills are required to use basic computer applications and computer technology.

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 conflict and agree to work together to come up with a solution.

Supervising Care →

the process of directing, monitoring, and evaluating the performance of tasks by another member of the healthcare team.

Delegating Care →

the process of transferring the authority and responsibility to another team member to complete a task, while retaining the accountability.

Assigning Care →

the process of transferring the authority, accountability, and responsibility of client care to another member of the healthcare team. Performed in a downward or lateral manner with regard to members of the healthcare team.

Data

these are discrete entities described objectively without interpretation.

Clinical decision support systems

these systems are computer applications designed to facilitate human decision making. Decision support systems are typically rule based, using a knowledge base with a set of rules to analyze data and information to reach recommendations.

Minimum data set

this describes the minimum categories of data with uniform definitions and categories; concerns a specific aspect or dimension of the healthcare system that meets the basic needs of multiple data users.

Data mining

this is a method used to locate and identify unknown patterns and relationships within data.

Scorecard →

this is a metric method used by management to assess and track performance, typically related to the HCO's agenda; it can focus on clinical, financial, and other indicators.

Clinical information system

this is an information system that supports the acquisition, storage, manipulation, and distribution of clinical information throughout an HCO, with a focus on electronic communication, using HIT applied at the point of clinical care. Typical clinical information system components include EMRs/EHRs, clinical data repositories, decision support programs, handheld devices for collecting data and viewing reference material, imaging modalities, and communication tools such as electronic messaging systems.

Information literacy

this is the ability to recognize when information is needed and then to locate, evaluate, and effectively use that information.

Information →

this represents data that have been interpreted, organized, or structured.

Checklists→

to ensure processes are followed and identify potential risks or near misses before they lead to harm and improve care.

Evidence-based practice →

to integrate the best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible.