Ch.15 Professional Practice Models, Leadership Exam #3

1. A(n) _____ is the operational mechanism by which care is actually provided to patients and families.

ANS: care delivery model Care delivery models are the operational mechanisms by which care is actually provided to patients and families. Well-designed models maximize the quality and safety of nursing care.

3. A(n) _____ is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes within an appropriate length of stay in a hospital setting.

ANS: critical path A critical path is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes within an appropriate length of stay in a hospital setting. As a pathway, it is a tracking system for the timing of treatments and interventions, health outcomes, complications, activity, and teaching/learning.

2. Organizations need to integrate the behaviors of employees to avoid random chaos and maintain some order, function, and structure. A(n) _____ is a guideline that has been formalized. It directs the action for thinking about and solving recurring problems related to the objectives of the organization.

ANS: policy A policy is a guideline that has been formalized. It directs the action for thinking about and solving recurring problems related to the objectives of the organization

4. Functional nursing: a. divided and distributed nursing tasks. b. enhanced client-oriented care. c. provided a smooth care delivery system. d. was expensive once implemented.

ANS: A Functional nursing focused on task accomplishment rather than individualized and holistic care. The division of labor was assigned according to specific tasks and technical aspects of the job, such as medication administration and taking vital signs.

1. A professional practice model is a: a. conceptual framework and philosophy of nursing within an organization. b. staffing grid that outlines nursing unit work schedules. c. mechanism by which care is actually provided to patients and families. d. blueprint for developing specific measurable objectives and actions.

ANS: A Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization

7. A patient is admitted with congestive heart failure, diabetes mellitus, and dementia. He has a new dark spot on the top of his toes on his right foot. The nurse contacts the primary care physician, consults with the wound care specialist nurse, writes a nursing order for a referral to the diabetic educator, and contacts the discharge planner to facilitate future discharge plans. Which of the following care delivery models best describes how the nurse is providing care? a. Case management b. Group nursing c. Functional nursing d. Private duty nursing

ANS: A The Case Management Society of America (CMSA) definition of case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes" (CMSA, 2016).

3. An example of a traditional nursing care delivery model is: a. case management. b. patient- and family-centered care. c. transitional care. d. patient-centered medical home.

ANS: A There are five traditional nursing models of care: (1) private duty, (2) functional, (3) team, (4) primary, and (5) case management. Of these, functional, team, primary, and case management were and are currently associated with hospital nursing practice. Private duty and case management were associated with public health, home health care, and community health but have been adapted to the inpatient setting.

6. A well-known conceptual framework by Donabedian (1988) is used to promote positive outcomes in an organization. The framework is composed of concepts related to: (Select all that apply.) a. structure. b. outcomes. c. processes. d. values. e. quality.

ANS: A, B, C One well-known conceptual framework by Donabedian (1988) frequently is used to "map" or determine what structures and processes promote positive outcomes. The three-concept framework is composed of structures, processes, and outcomes (S-P-O), and these three components are causally linked.

2. Which of the following nursing care models are hospital based? (Select all that apply.) a. Case management b. Functional c. Private duty d. Team

ANS: A, B, D Case management, functional, primary, and team are nursing care models that are hospital based.

7. Policies and procedures are two functional elements of an organization that are extensions of the mission statements. The similarities between policies and procedures include: (Select all that apply.) a. a need for regular, periodic reviews. b. a means for accomplishing goals and objectives. c. general guidelines for decision making about actions. d. a need for the smooth functioning of any work group or organization. e. a need to be very detailed as to how to perform a specific procedure on a specific unit.

ANS: A, B, D The similarities between policies and procedures are that both need regular, periodic reviews and that both are a means for accomplishing goals and objectives. Both are necessary for the smooth functioning of any work group or organization.

3. The determination of a care delivery model or system of care delivery depends on: (Select all that apply.) a. fiscal responsibility. b. accountability to the consumer. c. government reimbursement. d. the organization's philosophy. e. quality and safety considerations.

ANS: A, B, E Care delivery model redesign is influenced by fiscal responsibility, accountability to the consumer, available resources, and quality and safety considerations. The appropriate care delivery model is the one that maximizes existing resources while meeting organizational goals and objectives (i.e., the mission

4. Positive work environments are often found in Magnet-designated organizations. Organizational structures associated with Magnet-like healthy work environments are: (Select all that apply.) a. professional development opportunities. b. interdisciplinary collaboration. c. top-down approach to governance. d. decreased workloads. e. culture of safety.

ANS: A, B, E Organizational structures associated with Magnet-like healthy work environments include effective leaders at all levels of the organization, professional development opportunities, staffing structures that consider nurse competencies, patient needs, and teamwork; interdisciplinary collaboration; empowered, shared decision making; patient-centered culture/culture of safety; quality improvement infrastructure; evidence-based practice; and a visible acknowledgment of nursing's unique, valued contributions (e.g., professional practice model, vision/mission/philosophy statements).

1. The presence of a nurse professional practice model (PPM) is the nurse's: (Select all that apply.) a. control over practice. b. career focus. c. job satisfaction. d. psychological needs.

ANS: A, C One important predictor of RN job satisfaction is the presence of a nurse professional practice model (PPM). Nurse job satisfaction is directly associated with nurse turnover, a significant human resource challenge for management (Hayes et al., 2012). Professional practice models consist of structures, processes, and values that support nurse control over practice and enhance job satisfaction and retention (Erickson & Ditomassi, 2011).

8. Which of the following is true about team nursing? a. It includes only registered nurses (RNs) and licensed practical/vocational nurses (LPN/LVNs). b. Each team member has his or her own patient assignments. c. Team members must have dual degrees. d. The nurse with a bachelor's of science in nursing degree is the leader of the team.

ANS: B Team nursing is a delivery approach that provides care to a group of patients by coordinating a team of RNs, licensed practical nurses, and care aides under the supervision of one nurse, called the team leader. Each team member has his or her own patient assignments, and team members are expected to assist and support each other as needed

9. Disadvantages of private duty nursing include: (Select all that apply.) a. private duty nurses have a great degree of autonomy. b. private duty being a costly model. c. job security being tenuous and irregular. d. the nurse's focus being entirely on one client's needs. e. nurses maintaining close relationships with colleagues.

ANS: B, C One disadvantage was that private duty is a costly model because of its low efficiency. Furthermore, job security was tenuous and irregular. Other disadvantages were that nurses had little job mobility and were relatively isolated from colleagues.

5. Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization. The core elements of a PPM include: (Select all that apply.) a. goals. b. values. c. leadership. d. collaborative relationships. e. care delivery model.

ANS: B, C, D, E The core elements of a PPM include nursing values, leadership, the care delivery model, collaborative relationships and decision making, and professional development opportunities (Luzinksi, 2012).

8. Nurses still struggle to create a healthy work environment. The standards of a healthy work environment include: (Select all that apply.) a. staffing ratios. b. true collaboration. c. powerful leadership. d. meaningful recognition. e. skilled communication.

ANS: B, D, E The six standards of a healthy work environment are skilled communication, true collaboration, effective decision making, meaningful recognition, appropriate staffing, and authentic leadership. They have direct relevance to PPMs

6. Critical paths: a. are designed only for critical care or trauma patients. b. determine lifesaving interventions for a specific population. c. outline optimal care and time milestones for the routine patient. d. provide a list of supplies and equipment needed for care.

ANS: C A critical path is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes during an appropriate length of stay in a hospital setting

5. Primary nursing is a type of care delivery in which the nurse: a. cares for a patient 24 hours a day. b. is responsible for the client's daily care. c. monitors care from admission to discharge. d. provides total care for the patient.

ANS: C In the primary nursing model, the primary nurse has 24-hour-per-day accountability for the patient's plan of care from admission to discharge. Associate nurses oversee patient care delivery when the primary nurse is not on shift, although associate nurses are expected to follow the primary nurse's plan of care.

11. Stakeholders are informed of an organization's key goals through its: a. vision. b. values statement. c. mission statement. d. organizational philosophy.

ANS: C Publicly posted mission statements inform key stakeholder groups, such as the public and employees, of the organization's key goals.

13. Mary Lou is a nurse in the critical care unit. She works 12-hour shifts. Each shift she is assigned to one or two critical care patients. She is responsible for planning and delivering the care and treatment for each one of the patients she is assigned to. This is an example of which nursing model? a. Team nursing b. Managed care c. Total patient care d. Functional nursing

ANS: C The term total patient care has come to mean the assignment of each client to a nurse who plans and delivers care during a work shift (Minnick et al., 2007).

10. The responsibility for making decisions about and designing strategies to create a climate and environmental context around the provision of nursing and health care services lies with: a. staff nurses. b. care councils. c. the nurse manager. d. executive leadership.

ANS: D Executive leadership is responsible for making decisions about and designing strategies to create a climate and environmental context around the provision of nursing and health care services.

14. Janice is assigned to pass medications this shift. Mary is assigned to do wound care, Jennifer will give all the baths, and Jim will take all the vital signs. This model of nursing care is called _____ nursing. a. team b. primary c. modular d. functional

ANS: D In functional nursing the division of labor is assigned according to specific tasks and technical aspects of the job. It has been defined as work allocation by functions or tasks, such as passing medicine, changing dressings, giving baths, or taking vital signs. Under functional nursing, the nurse identifies the tasks to be done for a shift. The work is divided and assigned to personnel, who focus on completing the assigned tasks.

9. The conceptual framework and philosophy under which the method of delivery of nursing care is a component is known as: a. core values. b. mission statement. c. care delivery model. d. professional practice model (PPM).

ANS: D PPMs refer to the conceptual framework and philosophy under which the method of delivery of nursing care is a component. PPMs describe the environment and serve as a framework to align the elements of care delivery. The PPM can be thought of as a link between the problems presented by client populations, the purposes of professional occupations, and the purposes of health care organizations.

2. Which nursing care model was prominent before the Great Depression? a. Functional nursing b. Group nursing c. Hospital staffing d. Private duty nursing

ANS: D Private duty nursing is the oldest care model in the United States. Between 1890 and 1929 in the United States, graduate nurses acted as private duty nurses, caring for patients in their homes (Shirey, 2008).

12. Lilly, an RN, works full time in her client's home providing total care for him. She bathes and dresses him, provides tracheostomy care and wound care, and feeds him. She is paid directly by her client. This type of nursing care is commonly known as: a. primary nursing. b. functional nursing. c. case management. d. private duty nursing.

ANS: D Private duty nursing, sometimes called case nursing, is the oldest care model in the United States. Private duty nursing is defined as one nurse caring for one client. In this model, complete and total care is provided by one nurse, but the nurse carries only one client assignment.