Introduction to Nursing Exam 2

Describe what is meant by the nursing diagnosis of "spiritual distress". What can a nurse do to help a patient in spiritual distress?

The nursing diagnosis of "spiritual distress" is when a nurse recognizes an individual who has been harmed by their religious communities. To help a patient who is spiritual distress, nurses can support them by acknowledging their spiritual pain and accepting them and assuring them. Nurses can also say "I am here for you now" and refer them to the hospital chaplain or a support group.

Define negotiation.

The process of give and take between individuals or groups with the goal of reaching an agreement acceptable to both sides.

What is the impact of the IOM report "To Err is Human" on the healthcare industry?

The public became more aware of how frequently medical errors occur and consumer demand for higher-quality care increased dramatically.

What is the Patriot act? What concerns stem from it?

Under the patriot act, some federal agencies, such as the FBI, ICE, and NSA have the authority to wiretap or access, without court approval, any electronic information they believe may be associated with a terrorist attack. The concern of unauthorized sharing of health-care information, which is both unethical and illegal, stems from this. It also violates regulations that have been set by HIPAA.

Civil behavior in the clinical setting.

Assume goodwill, respect and celebrate differences, communicate respectfully, listen carefully, come to clinical prepared and on time, share work equally among group members, resolve conflicts directly and with respect, have fun

__________ and __________ are essential expectations of those who enter the profession of nursing.

Care ; respect

What is the difference between civil and uncivil behavior?

Civil behavior is when people treat others as they wish to be treated (the golden rule). It includes good manners and being polite. Uncivil behavior is any type of speech or behavior that disrupts the harmony of the home, work, or educational environment.

Describe how incivility manifests in both the classroom and the workplace.

Classroom- any type of activity that creates an unpleasant or negative learning atmosphere (can be student-to-falculty or falculty-to-student) Workplace- can be lateral/horizontal (among peers/coworkers) or vertical (between superior and inferior)

Define communication and explain why it is important.

Communication is an interactive sharing of information and requires a sender, a message, and a receiver. It is important because nurses must be able to communicate with patients, family members, physicians, and peers in an effective and constructive manner to achieve their goals.

Define needy behavior.

Complain and then emotionally and physically withdraw.

Define duck and cover behavior.

Complaints are disguised and intertwined with real problems.

List 2 ethical and security issues regarding health information.

Confidentiality of physician-patient communication and who owns the patient's health-care data.

Define information.

Data given form, interpreted.

List the 5 stages of grief.

Denial, anger, bargaining, depression, acceptance

Define dashboards.

Electronic tools that act as a scoreboard. They can provide retrospective or real-time data to assess quality.

Name 3 factors that contribute to conflict.

Emotions, differences of opinion, insecurity, lack of skills, diversity

Difficult people are found __________.

Everywhere

Identify the 6 QSEN competencies.

Evidence-based practice/research, quality improvement, patient-centered care, teamwork and collaboration, safety, informatics

Define lateral/horizontal violence.

Has many of the same characteristics as bullying except that it takes place almost exclusively in the work setting among peers. It can be covert or overt. Covert- undercover and not as noticeable. Includes unfair assignments, marginalizing a person, refusing to help someone, ignoring, making faces behind someone's back, refusing to work with certain people, whining, sabotage, exclusion, fabrication Overt- over the top and very noticeable. Includes name calling, shouting, threatening body language, intimidation, physical hazing, bickering, sarcasm, rude tones, blaming others, putting others down, gossiping sighing loudly, eye rolling, throwing objects

Define human factor.

Human factor refers to the interaction of the human with a technology of an automated process.

What are the 3 strategies to resolve conflict?

Ignore the conflict, confront the conflict, postpone the conflict

Describe "just culture".

It established an environment in which errors and near misses are acknowledged, reported, and analyzed for ways to improve the system. The focus is to determine what went wrong rather that identifying exactly who committed the error.

Describe root cause analysis.

It is a retrospective analysis of a sentinel event. The goal is to find the cause/root of the error and to fix it.

Explain how the app "Touch Surgery" can benefit patients.

It is an app that allows patients who are preparing for operations to download videos of their actual surgery or computer-based simulations of it. The app also provides patients with instructions about deep breathing exercises, activity limitations, and the use of medications. The app has the potential to increase patient satisfaction and improve outcomes.

What is the focal point of nursing practice in regards to civility?

It is the basis for caring, promotes emotional health, and creates a positive environment for learning and the promotion of healing in patients.

What is the ultimate consequence of incivility in the hospital setting?

It jeopardizes quality of care and patient safety.

What do HCAHPS measure?

It measures quality of care through patient satisfaction (survey).

What did the civil rights act of 1964 grant protection of? What protection is missing?

It protects employees and job applicants from employment discrimination based on race, color, religion, and national origin. The protection of discrimination based on sex was missing.

What the the common factors that contribute to uncivil behavior displayed by nursing students?

Juggling multiple roles, financial pressures, time management, lack of family support, demanding faculty, emotional issues

What are the 6 aims for the improvement according to the "Crossing the Quality Chasm" report?

Safe, effective, patient-centered, timely, efficient, equitable

Explain the role of the sneak and list 5 therapeutic techniques the nurse can use when communicating with the sneak.

Sneaks use devious, underhand, and often malicious attacks when you aren't looking. They often will gang up on a person as a group behind his/her back through gossip. Therapeutic techniques- stay on point when you speak with them, treat them with empathy and respect, listen carefully to their responses, plan for future interactions, let the group know that you know what was said.

What are the 4 key points/stages that spirituality entails?

Stage 1: the chaotic (antisocial) stage, with its superficial belief systems Stage 2: the formal (institutional) stage, with its adherence to the law Stage 3: the skeptic (individual) stage, with its emphasis on rationality, materialism, and humaneness Stage 4: the mystical (communal) stage, with its "unseen order of things"

Define quality indicators.

Standardized, evidence-based measures of health-care quality that can be used to measure and track the quality of clinical performance and outcomes.

List the specific parts of the ANA code of ethics that relate to incivility.

"The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual..." Principles of respect extend to all encounters, including colleagues "This standard of conduct precludes any and all prejudicial actions, any form of harassment or threatening behavior, or disregard for the effect of one's actions on others" "Nurse educators have a responsibility to...promote a commitment to professional practice prior to entry of an individual into practice"

Name 2 ways someone can become an informatics nurse.

-Earn a BSN, have 2 years of experience, earn CEUs in informatics, take and pass a certification test in informatics -Earn a master's or doctorate in nursing informatics

What types of jobs can an informatics nurse do?

-Software developer- analyze users' needs and then design, test, and develop software to meet those needs. -Coordinator- organize and lead meetings in which nurses provide information that they use to analyze and change the system design to make it more useful. -Tester- tests the software/program to see if it works as it should. -Trainer- trains staff on how to use the software/program.

Define spirituality.

A sense of meaning in life associated with a sense of an inner spirit. It includes a sense of transcendent reality, strength from inner resources, living fully in the present, and having a sense of inner knowing.

What is a "rapid response team"?

A team that will come to the assistance of a patient whose condition is deteriorating to prevent their death.

Define bargaining.

A type of negotiation that is used when money is involved.

What is a workaround? How can it be positive and negative?

A workaround is the ability to make the computer perform tasks it was not intended to perform. Positive workarounds can lead to new and innovative ways to complete tasks and increase the quality of patient care. Negative workarounds take the nurse's time away from patient care to fix a computer glitch and creates errors in data.

List 3 advantages of EHRs.

Accessible from remote sites, accessible to multiple users at the same time, provides reminders about completing information or carrying out protocols, reduces redundancy, improves communication

Define personality.

All the elements, both genetic and learned, that go into making that person who he/she is. Includes strongly held beliefs, attitudes, emotions, and behaviors.

Name the primary objectives of HIPPA.

Allow patient records to be transferred from one provider to another, guarantee security and privacy of health information, reduce health-care fraud and abuse

Define a sentinel event.

An unexpected occurrence involving death or serious physical of psychological injury, or the risk thereof.

Define wisdom.

Analysis of data, information, and knowledge.

Define vertical violence.

Any behavior conducted by a superior or supervisor that could reasonably be considered humiliating, intimidating, threatening, or demeaning to an individual or group of individuals.

Define bullying.

Any behavior that could reasonably be considered humiliating, intimidating, threatening, or demeaning to an individual or group of individuals. The goal is to coerce or intimidate another person into doing something that they do not want to do or to merely humiliate a person or group because of some perceived difference or weakness.

Define beyond help behavior.

Appear to be seeking help and support with a problem they are facing, then immediately reject the help without considering it.

Describe ways that you can "feed your spirit" or help enhance spirituality.

Being in nature, journaling, meditation, being part of a faith community, volunteering, retreating from the bustle of daily life by taking walks and being alone, honoring family traditions, partaking in cultural/religious holidays, enjoying special moments by doing whatever you like to do

Name 3 verbal communication builders and 3 blockers.

Builders- encouraging words, asking open-ended questions, use "I" messages, asking clarification questions, reflecting feelings and emotions, repeating what was just said, limit interruptions, reviewing what was said and verifying understanding, acknowledging what was said Blockers- automatic defensiveness, asking closed-ended questions, accusing or blaming, using sarcasm, constant interruptions, judging, name calling and diagnosing, stating opinions as proven facts, making generalizations, being patronizing, offering vague reassurance, telling people how they should feel, changing the subject, expecting mind reading, shaking or pointing a finger while speaking, walking away

Name 3 nonverbal communication builders and 3 blockers.

Builders- eye contact, stop what you are doing, nod the head, positive facial expressions, sitting or standing in close proximity, open posture (directly facing), listening empathetically, light touch Blockers- eye rolling, arm and leg crossing, slouching, hunching, turning away, fidgeting, deep and loud sighs, multiple watch or clock checks, continuing with an activity while the other person is talking, failure to make eye contact, tuning out or failing to pay attention

Name 2 paraverbal communication builders and 3 blockers.

Builders- silence, tone Blockers- threatening, ordering or menacing, yelling, calling names, hurling insults, nonstop and rapid talking

List several ways to create a positive work environment.

Building a collaborative culture that includes respectful communication and behavior, establishing a communication-rich culture that emphasizes trust and respect, making accountability central to the culture with clearly defined role expectations, maintaining adequate staffing, training leaders competent in cooperation and communication, sharing decision-making with all those it will affect, continuously developing employee skills and clinical knowledge, recognizing and rewarding employees' contributions

What is the difference between bullying and lateral/horizontal violence?

Bullying can occur anywhere, while lateral/horizontal violence occurs only in the workplace.

What does HIPAA stand for?

Health Insurance Portability and Accountability Act

List 5 assertive communication suggestions.

Maintain appropriate eye contact, convey empathy, keep body position erect, speak clearly and audibly, be comfortable with silence, use gestures and facial expressions, use appropriate location, use appropriate timing, focus on behaviors and issues.

Describe why Maslow's hierarchy of needs can be used to understand difficult people.

Maslow believed that if the lower level needs are not met, the person is unable to move to the higher level needs fulfillment. Safety and physiological needs must be met first.

Define wet blanket behavior.

Negative comments and complaints dampen everyone else's attitudes and ideas.

List the 7 basic principles to remember when working with difficult people.

No change, no reinforcement, no action, no anonymity, no ashes, no condemnation, no robbery

It it ok to ignore uncivil behavior?

No, because the problem won't go away unless you confront it. (but make sure that it doesn't escalate into violence)

Define the three communication styles.

Nonassertive communication is submissive and is when people allow their rights to be violated by others. Their requests and demands are surrendered to others without regard to their own feelings and needs. Assertive communication involves interpersonal behaviors that permit people to defend and maintain their legitimate rights in a respectful manner that does not violate the rights of others. It is honest and direct and accurately expresses the person's feelings, beliefs, ideas, and opinions. Aggressive communication strongly asserts the speaker's legitimate rights and opinions with little or no regard or respect for the rights and opinions of others.

Why do nurses need to know how to assess and value spirituality in patients?

Nurses have the role of working with patients at various tough times/transitions in their lives. They spend more time with patients during these times than any other health-care worker, and must be comfortable talking about their own spirituality with them.

Describe some situations that could cause anger.

Patients angry at nurses- serving cold/poorly cooked meals to patients, not answering call lights in a timely manner, waking up sleeping patients to give meds, taking many attempts to start an IV line Nurses angry at management- unilateral changes in work schedule, additional paperwork, reductions in staff levels, refusal of requests for vacation/time off

Name 3 causes of complaining and whining behaviors.

People are unhappy/disappointed because their lives have not met the expectations they had for themselves when they were younger, lack of self-esteem, feeling left out

Explain the role of the persecutor and list 5 therapeutic techniques the nurse can use when communicating with the persecutor.

Persecutors are also called dictators and bullies, and generally display an attitude of being superior to others and being in control. The attempt to humiliate, intimidate, threaten, and demean other individuals or groups. Therapeutic techniques- set the stage for communication, listen to what is really being communicated, be assertive, use a line of discussion that will get their attention, avoid doing nothing, avoid personal attacks, remember that they are acting the way they do because of some lack in their lives.

Differentiate between positive and negative ways to express anger.

Positive anger can promote change, release tension, increase others' attention, initiate communication, problem-solve, and energize the process. Negative anger is destructive, hinders communication, makes coworkers fearful, and erodes relationships with others.

Civil behavior in the classroom setting.

Practice proper etiquette, assume goodwill, listen to and respect others, be flexible and open-minded, keep cell phones on silent and use proper cell phone etiquette, use laptop for classwork only, do not have side conversations, give notice of change in advance, be present and on time, have fun

What are the common factors that contribute to uncivil behavior in the clinical setting?

Rapid technological changes, staff shortages, poor staff-to-staff interpersonal communication and relationships.

Define data.

Raw, unstructured facts.

Distinguish between religion and spirituality.

Religion is a way that someone can practice spirituality, and spirituality is often a component of religion. (you can be spiritual without being religious)

Define knowledge.

Synthesis of data and information.

What is an electronic health record (EHR)?

The digital version of a patient's paper chart. They make the patient's information available instantly and securely to authorized users.

How does the golden rule apply to civility?

The golden rule states "treat others how you wish to be treated" which is considered a simple definition of civility.

Describe the importance of communication in a culture of civility.

The health of patients is predicted on good communication.

Define arbitration.

The last step before the dispute is taken to court. Can be either non-binding or binding, and both parties must agree ahead of time to comply with whatever decision is reached by the arbitrator.

Define nursing informatics.

The specialty that combines nursing science and practice with information technology so that nurses can recognize, delineate, control, and communicate statistics, information, comprehension, and insight in nursing practice.

Describe "never events".

They are reasonably preventable medical errors that occur in the hospital.

How can human factors impact health care?

They can lead to medical errors which can cause injury or death of a patient.

Define benchmarking.

To evaluate something by comparing it with a standard.

Name one of the primary goals parents have in raising children.

To teach them adult coping skills to deal with problems and help them outgrow immature and childish coping mechanisms of manipulation and exploitation of others.

Establishing __________ is the key to any successful relationship.

Trust

Define bulldozer behavior.

Use aggressive complaining to manipulate others into working with them.

Define gossiping behavior.

Use complaining to make themselves look better (interrupting others, bragging about their accomplishments, etc...).

Define toxic behavior.

Use their behavior to purposely manipulate or poison the environment so everyone else will be just as unhappy.

Define mediation.

Used when the sides are unable to reach a resolution to their differences. An appointed mediator works with both sides to reach an agreement. The agreement is non-binding and either side can reject the settlement.

Differentiate between verbal, nonverbal, and paraverbal communication.

Verbal communication is either written or spoken. Nonverbal communication includes body language, facial expressions, gestures, physical appearance, touch, and personal space. Paraverbal communication is the tone, pitch, volume, and diction used when delivering a verbal message.