Leadership Exam 2

total quality management

- A philosophy that involves everyone in an organization in a continual effort to improve quality and achieve customer satisfaction. - focus on system more than ind. Doing right things, right way, and prevention.

What would accurately describe appropriate delegation?

- Increases the scope of the nurse's liability - Helps manage the health care team - Is based on clear communication

What is moral distress?

- When the nurse knows the right thing to do but either personal or institutional factors make it difficult to do the right thing. - usually occurs with 2 ethical principles compete

What are included in tort?

- assault and battery - false imprisonment - invasion of privacy - defamation of character - physical restrain that leads to claims of false imprisionment

Total Patient Care is also called

- case method nursing - span of control

What are leapfrog group initiatives?

- computerized physician order - EBP - ICU physician staffing - use leapfrog safe practice score

2 analysis benchmarking uses

- critical event analysis - root cause analysis

What is the "just culture"?

- deemphasizes blame for errors - focuses on addressing factors that lead to med error

Method to implement change of Studer (6)

- effective communication - critical thinking - rounding on staff and pt - motivate and recognize staff - select and retain talent - developing the healthcare team - pre-and post visit pt call

What is the disadvantage of functional nursing?

- fragment care - overlooking pt priority needs

The function of BOARD of RN?

- monitor RN educational standards - RN continouing education - Discipline RNs - Boundaries for practice are defined in the Nurse Practice Act of each state

What UAP can do?

- non invasive/ non sterile treatment - Collect/reporting data: VS, weight, height, I/O, cap ref, or collect urine for testing - Ambulation, positioning, turning - transport within facility - personal hygiene - feeding - ADLs and social activities

Medicaid

- poor - people dont have insurance - pregnant women dont have insurance - disability <65

Evidence Base leadership must have according to Studer

- rounding for outcomes - thank you notes - selection and the first 90 days - key words at key time - post phone call

Audit used in quality control

- structure - process - outcome

Hallmarks of Effective Quality Control Program

- support from top level administration - quality goals - process is going on

What are 5 rights of delegations?

- task - circumstance - person - direction/ communication - supervision

two approaches to Ethical Decision Making

1. Deontological - duty 2. Teleological - outcome/reason

Steps in Auditing Quality Control

1. Establish control criteria 2. Identify the info related to the criteria 3. determine ways to collect the info 4. Collect and analyze 5. Compare collected info with established criteria 6. make a judgement about quality 7. provide info and take correct action if needed 8. re-evaluation

Framework for ethical decision making

1. Utilitariansism 2. Duty-base reasoning 3. Right base reasoning 4. Intutionism

Steps in the decision making process

1. gather facts 2. brainstorm 3. pros/cons 4. decide 5. follow through 6. define/ clarify

Two models of QI

1. total quality management (TQM) - continuous quality improvement 2. Toyota production system (TPS)

3 prioritizing information

1. tracking pt information 2. setting time management 3. making lists 4. reprioritizing

What are the sample of ethical making decision?

1. traditional problem solving process 2. nursing process 3. MORAL - decision making model (Crisham, 1985)

how many days after feeding remove she dies?

13

how many malpractice case every year?

17,000

How many judges in her case?

19

What year her husband want to remove feeding tube?

1998

how many percent of pt show self of wareness when he tested?

20%

A nurse informs the nurse leader that it would be beneficial to delegate more to the UAP, but the nurse leader is reluctant to do so, stating, "Whenever I do, they always come back with so many questions. I need them to just do it!" What kind of delegation error is the nurse making?

Improperly delegating

A registered nurse on a busy hospital unit is responsible for several tasks that require clear and accurate communication. For which task should the nurse use the SBAR technique for communication?

Informing a health care provider about a change in a patient's health status

Who come check the hospital?

Joint Commission

What case manager uses?

MAP (multidisciplinary action plans): critical pathway and nursing care plan

What type of hospital needs to have accreditation?

Magnent status

Who facilitates with high nurses satisfaction?

Magnet status

MORAL

Massage the problem Outline options Review criteria and resolve Affirm position and act Look back. Evaluate the decision making

CMS is a regulatory organization for

Medicare and Medicaid

What private non profit organization that accredits managed care organizations, also developed the Health Plan Employer Data and Information Set (HEDIS) to compare quality of care in managed care organization?

National Commitee for Quality Assurance (NCQA)

A nurse manager has a high turnover rate of assistant managers in the unit. The current assistant manager states to the manager, "I may not be the right fit for this position. I can't keep up with the amount of work and delegated tasks." What delegation error is the manager making?

Overdelegating

What minor baseball team does Studer own?

Pensacola Blue Wahoos

Proof required to be found guity is

Preponderance of the evidence

A nurse is struggling with time management and thinks it might help alleviate stress and strengthen leadership skills if some tasks are delegated to unlicensed assistive personnel (UAP). What would be important for the nurse to consider when delegating to UAP?

Qualifications of the person who will carry out the task What can and can't be delegated safely

What is "the compact"?

RN maybe licensed in one state and practice in another state within compact

What happen to Terri?

She had a cardiac arrest and led her to have persistent vegetative state d/t lack of O2

A nurse has begun working in a new state and is unsure whether tasks involving a patient's intravenous line can be delegated to a licensed professional nurse/licensed vocational nurse (LPN/LVN). What is the best source for identifying whether this task can be delegated?

The state's Nurse Practice Act (NPA)

Nursing licensure is a privilege and not a right? T/F

True

What strategic examines?

an organization's purpose, mission, philosophy, and goals in the context of it's external environment.

Root cause analysis or critical event analysis

helps to identify the process of error and to make sure that it does not reoccur.

What is the disadvantage of team nursing?

improper implementation

What is sigma?

is a stastical measurement that reflects how well a product or process is performing

Benchmarking

is the process of measuring products, practices, and services against best performing organizations as a tool for identifying desired standards of organizational performance. In doing so, organizations can determine how and why their performance differs from exemplar organizations, and use the exemplar organizations as role models for standard development and performance improvement.

What is the role of CMS?

measuring quality in health care including pay for performance

The word for "reason for organization's existence"?

mission

What difference btw non-profit vs profit?

non-profit dont pay taxes

Paternalism

one individual assumes the right to make decisions for another

System Theory

organized (structure, technology, people, environment)

Organizing Patient Care is based on what?

patient acuity

the word for "expresses the values and belief's that members of the organization hold true"?

philosophy

Maslow's Hierarchy of Needs

physiological, safety, love/belonging, esteem, self-actualization

What model of pt care that primary nurse has 24 hours responsibility for planning pt care from admission to treatment to discharge?

primary nursing

What is the vital leadership role in ethical decision making?

self awareness

legal wrongs committed against a person or property, independent of a contract, that render the person who commits them liable for damages in a civil action?

tort

What model of pt care that nurse is responsible for meeting the needs of all assigned patients during their time on duty?

total patient care

Autonomy

promote self determination/freedom of choice

"the thing speaks itself", harm is obviously the result of negligence

res ipsa loquitur

"the master is responsible for the acts of his servant"

respondeat superior

"to let the decision stand" - use precedents

stare decisis

What is six sigma approach?

statistical measurement that reflects how well a product or process is performing

What is the hallmark of quality control?

support from top level administration

A new charge nurse is leaving work each day feeling overwhelmed and not completing tasks. What kind of delegation error is the charge nurse making?

Underdelegating

What model of pt care has ancillary personnel collaborated to provide care to pt under the direction of a professional nurse and requires extensive team communication and planning?

team nursing

Veracity

telling the truth

Utility

the good outweighs the want/need on ind

wrong fault act

tort

What is the minimum hours needs to complete before becoming CNA?

75 hours

Medicare

>65

What delegation requires?

trust

Chaos Theory

A theory that emphasizes systems processes that produce change, even sudden, rapid change.

Nurse Practice Act is written by who?

ANA

Who has played a key role in developing standards for the nursing profession?

ANA

The first code of ethics for nurses was adopted by who?

ANA (1950, been revised six times)

Who write Nurse Practice Act?

American Nurses Association (ANA)

What document document that will ensure the patient's wishes are carried out?

An advance directive

The Good Samaritan Law is based on what ethical framework?

duty base

fidelity

faithfulness; loyalty; keeping promises

What model of pt care is assigned by task rather than pt?

functional nursing

Transitioning nurse from caregiver to ___

Care integrator

Benchmarking

Comparing an organization's practices, processes, and products against the world's best.

Which of the following creates the potential for successful delegation as emphasized by the National Council State Board of Nursing?

Effective communication

Which of the following are delegation errors made by nurse leaders?

Failure to provide adequate directions Failure to release control of task Failure to delegate Failure to provide clear directions Failure to follow up

HIPAA stands for

Health Insurance Portability and Accountability Act

What is the first survey of pt's perspective of hospital care called?

Hospital Customer Assessment of Healthcare Provider and Sytems

A patient on a busy neurosurgical unit who just returned from surgery requires neurological checks every hour, but the nurse is too busy to do it and delegates this task to the unlicensed assistive personnel (UAP). What error in delegation has the nurse made?

Improper delegation

What is "involve helping others to grow and self-actualize" called?

advocacy

Joint Commission

an independent, not-for-profit organization that evaluates and accredits healthcare organizations

Best practices

are the determination of what type of process produces the best results after gathering information from multiple sources

The nurse at a long-term care facility is considering whether to delegate some tasks to nursing assistive personnel (NAP). Before doing so, the nurse must:

be familiar with the NAP's knowledge, skills and experience.

What model of pt care focuses on individual pt rather than population of clients?

case management

ED or clinical associated to the hospital has better funding?

clinical bc it gives better access of care

Crisham's MORAL decision-making model begins with

collect data about the ethical problem

The word for "articulated goal to which the organization aspires"?

vision

Frequent causes of claims against nurses?

• Inadequate charting. • Inadequate communication with physician or supervisors about changes in client conditions. • Leaving potentially harmful items within client reach. • Unattended patient falls. • Inaccurate counting of operative instruments and sponges. • Misidentifying patients for medications, surgeries, tests.