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NURS 455: Final Exam

Terms in this set (224)

#1 all communication is either assertive or passive
- there are actual 4 possibilities: passive, aggressive, indirectly aggressive or passive-aggressive, or assertive

#2 those who communicate or behave assertively get everything they want
- being assertive involves both rights and responsibilities

#3 assertiveness is unfeminine
- involves conveying a message that insists on being heard - assertive, active, decision making
- not rude or insensitive behavior; rather, it is having an informed voice that insists on being heard

#4 assertive and aggressive are synonymous: assertive communication does not become aggressive

when under attack by an aggressive person, an assertive person can
- Reflect: reflect the speaker's message back to him/her: focus on the affective components of the aggressor's message; ex. "I understand that you are very upset about your schedule. This is an important issue, and we need to talk about it"
- Repeat the assertive message: effective when the aggressor overgeneralizes or seems fixated on a repetitive line of thinking - ex. "I am willing to discuss this issue with you in my office. The hallway is not the appropriate place for this discussion"
- Point out the implicit assumptions: involves listening closely and letting the aggressor know that you have heard him/her - repeat major points or identify key assumptions to show that they are following the employee's line of reasoning
- Restate the message by using assertive language: defuse the emotion
- Question: when aggressor uses nonverbal cues to be aggressive --> put behavior in form of a question as an effective means of helping the other person become aware of an unwarranted reaction
cause #1: stems from the individual's false assumption that delegation may be interpreted as a lack of ability on his/her part to do the job correctly or completely
- leaders should delegate some of the most difficult tasks because reluctance to give ownership of the tough stuff to your employees indicates a lack of trust toward the people you hired

cause #2: individual's desire to complete the whole job personally d/t lack of trust in the subordinates; some nurses believe that he/she needs the experience or that he/she can do it better and faster than anyone else (even if that is sometimes the case)
- communicating frequently with those to whom you've delegated to check the progress of the task can help decrease this fear and should give the delegator some sense of control
- it will likely be unnerving (at least initially) to allow a team member to complete a task for which you are ultimately responsible

cause #3: leaders must remember that employees make mistakes
- employees will never learn how to really do a task if you don't give them the chance

cause #4: not enough time to delegate
- while it does take time to explain a task, delegation increases productivity and provides subordinates the opportunity to experience feelings of accomplishment and enrichment

cause #5: lack experience in the job or in delegation itself OR nurses refuse to delegate because they have an excessive need to control or be perfect

cause #6: fail to anticipate the help they will need
- the best time to delegate is before you become overwhelmed

cause #7: find it difficult to assume the manager role
common response by subordinates to delegation

one of the most common causes of subordinate resistance to, or refusal of, delegated tasks is the failure of the delegator to see the subordinate's perspective.

if the subordinate is truly overwhelmed, additional delegation of task is inappropriate, and the RN should re-examine the necessity of completing the delegated task personally or finding someone else who is able to complete the task

some resist delegation because they believe they are incapable of completing the delegated task
- if the employee is capable but lacks self-confidence --> the astute leader may be able to use performance coaching to empower the subordinate and build self-confidence levels
- if the employee is truly at high risk for failure --> appropriateness of delegation much be questioned and a task more appropriate to that employee's ability level should be delegated

another cause of subordinate resistance is inherent resistance to authority
- some subordinates need to "test the water" and determine what consequences are of not completing delegated tasks
- delegator must be calm but assertive about his/her expectations and provide explicit work guidelines and if necessary to maintain an appropriate authority power gap

resistance may be occurring because tasks are overdelegated in terms of specificity
- all subordinates need to believe there is some room for creativity and independent thinking in delegated tasks

the delegator must ascertain why the delegated task was not accomplished and take appropriate action to eliminate these restraining forces
define the scope and dimensions of professional nursing

ANA played a key role in this - established standards for nursing practice, thereby providing a means of determining the quality of nursing that a patient receives, regardless of whether such services are provided by a professional nurse alone or in conjunction with nonprofessional assistants
- assessment: collect comprehensive data pertinent to the healthcare consumer's health or the situation
- diagnosis: analyze assessment data to determine the diagnoses or issues
- outcomes identification: identifies expected outcomes for a plan individualized to the healthcare consumer or the situation
- planning: develop a plan that prescribes strategies and alternatives to attain expected outcomes
- implementation: coordinates care delivery and employs strategies to promote health and a safe environment
- evaluation: evaluate progress toward attainment of outcomes

nursing administration: scope and standards of practice: regarded as authoritative statements of the duties that all nurse administrators, regardless of role, are expected to perform competently

clinical practice guidelines (CPGs) or standardized clinical guidelines: provide diagnosis-based, step-by-step interventions for providers to follow to promote high quality care while controlling resource utilization and costs
- developed following an extensive review of the literature and suggest what interventions, in what order, will likely lead to the best possible patient outcomes
- should reflect evidence-based practice; that is, they should be based on cutting-edge research and best practices
employee must believe that the appraisal is based on standard to which other employees in the same classification are held
- if employees believe that the appraisal is based on their job description rather than on whether the manager approves of them personally, they are more likely to view the appraisal as relevant
- standard must be communicated clearly to employees at the time they are hired and may be a job description or an individual goal set by staff for the purpose of performance appraisal
- employees must know what happens if standards are not met

employee must believe the appraisal tool adequately and accurately assesses performance criteria directly r/t his/her job

employee should have some input into developing the standards or goals on which his/her performance is judged

employee must know in advance what happens if expected performance standards are not met

employee needs to know how information will be obtained to determine performance -- appraisal tends to be more accurate if various sources and types of information are used

appraiser should be one of the employee's direct supervisors
- communicate informally with staff on a continual basis, so there should be little or no new information at an appraisal conference

performance appraisal is more likely to have a positive outcome if the appraiser is viewed with trust and professional respect

employees' perception of fairness in the performance appraisal may be contingent on how well they feel they were supported by their supervisors as well as the transparency that existed between the employee and the manager in terms of expectations
do not need to know that someone is impaired; you must only have a reasonable suspicion that the behavior you are witnesses or has been reported to you does not meet the standards of safe practice

as the employee progresses into chemical dependency, managers can more easily recognize these behaviors
- 3 main areas: personality/behavior changes, job performance changes, time and attendance changes

in the earliest stages, employee uses addictive substance primarily for pleasure --- substance use does not usually occur during work hours

as it deepens, the employee develops tolerance to the chemical and must use greater quantities more frequently to achieve the same effect
- high use of defense mechanisms such as justifying, denying and bargaining about the drug
- employee uses drug both at and away from work
- most highly rated barriers to seeking assistance for substance use included fear and embarrassment and concerns about losing one's nursing license

in the final stages, the employee must continually use the chemical substance even though he/she no longer gains pleasure or gratification
- employee's personal and professional lives focus on needs for drugs, and employee becomes unpredictable and undependable in the work area
- assignments are incomplete or not done at all, charting may be sloppy or illegible, frequent judgment errors occur, signs of drug use during work hours, vials are missing, employee is absent for brief periods with no plausible excuse, excessive mood swings, employee looks physically ill