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Terms in this set (176)
The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the:
a.
resister.
b.
innovator.
c.
change agent.
d.
strategist.
a.
resister.
b.
innovator.
c.
change agent.
d.
strategist.
A small critical care unit forms a team of nurses to implement bedside rounds at shift change. The nurses have researched the efficacy of bedside rounds and have determined that this evidence-based practice will lead to improved communication of patient status. Which type of change does this demonstrate?
a.
Transforming care at the bedside
b.
Second-order change
c.
Emergent change
d.
Organizational change
a.
Transforming care at the bedside
b.
Second-order change
c.
Emergent change
d.
Organizational change
How is the refreezing stage of change similar to the nursing process?
a.
Refreezing is similar to the assessment phase of the nursing process.
b.
Refreezing is similar to the problem identification phase of the nursing process.
c.
Refreezing is like the planning and implementation phase of the nursing process.
d.
Refreezing is like evaluation in the nursing process.
a.
Refreezing is similar to the assessment phase of the nursing process.
b.
Refreezing is similar to the problem identification phase of the nursing process.
c.
Refreezing is like the planning and implementation phase of the nursing process.
d.
Refreezing is like evaluation in the nursing process.
A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of:
a.
rapid response teams.
b.
Failure Modes and Effects Analysis.
c.
root cause analysis.
d.
Rapid Cycle Change.
a.
rapid response teams.
b.
Failure Modes and Effects Analysis.
c.
root cause analysis.
d.
Rapid Cycle Change.
D. "This change is being made so that there is no further harm to another patient."
Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change.
Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change.
An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued?
a.
"These changes need to be made because the state and CMS require it."
b.
"We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building."
c.
"We need to make this change because it will help our lawsuit."
d.
"This change is being made so that there is no further harm to another patient."
a.
"These changes need to be made because the state and CMS require it."
b.
"We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building."
c.
"We need to make this change because it will help our lawsuit."
d.
"This change is being made so that there is no further harm to another patient."
D. Laggards
Nurse leaders need to recognize that change will be accepted at varying rates and target interventions accordingly. The five categories in order are innovators, early adopters, early majority, late majority, and laggards.Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change?
a.
Early adopters
b.
Late majority
c.
Innovators
d.
LaggardsC. Planned change
The development of new practices in response to new evidence or best practices occurs regularly and falls under planned change. One example is the broad adoption of evidence-based protocols and practices as a way of making sure that desirable outcomes are achieved.The development of new practices in response to new evidence is called:
a.
altered direction.
b.
organizational flux.
c.
planned change.
d.
status revision.B. Resistance
Almost all changes encounter some resistance as a natural phenomenon. Resistance may be rooted in anxiety or fear.Almost all changes encounter:
a.
attitudes.
b.
resistance.
c.
knowledge.
d.
communication.B. Transformation
Transformation is the use of new ideas, innovation, and creativity to change fundamental properties of the state of a system.The charge nurse of a small nursing unit would like to gain staff acceptance of a time-intensive, budget-imposed change required by the hospital administration. She plans to emphasize several evidence-based research projects that have shown improved patient health outcomes as a result of implementing this change. This is an example of which of the following organizational change concepts?
a.
Budget-oriented change
b.
Transformation
c.
Resistance
d.
Emergent changeA. Accepting the need for change
Change must begin with an awareness of the need for change and end with a general acceptance of the necessity of change.The first stage of planned change involves:
a.
accepting the need for change.
b.
cognitive redefinition.
c.
integration and stabilization.
d.
problem solving.B. Force field analysis
Driving and restraining forces influence any situation. A force field analysis facilitates the identification and analysis of driving and restraining forces in any situation.The identification of forces that drive and restrain change is called a(n):
a.
equilibrium evaluation.
b.
force field analysis.
c.
status quo analysis.
d.
refreezing system.A. Change agent
The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager's actions characterize her as a(n):
a.
change agent.
b.
implementation expert.
c.
restructuring motivator.
d.
supervisory threat.D. The grief model
The grief model is the most accurate, because change produces a longing for what is familiar, even if it is not what is best or realistic.A nurse manager recognizes that her staff's emotional responses to organizational change are similar to:
a.
adaptation techniques.
b.
integrative tactics.
c.
symptoms of mental illness.
d.
the grief model.D. Open communication
Open communication within the change process, early involvement of staff, listening to their input and concerns, and engaging them in the change may be the most effective means to assess readiness for change.A memo sent to the unit nurse manager reads that beginning next week; all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that change will be more effective through which manner of communication?
a.
Storytelling
b.
E-mail
c.
Discussion
d.
Open communicationB. Discuss the situation with the nursing manager who interviewed him.
The nurse should discuss the situation with the nursing manager who interviewed him before quitting. Perhaps there is a temporary problem affecting staffing that could explain the situation. If after this discussion it is believed that the staffing is not now or ever will be as it was relayed to him in the interview, then he should seek employment elsewhere.An experienced nurse has recently taken a position on a telemetry unit in the local hospital. After 2 weeks on the job, he finds that the staffing is not what was discussed during his employment interview with the nurse manager. Which approach would be most appropriate for the nurse to take?
a.
Give 2 weeks' notice and begin seeking employment at another hospital.
b.
Discuss the situation with the nursing manager who interviewed him.
c.
Talk to other employees about the staffing situation.
d.
Notify the charge nurse that this was not what was explained to him prior to employment.C. Ask the nurses to participate in the planning and implementation of the change.
Change is always difficult, especially when it has been forced on people, threatens their security, or seems unnecessary. Change is more palatable when nurses participate in the planning and implementation and see that it is worthwhile.The nurse manager on a medical-surgical unit wants to change to "walking rounds" in the patients' rooms for change of shift report. In the past, it has been "face to face" at the nurses' station. The nurse manager is meeting resistance from the staff, because they think that it will take longer, and the nurses will not finish their shift on time. What could the manager do to increase the nurses' acceptance of this change?
a.
Inform all shifts that there have been some lapses in communication regarding patient needs and that involving the patient in the report will help alleviate this.
b.
Inform all nurses that to reach Magnet status, this type of change of shift report is required.
c.
Ask the nurses to participate in the planning and implementation of the change.
d.
Ask the nurses to try this type of change of shift report for 1 week and then have them evaluate it.B. Change within an organization is often externally imposed.
C. Change within an organization may originate internally.
E. Change is often complex and irrational.
Changes within an organization may be necessary due to external or internal demands. Change is seldom easy and may be complex and irrational.Which of the following statements are accurate descriptors regarding change? (Select all that apply.)
a.
Organization-wide change is more sustainable when leadership imposes the change.
b.
Change within an organization is often externally imposed.
c.
Change within an organization may originate internally.
d.
Nurses do not need to participate actively in the organizational changes.
e.
Change is often complex and irrational.B. Viewing the organization as an interrelated system is known as systems thinking.
C. Individuals utilize mental models to understand how their vision affects their decisions and actions.
D. Shared vision is conducted within a group to determine plans to get to the preferred future.
Mental models allow individuals to develop, create, and project a personal vision and understand how these views affect their decisions and actions. Shared vision is encouraged within a group for development of plans. A sharing of learning skills is encouraged as a group so that learning can occur as a group. The organization is viewed as an interrelated system, rather than in unrelated parts, in systems thinking.Learning organizations adapt to change through their ability to be open, dynamic, and responsive to changes in the environment. Which of the following learning disciplines are true of these types of organizations? (Select all that apply.)
a.
Learning is conducted in individual parts rather than in groups.
b.
Viewing the organization as an interrelated system is known as systems thinking.
c.
Individuals utilize mental models to understand how their vision affects their decisions and actions.
d.
Shared vision is conducted within a group to determine plans to get to the preferred future.
e.
Personal mastery encourages individuals to create results as they see fit.A. Reframe difficult questions
C. Provide active listening
D. Promote action steps and solutions.
E. Keep staff informed of decisions.
F. Communicate with participation.
Emotional responses are an expected part of change, and managers need to be able to provide emotional support to staff during periods of stress. Some of the effective strategies are active listening, promoting action steps and solutions, keeping staff informed of decisions, soliciting input, encouraging participation, and reframing difficult questions.During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members? (Select all that apply.)
a.
Reframe difficult questions.
b.
Communicate facts through e-mail.
c.
Provide active listening.
d.
Promote action steps and solutions.
e.
Keep staff informed of decisions.
f.
Communicate with participation.A. Explain the rationale for a change so that individuals understand it
C. Give participants all the information they need
E. Help individuals cope with change
Announcing the change without laying a foundation and relying only on formal authority in implementing change are actions to be avoided when implementing change within an organization.The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.)
a.
Explain the rationale for a change so that individuals understand it.
b.
Simply announce the change without laying a foundation.
c.
Give participants all the information they need.
d.
Rely only on formal authority in implementing change.
e.
Help individuals cope with change.B. Give the nurses adequate notice of change
D. Explain the rationale and patient impact
A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.A group of nurses is showing resistance to changes the manager is making with regard to staffing. Which of the following ways can the manager deal with the emotionality of the situation? (Select all that apply.)
a.
Use persuasion.
b.
Give the nurses adequate notice of change.
c.
Avoid discussion.
d.
Explain the rationale and patient impact.
e.
Inform staff that senior leadership made the decision.C. Shared beliefs and values
Culture is described as shared beliefs and values. It provides a common belief system among its members but is not expected to hold similar views and opinions of its members.Culture is best defined as (the):
a.
deviation from the majority.
b.
differences in likes and dislikes.
c.
shared beliefs and values.
d.
similar views and opinions.B. Perceptions that individuals have about an environment
Climate is defined as the perceptions that individuals have about a particular unit or environment.Climate is best defined as the:
a.
health and well-being of the structure of a facility.
b.
perceptions that individuals have about an environment.
c.
style in which individuals treat each other.
d.
temperature in the nursing units of an institution.A. Climate
Climate is the perception that individuals have about a particular unit or environment.A professor at the local college of nursing is teaching at a new clinical site. She notes that the nurses greet each other and their clients with warmth and a smile. She also notes that the policies and procedures encourage nursing autonomy. Nurses and physicians seem to have a collegial relationship. These observations best describe the _____ of the unit.
a.
climate
b.
culture
c.
interactions
d.
operationA. Multidisciplinary collaboration
Characteristics of a Magnet hospital include nursing autonomy, practice control, and collaboration. Nursing support, collaborative partnerships with physicians, and nursing practice are other aspects.Characteristics of a Magnet hospital include:
a.
multidisciplinary collaboration.
b.
nursing leader authority.
c.
physician control.
d.
social worker retention.D. Insight
Insight can be described as a process used to achieve knowledge, skills, and behaviors of a certain group to belong and participate. Nurses' insight enables them to better understand behaviors, relationships, norms, change processes, expectations, and communication.A process used to achieve and internalize knowledge, skills, and behaviors of professional nursing in order to belong and participate is referred to as professional:
a.
actions.
b.
conduct.
c.
ownership.
d.
insight.C. Interview each nurse about his or her perspective
Changing the culture requires the following to be done: (1) identify the desired change; (2) assess the current status of the group; (3) create a shared need and group commitment to change; (4) use appropriate communication skills and personal contact to establish open discussion; (5) identify shared values and mission so that the group knows where it is going; (6) determine strategies; and (7) develop an action plan for change. Interviewing each nurse would provide an opportunity for personal contact and attempt to establish open discussion.The nursing manager wants to change the culture of the nursing unit. Some of the older nurses are bullying the newer nurses, which seems to be affecting self-confidence in their new nursing roles. Which of the following strategies would be helpful in this endeavor?
a.
Assign mentors to the new nurses.
b.
Determine the roles of each nurse.
c.
Interview each nurse about his or her perspective.
d.
Suspend the bullying nurses for harassment.B. Culture
Key areas under the leader's control in which culture can be affected are staff recruitment and retention, welcoming new staff, orientation, celebrating and recognizing staff accomplishments, facilitating change, and promoting a learning environment.The nursing manager of a telemetry unit has developed a policy in which all nurses automatically are scheduled to have a day off from work on their birthday unless they request to work on that day. He also gives a small gift to each nurse who becomes certified in his or her specialty area. This manager's actions are positively affecting the _____ of the unit.
a.
climate
b.
culture
c.
interactions
d.
operationC. The values and actions may not be congruent
The values drive the way that resources are distributed. In this case, the values of nursing and actions of the organization may not be congruent.A nurse is interviewing for a position at a prominent hospital in her community. She notes a separate physicians' dining room, but all other professionals and visitors eat in the same dining area. The physicians have a separate parking area. Nurse practitioners and physician assistants are asked to park in the staff lot. What might these observations suggest?
a.
The mission statement supports collaborative care.
b.
The philosophy of the organization depicts inequality.
c.
The values and actions may not be congruent.
d.
The vision for nursing is defined clearly.C. Climate
The climate of the unit is evident in policies, unit norms, dress code and appearance, environment, communication, and teamwork.Patient surveys reveal that patients do not know which caregiver is the registered nurse (RN). A task force consisting of nursing staff is formed to develop a plan to address this issue. Many ideas are discussed to reinforce the role of the professional nurse and to make it easy for patients to recognize the RN, such as changing the dress code. Decisions resulting from this task force will mostly reflect the:
a.
goals.
b.
mission.
c.
climate
d.
values.D. A root cause analysis
To change the culture from "who dunnit?" to an environment that is respectful and open to learning, it is necessary for the climate to change. It is essential to be able to discuss mistakes freely, with the intention of learning from them by doing a root cause analysis.Determining the origin of errors with a focus on prevention is known as which of the following?
a.
A civil investigation
b.
A voluntary reporting program
c.
An administrative review
d.
A root cause analysisB. provider; patient
The IOM report, Crossing the Quality Chasm, describes challenges in care provision and details the shift of moving from provider-centered care to patient-centered care. The need for patient and family participation is a dominant force in treatment decisions.The Institute of Medicine (IOM) report, Crossing the Quality Chasm, was useful in describing the challenges related to moving from _____-centered to _____-centered care.
a.
patient; provider
b.
provider; patient
c.
patient; facility
d.
provider; financiallyC. To provide a common bond so that members know how to relate to one another and show others outside the organization what is valued
Culture is the set of values, beliefs, and assumptions that are shared by members of an organization. The purpose of culture is to provide a common bond so that members know how to relate to one another and to show others outside the organization what is valued.What is the purpose of culture in an organization?
a.
To provide a perception of what it feels like to work in the organization
b.
To provide an organization's response to economic, social, and financial challenges
c.
To provide a common bond so that members know how to relate to one another and show others outside the organization what is valued
d.
To provide a small geographic area within the organization where nurses provide careA. Open visiting hours in the critical care unit (CCU)
Open visiting hours in the CCU convey the importance of family as partners in care delivery. This is a representation of culture within a nursing unit where a relationship-based nursing care model is used, and it represents an underlying belief in patient-centered care.How is culture represented at the unit level, with an underlying belief in patient-centered care?
a.
Open visiting hours in the critical care unit (CCU)
b.
Strict visiting hours in the CCU
c.
Tape-recorded report
d.
Verbal handoff conducted at the nurses' stationD. With a combination of qualitative and quantitative measures
The choice of a measurement instrument would be directed by definition, purpose, and context for the cultural assessment. It is likely that a combination of qualitative and quantitative measures would be the best means of capturing the culture of an organization.How is culture measured within an organization?
a.
Through the use of time-motion studies
b.
Through the use of quantitative instruments
c.
Through the use of qualitative instruments
d.
With a combination of qualitative and quantitative measuresC. Nursing work group
The nursing unit, or nursing work group, is a small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients.A small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients, is known as the:
a.
nurses' station.
b.
subculture.
c.
nursing work group.
d.
community.D. To offer a snapshot of strategic priorities
The mission statement for an organization offers a snapshot of strategic priorities and is an important way to get a sense of organizational values. A deeper understanding of cultural issues in an organization helps people understand how to improve outcomes.What is the purpose of a mission statement?
a.
To provide a method of achieving success and a competitive advantage
b.
To aid recruitment
c.
To guide members on problem solving and relationship management
d.
To offer a snapshot of strategic prioritiesA. Culture
Organizational culture affects the quality of nursing care and patient outcomes. The manner in which staff perceives culture, manages boundaries, and translates values has an impact on patient care.Organizational _____ affects the quality of nursing care and patient outcomes.
a.
Culture
b.
Climate
c.
fiscal stability
d.
case mixD. Asking staff to report near-misses of adverse events
Safety climate refers to keeping both patients and nurses safe. Part of a safety culture encourages nurses to report adverse events as well as near-misses of adverse events. Factors that influence avoidance of errors include staffing levels, excess fatigue, education, and experience.Which of the following exemplifies a safety climate within a nursing unit?
a.
Asking nursing staff to work a double shift
b.
Encouraging nurses to take the blame when a medication error occurs
c.
Asking staff to report medication errors only
d.
Asking staff to report near-misses of adverse eventsA. Nursing Home Reform Act
A series of quality improvement programs were implemented in nursing homes following the passage of the Nursing Home Reform Act legislation in 1987.Culture change within nursing homes was initiated by the:
a.
Nursing Home Reform Act.
b.
National Citizens' Coalition for Nursing Home Reform.
c.
Pioneer Network.
d.
Eden Alternative.C. E-mails or text messages
A work environment supportive to each generation is an important retention strategy. Tailoring the work environment to meet generational and life needs is a recurrent theme in being able to address staff retention.The nurse manager of a medical-surgical unit realized that there are differences in dealing with the varied generations of her nursing staff. How does the nurse manager communicate effectively with the Generation Y staff members (those born after 1980)?
a.
Typewritten memos
b.
Staff meetings held monthly for 2 hours
c.
E-mails or text messages
d.
Face-to-face interactionsA. Moving from a reactive culture to one that is fair and just
D. Providing a safe and efficient workspace
Included in the concept of a safety climate is a focus on nurse's health and safety. Nurses working in hospitals have one of the highest rates of work-related injuries, especially back injuries and needlesticks. One major shift in an organization's safety climate is the move from a punitive and reactive culture to a fair and just culture. In a fair and just culture, expectations for system and individual learning and accountability are transparent.The IOM report, To Err Is Human: Building a Safer Health System, recommends building a safety culture within an organization. This refers to keeping both patients and nurses safe. The organization supports nursing by: (Select all that apply.)
a.
moving from a reactive culture to one that is fair and just.
b.
demonstrating authoritarian behaviors.
c.
mandating nurses to meet patient needs.
d.
providing a safe and efficient workspace.A. Transparent communication
C. Evidence-based practice
D. Information technology
An explosion in information technology capacity is altering the speed and transparency of communication and information delivery. The impact of a nursing shortage, increased demand for nursing care, and the drive to incorporate evidence-based practice are changing the face of nursing care.What drivers of change are impacting nursing care? (Select all that apply.)
a.
Transparent communication
b.
Overabundance of nursing staff
c.
Evidence-based practice
d.
Information technology
e.
Reduced acute care needsC. To enable nurses to understand staff behaviors
D. To improve staff communication
E. To allow nursing staff insight into expectations and norms
Nurses' insight into culture enables them to better understand staff behaviors and relationships, norms, change processes, expectations, and communication.Why is it important for nursing staff to have insight into the culture of their unit? (Select all that apply.)
a.
So they can understand religious practices
b.
To allow time for peers to access the Internet more often
c.
To enable nurses to understand staff behaviors
d.
To improve staff communication
e.
To allow nursing staff insight into expectations and normsA. Supervisor support
C. Autonomy
D. Peer cohesion
E. Rewards and recognition
Some characteristics that are used to study climate are decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feeling of warmth, and risk.Researchers study organizational climate in order to examine how the work environment influences behaviors. Which of the following characteristics are utilized to study climate? (Select all that apply.)
a.
Supervisor support
b.
Unit staffing and its effect on incident reporting
c.
Autonomy
d.
Peer cohesion
e.
Rewards and recognitionA. Transformational leadership
C. New knowledge
E. Empirical outcomes
Today, hospitals and long-term care facilities wanting to achieve Magnet Recognition Program® status must meet five key components identified by the ANCC (2016): transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes.Hospitals and long-term care facilities wishing to achieve Magnet Recognition Program® must meet which of these components? (Select all that apply.)
a.
Transformational leadership
b.
Incident reporting
c.
New knowledge
d.
Actual staffing ratios
e.
Empirical outcomesB. Just culture occurs when the organization is transparent about its mistakes.
C. Interpersonal learning is balanced with personal accountability and discipline.
D. Expectations for system and individual learning are apparent.
In a just culture, organizational, individual, and interpersonal learning are balanced with personal accountability and discipline. In a fair and just culture, expectations for system and individual learning and accountability are transparent. The organization freely discusses mistakes with the intention of learning from them.Which of the following statements reflects just culture within an organization? (Select all that apply.)
a.
Just culture is a punitive reaction to patient errors.
b.
Just culture occurs when the organization is transparent about its mistakes.
c.
Interpersonal learning is balanced with personal accountability and discipline.
d.
Expectations for system and individual learning are apparent.
e.
Serious safety events are reported to senior leadership and kept confidential.B. Communication
Communication is the process in which information, perception, and understanding are transmitted from person to person.The process in which information, perception, and understanding are transmitted from person to person is:
a.
articulation.
b.
communication.
c.
evaluation.
d.
pronunciation.C. Non-verbal communication
Non-verbal communication is unspoken. It is composed of affective or expressive behaviors.Unspoken affective or expressive behaviors best describe which type of communication?
a.
Effective communication
b.
Ineffective communication
c.
Non-verbal communication
d.
Verbal communicationA. validation, emotion, reassurance, activity (VERA) framework.
The VERA (*validation, emotion, reassurance, activity*) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties (Hawkes et al., 2015).A communication model that focuses on compassion, expression of emotion, and providing validation via support is the:
a.
validation, emotion, reassurance, activity (VERA) framework.
b.
situation, background, assessment, and recommendation (SBAR) Communication Theory.
c.
nonviolent communication (NVC) model.
d.
Human Relationship Model.C. Persuasion
Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as:
a.
advisement.
b.
consultation.
c.
persuasion.
d.
suggestion.B. It is aimed at solving problems, conflicts, or disputes.
Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes.Which of the following is true about negotiation?
a.
It commonly results in a win-lose situation.
b.
It is aimed at solving problems, conflicts, or disputes.
c.
It is used only in contract and labor union disputes.
d.
It is the exchanging of favors or trading activity.A. Interpersonal communication
If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse's non-verbal behavior may suggest that she is not interested in interacting with the family.A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about:
a.
interpersonal communication.
b.
clarity.
c.
image.
d.
intention.B. Sharing vision and decision making
Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism.The transformational leader engages staff by:
a.
punishing errors.
b.
sharing vision and decision making.
c.
taking a top-down approach to leadership.
d.
making unilateral decisions for the team.A. Circumstance
Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own control. We have little control over others or the situation, because those are external to us.An example of an external variable that may affect communication is:
a.
circumstance.
b.
personality.
c.
thoughts.
d.
feelings.B. Disruptive
Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff._____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction.
a.
Defensive
b.
Disruptive
c.
Negotiating
d.
HumanizingD. Violation of the Health Insurance Portability and Accountability Act (HIPAA)
HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality.Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n):
a.
breach of beneficence.
b.
example of maleficence.
c.
potential assault and battery charge.
d.
violation of the Health Insurance Portability and Accountability Act (HIPAA).D. Communication between two or more individuals involving face-to-face interaction
Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.Interpersonal communication is defined as:
a.
the conscious intent by one individual to modify the thoughts or behaviors of others.
b.
a combination of written and spoken communication.
c.
a theory used to describe a manner of communicating.
d.
communication between two or more individuals involving face-to-face interaction.A. Unspoken cultural norms
The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole.Organizational tones are based mostly on:
a.
unspoken cultural norms.
b.
commitment to success.
c.
communication behavior.
d.
leadership styles.C. Negotiation
Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue.Which communication technique is most effective when handling patient complaints?
a.
Persuasion
b.
Bargaining
c.
Negotiation
d.
Non-verbal cuesD. TeamSTEPPS
Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events.A communication system developed originally to address communication patterns in critical situations is:
a.
VERA framework.
b.
NVC model.
c.
crucial conversations.
d.
TeamSTEPPS.B. Poor communication
The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program (AHRQ, 2016).The number one cause of preventable medical errors is:
a.
hostile work environments.
b.
poor communication.
c.
ineffective leadership.
d.
staff competency.B. SBAR (situation, background, assessment, and recommendation)
To address the "communication arm" of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.Which communication format was developed to address the communication arm of the TeamSTEPPS model?
a.
NVC (nonviolent communication)
b.
SBAR (situation, background, assessment, and recommendation)
c.
VERA (validation, emotion, reassurance, activity)
d.
MI (motivational interviewing)A. Trust
C. Respect
D. Empathy
Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.Effective communication is fostered through which of the following ingredients? (Select all that apply.)
a.
Trust
b.
Humility
c.
Respect
d.
Empathy
e.
SympathyB. Empathy
C. Compassion
D. Honesty
NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding.NVC communication processes are grounded in: (Select all that apply.)
a.
confrontation
b.
Empathy
c.
Compassion
d.
Honesty
e.
assertivenessB. Negotiation
C. Persuasion
Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co-operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse.A client's wife is concerned about her husband's declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed "no breathing machine" for long-standing care, but she is unsure of his wishes if he were to need a "breathing machine" for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client's physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client's concerns with the rest of the team. What type of communication technique is being utilized by the nurse? (Select all that apply.)
a.
Bargaining
b.
Negotiation
c.
Persuasion
d.
Spiritual assessment
e.
Collective actionB. Fax transmission sent to incorrect physician office
C. Prescription given to patient with wrong label attached
Fax transmissions sent to the incorrect physician's office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.Which of the following are examples of patient privacy or security breaches? (Select all that apply.)
a.
Encrypted e-mail communications
b.
Fax transmission sent to incorrect physician office
c.
Prescription given to patient with wrong label attached
d.
Case management coordinator obtaining information about a patient's diagnosis
e.
Discharge summary given to patient's spouseB. Beliefs
C. Values
D. Social
E. Religious
Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients' health care decisions and preferences.Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all that apply.)
a.
Culture
b.
Beliefs
c.
Values
d.
Social
e.
ReligiousA. Inwardly focused cultures
C. Fear of the unknown
D. Arrogant attitudes
Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process.Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.)
a.
Inwardly focused cultures
b.
Transformational leadership
c.
Fear of the unknown
d.
Arrogant attitudes
e.
Safety cultureB. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency
D. The communication of transformational leaders is focused on positive interchanges
E. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety
Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious. Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy (Sears, 2010).Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.)
a.
Transformational leaders have an authoritarian style of communication.
b.
Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency.
c.
Transformational leaders have a rigid bureaucratic one-way communication network.
d.
The communication of transformational leaders is focused on positive interchanges.
e.
Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety.B. At the forming stage, the group needs direction in defining goals
C. During the storming period, there is more willingness to accept the group goals
E. During the performing period, the members willingly perform the task
At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing.Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness? (Select all that apply.)
a.
Members are organized and secure about their roles in the forming stage.
b.
At the forming stage, the group needs direction in defining goals.
c.
During the storming period, there is more willingness to accept the group goals.
d.
The group becomes self-managing during the norming period.
e.
During the performing period, the members willingly perform the task.A. When you are mad
D. If there is any chance your words could be misunderstood
E. When rebuking or criticizing
Electronic communication has assisted us to be better informed regarding our patients. However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. Warrell (2012) noted that there are four times you should never use e-mail: (1) when you are mad, (2) when rebuking or criticizing, (3) if there is any chance your words could be misunderstood, or (4) when you are canceling or apologizing. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed.E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.)
a.
When you are mad.
b.
When scheduling a meeting
c.
When you are canceling or apologizing
d.
If there is any chance your words could be misunderstood
e.
When rebuking or criticizingB. Delegation
In their Joint Statement on Delegation (NCSBN, 2005b), the ANA and the NCSBN defined delegation in nursing as "the process for a nurse to direct another person to perform nursing tasks and activities."The process for a nurse to direct another person to perform nursing tasks and activities is:
a.
authorization.
b.
delegation.
c.
empowerment.
d.
supervision.D. Supervision
Supervision is the provision of guidance or monitoring of a delegated nursing task. It may occur in a variety of ways, including written and verbal communication (such as giving or receiving reports), observation of the performance of the delegated task, or assessing the patient for evidence that the delegated task has been completed successfully.The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is:
a.
authorization.
b.
delegation.
c.
observation.
d.
supervision.D. UAP
The NCSBN (2016) defined unlicensed assistive personnel (UAP) as any unlicensed personnel trained to function in a supportive role and to whom a nursing responsibility can be delegated.Individuals who are trained to help the registered nurse (RN) in the provision of patient-client care activities as delegated by and under the supervision of the RN are known as:
a.
certified assistive personnel.
b.
health care assistive personnel.
c.
medical assistive personnel.
d.
unlicensed assistive personnel.B. How complex the delegated action is
When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015).When considering whether to delegate a task, the nurse needs to assess the patient and:
a.
how many nurses are available to supervise.
b.
how complex the delegated action is.
c.
the severity level of the patient population.
d.
the expiration date of the license.C. Level of patient interaction
The level of patient interaction is the fifth factor that nurses should assess when making delegation decisions.According to the American Association of Critical-Care Nurses, there are five factors that a nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the:
a.
amount of time that the task will take.
b.
degree of comfort the delegatee has with the task.
c.
level of patient interaction.
d.
method of measuring outcomes.C. Supervision
The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation.The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right:
a.
interaction.
b.
outcome.
c.
supervision.
d.
time.A. Corrective action of the event
The nurse is also responsible for corrective action in case of an error.If an error occurs as a result of delegation, the nurse is accountable for supervision, follow-up, intervention, and:
a.
corrective action of the event.
b.
documentation of the event.
c.
evaluation of the process.
d.
summation of the occurrence.A. Assessment of the patient
The RN is responsible for assessment, evaluation, and nursing judgment, and should not delegate these professional responsibilities.The nurse has asked a nurse's aide to greet a postoperative patient who has just arrived on the unit and to determine whether he is in stable condition. This act of delegation is an example of a nurse inappropriately delegating:
a.
assessment of the patient.
b.
evaluation of an intervention.
c.
nursing judgment.
d.
teaching to a delegate.B. Institution where the LPN/LVN works
Organizational leadership in building the skills related to delegation enhances individuals and builds high-performing teams, as well as enhancing team member awareness of roles and responsibilities and their individual capabilities and limitations (Lanfranchi, 2013). The organization is accountable for the delegation processes in place and for upholding values of safe patient care and staff development.If a licensed practical/vocational nurse (LPN/LVN) provides discharge teaching, who is ultimately responsible?
a.
Chief executive officer
b.
Institution where the LPN/LVN works
c.
Risk manager
d.
UAPA. Accountability
The National Council of State Boards of Nursing (NCSBN, 2016) defined accountability as being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard.Being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard is:
a.
accountability.
b.
authority.
c.
supervision.
d.
delegation.C. RN who has experience as a hospice nurse
The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. A hospice nurse has experience in managing symptoms associated with the dying process. This is the best nurse to care for this patient.Which staff member should be assigned to a dying client who is experiencing symptoms of emotional distress?
a.
UAP who can be spared to sit with the client
b.
LPN/LVN who has grown attached to the family
c.
RN who has experience as a hospice nurse
d.
Newly graduated RNA. Client who had a vaginal hysterectomy and still has an indwelling catheter
The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. Options b, c, and d indicate the possibility of postoperative complications, but option a does not. The least experienced nurse should have the client who is not displaying the possibility of postoperative complications.The charge nurse is making assignments on a surgical unit. Which client should be assigned to the least experienced nurse?
a.
Client who had a vaginal hysterectomy and still has an indwelling catheter
b.
Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag
c.
Client who had a hip replacement and stated that something popped while walking
d.
Client who had a Whipple procedure and is reporting being thirsty all the timeD. Right direction/communication
The right direction/communication of delegated elements of care will be a clear, concise description of the task, including its objective, limits, and expectations. The nurse allows for clarification without the fear of repercussions.When determining that delegation of an element of patient care needs to occur, the nurse delegates with a clear, concise description of the task, including its objectives, limits, and expectations. The nurse allows the delegate to clarify without fear of repercussion. Which of the following five rights of delegation is being demonstrated?
a.
Right task
b.
Right circumstance
c.
Right person
d.
Right direction/communication
e.
Right supervision/evaluationA. The nurse who delegated the task
Accountability in delegation means being obligated to answer for one's actions, including the act of supervision. The nurse is ultimately accountable for the appropriateness and supervision of the delegated task. Thus the nurse may be found liable if found negligent in the process of delegating and supervising. The delegatee is accountable for accepting the delegation and for the actions in carrying out the delegated task.Who is ultimately accountable for the appropriateness and supervision of the delegated task?
a.
The nurse who delegated the task
b.
The UAP who accepted the task
c.
The nursing manager
d.
The hospital CEOB. Communication
Delegating requires skillful written and verbal communication to avoid liability. If an activity is not documented, it is considered that it was not done. Clear documentation of assignments and additional clarification of the delegated tasks for each health care team member are required when delegating.Delegating requires clear and skillful _____ to avoid liability.
a.
negotiation
b.
communication
c.
corrective action
d.
planningC. TeamSTEPPS
Invariably there will be potential problems as the use of delegation expands in health care. The nurse leader will need to be aware of techniques to address these potential problems. One such method is the TeamSTEPPS 2.0 (Team Strategies and Tools to Enhance Performance and Patient Safety) program. The framework followed is based on a foundation of team competencies including knowledge, attitudes, and performance. The principles the program abides by include team structure and the teachable principles of communication, leadership, situation monitoring, and mutual support.The nurse manager determines that communication style is contributing to problems with delegation on her unit. What tool is used to teach principles of communication, leadership, situation monitoring, and mutual support?
a.
American Nurses Association (ANA)
b.
Agency for Healthcare Quality and Research (AHRQ)
c.
Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)
d.
Institute for Healthcare Improvement (IHI)A. Nurse apprentices
B. Personal care attendants
E. Nursing assistants
Nurses often delegate to unlicensed assistive personnel (UAPs). UAPs include a number of health care disciplines, such as nursing assistants, medical assistants, nurse apprentices, and personal care attendants. A nurse would not delegate to a family member or a physician.Which of the following colleagues would a nurse typically delegate to in the health care setting? (Select all that apply.)
a.
Nurse apprentices
b.
Personal care attendants
c.
Family members at bedside
d.
Physicians
e.
Nursing assistantsA. Potential for harm
B. Complexity of the task
C. Amount of problem solving required
E. Level of patient interaction
In making a decision to delegate nursing tasks, the following five factors can be assessed: potential for harm, complexity of the task, amount of problem solving and innovation required, unpredictability of the outcome, and the level of patient interaction.When making a decision to delegate a nursing task, which of the following factors are assessed? (Select all that apply.)
a.
Potential for harm
b.
Complexity of the task
c.
Amount of problem solving required
d.
Predictability of the outcome
e.
Level of patient interactionA. The nurse assesses the situation and need for delegation
B. A plan for specific task delegation is established
D. The nurse determines the available resources and patient safety
With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation.When the licensed nurse makes a determination to delegate a task, which of the following occurs in the process? (Select all that apply.)
a.
The nurse assesses the situation and need for delegation.
b.
A plan for specific task delegation is established.
c.
The needs of the nurse are considered.
d.
The nurse determines the available resources and patient safety.
e.
Accountability is transferred to the manager.A. Legal guidelines and policies
B. Patient safety and accountability
E. Knowledge and education
At the core of the five rights of delegation and the roles of the UAP and nurse are three organizational principles that are present in many health care settings today. These principles include organizational and legal guidelines and policies, patient safety and accountability, and knowledge and education (Craftman et al., 2012).With regard to delegation, what organizational principles are considered? (Select all that apply.)
a.
Legal guidelines and policies
b.
Patient safety and accountability
c.
Relationship management and patient support
d.
Cost containment
e.
Knowledge and educationB. Good faith
D. Reasonable
E. Prudent
Nurses are held to a standard of patient care in which they use their expertise, knowledge, and skill in decision making (Wilkinson, 2016). When considering a questionable situation, the standards of "reasonable," "prudent," and "good faith" form the foundations for legal and ethical decision making.The legal and ethical standards to consider when questioning if delegation is appropriate include: (Select all that apply.)
a.
accountability
b.
good faith
c.
cost efficiency
d.
reasonable
e.
prudentB. Assess the condition and stability of the patient
D. Evaluate the complexity of the task
E. Determine the potential for harm to the patient
When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015). In making a decision to delegate a nursing task, the following five factors should be assessed:
1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient.
2. Complexity of the task: The more complex the activity, the less desirable it is to delegate.
3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated.
4. Unpredictability of outcome: When a patient's response to the activity is unknown or unpredictable it is not advisable to delegate that activity.
5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient (AACN, 2004, p.10).Which principles are important to consider when an RN delegates tasks to UAP? (Select all that apply.)
a.
Tasks are delegated that will challenge the UAP to use critical thinking.
b.
Assess the condition and stability of the patient.
c.
Delegate tasks that are within the expertise of the RN, particularly if the UAP is a student.
d.
Evaluate the complexity of the task.
e.
Determine the potential for harm to the patient.A. State nurse practice act
B. Organization's policies and procedures
D. American Nurses Association (ANA)
E. Board of Registered Nursing
Nurses are accountable for following their state nurse practice act, standards of professional practice, policies of the organization, and ethical-legal models of behavior. The ANA and each state's board of nursing regulate nursing practice.A unit manager is utilizing her staff as a resource for educational presentations. An RN in her unit has been requested to create a PowerPoint on delegation and supervision. What resources should she include for staff to obtain additional information on delegation and supervision? (Select all that apply.)
a.
State nurse practice act
b.
Organization's policies and procedures
c.
The Joint Commission (TJC)
d.
American Nurses Association (ANA)
e.
Board of Registered NursingB. Own acts
C. Accepting the delegation
D. Appropriate notification and reporting
E. Accomplishing the task
The delegatee accepts accountability for his or her own acts, accepts the delegation, uses appropriate notification and reporting, and accomplishes the task.Which of the following are the responsibilities of the delegatee in a situation? (Select all that apply.)
a.
Corrective action
b.
Own acts
c.
Accepting the delegation
d.
Appropriate notification and reporting
e.
Accomplishing the taskA. Prefers to do everything themselves so as not to transfer control
D. Often stays late to complete documentation
Many nurses fall into the "invincible" nurse style; they prefer to do everything themselves so as not to risk delegating to the UAP or transfer some control to someone else. This nurse often stays late after the shift completing documentation and may miss some cares that should have been completed due to trying to do everything him- or herself. The "pal" is the nurse who wants to be everyone's friend. These nurses do not want to be viewed as pushy or demanding. This type of delegator may come across as a pushover to the UAP. The "watchdog" nurse views delegation as a real risk and is constantly monitoring and micromanaging the UAP to the point that resentment may enter the nurse/UAP team and lead to poor teamwork and outcomes.Leadership style may be a significant barrier to effective delegation. Which of the following describes the "invincible" style? (Select all that apply.)
a.
Prefers to do everything themselves so as not to transfer control.
b.
Wants to be everyone's friend.
c.
Comes across as a pushover.
d.
Often stays late to complete documentation.
e.
Micromanages the UAP.B. Fear of criticism for mistakes
C. Overwhelming workload
D. Lack of confidence
E. Lack of resources
The delegatee may resist responsibility for a number of reasons, including fear of criticism, overwhelming workload, lack of confidence, and lack of resources.The process of delegation may be undermined in the health care setting as one member of the team moves work in a downward direction. What are some of the reasons for delegatees to resist responsibility? (Select all that apply.)
a.
Lack of ability to direct
b.
Fear of criticism for mistakes
c.
Overwhelming workload
d.
Lack of confidence
e.
Lack of resourcesA. Conceptual framework and philosophy of nursing within an organization
Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization.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.D. Private duty nursing
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).Which nursing care model was prominent before the Great Depression?
a.
Functional nursing
b.
Group nursing
c.
Hospital staffing
d.
Private duty nursingA. Case management
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.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.A. Divided and distributed nursing tasks
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.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.C. Monitors care from admission to discharge
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.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.C. Outline optimal care and time milestones for the routine patient
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.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.A. Case management
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).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 nursingB. Each team member has his or her own patient assignments
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.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.D. PPM
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.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).D. Executive leadership
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.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.C. Mission statement
Publicly posted mission statements inform key stakeholder groups, such as the public and employees, of the organization's key goals.Stakeholders are informed of an organization's key goals through its:
a.
vision.
b.
values statement.
c.
mission statement.
d.
organizational philosophy.D. Private duty nursing
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.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.C. Total patient care
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).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 nursingD. Functional
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.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.
functionalA. Control over practice
C. Job satisfaction
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).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.A. Case management
B. Functional
D. Team
Case management, functional, primary, and team are nursing care models that are hospital based.Which of the following nursing care models are hospital based? (Select all that apply.)
a.
Case management
b.
Functional
c.
Private duty
d.
TeamA. Fiscal responsibility
B. Accountability to the consumer
E. Quality and safety considerations
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).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.A. Professional development opportunities
B. Interdisciplinary collaboration
E. Culture of safety
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).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.B. Values.
C. Leadership.
D. Collaborative relationships.
E. Care delivery model.
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).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.A. Structure
B. Outcomes
C. Processes
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.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.A. A need for regular, periodic reviews
B. A means for accomplishing goals and objectives
D. A need for the smooth functioning of any work group or organization
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.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.B. True collaboration
D. Meaningful recognition
E. Skilled communication
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.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.B. Private duty being a costly model
C. Job security being tenuous and irregular
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.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.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.A(n) _____ is the operational mechanism by which care is actually provided to patients and families.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.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.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.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.A. 50%
Although health care workers incur less than 20% of all workplace injuries, health care workers nevertheless suffer 50% of all assaults in the workplace.What percentage of assaults in the workplace are committed against health care workers?
a.
50%
b.
20%
c.
15%
d.
40%A. De-escalation
De-escalation is a long-standing mental health nursing tool. De-escalation is defined as "a gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance and non-confrontational limit setting that is based on respect" (Cowin et al., 2003, p. 65).A long-standing mental health nursing tool may be used in an aggressive or violent situation. The use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting is known as:
a.
de-escalation.
b.
chemical restraint.
c.
stress management.
d.
emergency assistance programs.C. Environmental design
NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.The chief operations officer of a local hospital has issued a memorandum indicating that the modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence?
a.
Administrative controls
b.
Behavior modification
c.
Environmental design
d.
Fixture adaptationC. Method for evaluating the effectiveness of the program
According to the Occupational Safety and Health Administration (OSHA), the main components in a violence prevention program are a written plan, a worksite analysis, hazard prevention and control, safety and health training, and record keeping and evaluation of the program.A nurse executive is a member of a collaborative committee assigned to revise the violence prevention program. After reviewing the program, the committee has determined that the following components already were included in the existing program: a written plan available to all employees, a system for tracking work-related assaults, and specific strategies for reducing the severity of violent injuries. A primary revision recommended by the committee should be the inclusion of a:
a.
detailed description of last year's injuries.
b.
list of preferred work injury health care providers.
c.
method for evaluating the effectiveness of the program.
d.
way to determine whether an employee is at fault.D. Cognitive rehearsal training
On an individual level, cognitive rehearsal training can help nurses avoid bullying behavior. It can also teach nurses how to intervene in situations where they see others bullying (Stagg et al., 2013).Staff nurses may be able to avoid bullying behavior through:
a.
increasing time spent with patients at the bedside.
b.
ignoring the assaults.
c.
filing a grievance.
d.
cognitive rehearsal training.C. Provide services to help employees cope with stressors that occur at home or work
Employee assistance programs provide a range of services to help employees cope with stressors that occur at home and at work.Employee assistance programs:
a.
allow employers to place staff into anger management programs designed to help control potentially violent behavior.
b.
encourage employees to provide assistance to co-workers experiencing workplace violence.
c.
provide services to help employees cope with stressors that occur at home or work.
d.
train employees to deescalate violent situations.C. Developing comprehensive violence prevention policies and procedures
Human resource management policies addressing hiring, discipline, counseling, training, threat assessment, threat management, and reporting are essential for the prevention and/or mitigation of violence from current or former workers in health care organizations.An important role of the human resources department in limiting workplace violence is:
a.
allowing the local police force to control violence within the facility.
b.
delegating the control of workplace violence to individual unit managers.
c.
developing comprehensive violence prevention policies and procedures.
d.
empowering each nurse to assess each situation and react accordingly.A. An employer may be subject to liability claims
To date, 29 states have introduced legislation related to workplace bullying, often referred to as the Healthy Workplace Bill (HWB) or some version thereof (HWB, 2016; Mao, 2013). Basic provisions of the model HWB legislation, developed and introduced by Yamada in 2000, include a clear definition of an "abusive work environment," a legal right for those harmed by workplace bullying to seek recourse, and decreased employer liability when prevention and corrective policies and plans are implemented (Mao, 2013).One of the several legal issues surrounding workplace violence is:
a.
an employer may be subject to liability claims.
b.
maintaining mandatory security ratios.
c.
Department of Labor laws requiring employers to report each incidence of workplace violence.
d.
the patient's right to unrestricted visitation.B. Customers, clients, or patients
Customers, clients, patients, or students are regarded as the most prevalent source of violence against nurses.The most prevalent source of violence against nurses is from:
a.
a current or former employee.
b.
customers, clients, or patients.
c.
criminals with no other connection to the workplace but who simply intend to commit a crime.
d.
someone who is not employed at the workplace but has a personal relationship with an employee.C. Behavior modification
Behavior modifications provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness (OSHA, 2015b).Jeff, the manager of security at Methodist Hospital, has required that all of his security guards attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is:
a.
hazard prevention.
b.
environmental designs.
c.
behavior modification.
d.
administrative control.A. Worksite analysis
Worksite analysis is a common-sense look at the workplace to find existing or potential hazards for workplace violence.A common-sense look at the workplace to find existing or potential hazards for workplace violence is:
a.
worksite analysis.
b.
risk management.
c.
administrative rounds.
d.
hazard prevention and control.D. Someone who has a personal relationship with an employee
The implications for management of the threat of workplace violence vary depending somewhat on the source of violence. In dealing with someone who has a personal relationship with an employee, employee assistance programs can be especially useful.Employee assistance programs can be especially useful when mitigating which source of violence?
a.
Patients
b.
Current or former workers
c.
Criminals with no connection to the employer
d.
Someone who has a personal relationship with an employeeA. Risk
Risk management is an integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits.An integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits is called _____ management.
a.
risk
b.
threat
c.
total quality
d.
human resourcesC. Total quality
In a systems approach, organizational culture is also considered an aspect of environment. A worksite analysis conducted by a TAT or similar task force is among the recommendations by OSHA and is consistent with a total quality management approach. Such an effort analyzes records, trends, workplace security, physical characteristics, operating policies, and screening surveys of staff to provide an overview of the work environment.County Hospital has purchased a computerized reporting system for reporting incidents, including acts of violence. Violence reports are aggregated, trended, and used to mitigate future incidences of workplace violence. This type of management framework is _____ management.
a.
risk
b.
threat
c.
total quality
d.
human resourcesB. Threat assessment team
A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). Still another procedural approach for the TAT would be to circulate generalized information such as typical profiles of perpetrators of extreme workplace violence, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem.Posters have been distributed with information about workplace violence such as typical profiles of workplace killers, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. This approach is completed by:
a.
the FBI.
b.
threat assessment team.
c.
human resources.
d.
senior leadership.C. OSHA
OSHA is the agency that provides health and safety programs for health care workers, through the U.S. Department of Labor.The agency that oversees the safety and health of health care workers is:
a.
The Joint Commission (TJC).
b.
the Department of Public Health (DPH).
c.
OSHA.
d.
CMS.A. Horizontal
A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker's performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload (Hamblin et al., 2015).Jenna, a registered nurse (RN), has been accused of gossiping and bullying a new graduate RN on her unit. This type of workplace violence is called _____ violence.
a.
horizontal
b.
co-worker
c.
threatening
d.
nurse-to-nurseD. Management commitment
Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.What is the primary component of a violence prevention program?
a.
Regulatory guidelines
b.
Employee commitment
c.
Financial commitment
d.
Management commitmentA. Employee assistance programs
Employee assistance programs can be very useful in preventing or mitigating loss caused by domestic violence that extends to the workplace (ASIS/SHRM 2011, p. 10)._____ may be useful in preventing loss caused by domestic violence that extends to the workplace.
a.
Employee assistance programs
b.
Stress leave for up to 6 weeks
c.
Termination of the perpetrator
d.
Arrest and conviction of the perpetratorA. Adequate staffing levels.
B. Controlled access.
C. Development of systems to alert security personnel to threats of violence.
NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Administrative controls include (1) adequate staffing patterns to prevent personnel from working alone and to reduce waiting times, (2) controlled access, and (3) development of systems to alert security personnel when violence is threatened.Administrative controls that may affect workplace violence include: (Select all that apply.)
a.
adequate staffing levels.
b.
controlled access.
c.
development of systems to alert security personnel to threats of violence.
d.
conflict resolution.
e.
architectural modifications.A. A written plan
B. Worksite analysis
E. Record keeping and evaluation of the program
The main components in a violence prevention program are: (1) management commitment and worker participation, (2) worksite analysis and hazard identification, (3) hazard prevention and control, (4) safety and health training, and (5) record keeping and program evaluation. Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.The main components in a violence prevention program are: (Select all that apply.)
a.
a written plan.
b.
worksite analysis.
c.
criminal control.
d.
security staff training.
e.
record keeping and evaluation of the program.A. Well-lit parking lots
D. Metal detectors at hospital entrances
E. Posting security guards in the main lobby
NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.Examples of environmental designs that can improve worker safety include: (Select all that apply.)
a.
well-lit parking lots.
b.
critical incident debriefing.
c.
de-escalation training for all staff.
d.
metal detectors at hospital entrances.
e.
posting security guards in the main lobby.threat assessment teams
A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT reviews troubling or threatening behavior of patients or workers. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015).An evaluation of a specific threat of violence and an evaluation of the person making the threat is conducted by ______.D. Right skill mix.
The major goal of staffing management is to provide the right number of nursing staff with the right qualifications to deliver safe, high-quality, and cost-effective nursing care to a group of patients and their families as evidenced by positive clinical outcomes, satisfaction with care, and progression across the care continuum (Eck Birmingham, 2010; T.A. Fitzpatrick, personal communication, August 31, 2016). "Appropriate safe nurse staffing and skill mix levels are essential to optimize quality of care" (ANA, 2016a), and this determination is challenging yet essential.The provision of quality nursing care to clients, wherever delivered, depends on the:
a.
appropriate nursing diagnoses.
b.
current wage scale.
c.
number of nurse leaders.
d.
right skill mix.C. Organizational outcomes
Staffing management is one of the most critical yet highly complex and time-consuming activities for nurse leaders at every level of the health care organization today. How well or poorly nursing leaders execute staff management impacts the safety and quality of patient care, financial results, and organizational outcomes, such as job satisfaction and retention of registered nurses (RNs).Staffing management is one of the most critical activities for nurse leaders at every level of the health care organization today because it affects:
a.
delegation and supervision.
b.
unit leadership productivity.
c.
organizational outcomes.
d.
professional development and quality control.B. Staffing effectiveness.
Staffing effectiveness is the evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes.Evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes is known as:
a.
patient acuity.
b.
staffing effectiveness.
c.
nurse-to-patient ratio.
d.
nursing workload.A. Lack of reliability
Patient classification systems aimed at adjusting staffing for acuity have been plagued with an inability to accurately and reliably measure patient care variability. Further, they have lacked organizational credibility and added documentation burden to the direct-care nurse.The nursing manager of a general medical-surgical unit in a large hospital has gathered data reflecting the average length of time that it takes to provide nursing care to broad categories of client groups with typical characteristics. The patient classification system that the nursing manager has used is criticized for its:
a.
lack of reliability.
b.
medical elements.
c.
stereotyping of patients.
d.
subjective basis.D. Staff his nursing unit appropriately.
The nurse manager who is accountable for a patient care unit or area executes staffing management strategies to yield an optimal health experience and clinical outcomes for patients and their families; a healthy, satisfying work environment; and cost-effective staffing model for the organization.The nursing manager of a general medical-surgical unit in a large hospital has gathered data reflecting the average length of time that it takes to provide nursing care to broad categories of client groups with typical characteristics. The nursing manager will most likely use the patient classification data he collected to:
a.
avoid management layoffs.
b.
change professional nursing roles.
c.
obtain staffing reimbursement.
d.
staff his nursing unit appropriately.C. Conceptual framework
A conceptual framework provides logic and order to complex processes for administrators and scientists to consider (Edwardson, 2007).A(n) ______ provides logic and order to complex processes for administrators and scientists to consider.
a.
staffing plan
b.
organizational chart
c.
conceptual framework
d.
nursing care delivery modelC. Value of the nurse and patient/family relationship
One common element among care models is the value of the nurse and patient/family relationship. Patient assignment technology offers charge nurses access to real-time data in order to match the right nurse (i.e., competency, expertise) with the right patient and provide continuity of care during an episode of care. A second common trend is the evolving role of the charge nurse as the frontline leader with responsibility to coordinate patient flow with expert communication among health care team members.A common element among nursing care delivery models is the:
a.
ratio of nurses to patients.
b.
manager is the frontline leader.
c.
value of the nurse and patient/family relationship.
d.
needs of the patients drive the competency of the nurse.A. Continuity of care
Person (2004) described the four fundamental elements of any nursing care delivery model as follows: (1) nurse/patient relationship and decision making, (2) work allocation and patient assignments, (3) communication among members of the health team, and (4) management of the unit or environment of care. Translating the nursing care delivery model's elements and inherent values to staffing management is a key role for nursing leaders. One common element among care models is the value of the nurse and patient/family relationship. Patient assignment technology offers charge nurses access to real-time data in order to match the right nurse (i.e., competency, expertise) with the right patient and provide continuity of care during an episode of care.Relationship-based care (RBC) is a common model used in care delivery. Person (2004) articulated that _____ is/are central nursing care delivery models.
a.
continuity of care
b.
case management
c.
coordination of care
d.
the needs or characteristics of the patientsC. The needs or characteristics of the patients and families drive the competencies of the nurse
The synergy model for patient care is presented by the American Association of Critical-Care Nurses (Hardin & Kaplow, 2005). The core concept of the model is based on the nurse-patient relationship and acknowledges that the needs or characteristics of the patients and families drive the competencies of the nurse. Synergy, or optimum outcomes, results when the needs and characteristics of the patient clinical unit, or system, are matched with a nurse's competencies (Kaplow & Reed, 2008).The core concept of the synergy model for patient care is based on the nurse-patient relationship and acknowledges:
a.
frontline charge nurses make informed patient care assignment decisions.
b.
organizing and delivering nursing care achieves desired patient outcomes.
c.
the needs or characteristics of the patients and families drive the competencies of the nurse.
d.
the clinical nurse leader champions innovations that improve patient outcomes, ensures quality care, and reduces health care costs.C. Hospitals must also provide the right number of competent staff members to meet the patient's needs
TJC standards include the human resources function of verifying that nurses are qualified and competent to ensure that the hospital determines the qualifications and competencies for staff positions based on its mission, populations, care, treatment, and services. Hospitals must also provide the right number of competent staff members to meet the patients' needs (TJC, 2016).The Joint Commission's (TJC's) staffing regulation states:
a.
staffing ratios are recommended in perinatal and critical care areas.
b.
nurse managers may determine the nurse-to-patient ratio as long as the patient's needs are being met.
c.
hospitals must also provide the right number of competent staff members to meet the patient's needs.
d.
hospitals may limit the number of admissions to ensure there are an adequate number of staff members to meet patient needs.C. Decreased patient satisfaction
The approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations and often lacked evaluation of the skill mix change and other changes on the quality of care and nurse job satisfaction and retention (Eck, 1999; Norrish & Rundall, 2001). This was most apparent in California where a leaner RN skill mix was tried by Kaiser Permanente Northern California in the early 1990s. Skill mix was reduced from 55% RNs to 30% RNs in 1995 (Robertson & Samuelson, 1996). The changes in skill mix led to widespread real and perceived increases in RN workload, patient safety concerns, and nurse and consumer complaints (Norrish & Rundall, 2001; Seago et al., 2003).An approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations in the 1990s. These changes in skill mix led to:
a.
decreases in RN workload.
b.
increased nursing satisfaction.
c.
decreased patient satisfaction.
d.
decreased patient safety concerns.A. Staffing pattern
The staffing management plan provides the structured processes to identify patient needs and then to deliver the staff resources as efficiently and effectively as possible. An effective plan first focuses on stabilizing the unit core staffing. A staffing pattern, or core coverage, is determined through a forecasted workload and a recommended care standard (e.g., hours per patient day).A forecasted workload and a recommended care standard determine the:
a.
staffing pattern.
b.
skill mix of the unit.
c.
nurse-to-patient ratios.
d.
staffing management plan.D. Nursing care hours per patient day
The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The workload standard commonly used is nursing care hours per patient day, although the validity of this measure is disputed.The workload standard commonly used in nursing when calculating staffing patterns is:
a.
patient days.
b.
patient acuity system.
c.
average length of stay.
d.
nursing care hours per patient day.B. Variable staffing
With variable staffing, units are staffed below maximum workload conditions and staff is then supplemented when needed.The staffing method used when units are staffed below maximum workload conditions and staff is then supplemented when needed is called:
a.
fixed staffing.
b.
variable staffing.
c.
strategic staffing.
d.
staffing by acuity.B. Position control
Position control is the process of providing and measuring the correct FTE, or complement, to adequately staff a given area.The process of providing and measuring the correct full-time equivalent (FTE), or complement, to adequately staff a given area is known as:
a.
scheduling.
b.
position control.
c.
forecasted workload.
d.
demand management.C. Department manager
In a decentralized model, individual department managers and directors are responsible for daily staffing allocation.Key to effective staffing are protocols and processes for daily staffing decision support that are aligned with a budget-sensitive variable staffing plan. In a decentralized model, the responsibility of daily staffing allocation belongs to the:
a.
float pool.
b.
staffing office.
c.
department manager.
d.
chief nursing officer.A. Scheduling
Scheduling is the process of assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time (Barnum & Mallard, 1989).Assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time is known as:
a.
scheduling.
b.
staffing effectiveness.
c.
nursing direct-care hours.
d.
human resources staffing strategy.A. Synergy Model for Patient Care
The Synergy Model for Patient Care was developed by the American Association of Critical-Care Nurses (2016) and is a patient-centered model focused on the needs of the patient, the competencies of the nurse, and the synergy created when the needs and competencies match. Synergy—or optimum patient outcomes—results when the needs and characteristics of the patient and clinical unit or system are matched with a nurse's competencies. Patient assignment technology may assist in defining—and thereby aligning—patient needs with the nurse's abilities, a concept that is central to the model.The new nursing care model, developed by the American Association of Critical-Care Nurses (2016), focuses on the needs of the patient and the competencies of the nurse. It is known as the:
a.
Synergy Model for Patient Care.
b.
Case Management Model.
c.
Primary Nursing Model.
d.
Clinical Nurse Leader Model.B. Twelve-hour shifts
C. Mandatory overtime
E. Unplanned overtime
In this second edition, the ANA (2012) noted that since the initial publication of the original Principles for Nurse Staffing, the evidence has grown supporting the link between adequate nurse staffing and better patient outcomes. Under principles related to the practice environment, the ANA (2012, p. 10) stated "Registered nurses should be provided a professional nursing practice environment in which they have control over nursing practice and autonomy in their workplace," and "routine mandatory overtime is an unacceptable solution to achieve appropriate nurse staffing. Policies on length of shifts; management of meal and rest periods; and overtime should be in place to ensure the health and stamina of nurses and prevent fatigue-related errors."An RN is relocating and is seeking employment at a hospital that focuses on patient safety. Which staffing issues have a negative impact on patient safety? (Select all that apply.)
a.
Eight-hour shifts
b.
Twelve-hour shifts
c.
Mandatory overtime
d.
Student nurses on the unit
e.
Unplanned overtimeB. Labor and delivery
D. The emergency department
E. The neonatal critical care unit
In a decentralized model, individual department managers and directors are responsible for daily staffing allocation. Units with decentralized staffing are typically units whereby volume and/or acuity may be most unpredictable, and the nursing competencies are unique to that area (e.g., emergency department, labor and delivery, critical care).The hospital units most likely to employ a decentralized staffing model include: (Select all that apply.)
a.
the telemetry unit.
b.
labor and delivery.
c.
the medical-surgical unit.
d.
the emergency department.
e.
the neonatal critical care unit.A. Travel nurses
C. Registry nurses
D. Per diem nurses
Access to nurses outside the unit to cover transient shortages is critical to meet last-minute, unplanned nurse shortages, such as sick calls and high patient demand. Supplemental staffing resources, frequently referred to as the staffing pool, are defined as a group of nurses who supplement the core unit staffing. This includes per diem nurses, float pool nurses, part-time nurses desiring additional hours, seasonal nurses, agency nurses, and traveling nurses.Community Hospital is having a transient nursing shortage due to a high number of sick calls. The staffing office utilizes the staffing pool to obtain the required number of nurses. The staffing pool may include what types of nurses? (Select all that apply.)
a.
Travel nurses
b.
Foreign nurses
c.
Registry nurses
d.
Per diem nurses
e.
Full-time nursessynergy
Synergy—or optimum patient outcomes—results when the needs and characteristics of the patient and clinical unit or system are matched with a nurse's competencies. Patient assignment technology may assist in defining—and thereby aligning—patient needs with the nurse's abilities, a concept that is central to the model.When the needs and characteristics of the patient clinical unit, or system, are matched with a nurse's competencies, _____ results.workload
The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The unit of service is specific to the type of unit, such as the number of patients, patient days, deliveries, visits, treatments, encounters, or procedures.The amount of work performed by a unit is referred to as its _____.skill mix
Skill mix is the proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff.The proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff, is called _____.
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