ch 44 Flashcards
A newly licensed nurse is assigned to an experienced nurse for training on a medical unit of a hospital. What type of nurse-to-nurse collaboration does this assignment demonstrate?
a. Interprofessional
b. Shared governance
c. Interorganizational
d. Mentoring
ANS: D
Mentoring is a collaborative partnership between a novice nurse and an expert nurse to help transition a nurse through career development, personal growth, and socialization into the profession. Interprofessional collaboration is working with several disciplines. Shared governance is a type of management for nursing. Interorganizational collaboration often includes teams from inside and outside an organization to meet a common goal.
The nurse is presenting an in-service on the importance of collaborative communication. The nurse includes which critical event identified by the Joint Commission as an outcome of poor communication among healthcare team members?
a. The occurrence of a patient event resulting in death or serious injury
b. Decreased ability to document expenses of care provided
c. Longer time to begin surgical cases
d. Increased time to discharge patients to outpatient care
ANS: A
The Joint Commission has identified that poor communication is the primary factor in the occurrence of sentinel events, or events resulting in unintended death or serious injury to patients. Lack of documentation, longer time to begin surgery, and increased delays in discharge all contribute to the management of health care, but do not result in critical patient outcomes.
A nurse is reviewing the concept of professional collaboration. Which patient scenario should the nurse identify as the best example of professional collaboration?
a. The nurse, physician, and physical therapist have all visited separately with the
patient.
b. The nurse, physical therapist, and physician have all developed separate care
plans for the patient.
c. The nurse mentions to the physical therapist that the patient may benefit from a
muscle strengthening evaluation.
d. The nurse and physician discuss the patient’s muscle weakness and initiate a
referral for physical therapy.
ANS: D
Professional collaboration includes team management and referral to needed providers to meet patient needs. Each discipline retains responsibility for their own scope of practice but recognizes the expertise of other providers. Working separately does not develop a comprehensive plan of care. Casual mentioning of patient needs does not follow professional communication channels and frequently delays needed interventions.
A registered nurse (RN) is reviewing the concept of collaboration. Which statement correctly describes the RN nursing’ role in collaboration?
a. State boards of nursing mandate that collaboration can only occur in hospitals.
b. Collaboration should occur only with physicians.
c. Collaboration occurs only between nurses with the same level of education.
d. Collaboration may occur in health-related research.
ANS: D
RNs collaborate with many different persons, including patients, managers, educators, and researchers. Collaboration does not occur only with physicians or nurses of equivalent educational background, but with anyone who is working toward meeting patient goals. Collaboration occurs in any healthcare setting as well as community and home settings.
A nurse manager is looking to promote a culture of safety on the medical unit. Which action should the nurse manager implement?
a. Focus on the number of medication errors occurring on the unit.
b. Focus on adapting system changes.
c. Providing incentives to nurses who don’t make any medication errors.
d. Placing nurses on restricted duty who have made medication errors.
ANS: B
The Institute of Medicine (IOM) and QSEN initiative have switched their perspective from medication errors to systematic changes that focus on safety aspects. The nurse manager should not use rewards or incentives to motivate change of behavior as that would not promote a culture of safety if individuals feared retaliation or were treated differently for safe behavior practices.
The nurse and physician are explaining that home care that will be needed by a patient after discharge. The patient’s spouse states angrily that it will not be possible to provide the care recommended. What is the best response by the nurse?
a. “Let me review what is needed again.”
b. “It is important that you do what the physician has prescribed.”
c. “What concerns do you have about the prescribed care?”
d. “I can come back after you talk with your spouse about the care.”
ANS: C
The patient needs to be the focus of developing care plans, and communication is an important part of collaboration with the patient to discover barriers for the patient to follow recommendations. It is important to either provide solutions to the barriers or present other options. Reviewing the care again does not demonstrate willingness to have the patient be part of the team. Insisting that the patient do what is prescribed is autocratic and does not recognize the role the patient has in their care. Leav ing the patient and spouse with the situation unresolved fosters distrust and more anger.
The nurse is caring for a patient with a progressive, degenerative muscle illness. The patient states that she would like to remain in her home with her daughter as long as possible. What action should the nurse take?
a. Teach the patient muscle strengthening and stretching exercises.
b. Tell the patient to make plans to move to an assisted-living facility.
c. Discuss resources to help the patient and make appropriate referrals.
d. Ask the patient to come in for daily physical therapy.
ANS: C
To honor the patient’s request to stay at home the nurse should make appropriate referrals for needed evaluation and assistance. Most nurses will not have the expertise to teach appropriate exercises for degenerative illness. Asking the patient to move to an assisted-living facility does not account for the patient’s request. The patient has not been assessed for the need of daily therapy, and it is not likely that a patient with a degenerative illness will be able to make daily appointments for treatment as the illness progresses.
A patient has been admitted to an acute care hospital unit. The nurse explains the hospital philosophy that the patient be an active part of planning their care. The patient verbalizes understanding of this request when they make which statement?
a. “I will have to do whatever the physician says I need to do.”
b. “Once a plan is developed, it cannot be changed.”
c. “My insurance will not pay if I don’t do what you want me to do.”
d. “We can work together to adjust my plan as we need to.”
ANS: D
Treatment plans need to be developed, evaluated, and adapted as needed based on the patient status and willingness to complete the prescribed care. Stating that the patient has to do whatever the care provider prescribes does not include the principle of collaboration. Care plans can be altered based on patient status. Insurance providers do not determine a patient’s ability to complete prescribed care, although they do reimburse for standard care given.
The management of a community hospital is trying to encourage a more collaborative environment among staff members. Which concept is most important for management to develop first?
a. Post educational posters about how well collaboration is being performed
b. Highlight that no single profession can meet the needs of all patients
c. Provide meetings for each department on how their role affects patients
d. Begin implementing evaluations of collaborative skills on annual performance
reviews
ANS: B
Recognizing that collaboration needs all professions to provide patient-centered care is an important first step to implementing a different philosophy in the hospital. Posting an evaluation of performance before education will not encourage participation. Collaboration requires an understanding of more than your own discipline. It is unfair to evaluate staff on a requirement that they have not been introduced to.
Which activities are appropriate for the nurse to collaborate with a patient? (Select all that apply.)
a. Prescribing a new medication dose
b. Health promotion activities
c. End-of-life comfort decisions
d. Interpreting laboratory results
e. Lifestyle changes to improve health
ANS: B, C, E
Nurses should include patients and their families when exploring health promotion activities, end-of-life decisions, lifestyle changes, and treatment options. Prescribed medication doses are initiated by educated professionals, although the patient gives feedback on the effectiveness of medications. Patients are not trained to interpret lab results, but patients rely on health professionals to explain results to them.
