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Professional Nursing > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Leadership…

A
  • Ability to guide/influence others

* Ability to motivate others

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2
Q

Management…

A
  • Coordinates people, time, & supplies
  • Control of day-to-day operations
  • Plans & organizes
  • Involves problem solving & decision making
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3
Q

Authority

A

A legitimate right to direct others given by a organization

Ex: nurse manager

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4
Q

Power

A

Ability to motivate people to get things done w/ or w/o the legitimate right granted by the organization

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5
Q

Primary sources of Power

A
  • Reward
  • Coercive (punishment if task is not done)
  • Legitimate (official position)
  • Referent
  • Expert (based on knowledge & skills = respected by others)
  • Information
  • Connection (“know someone”)
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6
Q

Informal Power

A

Comes from…

  • Interpersonal relationships
  • Being in the right place at the right time
  • unique personal characteristics (attractiveness/education/experience/drive)
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7
Q

Formal vs. Informal Leadership

A

Formal: Given authority - appointed to an approved position
Ex: nurse manager, supervisor, charge nurse

Informal: No official appointed authority, but able to persuade/influence others

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8
Q

Leadership Trait Theory

A

Believes leaders were BORN with leadership.

Does not recognize traits can be learned/developed

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9
Q

Leadership Traits

A
  • Intelligence
  • Alertness
  • Dependability
  • Energy
  • Drive
  • Enthusiasm
  • Ambition
  • Self-Confidence
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10
Q

Transformational Leadership

A

2 Types of Leaders

  • Transactional: (Management) Day-to-Day
  • Transformational: (Leader) Has a vision, & is able to empower others with that vision.
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11
Q

3 Leadership Skills

A

Technical Skills: Clinical expertise & nursing knowledge

Human Skills: ability & judgement to work w/ people in an effective leadership role

Conceptual Skills: Ability to understand the complexities.

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12
Q

Management Theory

A

3 styles

  1. Authoritarian: makes all decisions, gives little feedback, makes fast decisions
  2. Democratic: Involves staffing, provides regular feedback
  3. Laissez-Faire: Does not provide guidance or feeback, works well w/ professional people
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13
Q

Organizational Theory

A

Provides a framework for understand complex organizations

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14
Q

Weber’s Theory of Bureaucracy

A
  • Fixed division of labor (checks&balances)
  • Hierarchy of offices (chain of command)
  • Rational-legal authority (must have skills to have position)
  • Creation of rules to govern performance
  • Separation of personal from official property & rights
  • Selection based on qualifications
  • Clear career paths
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15
Q

Systems Theory

A

Views organization as a set of interdependent parts that together form a whole.

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16
Q

Open Systems

A

Internal forces will affect the external enviornment

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17
Q

Closed Systems

A

System is independent of outside influences.

Unrealistic view for health care.

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18
Q

Chaos Theory

A

Attempts to account for the complexity & randomness in organizations
Ex: staff calls in sick

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19
Q

5 Management Functions

A
  1. Planning
  2. Organizing
  3. Staffing
  4. Directing
  5. Controlling
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20
Q

Roles of Nurse Leader & Manager

A
  • Team Builder
  • Resource Manager
  • Decision Maker/Problem solver
  • Change Agent
  • Mentor
  • Customer Service Provider
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21
Q

Communication Process Involves…

A

Sender, Receiver, Message

method of delivery influences the effectiveness of communication

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22
Q

Interpretation of Message Influenced by…

A
  • Context & Environment
  • Precipitating Event
  • Preconceived Ideas
  • Style of Transmission
  • Past Experiences
  • Personal Perceptions
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23
Q

Verbal Communication…

A
  • Most common form of interpersonal communication

- Involves talking & listening

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24
Q

Nonverbal Communication…

A
  • Facial Expression
  • Eye Contact
  • Posture
  • Body Movement
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25
Q

Positive Communication is characterized by…

A
  • Openness
  • Empathy
  • Supportiveness
  • Positiveness
  • Equality
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26
Q

Techniques for Communication

A
  • Developing Trust (keeping promises)
  • Using I messages (not ‘you’)
  • Establishing Eye Contact
  • Keeping promises
  • Expressing Empathy (share the feelings)
  • Open Communication (open-ended ?)
  • Clarifying Information (what I hear you saying)
  • Body Language & Touch
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27
Q

Negative Communication Techniques

A

Blocking = “oh you will be fine”
False Assurances = “Don’t worry”
Conflicting Messages = Saying one thing-body says another thing

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28
Q

4 Communication Styles

A
  1. Assertive
  2. Aggressive
  3. Passive
  4. Passive-Aggressive
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29
Q

Assertive

Communication Style

A
  • Healthiest form
  • Honest & direct
  • Respecting other’s
  • Win-Win
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30
Q

Aggressive

Communication Style

A
  • Feel superior, are controlling
  • Decisions made for them 2 come out on top
  • Use guilt, hurt, anger
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31
Q

Passive

Communication Style

A
  • Avoids confrontation
  • Allows other to make decisions
  • Dishonest (don’t state their true feelings)
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32
Q

Passive-Aggressive

Communication Style

A
  • Combine the worst of both styles
  • Avoid direct confrontation while manipulating
  • Appear to be honest but undermine through gossip, pouting, playing the victim
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33
Q

Special Influences on Communication

A
  • Gender Differences
  • Generational Differences
  • Cultural Diversity
  • Interprofessional Team
  • Confidentiality & Privacy
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34
Q

Difficult Conversations…

A
  • Require sensitivity
  • Nurse must be able to manage their own emotions
  • Discussing death/dying need to talk openly & honestly
35
Q

5 Styles of Conflict Resolution

A
  1. Avoidance: (passive response) tends to cause greater problems
  2. Accommodation: (passive response) giving in to others
  3. Competition: (aggressive/passive-aggressive) depends on type/style of manipulation
  4. Compromise: (assertive) mutual give & take
  5. Collaboration: (Assertive) work together to accomplish goals
36
Q

Nurses written communication will include…

A
  • nurse’s notes
  • memos
  • emails
  • kardexes
  • incident reports
  • discharge teaching forms
  • written staff report
37
Q

Basic Criteria for Documentation includes…

A
  • Accuracy of pt name, date, & time
  • Accuracy of entries
  • Legibility
  • Signatures
  • Correcting Mistakes
  • Logical Organization of Info.
  • Writing a Late Entry
  • Completeness
  • Omitted Interventions
  • Conciseness
  • Confidentiality
38
Q

Good Documentation for nurses notes is…

A
  • concise
  • accurate
  • complete
  • legible
  • timely
  • logically
39
Q

Attention to detail when writing a nurse notes

A
  • Be concise/descriptive/truthful
  • Start w/ Capital letter - end w/ .
  • Words can be used to depict a picture (create a verbal picture)
  • Descriptive - include measurements, color, position, location, drainage, or condition.
40
Q

Signatures should include…

A 
1st. letter, last name, title
M. McAllister, RN
or
PCT, SN 
for student nurse
41
Q

Writing a late entry…

A
  • Start w/ current date & time

- Then write “Addendum to nurses note of date/time” & note

42
Q

5 Types of Nurses Notes

A
  1. Long Note
  2. Charting by Exception
  3. Problem Oriented Approach (PIE)
  4. SBAR
  5. SOAP Notes
43
Q

Long Note

Nurses Note

A

paragraph form, data written long hand

PIE can be a long note

44
Q

Charting by Exception

Nurses Note

A

flow sheets/only chart if there is a problem

45
Q

Problem Oriented Approach (PIE)

Nurses Note

A

Problem: date/time/problem

Intervention: Interventions & Instructions to pt. Note if pt understand.

Evaluation: Describe pt response to tx. Include reassessment & evaluation of initial assessment

46
Q

SBAR

Nurses Note

A

Situation, Background, Assessment, Recommendation

  • Short & Breif
  • Used when communicating w/ physician
47
Q

SOAP Notes

Nurses Note

A

Subjective: what pt states - use quotes
Objective: observe pt
Assessment: physical assessment
Plan: Tx

(used most often by physicians to chart in the progress notes)

48
Q

Contributing factors to poor Quality of Care…

A
  • Overuse of expensive invasive technology
  • Underuse of inexpensive care services
  • Error-prone implementation of care that could harm pts & waste money
49
Q

What is the lag time between discovery of an improved tx & it’s implementation?

A

17 years

50
Q

What is the most common medical error for hospitalized pt’s that cost approx. $2 billion a year?

A

Medication

51
Q

How many American deaths occur annually from medical errors?

A

44,000 - 98,000

52
Q

What % of pt’s are not receiving the recommended care?

A

40%

53
Q

6 Guiding Aims for Health Care

A
  1. Safe
  2. Timely
  3. Effective
  4. Efficient
  5. Equitable
  6. # Pt centeredSTEEEP
54
Q

10 Simple Rules to Guide Improvement Initiatives

A

see book, pg 446-447

55
Q

Quality Assurance

A
  • Inspection Oriented (detection)
  • Reactive
  • Correction of Special Causes
  • Responsibility of few people
  • Narrow Focus
  • Leadership may not be vested
  • Problem solving by authority
56
Q

Quality Improvement

A
  • Planning oriented (prevention)
  • Proactive
  • Correction of common causes
  • Responsibility of all involved with the work
  • Cross-functional
  • Leadership actively leading
  • Problem solving by employees at all levels
57
Q

What was one of the 1st regulatory agencies to embrace quality improvement?

A

Joint Commission

  • also addressed pt’s rights, pt’s tx, & infection control.
  • Stipulates that health-care facilities use Clinical Pathways to meet accreditation standards.
58
Q

Clinical Pathways provides…

A

-A means of standardizing care for pt’s w/ similar Dx.

Dictate the type & amount of care given & have financial implications for the health care facility

59
Q

Clinical Pathways define…

A

-Key processes & pt goals in the day to day management of care.
(Usually developed within the health care facility)

60
Q

During a Clinical Pathway a variance has occurred when…

A

A pt’s progress deviates or leaves the planned path.
-Positive variance: Pt has progressed ahead of schedule
-Negative variance: Identified goals are not accomplished as planned
(RN generally identifies when a variance occurs)

61
Q

Why were Clinical Pathways developed?

A

To identify quality, cost-effective care plans to reduce the pt’s stay in the hospital.

62
Q

Triggers during Clinical Pathways alert…

A

Caregivers that an unexpected event has occurred & identify potential & actual variations in the pt’s response to the planned intervention.

63
Q

Components of Clinical Pathways are…

A
  • Physical assessment guidelines
  • Lab & Dx tests
  • Medications & Procedures
  • Safety & Self-care activities
  • Nutrition Requirements
  • Pt & Family Education
  • Discharge Panning & Milestones pt should meet
64
Q

Developing Clinical Pathways…

A
  • Individualized to meet pt’s specific needs
  • Based on accepted standards of practice
  • Developed for facility’s most common or costly Dx
65
Q

4 Benefits of Clinical Pathways…

A
  1. Reduction in Variation of the care provided
  2. Facilitation & achievement of expected clinical outcomes
  3. Reduction in care delays & length of stay
  4. Improvements in cost-effectiveness of the care delivered
66
Q

What is the most commonly used Clinical Pathway in Acute Care settings?

A

Tx of community acquired

  • pneumonia
  • total hip/knee replacement
  • stroke
67
Q

Algorithms

A

Represent more of a decision path that a practitioner might take during a particular episode/need.
Ex:
-tx of hypertension
-provision of both basic & advanced life support
-general Dx screening

68
Q

Definition of Case Management

A

A dynamic & systematic collaborative approach to provide & coordinate health care services to a defined population.

69
Q

What does Case Management do?

A

-Matches services to pt’s care needs

RN Case Manager coordinates pt’s care throughout the course of an illness

70
Q

Case Management results in…

A

Reduced costs & lengths of stay

71
Q

5 Components for nursing case management…

A
  1. Assessment
  2. Planning
  3. Implementation
  4. Evaluation
  5. Interaction
72
Q

Goal of Case Management…

A

Quality, Outcomes, & cost of care throughout pt’s illness & to assist pt to move through the continuum of care.

73
Q

RN manages a caseload of pt’s from…

A

Pre-admission to dischange

74
Q

Sentinel Event is…

A

Any unanticipated event in a healthcare setting resulting in death of serious physical or psychological injury to pt that is not related to the natural course of pt’s illness.
(defined by The Joint Commission (TJC))

75
Q

Sentinel Events specifically include…

A

Loss of a limb or gross motor function, & any event for which a recurrence would carry a risk of a serious adverse outcome.
Ex: Dehydration, Bowel Obstruction

76
Q

Never Events are…

A

Serious & costly errors in health care delivery that should never happen.
Ex: wrong site surgery, mismatched blood transfusions

77
Q

Surgical Events

Never Events

A
  • Surgery on wrong body part
  • Surgery on wrong pt
  • Wrong surgery on pt
  • Foreign object left in pt after surgery
  • Post-op death in normal health pt
  • Implantation of wrong egg
78
Q

Product of Device Events

Never Events

A

Death/Disability associated w/ use of…

  • contaminated drugs
  • device other than as intended
  • intravascular air embolism
79
Q

Pt Protection Events

Never Events

A
  • Infant discharged to wrong person
  • Death/Disability due to pt elopement
  • Pt suicide or attempted suicide resulting in disability
80
Q

Care Management Events

Never Events

A

Death/Disability associated w/

  • medication error
  • incompatible blood
  • hypoglycemia
  • hyperbilirubinemia in neonates
  • due to spinal manipulative therapy

Maternal Death/Disability w/ low risk delivery

Stage 3 or 4 pressure ulcers after admission

81
Q

Environment Events

Never Events

A

Death/Disability associated w/

  • electric shock
  • burn incurred within facility
  • fall within facility
  • use of restraints within facility

Incident due to wrong oxygen or other gas

82
Q

Criminal Events

Never Events

A
  • Impersonating a health care provider
  • Abduction of pt
  • Sexual assault of pt within/on facility grounds
  • Death/Disability resulting from physical assault within/on facility ground
83
Q

4 Phases of Reality Shock

A
  1. Honeymoon
  2. Shock/Rejection
  3. Recovery
  4. Resolution
84
Q

8 Types of nurses in Shock/Rejection Phase

A
  1. Natives: adopts way of least resistance (may mimic other nurses)
  2. Runaways: May choose new occupation/return to graduate school
  3. Rutters: Goes through the steps ‘Just a job’
  4. Burned out: too many responsibilities too quickly
  5. Compassion Fatigue: gradual decline. overexposed (most common in hospice, ER, mental health)
  6. Loners: quiet
  7. New nurse on the Block: job hoppers “teach me, I’m new”
  8. Change Agents: works towards change.

Professional Nursing (3 decks)

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