Exam 2 (Leadership)

Question 1

Type of Organizational Structure that places an emphasis on organizational positions and formal power

Formal or Informal Organizational Structure?

Answer 1

Formal

Question 2

Type of Organizational Structure that focuses on the employees, their relationships, and the informal power that is inherent within those relationships

Formal or Informal Organizational Structure?

Answer 2

Informal

Question 3

Types of Organizational Structures

Answer 3

-Line structures
-Ad hoc design
-Matrix structures
-Service line organization
-Flat designs

Question 4

What organizational structure?

-Designed to focus on both the product and the function
-Have a formal vertical and horizontal chain of command
-Have fewer formal rules and fewer levels of the hierarchy
-Can cause slow decision making due to information sharing
-Can produce confusion and frustration for workers because of dual-authority hierarchical design

Answer 4

Matrix Organizations

Question 5

What organizational structure?

-Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations
-Sometimes called care-centered organizations
-Smaller in scale than large bureaucratic systems

Answer 5

Service Line Organizations

Question 6

What organizational structure?

-Remove hierarchical layers by flattening the scalar chain and decentralizing the organization
-Continue to have line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out
-Despite being very flat, often retain many characteristics of a bureaucracy

Answer 6

Flat Organizations

Question 7

The values and behaviors that contribute to the unique social and psychological environment of an organization.

-Values, language, beliefs, history, language, challenges, priorities, traditions, rituals-

Answer 7

Organizational Culture

Question 8

What is Organizational climate?

Answer 8

How employees perceive an organization

The perception may be accurate or inaccurate, and people in the same organization may have different perceptions about the same organization.

Question 9

What is Shared Governance?

Answer 9

Nurses at every level play a role in the decisions that affect nursing activity throughout the system.

Question 10

What type of leadership does Shared Governance have?

Answer 10

Democratic leadership –> Decision making is made by the whole group, not just one person. Allows staff to have a real voice and provide input in the decision-making process.

Question 11

What is Participatory Management?

Answer 11

Participatory management implies that others are allowed to participate in decision making over which someone has control. Thus, the act of “allowing” participation identifies for the participant the real and final authority.

Lays the foundation for Shared Governance.

Question 12

The 14 Forces of Magnetism for Magnet Hospital Status

Answer 12

1) Quality of nursing leadership
2) Organizational structure
3) Management style
4) Personnel policies and programs
5) Professional models of care
6) Quality of care
7) Quality improvement
8) Consultation and resources
9) Autonomy
10) Community and the hospital
11) Nurses as teachers
12) Image of nursing
13) Interdisciplinary relationships
14) Professional development

Question 13

Characteristics of Effective Health-Care Delivery Systems

Answer 13

-Facilitate meeting the goals of the organization
-Cost-effective
-Satisfy the patient
-Provide role satisfaction to nurses
-Allow implementation of the nursing process
-Provide for adequate communication among health-care providers

Question 14

Traditional Models of Patient Care Organization

Answer 14

-Total patient care
-Functional nursing
-Team and modular nursing
-Primary nursing
-Case management

Question 15

What Model of Patient Care- Total Patient Care, Functional Nursing, Team & Modular Nursing, Primary Nursing, or Case Management?

The oldest model of organizing patient care. Nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty. It is sometimes referred to as the case method of assignment because patients may be assigned as cases. It is still widely used in hospitals and home health agencies.

Answer 15

Total Patient Care

Question 16

What are the advantages & disadvantages of Total Patient Care model?

Answer 16

The greatest disadvantage of total patient care delivery occurs when the nurse is inadequately prepared to provide total care to the patient.

Question 17

What Model of Patient Care- Total Patient Care, Functional Nursing, Team & Modular Nursing, Primary Nursing, or Case Management?

Evolved as a result of World War II. Uses relatively unskilled workers who have been trained to complete certain tasks. Care is assigned by task rather than by patient.

Answer 17

Functional Nursing

Question 18

What are the advantages & disadvantages of the Functional Nursing model?

Answer 18

A major advantage of functional nursing is its efficiency; tasks are completed quickly, with little confusion regarding responsibilities.

However, functional nursing may lead to fragmented care and the possibility of overlooking patient priority needs.

Question 19

What Model of Patient Care- Total Patient Care, Functional Nursing, Team Nursing. Modular Nursing, Primary Nursing, or Case Management?

Ancillary personnel collaborate to provide care to patients under the direction of a professional nurse. Requires extensive team communication and regular team planning conferences.

Answer 19

Team Nursing

Question 20

What are the advantages & disadvantages of the Team Nursing model?

Answer 20

Allows members to contribute their own special expertise or skills.

Disadvantages are associated with improper implementation rather than the philosophy itself.

Question 21

What Model of Patient Care- Total Patient Care, Functional Nursing, Team Nursing, Modular Nursing, Primary Nursing, or Case Management?

Modification of team and primary nursing. Similar to team nursing, but uses a smaller team. Pairs professional nurses with ancillary staff to deliver care to groups of patients. Used frequently during the 1980s and 1990s.

Answer 21

Modular Nursing

Question 22

What Model of Patient Care- Total Patient Care, Functional Nursing, Team & Modular Nursing, Primary Nursing, or Case Management?

Primary nurse assumes 24-hour responsibility for planning patient care from admission or start of treatment to discharge or treatment’s end. During work hours, the primary nurse provides total direct care for that patient. When the primary nurse is off duty, associate nurses follow the care plan established by the primary nurse and provide care.

Answer 22

Primary Nursing

Question 23

What are the advantages & disadvantages of the Primary Nursing model?

Answer 23

Brings nurse back to the bedside to provide clinical care. Can succeed with a diverse skill mix or an all-RN staff. Job satisfaction is high; however, this method is difficult to implement because of the degree of responsibility and autonomy required of the nurse.

Disadvantages lie primarily in improper implementation.

Question 24

What Model of Patient Care- Total Patient Care, Functional Nursing, Team & Modular Nursing, Primary Nursing, or Case Management?

Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes. Coordinates care through an episode of illness. The focus is on individual clients, not populations of clients.

Answer 24

Case Management Nursing

Question 25

Common Features of Disease Management Programs

Answer 25

-Provide a comprehensive, integrated approach to the care and reimbursement of common, high-cost, chronic illnesses.
-Focus on prevention as well as early disease detection and intervention to avoid costly acute episodes but provide comprehensive care and reimbursement.
-Target population groups (population based) rather than individuals.
-Employ a multidisciplinary health-care team, including specialists.
-Use standardized clinical guidelines—clinical pathways reflecting best practice to guide providers.
-Use integrated data management systems to track patient progress across care settings and allow continuous and ongoing improvement of treatment algorithms.
-Frequently employ professional nurses in the role of case manager or program coordinator.

Question 26

Reimbursement from insurance companies is intimately related to

Answer 26

patient satisfaction

Question 27

Patient and Family Centered Care is organized around the needs of patients …

Answer 27

-Patient and family perspectives are sought out and their choices are honored.
-Health-care providers communicate openly and honestly with patients and families to empower them.
-Patient and family perspectives are sought out and their choices are honored.
-Healthcare providers communicate openly and honestly with patients and families to empower them.

Question 28

Steps of the Decision Making Process

Answer 28

Identify the decision –> Collect data –> Identify criteria for decision –> Identify alternatives –> Choose alternative –> Implement alternative –> Evaluate steps in decision

Question 29

What are the three basic steps to time management?

Answer 29

1) Allow time for planning and establish priorities.
2) Complete the highest priority task whenever possible and finish one task before beginning another.
3) Reprioritize based on the remaining tasks and on new information that may have been received.

Question 30

Sx of poor time management

Answer 30

-constant rushing
-caught in crisis mode
-fatigue or listlessness, overwhelmed feeling
-constantly missing deadlines
-insufficient time for rest or personal relationships
-sense of being overwhelmed by demands and details
-having to do what you don’t want to, most of the time

Question 31

Two mistakes common in planning are

Answer 31

underestimating the importance of a daily plan and not allowing adequate time for planning

Question 32

Priority setting is perhaps the most critical skill in good time management because all actions we take have some type of relative importance.

One simple means of prioritizing what needs to be accomplished is to divide all requests for our time into three categories:

Answer 32

Don’t do, do later, & do now

Question 33

What are the Five Rights of Delegation?

Answer 33

Risk task- One that is delegable for a specific patient

Right circumstances- Appropriate patient setting, available resources, and other relevant factors considered

Right person- Right person is delegating the right task to the right person to be performed on the right person

Right direction/communication- Clear, concise description of task, including its objective, limits, and expectations

Right level of supervision- Appropriate monitoring, evaluation, intervention, and feedback

Question 34

Common delegation errors

Answer 34

under-delegating, over-delegating, and improper delegation

Question 35

Clear communication is important when delegating.

Be sure to

Answer 35

-define task clearly
-delegate end results, time frame, and standards
-delegate the objective, not the procedure

Question 36

In assigning tasks to NAP, the RN must be aware of

Answer 36

the job description, knowledge base, and demonstrated skills of each person.

The NAP has no license to lose for “exceeding scope of practice” and nationally established standards as to what the limits should be for NAP in terms of scope of practice do not exist.

Assuming the role of delegator and supervisor to the NAP increases the scope of liability for the RN. Although the NAP does bear some personal accountability for their actions, this does not negate accountability for the RN who delegated the task(s).

Question 37

Examples of tasks nurses can delegate to practical nurses

Answer 37

-Monitor findings (as input to the RN’s ongoing assessment
-Reinforcing client teaching from a standard care plan
-Performing tracheostomy care
-Suctioning
-Checking NG tube patency
-Administering enteral feedings
-Inserting a urinary catheter
-Administering medications (excluding IV meds in some states)

Question 38

Examples of tasks nurses can delegate to assistive personnel

Answer 38

-ADLs
-Bathing
-Grooming
-Dressing
-Toileting
-Ambulating
-Feeding (w/o swallowing precautions)
-Positioning
-Routine tasks
-Bed making
-Specimen collection
-Is & Os
-Vital signs (for stable pts)

Question 39

Prioritization Principles in Client Care

Answer 39

-Prioritize systemic before local (“Life before limb”)
-Prioritize acute before chronic
-Prioritize actual problems before potential problems
-Listen carefully to clients and don’t assume
-Recognize and respond to trends vs. transient findings
-Recognize indications of medical emergencies and complications vs. expected findings
-Apply clinical knowledge to procedural standards to determine the priority action

Question 40

What priority framework is this?

Nurses should consider this hierarchy of human needs when prioritizing interventions.

For example, the nurse should prioritize a clients:
-Need for airway, oxygenation (or breathing), circulation, and potential for disability over need for shelter
-Need for a safe and secure environment over a need for socialization

Answer 40

Maslow’s hierarchy of needs

Question 41

What priority framework is this?

This framework identifies, in order, the three basic needs for sustaining life.

Answer 41

Airway breathing circulation (ABC) framework

An open airway is necessary for breathing, so it is the highest priority. Breathing is necessary for oxygenation of the blood to occur. Circulation is necessary for oxygenated blood to reach the body’s tissues.

Question 42

ABCDE stands for

Answer 42

Airway- 1st
Breathing- 2nd
Circulation- 3rd
Disability- 4th
Exposure- 5th

Question 43

What priority framework is this?

Look first for a safety risk. For example: Is there a finding that suggests a risk for airway obstruction, hypoxia, bleeding, infection, or injury? Next ask, “What is the risk for the client?” and “How significant s the risk compared to other posed risks?” Give priority to responding to whatever finding poses the greatest (or most imminent) risk to the client’s physical well-being.

Answer 43

Safety/risk reduction

Question 44

What priority framework is this?

Use the nursing process to gather pertinent information prior to making a decision regarding a plan of action. For example, determine if additional information is needed prior to calling the provider to ask for pain medication for a client.

Answer 44

Assessment/data collection first

Question 45

What priority framework is this?

This framework is used in situations in which health resources are extremely limited (mass casualty, disaster triage). Give priority to clients who have a reasonable chance of survival w/ prompt intervention. Clients who have a limited likelihood of survival even w/ intense intervention are assigned the lowest priority.

Answer 45

Survival potential

Question 46

What priority framework is this?

Select interventions that maintain client safety while posing the least amount of restriction to the client. For example, if a client who has a high fall risk index is getting out of bed w/o assistance, move the client closer to the nurses’ work area rather than choosing to apply restraints.

Select interventions that are the least invasive. For example, bladder training for the incontinent client is a better option than an indwelling catheter.

Answer 46

Least restrictive/least invasive

Question 47

What priority framework is this?

-A client who has an acute problem takes priority over a client who has a chronic problem.
-A client who has an urgent need takes priority over a client who has a nonurgent need.
-A client who has unstable findings takes priority over a client who has stable findings.

Answer 47

Acute vs. chronic, urgent vs. nonurgent, stable vs. unstable

Question 48

What priority framework is this?

Use current data to make informed clinical decisions to provide the best practice. Best practice is determined by current research collected from several sources that have desirable outcomes.

Use knowledge of EBP to guide prioritization of care and interventions (responding to clients experiencing wound dehiscence or crisis). For example, initiating CPR in the proper steps for a client experiencing cardiac arrest.

Answer 48

Evidence-based practice

Question 49

A __________ __________ deemphasizes blame for errors and focuses instead on addressing factors that lead to and cause near misses, medical errors, and adverse events.

Answer 49

just culture

Question 50

What are some strategies to prevent medical errors?

Answer 50

-Better reporting of the errors that do occur
-The Leapfrog initiatives
-Reform of the medical liability system
-Bar coding
-Smart IV pumps
-Medication reconciliation
-Anonymous incident reporting

Question 51

Promotes openness and error reporting. Developing a culture of __________ often results in a lower number of adverse events.

Answer 51

safety

Question 52

Relate to client services and can include a slight delay in service or an unsatisfactory service.

Answer 52

Service occurrences

Question 53

Situations where a negative outcome almost occurs (an accident, illness, or injury).

Answer 53

Near misses

Question 54

Minor injuries, loss of equipment or property, or a significant service interrupted

Answer 54

Serious Incidents

Question 55

Unexpected death or major injury, whether physical or psychological, or situations where there was a direct risk of either of these. Major investigation is required in the case of these events.

These events are classified as one of the following:
-Major loss of function or death that was not expected with the client’s medical condition.
-Client attempted suicide during round-the-clock care, a hemolytic transfusion reaction, wrong site or wrong client surgical procedures, rape, infant abduction, or discharge to the wrong family.

Answer 55

Sentinel events

Question 56

Most severe and describes a situation where the client develops a complication that leads to death.

In these situations, there were client indicators that were missed by one or more healthcare personnel that indicated that a complication was occurring.

Answer 56

Failure to Rescue

Question 57

Other important areas for safety

Answer 57

-infection control & prevention
-hazardous materials
-fall prevention
-seizure safety/protective measures
-restraints & seclusions
-fire safety
-ergonomic safety

Question 58

Home safety risk factors

Answer 58

-Age and developmental status
-Mobility and balance
-Knowledge about safety hazards
-Sensory and cognitive awareness
-Communication skills
-Home and work environment
-Community
-Medical and pharmacological status

To initiate a plan of care, the nurse must identify risk factors using a risk assessment tool and complete a nursing history, physical examination, and home hazard appraisal.

Question 59

What are the five steps of medication reconciliation?

Answer 59

1) Identify medications the patient is currently taking when admitted to the hospital or when seen in an outpatient setting
2) Identify medication information (name, dose, route, frequency, purpose)
3) Compare the medication information the patient brought to the care setting with the medications ordered for the patient to identify and resolve discrepancies
4) Provide the patient (or family, caregiver, or support person as needed) with written information on the medications the patient should be taking when they are discharged from the hospital or at the end of an outpatient encounter.
5) Explain the importance of managing medication information to the patient when they are discharged from the hospital or at the end of the outpatient encounter.