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Leadership > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Delegation

Definition

A

transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome

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2
Q

Safe delegation practices

Know (5)

A

Know
- Know nurse practice act (SUPERSEDES any hospital policy)
- Know policies and procedures of hospital you are working in
- Know the patient (assess and assess patient stability) – do not delegate if change in condition possible after task
- Know the staff member (skills, knowledge, competencies, in their job description, past experiences)
- Know the task yourself (NEVER DELEGATE IF YOU DO NOT KNOW THE TASK)

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3
Q

Safe delegation Practices

Tips (6)

A
  • Tasks can be delegated, nursing practice CANNOT be delegated.
  • Explain tasks, expected outcomes, and f/u to prevent errors or patient harm
  • Expect responsible actions from Delegatee (Trust the person and Do not intervene in the task unless assistance requested, needed, or you observe unsafe practices)
  • Delegatee cannot delegate the task to someone else
  • Be supportive, positive, and available when delegating (Positivity gives them a sense of accomplishment)
  • If there are performance issues, need to let manager know!! b-c do not want them to be trends
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4
Q

Define:

  • Accountability (2)
  • Responsibility
  • Supervision
  • Assignment (2)
A

Accountability
- answerable to yourself or others for your own choices, decisions or actions.
- Measured based on standard of care

Responsibility
- doing something that you are suppose to do or obligated to do

Supervision
- provision of guidance, monitoring, oversight of a delegated task

Assignment
- distribution of work among staff members
- Delegation is things outside the CNA’s normal job description or assignment

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5
Q

Delegation: Delegator’s Accountability (7)

A
  • their own acts (Not responsible for delegatee’s mistakes unless due to not following rights of delegation)
  • act of delegation and supervision
  • assessment of situation and patient
  • follow-up/evaluation
  • intervention
  • Corrective action if needed
  • Communicating appropriate info to the person on what they need to do and what to report back to you
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6
Q

Delegation: Delegatee’s Accountability (6)

A
  • their own acts
  • If activity within their job description, skill set, and competency, must accept delegation
  • accomplishing the task
  • asking for assistance or training if needed
  • clarification of questions
  • Communicate back to delegator
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7
Q

Delegation: Organization’s Responsibilities (4)

A
  • Understand processes used during delegation
  • Evaluate and determine what nursing responsibilities can be delegated by RN
  • Write policies and procedures r/t delegation
  • Promote positive work environment
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8
Q

Factors to consider BEFORE delegating (5)

A
  • Does activity have potential for harm to patient?
  • task complexity (If more complex, less desirable for delegation)
  • nursing judgment (If uncomplicated but requires special skills or innovation, do not delegate; Cannot delegate nursing judgment unless to another RN)
  • outcome predictability (If unpredictable, do not delegate)
  • level of interaction (If need for emotional support, a lot of interaction, or patient education, do not delegate)
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9
Q

Factors to consider WHEN delegating (8)

A
  • patient’s needs (If you have not assessed, do not delegate)
  • knowledges, skill, and experience for task (Long time experience != able to do task)
  • ability to communicate r/t to task
  • Level of critical thinking in task
  • demonstrated competence r/t task (Check competency before delegating)
  • Organization’s policies and procedures r/t to task
  • compliance with the Nurse Practice Act
  • Current workload of person delegating to (Consider what other tasks they have been asked to do)
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10
Q

Things to never delegate (3)

A
  • Nursing Process (assessment, diagnosis, planning, and evaluation) –Implementation depends on the task to be delegated
  • Patient education
  • tasks that requires clinical judgement
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11
Q

Five Rights of Delegation (5)

A
  • Right Task
  • Right Circumstance
  • Right Person
  • Right Direction/Communication
  • Right Supervision and Evaluation
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12
Q

Delegation: Right Task (5)

A

Conforms w/

  • organizational guidelines
  • Policies and procedures
  • Staff job description
  • What staff it can be delegated to (any or particular staff?)
  • Nurse practice act rule on delegation
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13
Q

Delegation: Right circumstance (4)

A
  • clinical condition of patient needs to be STABLE
  • delegated task does not require nursing JUDGEMENT
  • Within their job description, policies and procedures
  • Appropriate resources available
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14
Q

Delegation: Right Person (2)

A
  • Appropriate knowledge and skill to perform the task
  • Within their job description, policies and procedures, nurse practice act
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15
Q

Delegation: Right Direction/communication (4)

A
  • Clear directions
  • Expected outcome
  • When, how, what they need to report back to you
  • Allow for questions/feedback/clarity
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16
Q

Delegation: Right Supervision and Evaluation (6)

A
  • RN ALWAYS RESPONSIBLE FOR SUPERVISION either directly or indirectly (Provision of guidance, oversight, and follow-up of the accomplished nurse )
  • Create environment of trustand cooperation
  • RN need to have competency in task being delegated
  • Give feedback (positive and negative)
  • Evaluate patient’s condition + response to delegated task
  • Intervene and report unsafe or poor performance
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17
Q

Obstacles to delegation

  • how to deal with Pushback and obstacles (7)
A
  • Consider if they are refusing to do it or are they resistant to doing it
  • Look at their assignment (# of patients, care required in their assignment, competencies)
  • If resistant to authority of RN
    approach CALMLY + ASSERTIVELY to talk to them (may need nurse manager)
  • avoiding over instructing but provide clear expectations and instruction
  • eliminate restraining forces
  • have mutual respect
  • proper communication and feedback (may need coaching if lack competency
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18
Q

Obstacles to Delegation

  • Fear (3)
  • inability (4)
A

Fear
- Fear of not being like
- fear of criticism after doing the task (delegatee obstacle)
- Fear of pushback from UAP

Inability
- inability to give up control (silos)
- Inability to determine what to delegate and to whom
- Inability to move past novice nurse role (lack of confidence)
- Inability to communicate effectively

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19
Q

Common UAP tasks (6)

A
  • Non-invasive and non-sterile treatments
  • Vital signs
  • Intake and output
  • Mobility (Positioning, turning, Ambulation)
  • Transportation of non critical pt within facility
  • ADLs (unless unstable or complex i.e., new stroke pt)
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20
Q

Ethical/Legal Issues With Delegation

  • Cost Containment (2)
  • Nursing Licensure (3)
  • Communication (1)
A

Cost Containment
- increase UAP = decrease RN staffing
- never okay to alter rules of delegation simply b-c short staffed

Nursing Licensure
- everyone is responsible for their own actions
- RN not responsible for UAP doing incorrect action if they have competency
- RN responsible for communication, supervision, evaluation of task and can be found negligent for inappropriate delegation

Communication
- should be clear and concise

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21
Q

Ethical/Legal Issues With Delegation

  • Scope of Practice (3)
  • Organizational issues (3)
A

Scope of Practice
- understand and know nurse practice act b-c outlines and defines duties that only RN can do
- know policies and procedures of hospital where you work
- know standard of practice

Organizational Issues
- substandard care should be reported to nurse manager
- staffing levels need to be safe to care for patients
- ethical issues reported to ethical committee

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22
Q

Common LPN tasks (9)

A
  • Administer P.O. medication
  • With IV certification course (Administer floor stock IV solutions and start IVs) – no IV Push/central line
  • Chart observations in medical record after RN does initial patient assessment
  • Complete the history on admission assessment (RN must do physical assessment)
  • Reinforce teaching initiated by RN
  • Feeding through NGT
  • Execute plan of care developed by the RN
  • Colostomy care
  • Non-complex wound care
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23
Q

Obstacles to Delegation

  • Other (4)
A
  • Negative past experiences w/ delegation
  • Perfectionism (belief you are the only one that can complete task)
  • Lack of knowledge regarding delegatee’s competencies, skills, education, job description
  • Problems w/ relationships (ex. don’t get along w/ people or difficulty developing relationships
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24
Q

Levels of Supervision (3)

A

Unsupervised
- Only if you delegate to an RN b-c same skills and credentials so you don’t need to supervise them

Initial direction then Periodic inspection
- RN supervises UAP or LPN

Continuous supervision
- continual support and assistance
- Ex: when you delegate a task to someone for the first time and don’t know how they will do so you go and watch them

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25
Q

Communication:

Definition

Notes (4)

A
  • process of assigning meaning to needs, feelings, and perceptions and then interpret what is brought into your awareness

Notes
- Basic principle in managing and coordinating care
- Professional communication sets tone for unit (upset charge nurse = upset everyone else)
- Lack of communication = significant barrier in errors of healthcare
- Nonverbal speaks louder than your verbal behavior because they SEE you before they HEAR you

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26
Q

Elements that influence Communication (Feedback loop)

  • interpretation (2)
  • filtration (3)
  • feedback (3)
A

Interpretation
- receiver’s beliefs about the message
- You can say one thing, but the way that the message is interpreted could be different

Filtration
- all information received is filtered by receiver i.e., colander
- Be mindful to not filter out too much because you may filter out something that is important when listening
- Be aware of filtration b-c it is essential that person you’re talking to understands the message that you’re sending

Feedback
- The RESPONSE and reaction FROM RECEIVER
- influenced by receiver’s interpretation and filtration
- Feedback loop starts cycle over

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27
Q

Communication: Components of Interpretation (6)

A
  • Context + environment = all circumstances and things in environment around the communication
  • Precipitating factors: all events that took place before the communication
  • Preconceived ideas: perceptions, thoughts and opinions prior to the encounter of situation; beliefs formed based on what has happened to you in the past
  • Style of transmission: the way the communication is conveyed (Open or closed statements; include body language, tone of voice, vocabulary that you use, emphasis on topic)
  • Past Experiences (Stop if any reaction noticed from receiver that may be biased based on previous experience (i.e. crying despite no apparent reason))
  • Personal perception = all the person knows about the situation; has to do with senses (taste, smell, touch, hearing, vision)
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28
Q

Barriers to Effective Communication (5)

A
  • distractions (framing an answer w/o listening; environment, preexisting worries)
  • inadequate knowledge
  • poor planning
  • differences in perception
  • emotional and personality
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29
Q

Positive Communication Techniques

  • Develop Trust (3)
  • Use “I” messages (2)
  • Establish Eye Contact (3)
A

Develop Trust
- Essential for all good relationships (pt needs to trust their nurse; needed for all relationships)
- Enhanced by responsiveness openness, honesty, integrity, and dependability
- To foster, Change communication style based on who you are communicating with to improve clarity (at their literacy level); protect confidentiality, be available

Use “I” messages (Ex. “I feel like I did not get a good report” instead of “YOU didn’t give a good report”)
- Always begin with “I” messages to not sound accusatory and make the receiver feel defensive
- Provides opportunity to address the real issue

Establish Eye Contact
- Shows respect and you care and value the conversation
- Make person feel you are giving undivided attention
- If no eye contact, can be perceived as shy, insecure, preoccupied, unprepared or dishonest (Be aware of cultural differences)

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30
Q

Positive Communication Techniques

  • Keep Promises (3)
  • Express Empathy (2)
  • Use open communication (2)
A

Keep Promises
- Follow through or you will lose trust.
- Just explain if you can’t keep a promise
- Be careful with what you say (Important for elderly pts b-c some patients watch the clock)

Express Empathy
- Ability to put yourself in another person’s situation to better understand the person and to share the emotions and feelings the person is having
- It is NOT feeling sorry for someone

Use open communication
- Open-ended questions allow for elaboration
- Allows for an answer rather than yes / no or one word answers
Ex: Are you distracted vs. you seem distracted where are you at right now?

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31
Q

Positive Communication Techniques

  • Clarifying Information (1)
  • Being Aware of Body Language (3)
  • Using Touch (3)
A

Clarifying Information
- Asking for feedback to ensure receiver understands message being said

Being Aware of Body Language
- Positioning and body movement show a strong message
- Closed body language makes a patient believe that you are closed/uninterested (e.g., crossed arms)
- Leaning forward can demonstrate interest in the receiver and conversation (Be careful b-c being too close can cause harm)

Using Touch
- Can portray genuine interest and concern
- Be sensitive to people’s body space and personal and culture preferences
- Read situation prior to using touch

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32
Q

Negative Communication techniques

  • closed communication styles (1)
  • blocking (3)
  • false reassurances (2)
  • conflicting messages (1)
A

Closed communication styles
- Require single word answer or yes/no questions which limit response

Blocking
- Occur when the response is generalized, cutting off a person’s feelings
- Can be perceived as minimizing concerns
- Happens when you are uncomfortable with a topic
Ex. Cutting the conversation off “Well everyone feels like that”

False assurances
- Placate or show lack of concern or knowledge about situation
- Dismissing patients concerns
“You will be okay, you’re going to live”

Conflicting messages
- Nonverbal not matching w/ verbal (What you say does not match how you act; nonverbal speaks louder)
Ex. Rolling your eyes OR tell pt call you if they need anything but you don’t answer when you answer

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33
Q

Logical Fallacies

Basics (3)

A
  • Faulty logic and reasoning that is barrier to communication
  • Related to individual’s culture, gender, background, or personal experiences
  • Occurs at significant times of stress in a person’s life
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34
Q

Logical Fallacies: Types

  • Ad hominem abusive (2)
  • Appeal to Emotion (1)
  • Red Herring (1)
A

Ad hominem abusive:
- An argument that attacks person over the issue
- Goal = discredit a person by bringing up unrelated fact.
Ex. “That doctor is too young to be practicing medicine” after not doing something right for a patient

Appeal to Emotion
- Attempt to manipulate other people’s emotions to avoid the real issue
Ex. “You are always late”-> “I have three kids, they have a lot going on, and I could not get here on time”

Red Herring
- Introduction of a completely irrelevant topic to divert attention from the real issue
Ex. “You are mad about my documentation because I am going back to NP school”
Ex. “It is not my work that you’re really made about, it is that I am a guy and you do not like male nurses”

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35
Q

Environmental Characteristics which support professional communication (5)

A
  • Empathy (concerned about feelings of others)
  • Equality (everyone treated the same)
  • Openness (people able to express their feelings and state them directly and honestly)
  • Positivity
  • Supportiveness
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36
Q

Active Listening Techniques (8)

A
  • Paraphrasing content of the message (clarifying meaning and interpretations; “What I hear you saying is”)
  • Reflecting on message (respond to emotions; “You are angry, what happened?”)
  • Open questions (Obtain more information to avoid assumptions “What happened when you talked to them?”)
  • Acknowledging (Conveys appreciation of other person’s perspective i.e. “This seems to be very frustrating to you”)
  • Summarizing (Pull important information together i.e. “So what is bothering you is ___”)
  • Directing a conversation: Communicate your message in a way people will be open to hearing it
  • Framing (Transferring issue to another person
    “I think it will be better to speak with nurse manager about these issues since she is more directly involved ”)
  • Reframing (Helps person see their concerns in a new light; Broadening the information and Diffuses negative feeling ‘It sounds like you need more information”)
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37
Q

Conflict

Basics (3)

A
  • a clash or struggle that occurs within oneself or with others when a real or perceived threat or a difference exists between desires/wants, thoughts, attitudes, and feelings.
  • catalyst for change (beneficial or detrimental)
  • No conflict = no change/stagnate
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38
Q

Conflict: Constructive effects (7)

A
  • Improves the quality of decisions
  • Stimulates creativity
  • Encourages interest
  • Provides medium for problem awareness and tension relief
  • Promotes open and honest discussion
  • Fosters environment of change
  • Improves group performance
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39
Q

Conflict: Destructive effects (5)

A
  • Constricts and blocks communication (disruptive)
  • Decreased team building/ cohesiveness of group
  • Hinders performance of the group and work environment
  • most NEGATIVE PARTS OF CONFLICT IS ITS IMPACT ON PATIENT OUTCOMES
  • can explode into fighting
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40
Q

Factor underlying conflict (4)

A
  • Ineffective communication and inactive listening
  • Interdependence (i.e. b/w co-workers): conflict in communication between people who are dependent on each other and perceive their interests as incompatible, different, or there is tension
  • Differences in Goals (do not see eye to eye; Agree to disagree)
  • Differences in Perceptions
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41
Q

Types of conflict

  • Relationship
  • Task
  • Process
A

Relationship conflict: interpersonal differences in ideas i.e. annoyance, frustration, or irritation
Impairs team performance

Task conflict: disagreement on how to complete tasks

Process conflict: incompatibility or viewpoint on how work can be accomplish

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42
Q

Types of conflict

  • intrapersonal (2)
  • interpersonal (2)
  • intragroup (1)
  • intergroup (2)
  • organizational (2)
A

Intrapersonal = Within (Internal conflict)
- Discord, tension or stress inside of someone
- Due to unmet needs, expectations, or goals
Ex. My 3-year-old child is sick, but I must work or they will be short

Interpersonal
- Between two or more people
- Clash in values, style, perspectives, beliefs

Intragroup = Conflict within members of the group

Intergroup
- Conflict BETWEEN two or more groups
- Related to authority, territory or resource issues
Ex: between physician and nursing between whose responsibility it is

Organizational
- struggle for scarce resources within an organization
- r/t goals, roles, policy and procedures, behaviors, personal conduct

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43
Q

Causes of conflict: individual (4)

A
  • Personality differences
  • Value differences
  • Ineffective communication
  • Diversity r/t age, gender, race, or ethnicity (Older vs younger nurses)
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44
Q

Causes of conflict: organizational (4)

A
  • Blurred job boundaries (Ex: Issues with LPNs on what they can and cannot do)
  • Battle for limited resources
  • Unmet expectations
  • Lack of clear jurisdiction (who does this person report to)
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45
Q

5 Stages of Conflict

A

Stage 1: Latent Conflict
- Actual Conflict has not developed but factors are present that have high likelihood of causing conflict
Ex: walking rounds are going to be implemented

Stage 2: Perceived Conflict
- Person perceives a problem as a conflict when it might not exist
Ex: rumor that goes around about time off or changing, and nurse thinks it will impact vacation request

Stage 3: Felt Conflict
- Begins when people involved start to feel an emotional response related to conflict

Stage 4: Manifest Conflict
- Parties involved aware of conflict and Conflict is being resolved positively or negatively

Stage 5: Conflict Aftermath
- completion of conflict but can be Positive (satisfied w/ plan developed) or Negative (cannot come to joint resolution)

46
Q

Conflict resolution
- negotiation (2)
- mediation (2)
- arbitration (4)

A

Negotiation
- Two people do it together
- Separate own feelings about situation so there can be negotiation with goal of resolving conflict

Mediation
- When things can’t be resolved, there must be a neutral mediator to listen to both sides of party and facts
- Listen to evidence and assist in making decision

Arbitration
- If the conflict is so complex, there is a 3rd party involved to make the final decision.
- Cannot bring in attorney
- binding or non-binding
- last step and no turning back

47
Q

Conflict Management Styles

  • Avoidance/Withdrawing (4)
  • Smoothing (4)
A

Avoidance/Withdrawing (Turtle)- Low assertiveness
- Aware of conflict but actively avoids
- Conflict is never resolved and neither party has their goals met
- Lose-lose because they are not dealing with the conflict and it can later resurface
- May be appropriate if one person has more power in the situation or problem is time-limited

Smoothing
- When someone tries to pacify the other party
- Focus on what they agree on rather than disagreement/conflict
- Used to preserve a peaceful working environment
- Lose-lose because you don’t deal w/ conflict

48
Q

Conflict Management Styles

  • Competing/Coercing (4)
  • Cooperating/Accommodating (4)
A

Competing/Coercing (Shark)
- uses power and creativeness to win at all costs (often defensive and aggressive)
- used when a quick or unpopular decision needs to be made ASAP
- Win-lose situation
- Losing party may get frustrated and try to get even

Cooperating/Accommodating (Teddy bear) – low assertiveness
- One person puts aside own goals to satisfy other’s desires i.e. “Whatever you want is okay with me”
- Lose-win situation
- Typically, original conflict will not be resolved and solution may result in more conflict if accommodator expects something in return
- Appropriate if unimportant to you

49
Q

Conflict Management Styles

  • Compromising/Negotiating (2)
  • Collaborating (3)
A

Compromising/Negotiating (Fox) – medium assertiveness
- always good
- Win-win – both parties give up something to get partial goal attainment i.e. “Let’s make a deal”

Collaborating (Owl) – high assertiveness
- Win-win-win - both parties try to actively find a new solution that will satisfy both
- MOST TIME INTENSIVE APPROACH (Takes longest because both people have to agree and develop new goals)
- Both parties set aside their original goals, so there can be some type of mutual agreement and resolution

50
Q

Perks of highly effective team (8)

A
  • greater exchange of data
  • problem solving for complex issues
  • increased interdisciplinary collaboration w/ diverse points
  • Better to work as a group than individual
  • Higher quality patient care and outcomes
  • strength, structure, + resilience for work changes
  • Everyone on team shares humility, honesty, discipline, creativity, and curiosity
  • Guided by clear roles, mutual trust, effective communication, shared goals and measurable outcomes
51
Q

STEEEP Principles

A

safe
timeliness
effectiveness
efficiency
equity
patient centered

52
Q

Steps in Team development

  • forming (3)
  • storming (4)
A
  1. Forming
    - Members of the team meet and get to know each other
    - Boundaries are set
    - Leader defines team’s tasks and offers direction
  2. Storming
    - Where conflict arise within the team
    - Members express different viewpoints
    - Team establishes rules for the group
    - Members of the team start taking on roles (cheerleader, informal leader)
53
Q

Steps in Team development

  • norming (3)
  • performing (2)
A
  1. Norming
    - Follow established rules
    - Cooperation and respect develops b-c differences between people start to resolve
    - Begin to accomplish tasks
  2. Performing
    - Team focuses on tasks given
    - Roles become functional and flexible
54
Q

Key concepts in teams (4)

A

Conflict resolution
- Members need to be able to communicate and resolve conflict among members to enhance working relationships with team members (communicating and dealing w/ conflict)

Singleness of Mission
- Every person on the team must be 100% committed to the purpose of the team

Willingness to Cooperate
- Members of the team need to work together in respectful and cooperative manner

Commitment
- Members need to be dedicated to doing the job that you are supposed to do AND to other members on their team

55
Q

Disruptive Roles in Teams (definition and how to deal with the role)

  • compulsive talkers (2)
  • nontalkers (2)
  • Distracted or unreliable members (2)
A

Compulsive Talkers
- Can’t stop talking
- Leader’s role: When they pause, thank the person for their input and ask for someone else’s opinion OR If it gets really bad, Manager might have to talk to them in private

Non-talkers
- Does not say anything and do not contribute due to discomfort w/ group talking
- Leader’s role: Ask this person what their opinion is on the topic, Create a safe environment for people to share their ideas! OR meet w/ them in private, show them the agenda, and say you value their opinion and want them to speak up

Distracted or Unreliable Members
- Not prepared or committed to the team i.e. plays w/ phone, shuffles papers
- Leaders role: In private, ask them if they want to work with the team OR Give them a specific assignment with due dates

56
Q

Disruptive Roles in Teams (definition and how to deal with the role)

  • Interrupters (3)
  • Squashers (4)
A

Interrupters
- Demonstrates lack of self-awareness and self-control
- Stifles the conversation because other people cannot get their thoughts out
- Leader’s role: Ask person to let other person finish their thought then they can talk AND set ground rules so everyone knows what rules are

Squashers
- Finds something wrong with every idea
- Generally, doesn’t like change or putting effort into change
- Does not want to take personal risks
- Leader’s role: set expectations/ground rules prior to discussion

57
Q

Define:

  • decision making
  • problem solving
A

Decision making = process of making a logical choice between several courses of action to solve a problem

Problem solving
- resolve an issue based on gap between what it is now and what it ought to be
- Step in decision making process

58
Q

Decision Making Models: Situational Assessment Procedure

Steps (4)

A

ethical decision making model

Steps

  1. Identify the ethical issue / problem
    - Must look at facts, emotions/attitudes, technical, values, varying perspectives, and environment when dealing with ethical issue
    - Want to state nature of ethical dilemma
    - Identify issue itself and hidden issues
  2. Identify and analyze available actions
    - List all possible actions that can be taken for given situation even if they’re not feasible
    - Ideally w/ interdisciplinary team b-c differ in outlook
  3. Select one alternative
    - based on ethical theory, principle, and logical approach
  4. Justify alternative selection
    - Use Reason, ethical basis, and anticipate objections
59
Q

Decision Making Models: Nursing Process

Assessment (3)
Diagnosis (2)

A

Assessment (assess symptoms of the problem)
- Separate the problem from symptoms of problem by gathering information about the problem
- Treating symptoms of problem will not solve the problem
- Talk to all parties involved to get their input and perspective

Diagnosis (identify the problem)
- Identify the actual problem to be solved based on info gathered i.e. symptoms of problem
- Leader decides if it is a problem they can deal with on their own or if they need assistance

60
Q

Decision Making Models: Nursing Process

Planning (5)
Implementation (2)
Evaluation (2)

A

Planning (goal: identify as many options as you can)
- Weigh each option for potential or unintended consequences
- consider positive and negative outcomes (pt outcome and staff satisfaction)
- Be flexible and open (do not let rigid thinking or negativity impact outcome)
- Involve staff in decision making
- Decide how the solution is going to be monitored

Implementation
- Carry out plan
- Ensure effective communication, delegation, support to solution

Evaluation
- Monitor for compliance and problem resolution
- Allocate time for monitoring

61
Q

DECIDE Model (6)

A
  • used in high stress environments to prevent thinking and cognitive errors*

D = Define the problem
- Determine what caused the problem and that something needs to be done

E = Establish the criteria
- decide what you want to accomplish; What needs to stay the same; What you can do to prevent future occurrence

C = Consider all the alternatives
- determine choices and desirable outcome

I = Identify the best alternative

D = Develop and implement a plan of action

E = Evaluate and monitor the solution (give feedback and troubleshoot)

62
Q

Decision Making Tools

  • Brainstorming (3)
  • Focus Groups (3)
  • SBAR (1)
A

Brainstorming
- Technique where group gets together and throws out all possible alternatives (says suggestions out loud including unrealistic and absurd solutions)
- Allows for innovative ideas to flow and surface (b-c people feed on each other’s ideas)
- Should not be any discussion of ideas (just throw out ideas)

Focus Groups
- Bring small groups together to discuss issues/problems and generate information on location of problems
- Based on group composition, you can facilitate discussion to fix some things immediately and determine other things that need to be addressed which aren’t quick fixes
- Ideally, focus group speaks for larger group

SBAR (Situation, background, assessment, recommendation)
- Communication tool to promote and organize effective communication

63
Q

Decision Making Tools

  • Nominal Group Techniques (2)
  • Pilot Projects (1)
  • SWOT (3)
A

Nominal Group Techniques
- Difference from brainstorming: Writing suggestions down instead of calling out ideas
- Round robin or Ideas are listed on board and then ranked

Pilot Projects
- small scale test of change which allows for preliminary analysis

SWOT Analysis
- strengths and weaknesses inside org
- Opportunities and threats outside org
- Used in strategic planning and Identifies organizations competitiveness

64
Q

Decision Making Tools

  • Delphi Technique (3)
  • Shared governance (4)
A

Delphi Technique
- send a survey, usually to get the physician’s opinions b-c time saving
- Refine and resend survey as you get more and more feedback and until you get the info you need
- Report results back to participant

Shared governance
- Staff leader partnership where decision making is done at the level that it occurs
- committee has autonomy and decision making ability
- improved nurse work environment, satisfaction, and retention because the nurses have say-so (active decision making) on things that impact their unit
- Magnet hospitals typically need to have this implemented.

65
Q

Leadership Decision Making Strategies

  • Direct intervention (2)
  • Indirect intervention (2)
A

Direct intervention
- Some decisions require direct intervention by the manager
- Used with policy violations -> disciplinary action

Indirect intervention
- Usage of conflict management and negotiation to address the issue (i.e. individuals involved solve the problem)
- Manager does not make the decision but persuades others to solve the problem

66
Q

Leadership Decision Making Strategies

  • Delegation (1)
  • Purposeful inaction (2)
  • Consultation/collaboration (1)
A

Delegation
- Manager delegates or passes the role of fixing the problem to someone else.

Purposeful inaction
- Manager makes purposeful decision to not act (Actively choosing to do nothing)
- Okay strategy if time-limited problem unless person is being disruptive

Consultation / Collaboration
- Bring in someone else to help manager w/ decision making

67
Q

Problem- solving process

Steps (7)

A
  1. Define and identify the problem, issue or situation (MOST IMPORTANT)
    - Distinguish actual problem from symptoms of problem
    - Influences values, attitudes, and experiences of everyone involved
    - Most common reason for failure to resolve a problem = failure to correctly identify what the problem is
  2. Gather Data
  3. Analyze the Data
  4. Develop Solutions
  5. Select a Solution (Think through pros and cons esp. risks and consequences)
  6. Implement the solution
  7. Evaluate the Results
68
Q

Principles of Prioritization (8)

A
  • systemic before local (life before limb; whole body > local reaction)
  • acute before chronic
  • actual problems before potential problems (i.e. listen to patient and do not make assumptions)
  • trends vs. transient findings (multiple high BPs > 1 high BPs)
  • medical emergencies and complications vs. expected findings (apply clinical knowledge and procedural standards to prioritize)
  • ABC (airway, breathing, circulation)
  • Urgent > non urgent
  • Unstable findings > stable findings
69
Q

Prioritizing Traps to Avoid (4)

A
  • Avoid “do whatever hits first”
  • Avoid taking the path of least resistance (do it yourself vs ask someone else)
  • Avoid responding to “squeaky wheels”- whoever or whatever is the loudest vs most pressing needs (need to determine if loudest is just loud or actual urgent issue)
  • Avoid relying on misguided inspiration i.e. putting charting over checking on unstable issue
70
Q

TIme Management Distractors (how to manage them)

  • Doing too much (3)
  • Inability to say “no or not now” (2)
  • Procrastination (2)
A

Doing too much
- Take a moment to prioritize care
- Finish one task before starting a new one
- Decide what needs to be done and what is nice to do

Inability to say “no or not now”
- Decide what you have time to do
- Okay to say no (Do not accept tasks you cannot complete)

Procrastination
- Identify reason for procrastination
- Do least desirable task first

71
Q

TIme Management Distractors (and how to manage them)

  • Complaining (1)
  • Perfectionism (3)
  • Interruptions (2)
  • Disorganization (3)
A

Complaining (express dissatisfaction and annoyance)
- Talk to manager r/t problem solving if continuous problem

Perfectionism
- May leave things unfinished b-c can not make it perfect
- Accept everything will not be perfect
- Accept people may do things differently from you

Interruptions (Part of everyday life)
- Prioritize work
- Set limits on time esp. w/ med administration to prevent med errors

Disorganization
- understand Organization is a PROCESS not product
- Anticipate patient needs
- Eliminate clutter

72
Q

Questions to ask yourself when prioritizing: (5)

A
  • Will the patient be jeopardized if the task is not done?
  • Is the task a priority because of a deadline?
  • Do safety concerns make this task a priority?
  • Will there be serious consequences if the task is postponed?
  • What are the legal issues related to the priority of this task?
73
Q

Horizontal Violence

Definition (2)

A
  • conflictual behaviors among individuals who consider themselves peers with equal power
  • an act of aggression toward another colleague
74
Q

Horizontal violence

Impact (8)

A
  • Low morale in staff
  • Stress
  • Sleep disturbances
  • Health complaints
  • Increased absenteeism
  • work-related suicide
  • Turnover
  • Higher cost
75
Q

Types of disruptive behavior: Bullying

  • Definition (4)
A
  • Repeated, unwanted harmful actions that occur with greater intensity and frequency
  • carried out in an effort to offend, distress, and humiliate an intended recipient.
  • Abusive power that makes receiver feel threatened, disgraced, and vulnerable (Ex. Taunting a person, verbal intimidation, undermining, threats)
  • perceived OR real power difference (receiver has inability or limited ability to defend themselves)
76
Q

Types of disruptive behavior: Bullying

Impact (5)

A
  • Psychological and physical stress
  • Professional disengagement
  • Underperformance
  • Increase job turnover
  • DECREASE in quality of patient care
77
Q

Types of disruptive behavior

Cyberbullying
Verbal Bullying
Physical Bullying

A

Cyberbullying: Disruptive behavior or slander using electronic devices

Verbal Bullying: Talking , Slandering , Ridiculing, Persistent name calling, Offensive remarks, receiver = butt of the joke; abusive or derogatory remarks

Physical Bullying: Pushing, Shoving, Kicking, Punching, Damaging working environment, assault, or threats

78
Q

Types of disruptive behavior

  • Incivility (2)
  • Exclusion
A

Incivility
- rude, inconsiderate or disrespectful behavior that can be intimidating and insulting (i.e as gossiping, spreading rumors, dirty looks, & refusing to help)
- If not addressed, it becomes bullying

Exclusion: socially or physically isolating someone

79
Q

Common Nurse-Nurse Bullying Behavior (9)

A
  • Silent treatment (Refusing to share pertinent information being shared during report)
  • Spreading Gossip and rumors
  • Sharing confidences
  • Putting down/humiliation r/t skills or ability
  • Using body language to convey negative messages (eye rolling, head back)
  • Manipulating/Intimidating someone to do something for you
  • Saying something negative and pretending to joke
  • Repeating information out of context
  • Failing to support someone you do not like
80
Q

Workplace violence: TJC Categories (4)

A
  • Person causing violence has no relation to hospital
  • Customer or patient of org
  • Current or former employer
  • Caused by spouse or partner of employee
81
Q

Workplace violence: TJC Mandates (4)

A
  • Code of conduct for disruptive behavior
  • Reporting systems needs to be available
  • Process and policy for managing disruptive behavior (b-c detrimental to patient safety)
  • Workplace violence to be reported as sentinel event
82
Q

Interventions to Deter Disruptive Behavior

Policies (5)

A
  • Support Zero tolerance policies for disruptive behavior
  • Ensure Policies which limit or prohibit retaliation
  • educate staff on code of conduct
  • Performance expectations in place for staff
  • Reporting systems to report workplace violence
83
Q

Interventions to Deter Disruptive Behavior

General (5)

A
  • Create environment of mutual respect
  • Model good behavior
  • Speak up b-c SAYING NOTHING = TELLING THAT PERSON THEIR BEHAVIOR IS OK
  • Avoid online remarks on social media (avoid talking about hospital completely)
  • avoid making excuses for someone’s disruptive behavior
84
Q

Resources to address workplace violence

  • Leadership (5)
A
  • responsibility to provide a safe work environment for all employees
  • be aware of culture on unit and what is going i.e. increased call-ins
  • be open to reporting bullying and horizontal violence and ensuring no retaliation
  • Provide de-escalation training for employees (Gradual resolution of aggressive situations where you’re taught to use non-confrontational limit setting early while maintaining dignity and respect of patient)
  • Zero tolerance for workplace violence
85
Q

Resources to address workplace violence

  • Human resources (3)
A
  • Per TJC, must have policies and procedures related to workplace violence prevention
  • Need to actively participate in any type of incident management (involved if horizontal violence)
  • Part of responsibility is to screen applicants for employment
86
Q

Resources to address workplace violence

  • Employee Assistant Programs (EAP) (3)
A
  • Assist employees w/ personal problems voluntarily or involuntarily in behavioral health plan
  • Certain number of visits that an employee can make for free for counseling, psychiatrist, or therapist
  • Manager can put in an employee request for employee to have EAP (usually if many patient deaths or other stressors)
87
Q

Resources to address workplace violence

  • Legal Implications (3)
A
  • No federal workplace laws prohibiting workplace violence
  • Healthy workplace bill: grassroots bill designed to prevent and correct abuse in workplace but Lost momentum w/ COVID
  • Harassment covered by civil rights laws and may overlap with bullying
88
Q

Joint Commission Workplace Violence Prevention Standards

  • Environment of Care Chapter (3)
  • Human Resource Chapter (1)
  • Leadership Chapter (2)
A

Environment of Care Chapter:
- Requires hospital’s Workplace Violence Program
- Requires annual analysis of the hospital’s Workplace Violence Program
- Requires process for monitoring, reporting, and investigating workplace violence events

Human Resource Chapter:
- Requires education on hire, annually, and with program changes

Leadership Chapter:
- Team to develop polices, track and trend, and provide follow up and support
- All incidents must be reported to governing board

89
Q

Patient Violence

General notes (5)

A
  • underreported b-c people do not report if not personally done to them
  • Patient violence is one of most frequent causes of staff injury esp. ED and behavioral health staff
  • Verbal abuse is the most common violence carried out by patients
  • assess patient risk for self-violence
  • Body language is the most significant cue to impending violence
90
Q

Patient Violence

  • Common Triggers (8)
A
  • Expectations not being met
  • Perceived loss of independence or control
  • Upsetting diagnosis, prognosis or disposition
  • History of abuse that causes an event or interaction to retraumatize patient
  • Long wait time (>1 hour in the ED)
  • inadequate security personnel
  • Time of day: 3-11pm = high risk time for violence
  • Men are more likely to commit physical abuse
91
Q

Patient Violence

  • Predisposing Factors (6)
A
  • Alcohol and substance withdrawal (alcohol decreases tolerance for frustration and incites violence)
  • Psychiatric diagnosis: Schizophrenia, Bipolar, MDD (2-3x more likely to demonstrate violent behavior)
  • Trauma
  • Stressors: Financial, Relationship, Situational problems.
  • Hx of violence in the domestic setting
  • Environmental risks: objects that could be used as weapon (chairs, IV poles)– remove items that can be used for violence
92
Q

Warning Signs of Violence: STAMP

A

S= Staring and eye contact (intense or prolonged glaring)
T= Tone and volume of voice (increased volume, yelling
A= Anxiety (irritability)
M= Mumbling
P= Pacing or walking back and forth

93
Q

Patient Violence

  • Behavioral Cues to observe (8)
A
  • STAMP
  • Aggressive statements: Sharp or casuistic remark; name calling or swearing
  • Resisting healthcare or failing to cooperate
  • Becoming quarrelsome or argumentative
  • Body language: Fist clenching, Teeth gritting
  • Rude and intimidating
  • Demanding attention
  • Asking repeated or rhetorical questions
94
Q

Strategies to Keep Yourself Safe Against Patient violence

Things to assess (5)

A
  • Patient and your body language
  • Hx of drug or alcohol abuse
  • Hx of mental illness (decrease agitation if their illness is not controlled or if deviation from normal routine)
  • S/s of aggression (name calling, threat, tense posture, rapid movement, increased voice volume)
  • Own stressors and how to manage them
95
Q

Strategies to Keep Yourself Safe Against Patient violence

How to respond (6)

A
  • Listen to gut feelings
  • Keep safe distance
  • Do not react emotionally but be rational (two emotional people != helpful)
  • Use buddy system if uncomfortable or afraid to go in patient room
  • Always be aware of surroundings and know how to call for help
  • All threats need to be investigated i.e., actual or perceived; spoken or unspoken, specific or vague, veiled
96
Q

Strategies to Keep Yourself Safe Against Patient violence

Communication Strategies (9)

A
  • Build trust and establish rapport (keep promises)
  • Listen to patient and validate feelings and concerns
  • Address concerns in a timely manner
  • Be respectful + professional
  • Introduce self and formally address patient
  • Always explain what you are doing before you do it
  • Ask patient if they have any questions
  • Offer positive choices prior to less desirable ones
  • Ensure words and body language (tone, facial expressions, posture, eye contact) match and are calm
97
Q

Define

  • Disaster (2)
  • Disaster Condition
A

Disaster
- type of emergency that, due to its complexity, scope, or duration threatens a healthcare center’s capabilities and requires assistance to sustain patient care, safety, or security functions.
- Every disaster begins w/ local event and heaviest burden on local community

Disaster condition: A significant natural disaster OR man-made event that overwhelms the affected state, necessitating both federal, public health, and medical assistance.

98
Q

Disaster: Mass Casualty Event

What is it?
Priority
Successful response requires (2)

A
  • disaster condition where number of victims are so large that multiple orgs are called to respond

Priority: doing greatest good for greatest number of people (crisis standard of care)–Care is given to people that have the best chance of survival

Success requires
- coordination of EMS, community providers, CDC, healthcare orgs, local level government
- considerations for sheltering people

99
Q

Emergency Preparedness Plan

TJC Requirements of all facilities (5)

A
  • need to be prepared w/ all hazards approach to disaster planning i.e plan, review, analyze, and address all credible hazards and serious threats to community
  • Need to be able to communicate and coordinate with each other
  • Need to respond on a local level before utilizing state/federal resources
  • Need to transport and coordinate supplies and patients during a disaster
  • Each hospital needs to have credentialing in place for providers to work in different hospitals in emergencies
100
Q

Phases of Disaster: Preparedness (3)

A
  • Activities are focused on planning, preparing, preventing, and warning
  • Must have emergency operations plan in place which says how they will respond to disasters
  • hospitals need to have 2 disaster drills a year
101
Q

Phases of Disaster: Relief Response (6)

A
  • Activities focused on responding to the disaster
  • Emergency management system activated
  • Provide emergency response to victims
  • Stabilize and minimize factors / effects
  • Interactions with ALL the responders (EMS, police, fire, hospitals, hazard response team, health department)
  • Manager on unit must evaluate resources on unit to bring list of # of vacant beds, # of patients that can be safely discharged, Evaluation of supplies on unit
102
Q

Phases of Disaster: Recovery (3)

A
  • Starts within 72 hours AFTER disaster
  • Continues for to 2-3 years
  • Building and rehabilitation
103
Q

Emergency Designations (3)

A
  • Level 1 Emergency: localized incident (Memphis)
  • Level 2 Emergency: regional incident (Shelby county or west Tennessee)
  • Level 3 Emergency: national incident (United States)
104
Q

Emergency Operating Plan: Key Components (9)

A
  • Command and Control
  • Communication
  • Safety and Security (ensure hospital functions and responds to safety threats)
  • Triage
  • Surge Capacity
  • Continuity of Services
  • Human Resources
  • Logistics and Supply Management (ensure linen and food)
  • Post-disaster Recovery
105
Q

Emergency Operating Plan: Necessary Roles (8)

A
  • Incident commander
  • Public information officer (talks to press)
  • Safety officer
  • Liaison officer: communicates w/ other hospitals
  • Operations: oversee hospital operations
  • Planning
  • Logistics
  • Finance/administration
106
Q

Specific emergency Situations: How to handle

  • Severe thunderstorm/tornado (3)
  • biologic incidents (ebola) and pandemic (COVID) (1)
A

Severe thunderstorm/tornado
- Move your patient away from the window
- Shut curtains / blinds if they have them
- Move ambulatory patients to the hallway

Biologic incidents (ebola) and pandemic (COVID)
- know hospital policy, plans, expectations

107
Q

Specific emergency Situations: Active Shooter

What is it?
Response per DHS (3)

A
  • person actively engaged in killing or attempting to kill people in confined area typically w/ firearm

Response per DHS
RUN (evacuate)
- Leave belongings behind
- Help others escape if possible but do not wait for them or help wounded
- Keep others from entering area
- Keep hands visible if you exit building police instructions
- Call 911 when safe

HIDE out (hide)
- Hide Where the shooter can’t see you i.e. behind barrier
- Silence phone
- Lock or Block door
- Turn off lights
- Remain calm

FIGHT: act against shooter
- LAST RESORT
- Act aggressively, throw items, yell
- fully committed because hesitation may lead to you being hurt

108
Q

Emergency Operating Plan: Key Components

  • Triage (2)
  • Surge Capacity (1)
  • Continuity of Services (2)
A

Triage
- Assigning the degree of urgency to each patient to determine order of treatment
- Typically done outside the ED if many victims

Surge Capacity
- The health care services or hospitals must be able to take care of more patients/expand via expanding patient rooms or putting patients in nontraditional areas

Continuity of Services
- essential and need to continue to function normally during the disaster (Do you normal job unless told otherwise)
- Normal hospital operations need to run PARALLEL to the disaster

109
Q

Emergency Operating Plan: Key Components

  • Human Resources (2)
  • Post-disaster Recovery (2)
A

Human Resources
- Needs to ensure adequate staffing to take care of pts
- Implement a call tree (order people are called in when shortage

Post-disaster Recovery
- Starts at BEGINNING of response activity
- has to do w/ recovery efforts to stop or limit long term effects of disaster.

110
Q

Emergency Operating Plan: Key Components

  • Command and Control (3)
  • Communication (4)
A

Command and Control Center
- HICS (Hospital incident command system) activated by disaster
- Each person has a designated role and knows where to report in emergency (be familiar w/ your hospital policy)
- Incident commander designates roles of people

Communication
- Clear, accurate, effective, timely b-c everyone wants to know what is going on
- Effective collaboration and cooperation
- Designate an informational spokesman who is responsible for communicating everything
- Requires public awareness and trust

Leadership (4 decks)

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