Final Exam Flashcards

Question

The validity of comments and ratings related to performance is enhanced by which of the following: a. Maintenance of anecdotal notes over the entire evaluation period. b. Quantity of information gathered for appraisal purposes. c. Agreement of the employee with the ratings and comments. d. Whether other individuals have contributed to the observations.

Answer 1

ANS: A Anecdotal notes compiled consistently over the entire rating period are a much more equitable method of providing an accurate summary of the employee’s performance.

Answer 2

ANS: D A BARS describes performance quantitatively and qualitatively, and when staff members are involved in the development of these instruments, they are more likely to understand the importance of evaluation for each criterion selected and to have an understanding of their performance expectations.

Answer 3

ANS: D BARS take a considerable amount of time to implement, and although they are specific to the specialty of nursing and are potentially well accepted by staff, they are expensive to develop.

Answer 4

ANS: C Rating scales are relatively easy to construct and easy to complete but usually consist of generalizations and nonspecific behaviours, and the rating is relatively subjective in nature; these characteristics do not reflect best evaluative practices. The effectiveness of any system is tied directly to the skills and communication abilities of the person who is using it. However, the system itself must be effective. BARS combine ratings with critical incidents (specific examples that have occurred) or criterion references (examples usually based on standards of practice or competency-based standards).

Answer 5

ANS: B Performance appraisal is tied to roles and responsibilities of the position, as outlined in the position description. If roles and responsibilities are not included specifically, they cannot be appraised.

Answer 6

ANS: D A BARS contains both quantitative (rating scales) and qualitative data. It is specific to situations and positions.

Answer 7

ANS: B To obtain and provide an accurate evaluation of performance over time, anecdotal notes need to be maintained throughout the evaluation period. This process assists in avoiding bias related to recent or sensational events that make a particularly strong impression.

Answer 8

ANS: A Behaviour-related questions seek demonstrated examples of behaviour from the candidate’s past experiences and concentrate on job-related functions and accomplishments.

Answer 9

ANS: B Empowerment is a process in which people acknowledge the values and judgements of other people and trust their decisions. It allows freedom for making decisions while retaining accountability and provides an environment that is safe in which to explore.

Answer 10

ANS: B Shared governance involves valuing the contributions of each member of the team, releasing the need to control, and understanding that accountability rests with members of the team.

Answer 11

ANS: B Role ambiguity in the workplace creates an environment for misunderstanding and hinders effective communication. Without clear expectations of performance, missteps in performance can occur.

Answer 12

ANS: A Satisfaction is linked to clear role expectations and a feeling that contributions are valued.

Answer 13

ANS: A Acquisition of a role is time dependent and involves application of life experiences to each role and interpretation of the role within a person’s own value system. As roles become more complex, an individual may take longer to assimilate the components of each role.

Answer 14

ANS: B Employees must have role clarity or clear role expectations and perceive that their contributions are valued. Role conflict is where employees know what is expected of them, but they are either unable or unwilling to meet those expectations due to differences in personal values and/or behavior fit. Role certainty is present when the nurse is confident in the work and satisfied with personal performance.

Answer 15

ANS: A, B, D Retention is based on understanding the role, being the right person for the specific role, understanding the organization’s mission and expectations, and knowing that support and encouragement are part of the unit’s culture. Being unclear about expectations for the role places the employee at a disadvantage and leads to a lack of job satisfaction and leaving for a more appropriate and supportive environment.

Answer 16

ANS: A, B, D Residency programs usually of a year duration are recognized as a method of easing new graduates transition from school to clinical practice. Having a preceptor for up to 12 weeks is also a transition support. A thorough orientation program eases the new nurse into the organization and assists in understanding the expectations and norms of the organization. Nurses expect ongoing staff development throughout their careers and not having support in this area leads to a retention issue

Answer 17

ANS: B, C, D Coaching is a process in which a manager helps others learn, think critically, and grow through communications about performance. This coaching process is a personal approach in which the manager and the employee interact on a frequent and regular basis with the ultimate outcome that the employee performs at an optimal level. Coaching is not financially costly as it occurs mostly during working hours, and is mutually beneficial to both employee and manager.

Answer 18

ANS: A, C During a performance appraisal, it is important to provide examples of both strong and problematic performance and to provide opportunities to express opinions. The supervisor needs to maintain a relaxed professional manner.

Answer 19

ANS: D Passwords must be protected to guard against unauthorized access to patient information and intrusion of privacy.

Answer 20

ANS: D Consistent nursing language, such as the uniform minimum health data set and the nursing minimum data set (NMDS), enables comparison of data across patient populations and sites and aids in the retrieval of meaningful comparison data from an information system.

Answer 21

ANS: A The nurse manager must recognize the utility of nursing involvement in the planning, design, choice, and implementation of information systems in the practice environment.

Answer 22

ANS: A Clinical databases are collections of elements organized and structured for the processing, organization, and presentation of data for interpretation as information, which in this particular instance includes outpatient data.

Answer 23

ANS: D Data about adverse events suggests that a majority of physiologic abnormalities are not detected early enough and may be present hours before an adverse event actually occurs. Physiologic monitoring aids in early detection of such changes.

Answer 24

ANS: A Although there continues to be inconsistency in nursing language, the NMDS defines essential nursing data to be collected for all patients that enable comparison of patient data, description of patient care, determination of trends, stimulation of nursing research, and provision of nursing data to influence decision-making

Answer 25

ANS: A PDAs offer a lower-cost method of documentation and communication than do personal computers, and also easy portability. Disadvantages of PDAs include small screen size, suboptimal readability, and slowness in situations when speed is most needed.

Answer 26

ANS: B Speech recognition systems rely on staccato-like speech, pauses between words, and programming for each user, any and all of which would be rare in a pressured crisis situation. SR is being used primarily for therapeutic purposes and in situations in which data entry is stable

Answer 27

ANS: D The most accessible and cost-effective approach would be use of what is already available in the work environment. Development of new software is often expensive; DVDs are visually appealing but less nimble in enabling staff to find answers quickly at the point of care.

Answer 28

ANS: B Confidence in using technology was found to be the result of the adequacy of professional development in the (Wang, Nagle, Li, et al., 2004) study. Regardless of age, education level, and area of practice, peer and leader support appropriate professional development was critical to success.

Answer 29

ANS: A, B, C Password must have a unique signature assigned to a nurse that is traceable to documentation and care the nurse provides. Having staff nurses involved in this process provides maximum input on the issue and keeps the information at the critical level to ensure confidentiality. Understanding privacy legislation and work policies provides a framework for ethical standards. Monitoring individual nurses is unlikely as the unique individual identifiers will highlight a problem if an anomaly is detected.

Answer 30

ANS: A, B, C Therapeutic relationships can be enhanced through the use of technology and patient safety increased when nurses engage the patient in their care and incorporate technology and patient engagement when documenting and recording data from medical devices. Keeping the patient at the centre of care avoids the likelihood of losing the therapeutic connection between nurse and patient.

Answer 31

ANS: A, B, C Point-of-care devices that allow documentation of assessment, care, and teaching at the patient’s bedside reduce the gap in time between care and documentation, thereby reducing error, increasing accuracy, and improving communication of care, discharge planning, and teaching, in addition to fitting better with nursing workflow.

Answer 32

ANS: C Findings related to staffing and patient outcomes suggest that patient outcomes are improved with a low ratio of nurses to patients and especially with a low ratio of registered nurses to patients.

Answer 33

ANS: B Leaders must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks. One method of doing this is to invite all staff into a discussion related to solutions to an identified concern. This approach encourages teamwork.

Answer 34

ANS: C The primary purpose of QI is improvement of patient outcomes. Quality improvement refers to an ongoing process of innovation, prevention of error, and staff development that is used by institutions that adopt the QM philosophy

Answer 35

ANS: B Standards establish the minimal safety level of care. Within health care systems, QI combines the assessment of structure, process, and outcome standards. Policies should be reviewed frequently and updated so that they reflect best practice standards and do not become barriers to innovation.

Answer 36

ANS: D QM emphasizes improving the system, rather than focusing on staff errors. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.

Answer 37

ANS: C In theory, any and all aspects of clinical activity could be improved through the QI process. However, QI efforts should be concentrated on changes to patient care that will have the greatest effect.

Answer 38

ANS: A A root-cause analysis is very similar to the QI process described in this chapter except that the root-cause analysis is a retrospective review of an incident to identify the sequence of events with the goal of identifying the root causes of the incident and may lead to the development of specific risk-reduction strategies.

Answer 39

ANS: A The Registered Nurses’ Association of Ontario launched the Nursing Best Practice Guidelines (BPGs) program. To date, the program team has developed and disseminated 50 guidelines covering clinical topics in five broad areas: gerontology, primary health care, home health care, mental health care, and emergency care.

Answer 40

ANS: D Patients are reliable and motivated sources of their own experience but often do not have sufficient knowledge of clinical procedures to provide feedback about clinical competence.

Answer 41

ANS: A Histograms are bar graphs that are useful in outlining and identifying frequency.

Answer 42

ANS: B Nursing-sensitive outcomes are outcomes that are affected by nursing activity and are precise, measurable, and patient centred.

Answer 43

ANS: D The aim of QM is improvement, not the assignment of blame.

Answer 44

ANS: E The fifth and final principle of HROs is deference to expertise. Those who have the most knowledge about the situation are encouraged to speak up, voice concerns and share ideas. Preoccupation with failure, the first principle, relates to the relentless focus of organizations on safety concerns in the work environment. The second principle, reluctance to simplify, focuses on the need for staff to look beyond the obvious and avoid jumping to potential quick fix solutions. Sensitivity to operations, the third principle, outlines the importance of situational awareness related to how systems and processes are working in the organization so that potential risks to safety can be identified and actioned. The fourth principle, commitment to resiliency, focuses on the ability of individuals and teams to address problems, implement solutions and bounce back from errors.

Answer 45

ANS: D Information technology plays a vital role in QI by increasing the efficiency of data entry and analysis. A consistent information system that trends high-risk procedures and systematic errors would provide a useful database regarding outcomes of care and resource allocation. Efforts are underway to develop standardized indicators of performance so that true comparisons can be made across health care settings, provinces, and territories.

Answer 46

ANS: A, B, D, E Sentinel events are serious, unexpected occurrences leading to death or to physical or psychological harm.

Answer 47

ANS: C Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty.

Answer 48

ANS: D Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff.

Answer 49

ANS: A In documenting staff problems, it is important to indicate specifically what rules were broken or violated, consequences if behaviour is not altered, employee’s explanation of the incidents, and the plan of action to achieve and to reach new goals. Accurate and factual documentation and follow-up actions are key elements in the successful management of all personnel issues.

Answer 50

ANS: B It is important to know the policies of the organization to address disciplinary issues fairly and equitably, and also to know the model that is employed to address employee problems.

Answer 51

ANS: C The progressive model of discipline advocates that the first step of the disciplinary process is to counsel the employee regarding the problem. The second step is a reprimand of the employee (first verbally, then in writing). The non-punitive discipline model advocates reminding the employee of the employment policies and procedures of the agency.

Answer 52

ANS: D The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position. Competency assessment and goal setting should help the nurse learn how to excel and identify which competencies the nurse wants to achieve in the future.

Answer 53

ANS: B In documenting staff problems, it is important to indicate specifically what rules were broken or violated, consequences if behaviour is not altered, employee’s explanation of the incidents, and the plan of action to reach new goals.

Answer 54

ANS: C A chemically impaired nurse jeopardizes patient care through impaired skills and judgement. She or he also compromises teamwork and continuity as peers attempt to cover deficiencies in work performance for their impaired team member.

Answer 55

ANS: D In some situations, despite best efforts of the manager/leader, the employee’s issue or disruptive behaviour may continue. In such cases, there is sometimes no choice but to terminate the employee

Answer 56

ANS: C All steps should be followed, including having full, appropriate, detailed documentation and following the procedures of the organization.

Answer 57

ANS: A Many employees increase their absenteeism just before submitting their resignation. If the health care worker is experiencing some form of role stress, it might be manifested through absenteeism. Role strain may be reflected by: (1) withdrawal from interaction; (2) reduced involvement with colleagues and the organization; (3) decreased commitment to the mission and the team; and (4) job dissatisfaction. Testing of workplace guidelines and defensiveness are associated with immaturity.

Answer 58

ANS: A Situations that may warrant immediate dismissal include theft, violence in the workplace, and wilful abuse of the patient.

Answer 59

ANS: C When suspicions of chemical dependency are raised, a manager needs to be alert to behavioural changes in the affected employee. These changes include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, increases in absenteeism, and increases in tardiness.

Answer 60

ANS: B Effective management mandates that the organization take an active role in helping employees with chemical dependencies. It is important for the manager/nurse leader to be supportive, caring, empathic, and encouraging with such an employee. Many organizations have employee assistance programs, to which the manager should refer employees.

Answer 61

ANS: D Dismissal does not enable the organization to attempt remediation of the behaviour and is not consistent with first steps in progressive discipline.

Answer 62

ANS: C Studies have shown that following this sequence is a fair and effective strategy for discipline and remediation.

Answer 63

ANS: D Situations that may warrant immediate dismissal include theft, violence in the workplace, and wilful abuse of a patient.

Answer 64

ANS: A Employment termination requires careful planning as to timing, privacy, safety, and how to preserve the employee’s dignity and avoid humiliation. Choosing a private location where colleagues are not present and organizing all documentation that is required to be given to Gregory achieves these goals and prevents his having to come to the organization at a future date.

Answer 65

ANS: B Nurse leaders must confront persistent absenteeism and discuss the situation directly with the employee by verbalizing their concern, in this case, when they see that a staff nurse has been absent 2 to 3 days per month in the past 3 months. The manager mentions examples of observed behaviour and tells the employee how they makes the manager feel. Asking why the staff member has been absent is not the best response. Although the manager may ask the nurse if she wants to talk about it, the manager would not begin the statement with a value-laden negative response. Changing the shift rotation is based on the assumption that scheduling is the problem, and that assumption may not be correct.

Answer 66

ANS: A Not all absenteeism is voluntary or preventable, which means that absenteeism can never be fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction, and involuntary reasons such as jury duty

Answer 67

ANS: D As a manager, you need to be familiar with provincial/territorial professional regulatory and reporting requirements regarding chemical use and abuse, and also with the human resources department’s practices and guidelines.

Answer 68

ANS: B Documentation of personnel problems is one of the most important aspects of the nursing manager’s role. Through carefully detailed and timely documentation of the problem and plan, the manager decreases the burdensome problems that can ensue from improper or inadequate documentation.

Answer 69

ANS: B Absenteeism puts a strain on staff, produces morale problems, and can jeopardize patient safety

Answer 70

ANS: D Although all of the answers are correct the nurses’ mandate is to protect the public

Answer 71

ANS: A, B, C, D The nurse leader must remind employees that professional responsibility is to maintain quality care, and thus they are obligated to report instances of clinical incompetence, even when it means reporting a coworker. Ignoring safety violations or poor practice is unprofessional and jeopardizes patient care.

Answer 72

ANS: A, C, D If a nurse has a feeling of belonging there is job satisfaction, increased commitment to the team, and a withdrawal from interaction. If role strain continues, there is a likelihood of increased absenteeism and the possibility of changing jobs or leaving the profession.

Answer 73

ANS: A, B, C, D All of the above are a manifestation of personal past trauma. Testing of workplace guidelines is a derivative of maladaptive perfectionism. If the nurse manager focuses on identifying the root cause of the undesirable behaviour, he or she will be better able to find the right solution and be better prepared to address the issue as a whole.

Answer 74

ANS: A, B, D Nonpunitive discipline minimizes power battles, focuses on objective measures, and puts the choice in the hands of the employee. The nonpunitive disciplinary process begins with a verbal discussion, whereby the agencies standards and employment expectations that were agreed to at the time of hiring, or are part of one’s professional nursing requirements, are reiterated, as is the gap between what is expected of the employee and the employee’s current performance.

Answer 75

ANS: B The benefits of interdisciplinary care can be recognized through reduced duplication of services, decreased fragmentation of care, and improved quality of care for patients. Implementation and integration of interdisciplinary teams within Canada’s health care system has the potential to allow health care providers to practise to their full scope of practice and create innovative, sustainable ways to provide high quality health care for all Canadians.

Answer 76

ANS: C To delegate effectively, the nurse manager must assess the abilities required in the situation and the abilities that staff have. The nurse manager can thereby anticipate the amount of direction, monitoring, explanation, and independence that are needed.

Answer 77

ANS: D The use of multilevel health care providers enables health care organizations and nurses to provide patient-centred care, with a focus on abilities and skills that can be employed to perform what is needed when it is needed. As tasks become more complicated, delegating skills to other workers enables the nurse to deliver a complex level of care effectively.

Answer 78

ANS: A The nurse manager should hold self and others accountable for actions and outcomes.

Answer 79

ANS: D In delegating tasks to others, the nurse considers factors such as stability of the patient, safety of the situation and of the patient, time and intensity of the task involved, and level of critical thinking required to achieve desired outcomes.

Answer 80

ANS: B The effectiveness of leaders depends on their relationships with followers, which should develop through motivating and inspiring others, as opposed to managing and controlling them.

Answer 81

ANS: C In delegating tasks to unregulated care providers, the nurse must consider what cannot be delegated, in addition to the factors of safety, time, critical thinking, and stability of patients’ conditions

Answer 82

ANS: B Identified barriers to interdisciplinary collaboration include policies (including policy overload), funding, power inequalities, and overlapping scopes of practice

Answer 83

ANS: C The registered nurse is accountable and responsible for nursing care provided. Activities considered outside the legislative scope of nursing practice were “covered” by extensive use of delegation, or “transfer of function,” from physicians. In some cases, the physician apparently presumes that it would be the employer’s responsibility to ensure that the nurse was competent to provide the care, whereas the employer placed a large portion of the responsibility on the nurse and thus the nursing regulatory body

Answer 84

ANS: B In Ontario, Alberta, and British Columbia, a common framework known as a restricted activities or controlled acts model created consistent approaches among the health professions with regard to discipline, registration, continuing competency, and restricted activities. A main distinction between this model and the model of licensure still used in all other provinces and territories is that nurses are not bound by exclusive scopes of practice. Rather than care providers being licenced, specific acts are licenced. This allows more than one profession to perform the same act, or parts of the act, for example, prescribing medication.

Answer 85

ANS: C Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse manager are consistent with responsibility. Accountability refers to being answerable for actions and results

Answer 86

ANS: C Several benefits of the controlled acts model over the licensure model have been identified: It is viewed as allowing health care providers to perform to the range of their competency and abilities; the scope of practice is recognized as not static or to have firm boundaries; it places greater emphasis on standards and competence; and it increases flexibility in allowing patients more choice in providers and employers more innovation in optimal skill mix, while protecting the public from harm.

Answer 87

ANS: C The legislative reform of the controlled acts model to recognize overlapping competencies has caused increased role confusion, further competition over “turf” for various providers, and difficulty in optimizing skill mix.

Answer 88

ANS: D Delegation communication is very important and needs to be specific. Communication also includes conveying recognition of the authority to do what is expected.

Answer 89

ANS: B The framework consists of six competency domains: interprofessional communication; patient-centred care; role clarification; team functioning; collaborative leadership; and interprofessional conflict resolution.

Answer 90

ANS: C In every situation, the domains of patient-centred care and interprofessional communication are relevant and consistently influence and support the other four domains.

Answer 91

ANS: B Although all the choices are considered barriers, only the barrier of power and control issues is considered a system-relevant barrier.

Answer 92

ANS: A Although all choices are considered facilitators, only shared protocols is considered an organizational facilitator.

Answer 93

ANS: B When collaboration is ineffective or unsuccessful, disciplinary silos are reinforced, and turf protection escalates. These environments contribute to workplace stress and adversely affect patient care.

Answer 94

ANS: C Role clarity is defined as having an understanding of one’s own role and that of others, and this understanding is applied through description, performance, and communication to achieve patient goals (Canadian Interprofessional Health Collaborative, 2010). When there is lack of role clarity, health care providers tend to revert to what is familiar, often their own disciplinary silos.

Answer 95

ANS: D When there is lack of role clarity, health care providers tend to revert to what is familiar, often their own disciplinary silos; one way to counteract this tendency is to practise patient-centred care.

Answer 96

ANS: D Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though other people provide aspects of care.

Answer 97

ANS: B All team members should be clear about what skills they bring to the health care and team process, and this can be facilitated by colocation of the team. Although simply grouping a variety of health care providers together in the same building will not create a team, colocation can have many benefits, including timely and personal consultations or referrals regarding patient care, increased understanding, and respect for all members’ roles, and informal opportunities to connect, whether personally or professionally.

Answer 98

ANS: A, C, D Every jurisdiction in Canada is currently implementing interdisciplinary teams in a variety of settings. The rationale for this shift toward interdisciplinary care is directly related to changes in Canadian health care: the aging population, who have increasingly complex and comorbid illnesses; health care provider shortages; and the realization that no single health care provider can adequately address patient needs in the twenty-first century

Answer 99

ANS: A, B, D Despite the laudable benefits of interprofessional collaboration, it is a concept that can be difficult to implement and measure in practice. Barriers to collaboration include macro-level restrictions impacting micro-level processes such as outdated legislation, regulatory mechanisms, and practice protection.

Answer 100

ANS: A, B, C Perform particular services or functions within professions is part of the licensure system. Over time several provinces have replaced health professional licensing, which allowed only professions with a particular license to perform particular services or functions within regulation. Ontario, Alberta, and British Columbia have adopted a common framework known as a “restricted activities” or “controlled acts” model.

Answer 101

ANS: A, B Nurses working in an intraprofessional team can registered practical nurses, degree nurses, advanced practice nurses, and nurses holding a doctoral degree.

Answer 102

ANS: B Interpersonal factors such as distrust, perceptions of injustice or disrespect, and inadequate or poor communication style can lead to conflict.

Answer 103

ANS: B By definition, conflict involves a difference in perception between two or more individuals.

Answer 104

ANS: A Purposeful avoiding is an appropriate strategy when the conflict is interpersonal and the individuals involved in the conflict have the necessary skills and insight to be able to own the problem and solve it themselves. When these conditions are not present and avoidance is not purposeful, then avoidance can increase stress and escalate conflict.

Answer 105

ANS: D The manager must determine whether a conflict is constructive or destructive. In this situation, the manager has determined that the conflict is destructive and does not want the conflict to escalate, and so a mediator has been engaged.

Answer 106

ANS: A Intrapersonal conflict occurs within a person when confronted with the need to think or act in a way that seems at odds with one’s sense of self. Questions often arise that create a conflict over priorities, ethical standards, and values. Some issues present a conflict over comfortably maintaining the status quo and taking risks to confront people when needed, which can lead to interpersonal conflict.

Answer 107

ANS: B Thomas (1992) determined that conflict proceeds through the four stages of frustration, conceptualization, action, and outcomes, in that particular order.

Answer 108

ANS: C Differences in ideas, perceptions, and approaches, when managed well, can lead to creative solutions and deepened human relationships. Conflict can stimulate growth, creativity, and change

Answer 109

ANS: C Interpersonal conflict transpires between and among nurses, physicians, members of other departments, and patients.

Answer 110

ANS: B Thomas’s stages of conflict include conceptualization, which involves different ideas and emphasis on what is important or about what should occur.

Answer 111

ANS: C The nurse’s actions did not include actions such as clarifying Mr. Gordon’s views on feeding his wife, clarifying what was necessary to achieve good care for his wife, and engaging in dialogue with Mr. Gordon, thus preventing identification of a common goal. The action stage involves a behavioural response such as clarification or dialogue.

Answer 112

ANS: D The collaboration technique has both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.

Answer 113

ANS: A Research has shown that conflict, like change, increases creativity and allows for the development of new ideas.

Answer 114

ANS: A Goal conflicts often arise from competing priorities. In this example, the nurse manager desires to empower employees, but his behaviours indicate to the staff that he is practising micromanagement

Answer 115

ANS: C In this particular situation, an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading occurs. This strategy supports a balance of power.

Answer 116

ANS: B Negotiation must occur for the situation to be rectified. Marcus must apologize for his error, and so must the surgeon for his inappropriate response. Resolution must be accomplished with the understanding that time is of importance. This strategy results in appeasement of each side to some degree.

Answer 117

ANS: B Successful resolution of conflict yields constructive outcomes and leads to improved team functioning. Unsatisfactory resolution is typically destructive and results in inhibition of movement, or diminished resolutions, and lower employee satisfaction levels.

Answer 118

ANS: D Bullying involves aggressive or destructive behaviour or psychological harassment of a recipient who has less power than the perpetrator (the head nurse). Bullying is closely related to lateral or horizontal violence and involves such behaviours as withholding information, undermining activities, sabotage, and backstabbing.

Answer 119

ANS: D Compromise involves trading and negotiation and is the preferred conflict management style of managers.

Answer 120

ANS: C Jillian is demonstrating avoidance by staying away from meetings to discuss her team relationships, and Lee is demonstrating compromise by offering coaching in return for Jillian’s being able to engage in more satisfying relationships.

Answer 121

ANS: D Accommodating involves neglecting one’s own needs while trying to satisfy the needs of another.

Answer 122

ANS: D Organizational conflict arises when discord exists with regard to policies and procedures, personnel codes of conduct, or accepted norms of behaviour and patterns of communication. Some organizational conflict is related to hierarchical structure and role differentiation, in this case, among employees with less autonomy.

Answer 123

ANS: C Self-compassion correlates with one’s ability to receive and respond constructively to feedback and is a necessary element toward attaining congruence. It occurs when one extends kindness to themselves in response to suffering and during times of perceived inadequacy

Answer 124

ANS: A, B, C Avoiding, or withdrawing, is a fear-based approach to conflict management. Most people do not consciously choose avoidance, but rather, from a place of fear they will subconsciously distract themselves from acknowledging the conflict and the impact it has on themselves and others. Not all conflict must be addressed immediately as some issues require considerable reflection before strategies can be selected and action taken. The positive side of withdrawing may be postponing an issue until a better time, or simply walking away from a “no-win” situation.

Answer 125

ANS: B, D Professional nurses often avoid conflict when they fear a consequence (Johansen, 2012). Nurses sometimes choose to avoid conflict because they fear that engaging in conflict or even attempting to resolve conflict may jeopardize their career advancement. The stereotypical self-sacrificing behaviour seen in avoidance and accommodation is strongly supported by the altruistic nature of nursing (Blair, 2013). However, it erodes the ability for coworkers to be authentic and to establish relationships of trust.

Answer 126

ANS: A, B, C, D, E By nature, conflict has the potential to occur in all interpersonal situations. The nurse manager should create an environment in which differences in staff, physicians, patients,

Answer 127

ANS: B Sporadic work histories and a “pushy” attitude may or may not be associated with aggression and violence. Thoroughly checking references helps to effectively confirm or rule out impressions obtained during the interview, and may yield useful information about issues related to violence and aggression in previous employment.

Answer 128

ANS: B Studies indicate that new graduates were likely to experience horizontal violence, which resulted in high absentee rates and thoughts of leaving nursing after their first year.

Answer 129

ANS: C Jake seems at most risk for violence mainly because of his alcohol use and the end of what may be an obsessive relationship with Carla. In the other situations, Jordan is expressing a legitimate concern and is behaving assertively; Heinrich may have health concerns or other issues that are private and interfering with his work life; and Sarah’s change in behaviour is probably related to a higher level of comfort with work and colleagues.

Answer 130

ANS: B Workplace bullying involves aggressive and destructive behaviours such as running a smear campaign and failing to support another nurse.

Answer 131

ANS: C Horizontal or lateral violence and bullying are terms used to describe destructive behaviours towards coworkers, such as the “silent treatment,” and excluding others from socializing.

Answer 132

ANS: C Sabotage is harassment, which is any behaviour that demeans, embarrasses, humiliates, annoys, alarms or verbally abuses a person and that is known or would be expected to be unwelcome. Sabotage includes words, gestures, intimidation, bullying, or other inappropriate activities.

Answer 133

ANS: B A common perception is that incidents such as these, which involve threats rather than physical injury or harm, are part of the job. Because of underreporting, data related to violence and aggression in the workplace may not be reflective of their true incidence.

Answer 134

ANS: A Violence and aggression and a toxic workplace can lead to staff dissatisfaction and high staff turnover rates. Surveying staff provides a useful starting place in identifying problems such as employee dissatisfaction, bullying, and other forms of violence.

Answer 135

ANS: A Empathizing helps the other person to know and feel that he has been understood and is powerful in deescalating a situation that has potential for aggression and violence. Communication techniques and body language skills were used to try to deescalate the situation.

Answer 136

ANS: A The behaviour of the individual (flushed appearance, furtive glances, speed of speech) and the hand in his pocket suggest the potential for violence or aggression. The first step is to quickly assess your surroundings for other people who might assist you and for safety alarms.

Answer 137

ANS: B The CNA cites studies that suggest that intimidating and disruptive behaviours in the nursing profession contribute to low patient satisfaction and an increase in preventable adverse outcomes. Although intimidating and disruptive behaviours may contribute to low morale, these were not identified as contributors by the CNA.

Answer 138

ANS: D Working during periods of understaffing, especially during visiting hours and meal times, is a risk situation for violence and aggression. Reducing activity levels through interventions such as a separate dining area may reduce incidents of violence and aggression.

Answer 139

ANS: B Many people believe workplace violence to refer specifically to physical injury; unfortunately, it is this belief that perpetuates verbal abuse in the health care setting. However, the Canadian Centre for Occupational Health and Safety defines workplace violence as “any act in which a person is abused, threatened, intimidated or assaulted in his or her employment.”

Answer 140

ANS: A Shield and Wilkins noted that abuse was related to being male, having less experience, usually working non-day shifts, and perceiving staffing or resources as inadequate, nurse-physician relations as poor, and coworker and supervisor support as low.

Answer 141

ANS: B Workplace violence and aggression contribute to staff turnover and toxic work environments. Loss of the organizational investment required to train new staff and departure of experienced staff can increase operating costs and reduce the quality of care

Answer 142

ANS: B In a potentially violent situation, it is important to look and behave in a calm and confident manner, even if you do not feel calm or confident. The person whose behaviour you are deescalating will notice and take his or her cues from you.

Answer 143

ANS: B Knowledge of the scale of workplace violence remains incomplete in Canada because no consistent system of data collection exists. Data regarding the less severe forms of workplace violence are particularly sparse.

Answer 144

Nurses are the primary target of violence in health care settings. Hader (2008) found that nurses were the primary targets of violence in 79.7% of such incidents.

Answer 145

ANS: D Nurses need to know how to access the workplace safety plan in their areas of practice. A safety plan provides overall direction in relation to what is expected, how violence is prevented, and what will occur when violence happens.

Answer 146

ANS: B If nurses are the victims of or witness workplace violence, they have a duty and right to report the situation and to seek support to address the incident. When violence occurs, it is important to foster an environment that offers open communication, support, assistance with documentation, and psychological and other supported therapies.

Answer 147

ANS: B Other terms associated with this type of violence include bullying, which is a practice closely related to lateral or horizontal violence, but a real or perceived power differential between the instigator and recipient must be present in bullying

Answer 148

ANS: C This data was drawn from Workplace Safety and Insurance Board (WSIB) data published in 2016. In a 2014 analysis by the WSIB regarding claims, it is noted that there was an increase of 6.4% in reports of workplace violence from 2013-2014 in the health care sector.

Answer 149

ANS: B, C It is troubling that the rates of violence do not appear to have decreased, as is evidenced by a review conducted by Hader (2008). One survey found that 80% of the 1377 nurse respondents from the United States and 17 other countries reported having experienced some form of violence within the work setting.

Answer 150

ANS: A, B, C, D Historically, horizontal violence in nursing was considered to be a result of nursing’s traditional hierarchical structure, the oppression of nursing as a profession, or feminism (Farrell, 2001). More recently, bullying in the workplace has been linked to worker burnout and decreased access to empowering structures in the work environment, including access to information, resources, supports, and opportunities (Laschinger, Grau, Finegan, et al., 2010).

Answer 151

ANS: A, B, C Although the potential for violence and aggression exists in all health care settings, emergency, psychiatric, and geriatric settings are at particular risk for violence.

Answer 152

ANS: B Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs, and practices that may be different between patients and nurses.

Answer 153

ANS: C Symbols define and reflect a culture. National Nurses’ Week, with a focus on nursing interests, reflects the culture of nursing.

Answer 154

ANS: B The response of the nurse manager invites cultural awareness, which involves self-examination and in-depth exploration of the nurse’s own biases, prejudices, and assumptions.

Answer 155

ANS: D Stereotyping and prejudice enable people to predict behaviours and make sense of situations, but they constrain people’s understanding and development of new insights.

Answer 156

ANS: D Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions unique to a group of people.

Answer 157

ANS: A Acknowledging the patient’s use of acupuncture demonstrates cultural sensitivity through acknowledgement of treatments that would be consistent with the patient’s cultural interpretation of illness and responses to it. The other responses indicate lack of cultural sensitivity and cultural imposition, in that the nurse diverts the line of inquiry toward interventions that would be common to the nurse’s experience of health care in Western cultures.

Answer 158

ANS: B Fewer than 2% of health care providers in Canada are of Aboriginal ethnicity; about 6% of the 8% in nursing work force is male.

Answer 159

ANS: A Culture is determined by behaviours and beliefs, and it develops slowly

Answer 160

ANS: A Culture is a patterned behavioural response that evolves slowly as times change. The culture may or may not maintain a strong work ethic.

Answer 161

ANS: C Accessibility to health care in Canada is based on the Canada Health Act principles of universality and accessibility. However, such principles are not always adequately upheld. For instance, individuals living in rural or remote areas might not have ready access to health care or might have access to only limited amounts and types of care.

Answer 162

ANS: B When a nurse is working with people of various cultural groups and diversity, it is important to recognize that diversity also exists within groups.

Answer 163

ANS: D Ethnicity refers to the classification of people according to common racial, tribal, religious, linguistic, or cultural backgrounds.

Answer 164

ANS: B Cultural sensitivity is the affective capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people. In this situation, acknowledgement of the patient’s background in relation to eye contact demonstrates cultural sensitivity.

Answer 165

ANS: A When communication with a patient is hampered, the patient may have difficulty accessing needed health care services, which might lead to negative health outcomes.

Answer 166

ANS: C Culture develops over time, is essential to survival, is learned and shared by members, and changes with difficulty

Answer 167

ANS: B Prejudices enable people to make sense of the situations in which they find themselves, but prejudices also constrain understanding and limit the capacity to develop new or different ways of understanding

Answer 168

ANS: B Cultural awareness involves self-examination and in-depth exploration of a person’s own cultural and professional background, such as biases, prejudices, and assumptions, including assumptions about thinking modes and decision-making.

Answer 169

ANS: D Transcultural care involves consideration of health beliefs and practices between genders among races, ethnic groups, and people with different socioeconomic status.

Answer 170

ANS: B Spatial differences (closeness or distance) are inherent within and across cultures.

Answer 171

ANS: C The new graduate is caught between two cultures at this point—work and education—and expresses feelings of belonging to neither.

Answer 172

ANS: C The Giger and Davidhizar Transcultural Assessment Model identifies six phenomena to assess provision of care to patients who are from different cultures, including social organizations, which include how relationships are formed and expressed in different cultures.

Answer 173

ANS: B The circle of familiarity refers to constrained interpretation on the basis of a person’s values, attitudes, and beliefs.

Answer 174

ANS: D Finding out more about Jim’s traditions helps Monique to step out of her circle of familiarity.

Answer 175

ANS: A, B, D Although social context, political understanding, and economic status influence a constructivist perspective, the essentialist perspective maintains that culture is unchangeable and based on the “norm” culture in Canada that is white and moderately affluent.

Answer 176

ANS: A, C Translation of illness or disease conditions and treatment can be complex and requires a qualified translator with an understanding of medical terminology as a translator who translates word for word does not convey the complexity and understanding of medical terminology. For common points of reference and linguistic equivalence language clarity is important for cultural safety.

Answer 177

ANS: A, B, D Interpreters must be trained to decode words and ensure the right meaning in the translation. Nursing care is complex and the patient population is diverse. Knowing how one’s own prejudice influences recipient care, to receive more than adequate support. Presuming openness exists between different cultures may prevent the right implication and understanding of care provided

Answer 178

ANS: B, C, D Cultural competence involves knowledge of diverse cultural and ethnic groups, including knowledge of staff members and respect for other people and their cultural differences.

Answer 179

ANS: D Nonmaleficence refers to “doing no harm.” By focusing only on good qualities, the manager seeks to do no harm to the employee.

Answer 180

ANS: C Normative ethics is concerned with the standards that most people use to guide their behaviours (e.g., “murder is wrong”) and how they are determined. Metaethics concerns the broader theory and meaning of morality and the foundation and scope of moral values, words, and practice. In applied ethics, ethical principles are studied in relation to real-life moral issues, such as how to provide nursing care and how to conduct research on human subjects.

Answer 181

ANS: C Autonomy refers to the freedom to make a choice (e.g., to refuse a procedure), and beneficence refers to doing good (performing a procedure that will benefit the patient)

Answer 182

ANS: A Beneficence refers to doing what is good for the patient; in this situation, doing what is good means providing care to the patient with the best likelihood of recovery.

Answer 183

ANS: B Autonomy refers to the right to choose freely, which is inherent in informed consent

Answer 184

ANS: B A key area of ethical nursing practice is the therapeutic relationship between the nurse and the patient.

Answer 185

ANS: B Relational ethics involves asking not only “What should I do?” but also “What should I do for others?”

Answer 186

ANS: D Nurse managers show respect for students, nurses, and the health care team by facilitating interprofessional team meetings to discuss and plan patient care. Team meetings provide an opportunity to value everyone’s contributions and foster mutual respect, which is a critical aspect of effective teamwork.

Answer 187

ANS: B A relational ethics perspective can help nurse leaders realize that relationships are critical in the development and maintenance of the nurse managers’ and leaders’ roles and actions.

Answer 188

ANS: B One criticism of the principle of autonomy is that it can lead to a focus on the rights or needs of one individual at the expense of the rights or needs of others (including entire groups).

Answer 189

ANS: B A relational approach to autonomy suggests that autonomy is best promoted through social change rather than through protecting an individual’s freedom of choice.

Answer 190

ANS: C Nurse managers who apply the principle of justice in their nursing practice and managerial decision-making ensure that workload is fairly distributed among the nursing staff. Performance appraisals by nurse managers ought to be guided by the principle of justice. For example, if one nurse is disciplined for being late, then all nurses who are late should be disciplined in the same way.

Answer 191

ANS: C The element of the Code of Ethics of the International Council of Nurses that is reflected in the question statement is the element of profession

Answer 192

ANS: B The element of the Code of Ethics of the International Council of Nurses that is reflected in the creation of performance appraisals is the element of practice

Answer 193

ANS: B At the simplest level, an ethical experience is a situation that creates a sense of moral uncertainty: when a nurse feels indecision or a lack of clarity or is unable to even know what the moral problem is, while at the same time feeling uneasy or uncomfortable.

Answer 194

ANS: B Ethical violations reflect a nurse’s neglect of moral obligations and a breach of duty (e.g., when a nurse discusses patient information in the cafeteria).

Answer 195

ANS: C In case where the nurse’s personal values do not allow for moral acceptance of practices of the patient, a nurse is permitted to step back from the situation that involves a “conflict with their conscience” (CNA, 2017, p. 35) to work with the team and allow another nurse to take over care.

Answer 196

ANS: A There are a number of both internal and external factors that can interfere or threaten the integrity of the nurse-patient relationship. External factors such as high rates of turnover or casual nursing staff, staff shortages, consistently high workloads, unhealthy or hostile work environments, or poor staff morale might make it difficult to establish and sustain nurse-patient relationships. Internal factors might include fatigue, moral residue, moral distress, or a values conflict.

Answer 197

ANS: C Justice refers to the principle that addresses how we treat others out of a sense of what we consider to be fairness. The Canadian Nurses Association (CNA) considers the principle of social justice to be a key policy initiative, and considers it an organizational priority, noting clearly that the value of social justice is aligned with the professional values outlined in the CNA Code of Ethics.2

Answer 198

ANS: A, B, C, D For many type of routine nursing procedures, written informed consent is not necessary but consent should still be obtained from the patient, in a less formal way. Each time a nurse approaches a patient to administer a medication, to check vital signs or to change a dressing, the nurse should always first check in with the patient that they understand what is about to happen and that the immediate plan of care is acceptable to them at that point in time. Respecting patient autonomy means always ensuring that patients are not passive recipients of care, but rather that they are as involved as possible in all decisions that are part of their own health care experience.

Answer 199

ANS: A, B, D Nursing management decisions and actions are guided by three elements: ethical principles, professional accountabilities, and the law.

Answer 200

ANS: A, D The core elements of relational ethics are engaged interactions, mutual respect, embodied knowledge, uncertainty and vulnerability, and interdependent environment.