Leading, Managing, Delegating Flashcards
Qualities of a leader
SELF-DIRECTED
FLEXIBLE
KNOWLEDGEABLE
POLITICALLY AWARE
Leadership types
1.Explicit: leadership based off position
2. Implied: leadership based off personality
Just culture
MAG Status: THEY HAVE FOCUS ON PATIENT SAFETY AND POSITIVE PATIENT OUTCOMES
ENCOURAGED TO REPORT CLINICAL AND POTENTIAL ERRORS WITHOUT THE FEAR OF PUNITIVE ACTIONS
EVERYONE LEARNS FROM EVERYBODY’S MISTAKES
CREATES OPPORTUNITIES FOR IMPROVEMENT
MANAGEMENT Roles
- planning: pt problems
- organizing: get resources/ skills days,
3.directing: policies in place, - staffing
- Directing
- Controlling
Centralized v Decentralized
- Central: authoritarian style, decisions made w/ little input from others
2.DECENTRALIZED:decisions made by those most knowledgeable about issue being decided
5 Resistance to change
- THREAT TO SELF
- LACK OF UNDERSTANDING:
- LIMITED TOLERANCE FOR CHANGE: some ppl say no
- DISAGREEMENTS ABOUT THE BENEFITS OF CHANGE
- FEAR OF INCREASED RESPONSIBILITY
8 ways to overcome resistance to change
- EXPLAIN PROPOSED CHANGE TO ALL AFFECTED: give time lines
- LISTING THE ADVANTAGES
- RELATE THE CHANGE TO THE PERSON’S EXISTING BELIEFS AND VALUES
- PROVIDE OPPORTUNITIES FOR OPEN
- COMMUNICATION AND FEEDBACK
- INDICATE HOW THE CHANGE WILL BE EVALUATED
- INTRODUCE CHANGE GRADUALLY
- PROVIDE INCENTIVES FOR COMMITMENT TO CHANGE
8 Considerations when delegating
- Pt condition
- Complexitiy of task
- potential for harm
- predicted outcome
- context of other pt needs
- degree of problem solving
- capabilites of UAP
- amount of interaction/staffing
Delegation
- Basic care tasks can be delegated
- Only nurses can assess, plan, educate, interpret data, adminster meds
Phases of therapeutic relationship
- Orientation: introduction, get to know pt
- Working: providing care, solving problems, interventions
- Termination: End relationship w/ pt: review, summarize, memories
Therapeutic communication skills
- competent, honest, skilled
- control tone
- knowledge on topic
- be flexible
- clear and concise
6 Interviewing techniques
- Open-ended questions without leading
- Closed questions
- Clarifying questions
- Reflective questions: can reflect on why there, and determine what is causing emotions, etc
- Sequencing questions : pt telling events leading up to care
- Directing questions: circling back to get more information on topic mentioned earlier
Barriers to communication
Cultural considerations
- Linguistic competence - Ability of caregivers (nurses) and organizations to understand and effectively respond
- learn things about culture
Communicating with clients that have special needs
- Visual Impair: address yourself, clean glasses, orient
- Hearing: speak facing, don’t chew gum/cover mouth, use gestures
- Unconicous: be mindful, let them know before you touch them
Clinical judgment
-outcome of critical thinking and decision making
-Involves concepts of critical thinking, clinical reasoning
Critical Thinking
- Identify purpose or goal of your thinking
2.Make a judgment about a patient or situation and to make a decision about how best to intervene
3.Identify alternative judgments or decisions, weigh the pros and cons of each, and reach a conclusion
Clinical reasoning
Process of thinking that results in clinical judgment
types of reasoning
- Deductive reasoning (aka backward reasoning): Testing identified theories or hypotheses and predicting consequences utilizes deduction
Inductive reasoning (aka forward reasoning) - Inductive reasoning:observing, then drawing conclusions, Require the ability to recognize patterns and connections and form hypotheses and theories, Requires experience, knowledge, a holistic view, intuition, and organized thinking
Situational Awareness
-recognizing cues (can be subtle) that show a client is deteriorating, recognizing implications of these assessments, and implementing protocol(s) and/or notifying the health care team
-Novice nurses have a narrower focus that focuses on task and cues immediately available to them
-Expert nurses use intuition and continuously study the environment to prioritize their nursing actions.
Tanner’s Clinical Judgment Model steps
- Noticing: perceptions of the situation that are impacted by context, practical experience, knowledge of expected vs unexpected data, ethical perspectives, and client-nurse relationship
- Interpreting: Assigning meaning to data through multiple reasoning patterns
Responding - Deciding on an action or inaction and monitoring outcomes
- Reflecting
In-action – happens when actively engaged in the situation and during ongoing monitoring and assessment
On-action – Similar to debrief or post-conference, occurs after the situation and creates clinical learning
NCSBN’s Clinical Judgment Measurement Model
Layers 0-2: Emphasize how clinical judgment informs clinical decisions made to address the client’s needs.
Layers 3-4:Evaluation of those decisions determines if processes
Layers 3-4 need to be done again. Focus on expected behaviors of a specific case
TEACH
T: tune into pt
E: edit pt info
A: act on every teaching moment
C: clarify
H: honor pt as partenr in educating
Learning domains
- Cognitive: using brain
- Psychomotor: muscles
- Affective: emotions/feelings
10 Teaching Strategies/Methods
- Lecture
- Discussion
- Demonstration
- Discovery
- Role playing
- Audiovisual materials
- Printed materials
- Programmed instruction
- technology
- Teach-Back Method
Factors affecting client learning
- Age and developmental level
- Family support networks
- Financial resources
- Cultural influences
- Language deficits
- Health literacy level
Steps of the teaching-learning process (AID DIE)
Assess learning needs and learning readiness
Identify learning needs
Develop learning outcomes
Develop a teaching plan
Implement teaching plan and strategies
Evaluate learning
Promoting compliance (IIUD)
Instructions: support client goals and understood
Include client and family in the process
Utilize strategies that gets the learner to interact
Develop good therapeutic relationships with the client and family
Older adults and teaching
Identify learning barriers
Allow extra time
Plan short teaching sessions
Accommodate for sensory deficits
Reduce environmental distractions
Relate new information to something that is familiar
Communication in education
Be sincere and honest
Avoid too much detail and stick to the basics
Ask for questions
Be a cheerleader for the client
Use simple vocabulary
Keep content clear
Listen and do not interrupt
Make sure the environment is good to learning
Be sensitive to the timing of teaching sessions
Rheumatoid Arthritis (RA)
Autoimmune disease
Has 3 distinct characteristics: inflammation, autoimmunity, degeneration
Genetic predisposition
Cause unknown but reaction comes from synovial fluid becoming destructive → cartilage is destroyed
Degenerative changes to muscles and bone can be eroded > Patient experiences a loss of joint motion
Expect exacerbations and remissions
Osteoarthritis (OA)
Non-inflammatory degenerative disorder in the joints
Not autoimmune or systemic
Can be primary or secondary to something else
Cartilage breaks down → bone spurs created (narrowing joint space) → less movement with joint progressively deteriorating
Insidoues onset
Difference between OA & RA
RA: symmetric, inflammation, genetic/ autoimmune
OA: asym, insidous, due to wear and tear, no inflammation
Nursing management for RA
-DMARDS, NSAIDS, corticosteroids, synovectomy, joint replacement, PT
-promote activity, heat, manage pain/sleep, educate and help cope
Signs/symptoms of OA
pain,stiffness (less than 30), functional impairment, joint asym, aggratvated movement
Nursing/medical management for OA
-NSAIDS, Glucosaimes, surgery, PT
-Plan activites when less pain, assistive devices, TEACH
Osteoporosis (OP)
reduced bone mass due tolow ca/vit D
Treatment for OP
ca/vit D supplements, biophosphates, estrogen
-weight barin exercise, self-care, high ca diet, no smoking/alc, saftey
considerations for bisphosphonates
GI issues
Major complication of osteoporosis
-broken bones
Types of Leaders
- Authoritarian: total control over decisions
- Democracy: equality among leader and staff, work together
- Laissez-Fair: no leader, power to group (good when everyone in the group is an expert)
4.Servant: pt focused - Quantum: organization and it’s members are interconnected and collabrative
- Transactional: money
- Transformational: wanting to make change
