Quiz Two Test Bank Flashcards

Question

The most important aspect of budgeting for the nurse manager is: a. To have hierarchal approval b. To have decision-making ability c. To have budgetary control d. To have input from others

Answer 1

ANS: C Rationale: Mentoring has been defined as “an intense interpersonal exchange between a senior experienced colleague (mentor) and a less experienced junior colleague (protégé) in which the mentor provides support, direction, and feedback regarding career plans and personal development”. Mentoring is a voluntary, an interactive, and mutually beneficial and multifaceted relationship role that assists staff with setting realistic, attainable goals.

Answer 2

ANS: A, B, C, D Rationale: Five management practices have been found to be effective when instituting change in complex organizations: Managing the change process actively, balancing the tension between efficiency and reliability, creating a learning environment that creates and sustains trust, involving the workers in the work redesign and the workflow decision making.

Answer 3

ANS: A, B, C Rationale: Professional nursing within an ethical framework also involves endeavouring to address broad aspects of social justice that are associated with health and well-being. The primary values within the code of ethics that support patient rights include preserving dignity, promoting and respecting informed decision making, and maintaining privacy and confidentiality (CNA, 2008).

Answer 4

ANS: A, B, D, E Rationale: Drucker’s five basic functions include division of work into tasks; development and communication of goals and outcomes; motivation and communication; and analysis, approval, and interpretation of staff performance.

Answer 5

ANS: D Rationale: Identification of a problem is the first step in problem solving and occurs before any other step. Improper identification of a problem is the most common reason for failure to resolve problems.

Answer 6

ANS: A Rationale: Shared decision making leads to a number of successful outcomes, including team pride, the team’s ability to engage in discussions with the nurse leader about work issues, and continued team involvement in shared decision making. Involvement of other health care professionals is essential in decisions involving patient care.

Answer 7

ANS: C Rationale: Brainstorming encourages creativity in the beginning of problem solving and avoids premature shutting down of ideas through early evaluation.

Answer 8

ANS: B Rationale: Some problems, such as the crisis situation depicted in this example, necessitate immediate decision making to ensure patient safety.

Answer 9

ANS: D Rationale: The nurse leader or manager needs to provide a nonthreatening and positive environment, in which group members actively participate, by controlling aggressive individuals and encouraging passive individuals to participate actively. Diversity, managed conflict, and moderate cohesiveness are effective in reaching quality decisions.

Answer 10

ANS: C Rationale: To proceed effectively, it is important to determine whether a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.

Answer 11

ANS: D Rationale: In assessing risk, the nurse engages in the initial step of the problem-solving process, which involves asking, “What benefits (or risks) will be derived from solving it?” Purposeful inaction may not be appropriate when the individual cannot resolve the problem or when there is risk to patients.

Answer 12

ANS: C Rationale: Critical thinking is a higher order thinking process. Problem solving is a step in decision making that is focused on solving an immediate problem, which can be viewed as a gap between “what is” and “what should be.”

Answer 13

ANS: A Rationale: A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).

Answer 14

ANS: B Rationale: Decision-making tools such as decision grids and SWOT (strengths, weaknesses, opportunities, and threats) analyses are most appropriate when information is available and options known.

Answer 15

ANS: C Rationale: Problem solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem.

Answer 16

ANS: D Rationale: Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action.

Answer 17

ANS: A Rationale: In this particular model (a model similar to the nursing model), data collection is the first step toward identifying important alternatives or determining whether there is a problem or problems.

Answer 18

ANS: A Rationale: Research has determined that a structured approach to decision-making increases critical thinking and is the best way to learn how to make quality decisions because it eliminates trial and error and focuses on proven processes.

Answer 19

ANS: C Rationale: Critical thinking is associated with a thoughtful and orderly approach to considering problems, knowledge of methods of logical inquiry and reasoning skills, and the ability to apply them. In practice, critical thinking involves recognizing problems and finding ways to solve them by gathering pertinent information, appraising evidence, and evaluating arguments.

Answer 20

ANS: B Rationale: The hallmark of decision making is choosing among options. Generating options is one phase of decision-making, and solving a problem refers to problem solving, which is problem centred. Decision making does not always begin with problems, but rather it is defined as a purposeful, goal-directed effort in which a systematic process is used to choose among options.

Answer 21

ANS: D Rationale: The satisficing decision is a decision-making model whereby the decision-maker selects the solution that is the simplest and provides for the quickest solution.

Answer 22

ANS: C Rationale: The clinical judgement model described by Tanner (2006) emphasizes the role of intuition in decision making by nurses, particularly expert nurses.

Answer 23

ANS: D Rationale: The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with “why?”

Answer 24

ANS: B Rationale: Other departments were not involved in the problem-solving process; therefore they lacked input into the concerns, issues, and possible solutions. Thus it is not surprising that they did not follow the new policy of another department. Problem solving should be a group process that should involve as many personnel as possible.

Answer 25

ANS: C Rationale: Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.

Answer 26

ANS: A Rationale: People respond to cues in the situation and draw from stored information (tacit knowledge that is hard to describe) in the subconscious to make rapid decisions instead of taking an incremental, analytical approach such as that found in the rational decision-making model. Rational thinking and intuitive thinking are complementary, and successful decision making is a balance between the two approaches. If the task and the outcome are relatively simple, decisions can be made by one individual.

Answer 27

ANS: D Rationale: This choice is based on a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.

Answer 28

ANS: C Rationale: A nurse can draw upon many models in making a decision. It is critical to realize that decision-making expertise grows with exposure to decision making, and that diversity in expertise helps in developing options.

Answer 29

ANS: A Rationale: Problem analysis includes identifying, clarifying, and verifying a problem, whereas decision making focuses on developing cognitive strategies to solve a problem. Problem analysis begins with an investigation of the presenting problem. Decision making involves the individual, or organization, choosing a rational action, based on individuals’ preferences.

Answer 30

ANS: D Rationale: The scientific method is a rational, logical, and widely used problem-solving approach. It is the foundation for many models of decision making.

Answer 31

ANS: C Rationale: The Clinical Judgement Model described by Tanner (2006) emphasizes the role of intuition in decision making by nurses, particularly expert nurses. This model is systematic and similar in its sequence of steps to other models, although the thinking processes involved differ.

Answer 32

ANS: D Rationale: Nominal group technique involves asking individual group members to identify a problem, generate solutions, establish priorities and respond to questions posed by obtaining views on a topic by a moderator and arriving at a consensus (Harvey & Holmes, 2012). Typically this is accomplished through asking participants to evaluate and prioritize the ideas of a structured, mediated, approach by all group members.

Answer 33

ANS: A, B Rationale: Internal factors include variables such as the decision maker’s physical and emotional state, personal philosophy, biases, values, interests, experience, knowledge, attitudes, and risk-seeking or risk-avoiding behaviours. External factors include environmental conditions, time, and resources.

Answer 34

ANS: A, B, C Rationale: Taking a majority consensus is not a step in the critical thinking process. Steps A, B, and C are considered by most authors to be the essential steps in the process of critical thinking.

Answer 35

ANS: D Rationale: In differentiated nursing practice, rules are structured according to education and experience.

Answer 36

ANS: A Rationale: The effective functioning of teams in this model is heavily reliant on the leadership, organization, and communication skills of the leader, in addition to comfort and confidence in providing care to a specific patient group. Although leadership and critical thinking are part of basic education in baccalaureate programs, the new registered nurse (RN) needs time to develop clinical confidence and expertise.

Answer 37

ANS: B Rationale: The functional care delivery model depends on the decision of care according to tasks or functions that are assigned to specific teams or team members.

Answer 38

ANS: C Rationale: A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care, and to optimize patient outcomes.

Answer 39

ANS: D Rationale: The goals and outcomes established in a care map or critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of the need for hospital readmissions.

Answer 40

ANS: B Rationale: Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable use of various types of health care providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost effective in patient care settings that have the potential for high resource consumption, such as settings with medically complex cases, through collaboration and close attention to outcomes.

Answer 41

ANS: D Rationale: In a functional nursing model, in which other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

Answer 42

ANS: A Rationale: Because of the breadth of nursing knowledge required, baccalaureate education is preferred for primary nurses.

Answer 43

ANS: C Rationale: The partnership care delivery model is a variation of primary nursing in which an RN works with a medication assistant, who performs basic nursing functions.

Answer 44

ANS: C Rationale: The setting in which the case method of delivery can be most justified is the pediatric intensive care unit, in which the status of patients can rapidly change and complex functions of care involve both patients and families.

Answer 45

ANS: A Rationale: The case method may involve an RN’s treatment of the “total patient.” Employment of the most highly paid nursing personnel (RNs) for all patient care is the most expensive model and may be difficult to operationalize in times of RN shortage.

Answer 46

ANS: C Rationale: In functional nursing, licensed and unlicensed personnel perform specific tasks for a large number of patients. A disadvantage of this system is that care is assigned by task and not by patient, which can leave patients with the experience of multiple caregivers and a sense of confusion.

Answer 47

ANS: D Rationale: An advantage of functional nursing is that both unlicensed assistive personnel and licensed staff are involved in performance of specific tasks, and the repeated performance of tasks enables staff to become very efficient in specific functions. Disadvantages of the model include difficulty in being able to assess the patient’s nonphysical needs effectively and the potential for ineffective communication because of the focus on specific tasks.

Answer 48

ANS: A Rationale: Although repetition of tasks increases confidence and competence, it can also lead to boredom. In-service opportunities, adequate orientation, and building a team culture are strategies that are important to all models, but rotation of tasks can specifically reduce the boredom that is a potential disadvantage of this model.

Answer 49

ANS: A Rationale: Team nursing delivers care to a small group of patients; the team is a mix of licensed and unlicensed personnel. Assignment is based on the needs and background of the patient and on the strengths, licensure, and roles of team members. Team functioning and satisfaction can be compromised unless the team leader has strong delegation, communication, and leadership skills.

Answer 50

ANS: C Rationale: A particular challenge in team nursing is that staff mixes and personnel may change daily because of individual schedules and shortages.

Answer 51

ANS: C Rationale: Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from a patient’s time of admission to discharge and 24 hours a day during the hospital stay.

Answer 52

ANS: A Rationale: The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of care and therefore for altering it with the input of an associate. The associate is responsible for the implementation of the care plan that has been established when the primary nurse is off duty.

Answer 53

ANS: D Rationale: Primary nursing tends to be satisfying for RNs who enjoy a high level of accountability and autonomy in decision-making. Patient satisfaction is also high, inasmuch as patients form close therapeutic relationships with the nurse because of the continuousness of the relationship. Functional nursing is criticized for low patient satisfaction and potential staff dissatisfaction related to boredom and an autocratic approach to management.

Answer 54

ANS: B Rationale: The nurse manager who is considering movement to primary nursing needs to consider how the role of the manager changes, in addition to the roles of the staff. The role of decision-making at the patient care level is relinquished to the primary nurse. The nurse manager functions as a role model, advocate, coach, and consultant.

Answer 55

ANS: B Rationale: This particular model includes a focus on patient care that includes multidisciplinary teams and assistants at the patient’s bedside. Services, including those of laboratories and pharmacies, are decentralized to bring them closer to where care is delivered.

Answer 56

ANS: D Rationale: Case managers can come from a variety of disciplines but should have advanced preparation with the particular at-risk population being served, be comfortable in an advocate role, and be focused on outcome and patient.

Answer 57

ANS: A Rationale: Case-managed care does not generate revenue; rather, it protects revenue in that better coordination of care enables efficient achievement of patient outcomes, can result in a shorter length of hospital stay, and can prevent the need for readmission.

Answer 58

ANS: B Rationale: Nurses who have less than 2 or 3 years of experience in primary nursing or less than 2 or 3 years of nursing experience will probably require more assistance than do other nurses, which will put a greater demand on the unit during a time of transition.

Answer 59

ANS: C Rationale: The synergy model identifies patient characteristics as “drivers” of the necessary competencies for nurses.

Answer 60

ANS: B Rationale: Despite a variety of efforts to differentiate the roles and competencies of nurses with various educational backgrounds and experience, the demands of the workplace, the chronic shortage of nurses, and the greater use of technology have made it difficult to differentiate nursing practice in many clinical settings even among RNs with differing levels of education.

Answer 61

ANS: A, B, C Rationale: Although case management has many benefits, there are also several barriers including financial barriers, lack of administrative support, human resource inequities, turf battles, and a lack of information support systems.

Answer 62

ANS: C, D Rationale: In today’s costly health care environment, total patient care provided by one nurse, typically an almost all registered nurse (RN) staff, is very expensive. In a time of a global nursing shortage, there may not be enough nurses to use this model or funding to provide for this model of care. The nurse, patient, and family trust one another and work together toward specific goals. Total patient care remains popular with patients as the care is seen as being consistent and high quality, and care that is provided by highly qualified nursing staff.

Answer 63

ANS: C, D, E Rationale: Team leaders require both leadership skills and knowledge, in addition to clinical confidence and expertise, to effectively delegate responsibilities according to staff background, role, and expertise and according to patient needs.

Answer 64

ANS: B Rationale: 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 65

ANS: C Rationale: 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 66

ANS: D Rationale: 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 67

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

Answer 68

ANS: D Rationale: 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 69

ANS: B Rationale: 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 70

ANS: C Rationale: 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 71

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

Answer 72

ANS: C Rationale: 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 73

ANS: B Rationale: 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 74

ANS: C Rationale: 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 75

ANS: C Rationale: 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 76

ANS: C Rationale: 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 77

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

Answer 78

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

Answer 79

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

Answer 80

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

Answer 81

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

Answer 82

ANS: B Rationale: 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 83

ANS: C Rationale: 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 84

ANS: D Rationale: 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 85

ANS: D Rationale: 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 86

ANS: B Rationale: All team members should be clear about what skills they bring to the health care and team process, and this can be facilitated by the colocation of the team. Although simply grouping a variety of healthcare 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 87

ANS: A, C, D Rationale: 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 88

ANS: A, B, D Rationale: 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 89

ANS: A, B, C Rationale: 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 90

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

Answer 91

ANS: D Rationale: A number of studies (for example, Dunton et al., 2007) have demonstrated that adverse events such as falls can be reduced by increasing the number of RNs on a unit (relative to other personnel), and the number of experienced RNs. Overtime and 12-hour shifts are linked to higher incidences of errors.

Answer 92

ANS: B Rationale: The occupancy level is calculated as 34/40, or 85%.

Answer 93

ANS: C Rationale: Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

Answer 94

ANS: C Rationale: Among the largest expenditures for a nursing unit are employee salaries and benefits. In order to manage the costs on a unit, it is important that the nurse manager develop staffing plans that outline the number of individuals by classification that are needed on a per-shift basis, thus optimizing the management of financial resources.

Answer 95

ANS: D Rationale: Internal considerations are staffing policies, regulations, or recommendations and how they can relate to the minimum number of regulated or professional nurses required on an acute care unit at a given time, or to the amount of minimum staffing in an ambulatory care program, a continuing care facility, or correctional facility. Licensing standards and staffing recommendations by provincial and territorial professional association and regulatory bodies affect staffing plans and are considered to be external, or outside of the organization.

Answer 96

ANS: A Rationale: Internal policies determine what a nurse may do in a particular setting—for example, organizational staffing policies. External variables to consider are provincial/territorial licensing standards that outline what a nurse can do; the Canadian Nurses Association is a national regulatory organization; and consumer expectations fall within the public realm, which is also an external variable that affects staffing plans.

Answer 97

ANS: B Rationale: The numbers of acutely ill patients are determined through classification systems, which determine the nursing resources required.

Answer 98

ANS: C Rationale: It is important for staff retention to have a variety of scheduling options. Exact constraints regarding weekends and holidays are determined through contracts and policies.

Answer 99

ANS: A Rationale: Staffing is concerned with finding and assigning qualified individuals to care for a group of patients. Scheduling assigns personnel to specific hours and days of the week.

Answer 100

ANS: A Rationale: In complex patient care areas, a factor evaluation system, in comparison with a prototype system, would be used. The AHRQ produces studies related to staffing and scheduling. As of yet, there is no National Database of Nursing Quality Indicators in Canada, although it does exist in the United States.

Answer 101

ANS: C Rationale: In a factor evaluation system, tasks, thought processes, and patient care activities are considered and given a time or rating. These times or ratings are then used to determine the number of patient care hours required.

Answer 102

ANS: B Rationale: Staff morale suffers both when models of acute illness indicate a gap between staffing and the number of acutely ill patients, and when there is no model but perceived acute illness that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with similar institutions.

Answer 103

ANS: B Rationale: Validity of categories and implications for staffing levels are in question in this situation because staffing levels do not reflect the levels of activity required for patient care.

Answer 104

ANS: D Rationale: Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.

Answer 105

ANS: C Rationale: Studies of off-peak hours (weekends and nights) are limited to date, but those that have been done indicate that mortality increases during weekends and nights, when staff work with fewer and often less experienced staff, and when communication among on-call healthcare providers may be strained.

Answer 106

ANS: B Rationale: Nurse staffing plans employ nursing judgement and flexibility that is based on the number of acutely ill patients, nurse experience, and unit configuration rather than set nurse-to-patient ratios.

Answer 107

ANS: A Rationale: Adequate staffing, as demonstrated through a staffing plan and compliance reports, contributes to staff morale.

Answer 108

ANS: A Rationale: Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.

Answer 109

ANS: C Rationale: Strategies to reduce overtime increase patient safety. Studies suggest that every additional 10% of overtime hours worked contributes to a 1.3% increase in hospital-related mortality.

Answer 110

ANS: A Rationale: A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.

Answer 111

ANS: B Rationale: To avoid understaffing, average nonproductive or benefit hours need to be considered, so that the unit is properly staffed when staff members are off.

Answer 112

ANS: D Rationale: In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation are characteristics of staff self scheduling models.

Answer 113

ANS: B Rationale: Factor evaluation system is more objective and gives each task, thought process, and patient-care activity a time or rating. These indicators are then summed to determine the hours of direct care required, or they are weighted for each patient. Used for patients with more complex care needs and a less predictable disease course.

Answer 114

ANS: A, D Rationale: Leadership support ensuring adequate staffing levels and appropriate skill, education, and experience of staff including staff mix decreases mortality rates. An increase in staff burnout and casual or temporary positions has been demonstrated to increase mortality rates.

Answer 115

ANS: A, C Rationale: Although an increase in the number of registered nurses and a better staff mix will support better patient care and decreased mortality rates. It is more important that, in Canada, mandated nurse-patient ratios and development of a staffing plan for a period of time, usually a budget cycle, will provide consistency and ensure the nurse-patient ratio is appropriate based on evidence.

Answer 116

ANS: B, D Rationale: Research demonstrates that mandatory overtime hours and resulting nurse fatigue are primary factors for increasing mortality rates in off peak hours. Rotating shifts may have a minor influence and a good staff mix increases mortality rates.

Answer 117

ANS: A, D, E Rationale: A nurse manager manages financial resources by developing business and staffing plans. They also prepare nursing benchmarks and change staffing plans according to their unit’s needs.

Answer 118

ANS: A Rationale: Performance appraisal tools and processes should reflect the organizational mission and philosophy, and also position requirements.

Answer 119

ANS: B Rationale: In management by objectives, the employer and the employee jointly establish clear and measurable objectives for the next performance period.

Answer 120

ANS: D Rationale: Traditional rating scales are commonly used in evaluation and reflect generalizations rather than specific behaviours.

Answer 121

ANS: B Rationale: A combination of tools is probably superior to any one method in any situation. Peer review would not be recommended alone or in combination because it is not useful in an environment characterized by a high degree of mistrust or conflict.

Answer 122

ANS: C Rationale: Preceptors teach newly hired nurses in the clinical setting. Clinical nurse educators can assist in developing strategies that cover a variety of learning styles of new employees. This allows the preceptor to ensure uptake and retention of information in the newly hired staff member.

Answer 123

ANS: C Rationale: An employment interview should always conclude with information as to how and when follow-up to the interview will occur.

Answer 124

ANS: C Rationale: The primary challenge in the recruitment of new staff is finding candidates who can function well within your work culture. Asking behaviour-related questions in the interview allows you to assess how a candidate may function in real-life situations and to assess whether this behaviour is compatible with the culture on the unit.

Answer 125

ANS: A Rationale: Choosing the right individual is the challenge for managers and involves finding qualified candidates who will work well within the culture.

Answer 126

ANS: B Rationale: Anecdotal notes should be kept consistently throughout the evaluation period and should reflect both favourable and unfavourable behaviours if they are to provide an accurate assessment of performance. Anecdotal notes provide documentation to support scale ratings and narrative evaluation summaries.

Answer 127

ANS: A Rationale: The position description provides the basis for this position within the organization and communicates expectations for the role.

Answer 128

ANS: A Rationale: A halo effect occurs when the performance rating is based on a characteristic of the individual that actually has nothing to do with the work traits being considered. Managers may give higher ratings to individuals they like (halo effect) and lower ratings to individuals they do not like (negative halo effect).

Answer 129

ANS: A Rationale: 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 130

ANS: D Rationale: 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 131

ANS: D Rationale: 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 132

ANS: C Rationale: 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 133

ANS: B Rationale: 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 134

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

Answer 135

ANS: B Rationale: 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 136

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

Answer 137

ANS: B Rationale: 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 138

ANS: B Rationale: 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 139

ANS: B Rationale: 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 140

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

Answer 141

ANS: A Rationale: 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 142

ANS: B Rationale: 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 143

ANS: A, B, D Rationale: 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 144

ANS: A, B, D Rationale: 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 145

ANS: B, C, D Rationale: 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 146

ANS: A, C Rationale: 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 147

ANS: D Rationale: Strong leadership across the nursing profession is essential to ensure the delivery of safe care. Reducing nursing managers who provide support, consultation, and leadership in securing resources and in inspiring standards of excellence may increase the number of adverse events related to lack of leadership.

Answer 148

ANS: A Rationale: When health care facilities create a culture of safety, their staff are more willing to report adverse events because the focus is on addressing issues in the system and not blaming individuals.

Answer 149

ANS: B Rationale: The primary purpose of standards is to identify for nurses, the public, government, and other stakeholders the desired and achievable level of performance expected of nurses in their practice, against which actual performance can be measured.

Answer 150

ANS: B Rationale: Consulting with the staff enables the nurse manager to ascertain the root of the problem, inasmuch as the equipment may be faulty or unsafe because of its age and needs to be replaced. Client focused provision of care requires the nurse administrator to communicate, collaborate, and consult with nurses and other members of the health care team about the provision of health care services.

Answer 151

ANS: A Rationale: Patient-centred care is a priority in two main roles for nursing managers: making policies and ensuring system accountability. A number of activities can be implemented to enact these two roles, and nurses can support or implement many of them. For example, nurses can lead changes that promote team-based and collaborative care, as demonstrated in this question.

Answer 152

ANS: D Rationale: Governance and management activities that support patient-centred care include e-health stations and other technologic devices that facilitate communication, efficiency, and convenience.

Answer 153

ANS: D Rationale: Working within interprofessional teams optimizes patient safety and quality of the care that patients receive.

Answer 154

ANS: D Rationale: Patient-centred care contributes to a safer health care environment. Patient focus is integrated in the entry-level competencies for nurses that guide nursing education programs. These entry-level competencies are developed through collaboration among nursing regulatory bodies in Canada. The competencies are grounded in a standards-based conceptual framework in which the patient is central.

Answer 155

ANS: A Rationale: One of the patient outcomes includes self-care, that is, the patients’ perceptions and abilities to manage their care, including medication administration. It is important that a patient advocate educate patients about their medications and assess their ability to correctly take their own medications.

Answer 156

ANS: C Rationale: In a culture of safety, the focus is on effective systems and teamwork to accomplish the mutual goal of safe, high-quality performance. When something goes wrong, the focus is on what the problem is, rather than who. The intent is to expose process failures and system issues and to solve them in a nonbiased, nonthreatening way.

Answer 157

ANS: D Rationale: Attributes of common features of a culture of safety include a nonpunitive approach to adverse event reporting and analysis; open communication; teamwork; organizational learning; shared belief in the importance of safety; and leadership commitment to safety.

Answer 158

ANS: A Rationale: Nursing-sensitive outcome is the phrase used to describe patient outcomes that are sensitive to nursing practice or interventions; therefore programming that incorporates individual nurse competency into smoking cessation programs is an example.

Answer 159

ANS: B Rationale: Some examples of activities that health care organizations can implement to support a culture of safety include establishing Quality Improvement (QI) teams, having regular team “huddles” on the unit, debriefing with regard to adverse events, and requiring completion of a surgical safety checklist.

Answer 160

ANS: B Rationale: The adverse events rate was found to be 7.5 per 100 Canadian hospital admissions. This means that an adverse event was experienced in 7.5% of hospital admissions.

Answer 161

ANS: B Rationale: The Canadian Patient Safety Institute’s (CPSIs) Effective Governance for Quality and Patient Safety: A Toolkit for Healthcare Board Members and Senior Leaders provides information on the drivers of quality and patient safety, references (including Canadian studies), and stories from health care organizations. Important drivers of quality and patient safety include access to information, evidence and research, and relevant measures.

Answer 162

ANS: A Rationale: Doran, Harrison, Laschinger, et al. (2004, p.3) suggested the following uses for nurse-sensitive outcomes: * Develop treatment plans for individual patients. * Evaluate different approaches to patient care. * Inform best practices. * Improve the quality of nursing care. * Improve patient outcomes. * Inform staffing policies and decisions. * Assist organizations to balance the competing demands of access, cost, and quality.

Answer 163

ANS: B Rationale: One of the six CPSI competencies is to optimize human and environmental factors, managing the relationship between individual and environmental characteristics to optimize patient safety.

Answer 164

ANS: A Rationale: It is the nurse manager’s responsibility to challenge any action that is unsafe and to stop actions that are not performed in the patient’s best interest. This includes ensuring that staffing mixes are appropriate for care provided on each shift.

Answer 165

ANS: C Rationale: Recognizing the occurrence of an adverse event or close call and responding effectively help mitigate harm to the patient, ensure disclosure, and prevent recurrence. In this case, the error would have occurred if the patient had not questioned the colour of the medication.

Answer 166

ANS: B Rationale: The CPSIs flagship program is Safer Healthcare Now, with its vision as safe health care for all Canadians.

Answer 167

ANS: A Rationale: Organizational changes that promote systems thinking, collective accountability, and team-based care are examples of activities that promote patient-centred care.

Answer 168

ANS: C Rationale: Studies have found that when health care facilities create a culture of safety, their staff are more willing to report adverse events (Vogus, Sutcliffe, & Weick, 2010). This willingness is because they understand that the focus is on addressing issues in the system and not blaming individuals. The CNA (2009) position statement on patient safety is as follows: “Although individual competency may be a contributing factor, and individuals remain accountable for their own actions, it is increasingly evident that system competency plays a major role in patient safety.

Answer 169

ANS: B, C Rationale: Several broad categories of patient outcomes were identified by Doran (2011): Symptom management: how well symptoms are managed. Examples: pain, and fatigue. Patient satisfaction: patient satisfaction with nursing care.

Answer 170

ANS: A, B, D Rationale: Doran, Harrison, Laschinger, et al. (2004, p. 3) suggested the following uses for nurse-sensitive outcomes: Develop treatment plans for individual patients. Evaluate different approaches to patient care. Inform best practices, improve the quality of nursing care, improve patient outcomes, inform staffing policies and decisions, and assist organizations to balance the competing demands of access, cost, and quality.

Answer 171

ANS: A, B, C, D Rationale: Halligan and Zecevic (2011, p. 340) list the following attributes as common features of a culture of safety: Leadership commitment to safety, open communication founded on trust, organizational learning, a nonpunitive approach to adverse event reporting and analysis, teamwork, shared belief in the importance of safety.

Answer 172

ANS: A, B, C Rationale: Halligan and Zecevic (2011) list the following attributes as common features of a culture of safety: Leadership commitment to safety. Patient involvement in their own care has been shown to reduce adverse events and increase patient satisfaction.

Answer 173

ANS: B Rationale: Informatics is the application of technology to all fields of nursing to facilitate and extend nurses’ decision-making abilities and to support nurses in the use, storage, and linkage of clinical information in providing effective and efficient patient care. Nursing informatics, like all nursing communication, is founded on the concepts of data, information, knowledge, and, more recently acknowledged, wisdom.

Answer 174

ANS: D Rationale: Evidence-informed practice is a systematic approach to clinical decision-making; to provide the most consistent and best possible care to patients in this scenario, evidence is being used to optimize care for patients after cardiac catheterization.

Answer 175

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

Answer 176

ANS: C Rationale: Telecommunications facilitate clinical oversight and provision of health care at a distance via telephone, remote monitoring, and the Internet.

Answer 177

ANS: C Rationale: Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.

Answer 178

ANS: D Rationale: 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 179

ANS: A Rationale: 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 180

ANS: A Rationale: 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 181

ANS: D Rationale: 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 182

ANS: A Rationale: 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 183

ANS: A Rationale: An ideal hospital information system should include as much instrumentation as possible to minimize data entry. As a clinical end-user, you would expect orientation and training on how the screen display can be configured so as to suit the purposes and preferences of users in clinical areas.

Answer 184

ANS: A Rationale: 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 185

ANS: B Rationale: 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 186

ANS: D Rationale: 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 187

ANS: B Rationale: 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 188

ANS: A, B, C Rationale: 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 189

ANS: A, B, C Rationale: 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 190

ANS: A, B, C Rationale: 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 191

ANS: C Rationale: Identifying standards most important to the user of health care services is the first step in a six-step process for quality improvement.

Answer 192

ANS: C Rationale: 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 193

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

Answer 194

ANS: B Rationale: 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 195

ANS: C Rationale: 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 196

ANS: B Rationale: 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 197

ANS: D Rationale: 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 198

ANS: C Rationale: 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 199

ANS: B Rationale: Active involvement of staff in risk management activities is key to prevention of adverse events. Accountability for safety can be one aspect of performance evaluations.

Answer 200

ANS: A Rationale: 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 201

ANS: A Rationale: Magnet hospitals are particularly successful in implementing excellence in patient care through use of standards, evidence, and participatory decision-making in quality improvement. Organizations that cannot pursue Magnet status can implement strategies such as career ladders.

Answer 202

ANS: A Rationale: 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 203

ANS: D Rationale: 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 204

ANS: A Rationale: Statements about patient outcomes must include measurable, specific, and patient-centred information.

Answer 205

ANS: C Rationale: Quality and patient dissatisfaction are useful indicators of the areas that are of greatest concern to patients, and of what matters to nurses and organizations. Patient perceptions guide areas of inquiry; however, they do not establish which disciplinary decisions would be made.

Answer 206

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

Answer 207

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

Answer 208

ANS: C Rationale: Benchmarking is a widespread search to identify the best performance against which to measure practices and processes.

Answer 209

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

Answer 210

ANS: E Rationale: 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 211

ANS: D Rationale: 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 212

ANS: B Rationale: The QI process begins with the selection of a clinical activity or issue for exploration and improvement—what is the goal or aim of the improvement? Theoretically, any and all aspects of clinical care could be improved through the QI process. However, the aim of QI efforts should be concentrated on changes to patient care or systems that will have the greatest effect.

Answer 213

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

Answer 214

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

Answer 215

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

Answer 216

ANS: A Rationale: 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 217

ANS: D Rationale: 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 218

ANS: A Rationale: 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 219

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

Answer 220

ANS: C Rationale: 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 221

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

Answer 222

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

Answer 223

ANS: C Rationale: 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 224

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

Answer 225

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

Answer 226

ANS: A Rationale: 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 227

ANS: C Rationale: 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 228

ANS: B Rationale: 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 229

ANS: B Rationale: 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 230

ANS: D Rationale: 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 231

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

Answer 232

ANS: C Rationale: 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 233

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

Answer 234

ANS: D Rationale: 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 235

ANS: C Rationale: 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 236

ANS: A, B, C Rationale: 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 237

ANS: B, D Rationale: 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 238

ANS: A, B, C, D, E Rationale: 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, and communities are recognized and valued.

Answer 239

ANS: C Rationale: 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 240

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

Answer 241

ANS: A Rationale: 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 242

ANS: B Rationale: 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 243

ANS: C Rationale: 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 244

ANS: D Rationale: 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 245

ANS: B Rationale: 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 246

ANS: C Rationale: 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 247

ANS: D Rationale: 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 248

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

Answer 249

ANS: A Rationale: 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 250

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

Answer 251

ANS: C Rationale: 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 252

ANS: B Rationale: 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 253

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

Answer 254

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

Answer 255

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

Answer 256

ANS: A Rationale: 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 257

ANS: B Rationale: 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 258

ANS: A Rationale: 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 259

ANS: D Rationale: 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 260

ANS: B Rationale: 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 261

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

Answer 262

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

Answer 263

ANS: A, B, C, D Rationale: 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 264

ANS: A, C, D Rationale: 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 265

ANS: A, B, C, D Rationale: 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 266

ANS: A, B, D Rationale: 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 267

ANS: B Rationale: 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 268

ANS: B Rationale: 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 269

ANS: C Rationale: 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 270

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

Answer 271

ANS: C Rationale: 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 272

ANS: C Rationale: 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 273

ANS: B Rationale: 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 274

ANS: A Rationale: 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 275

ANS: A Rationale: 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 276

ANS: A Rationale: 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 277

ANS: B Rationale: 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 278

ANS: D Rationale: 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 279

ANS: B Rationale: 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 280

ANS: A Rationale: 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 281

ANS: B Rationale: 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 282

ANS: B Rationale: 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 283

ANS: B Rationale: 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 284

ANS: A Rationale: 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 285

ANS: A Rationale: According to Hader (2008), the perpetrator was a patient in 53.2% of violent incidents; a nurse colleague, in 51.9%; a physician, in 49%; a visitor, in 49%; and other health care workers, in 37.7%.

Answer 286

ANS: D Rationale: 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 287

ANS: B Rationale: 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 288

ANS: B Rationale: 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 289

ANS: C Rationale: 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 290

ANS: B, C Rationale: 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 291

ANS: A, B, C, D Rationale: 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 292

ANS: A, B, C Rationale: 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 293

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

Answer 294

ANS: C Rationale: 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 295

ANS: C Rationale: 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 296

ANS: A Rationale: 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 297

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

Answer 298

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

Answer 299

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

Answer 300

ANS: D Rationale: 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 301

ANS: B Rationale: 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 302

ANS: B Rationale: 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 303

ANS: B Rationale: 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 304

ANS: C Rationale: 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 305

ANS: C Rationale: 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 306

ANS: B Rationale: 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 307

ANS: B Rationale: 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 308

ANS: B Rationale: 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 309

ANS: C Rationale: 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 310

ANS: A Rationale: 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 311

ANS: C Rationale: 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.

Answer 312

ANS: A, B, C, D Rationale: 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 313

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

Answer 314

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

Answer 315

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

Answer 316

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

Answer 317

ANS: B Rationale: 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 318

ANS: D Rationale: 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 319

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

Answer 320

ANS: A Rationale: 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 321

ANS: B Rationale: 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 322

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

Answer 323

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

Answer 324

ANS: C Rationale: 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 325

ANS: B Rationale: 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 326

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

Answer 327

ANS: B Rationale: 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 328

ANS: A Rationale: 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 329

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

Answer 330

ANS: B Rationale: 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 331

ANS: B Rationale: 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 332

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

Answer 333

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

Answer 334

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

Answer 335

ANS: C Rationale: 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 336

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

Answer 337

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

Answer 338

ANS: A, B, D Rationale: 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 339

ANS: A, C Rationale: 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 340

ANS: A, B, D Rationale: 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 341

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