week 2 Flashcards
power def
Power is the ability to create, acquire and use resources to achieve one`s goals. It comes from the ability to influence others or to affect their thinking or behaviour
Power can be:
three things
- Personal – how the individual perceives power
- Professional (Experts) - authority
- Organizational - utilize all the mandatory resources in favor of organization development
Expert power:
derived from knowledge & skills ie expert nurses vs novice nurses
Legitimate power:
derived from the position of authority a person holds ie managers, CEO of an organization
Referent (charismatic) power:
derived from how much others respect & like a person
Reward power:
derived from a person’s ability to bestow rewards on people ie offering incentives which greatly motivates employees
Coercive (Forced) power:
is the opposite of reward power. It is the ability of the power holder to remove something from a person or to punish them for not conforming with a request
Connection power:
derived from a person’s connection to others with power ie networking for a job position with “who you know”
Information power:
derived from a person’s ability to provide information
Power – CNO, 2009
-Power. The nurse-client relationship is one of
unequal power
-A misuse of power is considered abuse.
Empowerment
the process by which we facilitate the participation of others in decision-making and taking action within an environment where there is an equal distribution of power
- There are many reasons to empower nurses –ineffective nurses are those who lack power - they lack job satisfaction and experience more burnout
- In order to be empowered individuals need to recognize the power that exists in their experience, knowledge, and internal motivation – self awareness
Leaders empower themselves and others by:
- Demonstrating high values for individuals and their opinions
- Encouraging critical thinking
- Viewed as important contributors
- Honoring and recognizing excellent workers
- Encouraging autonomy
- Viewed as valued team members
- Allow employee skills and abilities to benefit both the organization and themselves
Advocacy
Advocacy in nursing means taking the part of another, speaking for persons who cannot speak for themselves, or intervening to ensure that their views are heard.” (Oberle & Bouchal, 2009)
Requires good awareness of the context and the power relations involved
office of nursing policy
The lobbying efforts by nurses for a nursing voice in the federal government during this time led to the creation in 1999 of the Office of Nursing Policy – part of Health Canada which advises on health policy issues from a nursing perspective. (Kelly, 2009)
Nurses have gained respect and a place in the political views where their voices have been heard advocating for change – better work environments, decreased patient load leading to safe nursing care and recognition for the services nurses provide
Passive Communication
is when a person speaks quietly, avoids eye contact or slumps their posture. They may agree to something they don’t feel comfortable doing or back down from confrontation
Passive-Aggressive Communication
is when a person is passive and agreeable in face-to-face situations, but aggressive when the other person is no longer present
Passive Communication
is when a person speaks quietly, avoids eye contact or slumps their posture. They may agree to something they don’t feel comfortable doing or back down from confrontation
Assertive Communication
is clear, direct and shows respect for self and others. An assertive communicator makes eye contact, appears relaxed, and speaks firmly from their own viewpoint. Use “I”
Aggressive Communication
is when a person yells at others, clenches his jaw or fists, and points at the flaws in others. This sometimes escalates into violence. Blame others use “you”
Critical Thinking
- a set of information and beliefs generating and processing skills
- the habit, based on intellectual commitment, of using those skills to guide behaviour
Critical Thinking should be viewed from three diff perspectives
- thinking ahead (ability to be proactive)
- thinking in action (thinking on your feet)
- thinking back (reflective thinking)
A good critical thinker:
- Examines decisions from all sides and takes into account varying points of view
- Generates new ideas & alternatives when making decisions
- Asks “why” questions about a situation in order to arrive at the best decision
The problem-solving process consists of 5 steps:
- Identify the problem (assessment, diagnosis)
- Gather and analyze data (outcome identification)
- Generate alternatives & select an action (planning)
- Implement the selected action (implementation)
- Evaluate the action (evaluation)
Nature of decision making in nursing (2 types of decisions
- in the context of a therapeutic relationships with clients
- in the context of their own professional development
autonomy
- Nurse autonomy—key indicator of quality work environments
- Autonomy is an interactive, relational process that occurs with in the context of one’s being & work
- 3 types of autonomy—structural & work, attitudinal, & aggregate
Autonomous decision
- Autonomous decision making helps us to understand that we are the cause & not the effect
- Choosing autonomous decision making over dependency puts us in charge
Numerous factors influence decision making including:
•
– Individual variables (experience & knowledge)
– Creative thinking ability
– Education
– Self concept
– Environmental & situational stressors
• Intrinsic factors can be controlled
• Extrinsic factors include organizational climate & culture, client rights & choices, legal legislative frameworks
Perception can help with decision making
- Objective perception — characterized by seeing problem objectively (logically)
- Subjective perception — done with feelings (empathy)
-Incorporating both objective & subjective important
Intuitive
(understanding without rationale) is hallmark of expert nursing judgment
Competence —
The specific knowledge, skills, judgment and personal attributes required for a registered nurse to practise safely and ethically in a designated role and setting
To be effective decision-makers, nurses must
have a solid anchoring in the core competencies related to entry to practice and must possess knowledge and abilities related to problem solving and decision making, which have been integrated into professional practice
Decision Making
External Factors
- Organizational Climate and Culture
- Client Choice and Rights
- Legislation and Regulation
Steps in Decision Making
- Identify the need for a decision.
- Determine the goal or outcome.
- Identify the alternatives or actions along with the benefits and consequences of each action.
- Decide which action to implement.
- Evaluate the action.
Nominal Group Technique
- Group members write ideas, without discussion
- Each idea is presented with advantages & disadvantages
- Group discusses, clarifies, & evaluates ideas
- Group votes privately on ideas
Delphi Group Technique
- There is no face-to-face meeting
- Questionnaires are distributed to groups
- Responses are summarized & disseminated to group members
- The process is repeated until the group reaches consensus
Consensus Strategy
Consensus means that everyone in the group can live with & fully support the decision regardless of whether they totally agree
This strategy should be reserved for important decisions that require strong support from participants who will implement them
Consensus decision making is best used under these conditions:
- All members of the team are affected by the decision
- Implementation of the solution requires coordination among team members
- The decision is critical, requiring full commitment by team members
Group Think
In groupthink, the goal is for everyone to be in 100% agreement
Groupthink hinders creativity, & usually leads to inferior decisions
To avoid groupthink:
Appoint group members to roles that evaluate how the group decision making occurs
Encourage all group members to think independently & verbalize their individual ideas
Allow the group time to gather further data & reflect on data already collected
10 Rights for health professionals—Assertiveness training
- The right to be treated with respect
- The right to a reasonable work load
- The right to an equitable wage
- The right to determine your own priorities
- The right to ask for what you want
- The right to refuse without making excuses or feeling guilty
- The right to make mistakes and be responsible for them
- The right to give and receive information as a professional
- The right to act in the best interest of the patient
- The right to be human
Evidence-based Care:
a blend of the beliefs, values & attitudes of clients, families, & practitioners, with the most current knowledge of incidence & prevalence of the health care problem at hand & an understanding of the organization & delivery of health care
Best Research Evidence
refers to methodologically sound, clinically relevant research on effectiveness and safety of nursing interventions, the accuracy & precision of nursing assessment measures, the power of prognostic markers, the strength of causal relationships, the cost effectiveness of nursing interventions, and the meaning of illness & client experiences
EBC does not guarantee good decisions but it is key to improving outcomes that affect health
EBC should be viewed as the highest standard of care (supported by critical thinking & sound clinical judgement)
How do organization create supportive environment for Evidence Based Practices?
Compensate managers & front-line nurses for participation in academic activities
Provide easy access to library resources & computers
Include clinical nurse specialists in staffing mixes
Use evidence in management decision making
Adopt evidence-based corporate goals
Udod & Care (2004)
What are the behaviors and factors that facilitate the use of Evidence Based Practices
Behaviors:
On going and supportive leadership
continuing education
an organizational culture supportive of evidence-informed practice
integration of guideline recommendations into organizational policies and procedures
Factors: On going leadership by champions management support On going staff education the integration of the guidelines into policies and procedures staff buy-in and ownership synergy with partners multidisciplinary involvement
Health Outcomes for Better Information and Care (HOBIC)
• Ontario Ministry of Health & Long Term Care created Ontario Nursing Task Force in 1998—now known as Health Outcomes for Better Information and Care (HOBIC)
– Goals HOBIC
1) identify nursing-sensitive client outcomes
2) determine appropriate ways of measuring these outcomes
3) identify databases on which these outcomes could be housed
End result for HOBIC to inform health policy and guide nursing practice
evidence-based guidelines
care plans
other decision-aid tools
Evidence-based Practice Process 5 steps:
1) define the clinical question
2) search the literature
3) select and critically appraise the most relevant reports
4) decide whether and how to use the information
5) evaluate the effects of your decision
Knowledge Transfer & Exchange (KT & E)–
refers to responsibility of creating and disseminating research so that it can be readily used by decision-makers at all levels
Examples of KT & E
Canadian Health Services Research Foundation (CHSRF)
Canadian Population Health Initiative (CPHI)
Canadian Institutes of Health Research (CIHR)
CHSRF & CIHR
fund nursing research chairs to examine nursing practice, resources and strategies to transfer knowledge into policy & practice
american nursing assoc.
Framework for How to Read and Critique a Research Study
- Critiquing the research article
- Determine the level and quality of the evidence using a scale
- Decide if the study is applicable to your practice
