bstrandable NCLEX Leadership and Management

Autocratic Leadership

Centralized decision-making style with the leader making decisions and using power to command and control others

Bureaucratic Organization

Hierarchy with clear superior-subordinate communication and relationships, based on positional authority, in which orders from the top are transmitted down through the organization via a clear chain of command

Consideration

Activities that focus on the employee and emphasize relating and getting along with people

Contingency Theory

Style that acknowledges that other factors in the environment influence outcomes as much as leadership style and that leader effectiveness is contingent upon or depends upon something other than the leader's behavior

Democratic Leadership

Style in which participation is encouraged and authority is delegated to others

Emotional Intelligence

Component of leadership and refers to the capacity for recognizing your own feelings and those of others, for motivating yourself, and for managing emotions well in yourself and in your relationships.

Employee-Centered Leadership

Style with a focus on the human needs of subordinates

Formal Leadership

When a person is in a position of authority or in a sanctioned role within an organization that connotes influence

Hawthorne effect

Term coined to reflect the findings of a research study that demonstrated that change in employee behavior occurs as a result of being observed

informal leader

Individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group rather than as the head or leader of the group

initiating structure

style that involves an emphasis on the work to be done a focus on the task and production

job-centered leaders

Style that focuses on schedules, cost, and efficiency with less attention to developing work groups and high-performance groups

knowledge workers

health care professionals who are well educated and technologically savvy and see themselves as owning their intellectual capital

laissez-faire leadership

Passive and permissive style in which the leader defers decision making

leader-member relations

Feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader

leadership

Process of influence whereby the leader influences other toward goal achievement

maintenance or hygiene factors

Elements such as salary, job security, working conditions, status, quality of supervision, and relationships with others that prevent job dissatisfaction

management

Process of coordinating actions and allocating resources to achieve organizational goals

management process

Function of planning, organizing, coordinating, and controlling

motivation

Whatever influences our choices and creates direction, intensity, and persistence in our behavior

motivation factors

Elements such as achievement, recognition, responsibility, advancement, and the opportunity for development that contribute to job satisfaction

position power

Degree of formal authority and influence associated with the leaders

substitutes for leadership

Variable that may influence or have an effect on followers to the same extent as the leader's behavior

task structure

Involves the degree that work is defined, with specific procedures, explicit directions and goals

taxonomy

System that orders principles into a grouping or classification

Theory X

View that in bureaucratic organizations, employees prefer security, direction, and minimal responsibility; coercion, threats, or punishment are necessary because people do not like the work to be done

Theory Y

View that in the context of the right conditions, people enjoy their work, they can show self-control and discipline, are able to contribute creatively and are motivated by ties to the group, the organization, and the work itself; belief that people are i

Theory Z

View of collective decision making and a focus on long term employment that involves less direct supervision

transactional leader

traditional manager concerned with day-to-day operations

transformational leader

Leader who is committed to a vision that empowers others

Hawthorne effect

phenomena of how being observed or studied results in a change in behavior

NEGLIGENT ACTS

*Medication errors that result in injury to the client
*IV administration errors: incorrect flow rates; failure to monitor a flow rate that results in injury
*Falls that occur as a result of failure to provide safety
*Failure to check equipment for proper

NEGLIGENCE

*Conduct that falls below the standard of care
*Can include acts of commission and omission
*A nurse who does not meet standards of care can be held liable

MALPRACTICE

*Negligence on the part of a nurse
*Determined if the nurse owed a duty to the client & did not carry out the duty and the client was injured

PROOF OF LIABILITY

*DUTY: At the time of injury, a duty existed between the plaintiff & the defendant
*BREACH OF DUTY: The defendant breached duty of care
*PROXIMATE CAUSE: The breach of duty was the legal cause of injury to the client
*DAMAGE/INJURY: The plaintiff experien

LEGAL RISK AREAS
**Assault

When a person puts another person in fear of a harmful or offensive contact
*The victim fears & believes that harm will result because of the threat

LEGAL RISK AREAS
**Battery

Intentional touching of another without consent

LEGAL RISK AREAS
**Invasion of Privacy

Violating confidentiality
*Intruding on private client/family matters
*Sharing client information with unauthorized persons

LEGAL RISK AREAS
**False Imprisonment

*When a client is not allowed to leave a health care facility when there is no legal justification to detain
*When restraining devices are used without an appropriate clinical need (includes meds)

LEGAL RISK AREAS
**Defamation

False communication that causes damage to someone's reputation
*In writing: libel
*Verbal: slander

LEGAL RISK AREAS
**Fraud

Deliberate deception to produce unlawful gains

INCIDENT REPORTS

*Used as a means of identifying risk situations & improving care
*Follow specific documentation guidelines
*Fill out report completely, accurately & factually
*Report form should not be copied or placed in client's record
*Make no reference to the inciden

INCIDENTS THAT NEED TO BE REPORTED

*Accidental omission of prescribed therapies
*Circumstances that lead to injury or a risk for client injury
*Client falls
*Needle stick injuries
*Medication administration errors
*Procedure related/equipment related accidents
*A visitor injury that occurr

TELEPHONE PRESCRIPTIONS

*Date & time the entry
*Repeat the prescription to the HCP & record
*Sign the prescription: begin with "t.o. (telephone order), write the HCP's name & sign
*If another nurse witnessed the prescription, that nurses' name follows
*The HCP needs to countersi

COMPONENTS OF A MEDICATION PRESCRIPTION

*Date & time written
*Medication name
*Medication dosage
*Route of administration
*Frequency of administration
*HCP's signature

REPORTING RESPONSIBILITIES

*Certain communicable diseases
*Child/elder abuse
*Domestic violence
*Dog/other animal bite
*Gunshot
*Stab wounds
*Assaults
*Homicides
*Suicides
**Impaired nurse (report to administration)

PATIENT'S BILL OF RIGHTS

*Right to considerate & respectful care
*Right to be informed about diagnosis, possible treatments, likely outcome, and discussion with HCP
*Right to know the names & roles of persons involved in care
*Right to consent or refuse a treatment
*Right to have

MENTALLY OR EMOTIONALLY INCOMPETENT CLIENTS
**Unable to sign informed consent

*Declared incompetent
*Unconscious
*Under the influence of chemical agents (alcohol or drugs..even legal ones)
*Chronic dementia or other mental deficiency that impairs thought processes and ability to make decisions

VIOLATIONS OF PRIVACY

*Taking photographs of the client
*Release of medical information to unauthorized person
*Use of client's name/picture for health care facility's advantage
*Intrusion into client's affairs
*Publication of information or embarrassing facts about client
*Pu

COMPUTERIZED MEDICAL RECORDS
**Protecting client's information

*Employees should have access only to records in the nursing unit or work area
*Use of special computer access codes to limit what employees have access to
*Use of password/identification code is needed to enter and sign off computer system
*Password/iden

Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately.

A client who had a "Do Not Resuscitate" order passed away. After verifying there is no pulse or respirations, the nurse should next:

False

True or False - The nurse practice acts are an example of civil law.

Collecting all available information about the situation

The nurse is working with parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. In helping the parents resolve this ethical conflict, the nurse knows that the first step is

The sequencing of stages of grief may occur in order, they may be skipped, or they may reoccur

When helping a person through grief work, the nurse knows

Relationships

The philosophy sometimes called the code of ethics of care suggests that ethical dilemmas can best be solved by attention to

Civil

The client's right to refuse treatment is an example of _________ laws.

True

True or False - The dominant value in American society of individual autonomy and self-determination may be in direct conflict with diverse groups.

Current health standards should determine the acceptability of cultural practices.

When providing care to clients with varied cultural backgrounds, it is imperative for the nurse to recognize that:

Bio-cultural needs

Which factor is least significant during assessment when gathering information about cultural practices?

Assess the client's point of view and prepare to articulate this point of view.

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to:

The choices involved do not appear to be clearly right or wrong.

A health care issue often becomes an ethical dilemma because

American Nurses Association's (ANA's) Code of Ethics

Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the:

American Nursing Association

The code of ethics for nurses is composed and published by

4. Defines the principles of right and wrong to provide patient care.

You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A nonnursing colleague as

3. Assessment

An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, auscultates her lung sounds, listens to her heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Whi

4. Implementation

A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice performed?
1. Planning
2. Evaluation
3. Assessment
4. Implementa

2. Advocate

A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family an

3. A problem-solving approach that integrates best current evidence with clinical practice

Evidence-based practice is defined as:
1. Nursing care based on tradition
2. Scholarly inquiry of nursing and biomedical research literature
3. A problem-solving approach that integrates best current evidence with clinical practice
4. Quality nursing prov

4. Provides a minimal standard of knowledge for a registered nurse in practice

The examination for registered nurse licensure is exactly the same in every state in the United States. The examination:
1. Guarantees safe nursing care for all patients
2. Ensures standard nursing care for all patients
3. Ensures that honest and ethical

1. Caregiver
2. Autonomy and accountability
3. Patient advocate
4. Health promotion

Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.)
1. Caregiver
2. Autonomy and accountability
3. Patient advocate
4

1. Function independently

Advanced practice registered nurses generally:
1. Function independently
2. Function as unit directors
3. Work in acute care settings
4. Work in the university setting.

1. Moving from an acute illness to a health promotion, illness prevention model

Health care reform will bring changes in the emphasis of care. Which of following models is expecting from health care reform?
1. Moving from an acute illness to a health promotion, illness prevention model
2. Moving from illness prevention to a health pr

2. Nurse practitioner
3. Certified clinical nurse specialist

Which of the following nursing roles may have prescriptive authority in their practice? (Select all that apply.)
1. Critical care nurse
2. Nurse practitioner
3. Certified clinical nurse specialist
4. Charge nurse

4. Informatics

A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia cause by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses

2. Safety

A nurse is caring for an older-adult couple in a community-based assisted living facility. During the family assessment he notes that the couple has many expired medications and multiple medications for their respective chronic illnesses. They note that t

4. nurse researcher

The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first the procedure currently used to assess for pressure ulcer risk. The second

3. In-service education

Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education?
1. Continuing education
2. Graduate education
3. In-service education

4. Problem solving.

While assessing a patient, the nurse observes that the patient's intravenous (IV) line is not infusing at the ordered rate. The nurse assesses the patient for pain at the IV site, checks the flow regulator on the tubing, looks to see if the patient is lyi

1. Diagnostic reasoning.

The nurse sits down to talk with a patient who lost her sister 2 weeks ago. The patient reports she is unable to sleep, feels very fatigued during the day, and is having trouble at work. The nurse asks her to clarify the type of trouble. The patient expla

3. Conducting reflective practice.

A patient on a surgical unit develops sudden shortness of breath and a drop in blood pressure. The staff respond, but the patient dies 30 minutes later. The manager on the nursing unit calls the staff involved in the emergency response together. The staff

3. Analyticity
4. Self-Confidence

A nurse has worked on an oncology unit for 3 years. One patient has become visibly weaker and states. "I feel funny." The nurse knows how patients often have behavior changes before developing sepsis when they have cancer. The nurse asks the patient quest

2. Think about past experience with patients who develop postoperative complications.
3. Decide which activities can be combined for patient B and C.

A nurse who is working on a surgical unit is caring for four different patients. Patient A will be discharged home and is in need of instruction about wound care. Patients B and C have returned from the operating room within an hour of each other, and bot

3. Consistent

The surgical unit has initiated the use of a pain-rating scale to assess patients' pain severity during their postoperative recovery. The registered nurse (RN) looks at the pain flow sheet to see the pain scores recorded for a patient over the last 24 hou

1. "I understand your reluctance, but the exercises are necessary for you to regain function in your shoulder. Let's go a bit more slowly and try to relax.

During a home health visit the nurse prepares to instruct a patient in how to perform range-of-motion (ROM) exercises for an injured shoulder. The nurse verifies that the patient took an analgesic 30 minutes before arrival at the patient's home. After dis

2. Description of the efforts to restore the child's blood pressure, what was used, ad questions about the child's response
3. The meaning the experience had for the nurse with respect to her understanding of dealing with a patient's death
4. A descriptio

The nurse cared for a 14-year old with renal failure who dies near the end of the work shift. The health care team tried for 45 minutes to resuscitate the child with no success. The family was devastated by the loss, and, when the nurse tried to talk with

3. Basic critical thinking

A nurse has been working on a surgical unit for 3 weeks. A patient requires a Foley catheter to be inserted, so the nurse reads the procedural manual for the institution to review how to insert it. The level of critical thinking that the nurse is using is

2. Evaluation

A patient had hip surgery 16 hours ago. During the previous shift the patient had 40 mL of drainage in the surgical drainage collection device for an 8 hour period. The nurse refers to the written plan of care, noting that the health care provider is to b

3, 5, 2, 4, 1

A 67-year old patient will be discharged from the hospital in the morning. The health care provider has ordered three new medications for her. Place the following steps of the nursing process in the correct order:
1. The nurse returns to the patient's roo

3. knowledge application

The nurse asks a patient how she feels about her impending surgery for breast cancer. Before the discussion the nurse reviewed the description of loss and grief and therapeutic communication principles in his textbook. The critical thinking component invo

1. A nurse explain to the NAP the approach to use in getting the patient up and why the patient has activity limitations.
3. The nurse sees the NAP preparing to help a patient out of bed, goes to assist, and thanks the NAP for her efforts to get the patie

A nurse is working with a nursing assistive personnel (NAP) on a bust oncology unit. The nurse has instructed the NAP on the tasks that need to be performed, including getting patient A out of bed, collecting a urine sample from patient B, and checking vi

4. Anticipated when to make choices without others' assistance.

Which of the following is unique to the commitment level of critical thinking?
1. Weighs benefits and risks when making a decision.
2. Analyzes and examine choices more independently.
3. Concrete thinking.
4. Anticipated when to make choices without other

4. The nurse explains the procedure for giving a tube feeding to a second nurse who has floated to the unit to assist with care.

In which of the following examples is the nurse not applying critical thinking skills in practice?
1. The nurse considers personnel experience in performing intravenous (IV) line insertion and ways to improve performance.
2. The nurse uses a fall risk inv

4. Feedback

The nurse summarizes the conversation with the patient to determine if the patient has understood him or her. This is what element of the communication process?
1. Referent
2. Channel
3. Environment
4. Feedback

2. Coach her to give herself positive messages about her ability to do this

Mrs. Jones states that she gets anxious when she thinks about giving herself insulin. How do you use your understanding of intrapersonal communication to help with this?
1. Provide her the opportunity to practice drawing up insulin
2. Coach her to give he

3. The patient is short of breath.

The nurse has a patient who is short of breath and calls the health care provider using SBAR (situation-background-assessment-recommendation) to help with the communication. What does the nurse first address?
1. The respiratory rate is 28.
2. The patient

4. Talk with him about his favorite hobbies

You are caring for Mr. Smith, who is facing amputation of his leg. During the orientation phase of the relationship, what would you do?
1. Summarize what you have talked about in the previous sessions
2. Review his medical record and talk to other nurses

2. Clarifying

The nurse states, "When you tell me that you're having a hard time living up to expectations, are you talking about your family's expectations?" The nurse is using which therapeutic communication technique?
1. Providing information
2. Clarifying
3. Focusi

2. "Why do you always put so much salt on your food?

Which of the following statements would be most likely to block communication?
1. "You look kind of tired today."
2. "Why do you always put so much salt on your food?"
3. "It sounds like this has been a hard time for you."
4. "If you use your oxygen when

3. Move to her bedside, get her attention, and repeat the question while facing her

You are caring for an 80-year old woman, and you ask her a question while you are across the room washing your hands. She does not answer. What is your next action?
1. Leave the room quietly since she evidently does not want to be bothered right now
2. Re

2. "When you brush me off like that, it takes me even longer to do my job.

You ask another nurse how to collect a laboratory specimen. The nurse raises her eyebrows and asks, "Why don't you figure it out?" what would be the best response?
1. Say nothing and walk away. Find a different nurse to help you.
2. "When you brush me off

3. 18 inches to 4 feet from the patient.

When the nurse takes the patient's history, he or she sits:
1. Next to the patient.
2. 4 to 12 feet from the patient.
3. 18 inches to 4 feet from the patient.
4. 12 inches to 3 feet from the patient.

3. Shifting quickly from subject to subject.

When working with an older adult, the nurse remembers to avoid:
1. Touching the patient.
2. Allowing the patient to reminisce.
3. Shifting quickly from subject to subject.
4. Asking the patient how he or she feels.

4. The professional nurse works with colleagues and the patient's family to provide combined expertise in planning care.

The statement that best explains the role of collaboration with others for the patient's plan of care is which of the following?
1. The professional nurse consults the health care provider for direction in establishing goals for patients.
2. The professio

1. Answer the call light promptly.
4. Answer questions honesty.
5. Demonstrate competence when doing treatments.

Identify behaviors that foster the development of trust. (Select all that apply.)
1. Answer the call light promptly.
2. Call the patient by first name unless requested otherwise.
3. Do all the care as quickly as possible and leave the room as the patient

3. Obtains an interpreter to facilitate communication of medication information

A patient with limited English proficiency is going to be discharged on new medication. How does the nurse complete the discharge teaching?
1. Uses a dictionary to give directions for medication administration
2. Explains the directions to the patient's 1

2. Pulling the curtain to provide privacy
3. Offering to discuss information about her condition
5. Sitting quietly by her bed and hold her hand

Your patient has just been told that she has cancer, and she is crying. Which actions facilitate therapeutic communication? (Select all that apply.)
1. Turning on the television to her favorite show
2. Pulling the curtain to provide privacy
3. Offering to

3. Deflect your eyes downward to show respect

Mr. Sakda emigrated from Thailand. When taking care of him, you note that he looks relaxed and smiles but seldom looks at you directly. How do you respond?
1. Use therapeutic communication to assess for increased anxiety
2. Sit down and position yourself

4. Psychomotor domain

A patient needs to learn to use a walker. Which domain is required for learning this skill?
1. Affective domain
2. Cognitive domain
3. Attentional domain
4. Psychomotor domain

2. When the patient's pain medications are working
3. Just before lunch, when the patient is most awake and alert

The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.)
1. When there are visitors in the room
2. When the patient's pain medications are working
3. Just before lunch

3. Provide only the information that the patient needs to go home

A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient?
1. Teach the patient's spouse
2. Focus on knowledge the patie

3. Develop topics for discussion that require problem solving

The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes?
1. Provide information using a lecture
2. Use simple words to pro

3. The patient will perform breast self-examination correctly on herself before the end of the teaching session.

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination?
1. The patient will verbalize the steps involved in breast self-exa

1. Telling approach

A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation?
1. Telling approach
2. Selling approach
3. Entrusting approach
4. Participating approach

1. Role play

The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach di

4. Allows the patient time to express himself or herself and ask questions

And older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse:
1. Speaks loudly
2. Presents the information once
3. Expects the patient to understand the information quickly
4. Allows the pa

2. Expressing the importance of learning the skill correctly

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn?
1. Describing difficulties a family member has had in taking insulin
2. Expressing the importance of learning the skil

2. Demonstration

A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use?
1. Simulation
2. Demonstration
3. Group instruction
4. One-on-one discussion

2. Analogy

When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use?
1. Te

1. How to use an inhaler during an asthma attack

A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first?
1. How to use an inhaler during an asthma attack
2. The need to avoid people who smoke to prevent asthma

4. Health promotion and illness prevention

A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing?
1. Simulation
2. Restoring health
3. Coping with impaired function
4. Health promotion and ill

2. A learning objective

A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an exam

1. Cognitive

A nurse is teaching a 27-year old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this?
1. Cognitive
2. Affective
3. Adaptation
4. Psychomotor

3. Remove all patients in immediate danger

The nurse's first action after discovering an electrical fire in a patient's room is to:
1. Activate the fire alarm
2. Confine the fire by closing all doors and windows
3. Remove all patients in immediate danger
4. Extinguish the fire by using the nearest

3. Call the poison control center.

A parent calls the pediatrician's office frantic about the bottle of cleaner that her 2-year old son drank. Which of the following is the most important instruction the nurse gives to the parent?
1. Give the child milk.
2. Give the child syrup of ipecac.

4. Risk for falls

The nursing assessment on a 78-year old woman reveals shuffling gait, decreased balance, and instability. On the basis of the patients data, which of the following nurses diagnoses indicates an understanding of the assessment findings?
1. Activity intoler

4. Automobile accidents, suicide, and substance abuse

A couple is with their adolescent daughter for a school physical and state they are worried about all the safety risks affecting this age. What is the greatest risk for injury for an adolescent?
1. Home accidents
2. Physiological changes of aging
3. Poiso

2. Leave a night light on in the bathroom.
6. Provide scheduled toileting during the night shift.
7. Keep the pathway from the bed to the bedroom clear.

The nurse found a 68-year old female patient wandering in the hall. The patient says she is looking for the bathroom. Which interventions are appropriate to ensure the safety of the patient? (Select all that apply.)
1. Insert a urinary catheter.
2. Leave

3. Ask the family to stay with the patient if possible.
4. Inform the family of the risks associated with side rail use.
6. Discuss alternatives with the family that are appropriate for this patient.

The family of a patient who is confused and ambulatory insists that all four side rails be up when the patient is alone. What is the best action to take in this situation? (Select all that apply.)
1. Contact the nursing supervisor.
2. Restrict the family'

3, 4, 1, 5, 2

A physician writes an order to apply a wrist restraint to a patient who has been pulling out a surgical wound drain. Place the following steps for applying the restraint in the correct order.
1. Explain what you plan to do.
2. Wrap a limb restraint around

4. Clear the area around the child to protect child from injury.

A child in the hospital starts to have a grand mal seizure while playing in the playroom. What is your most important nursing intervention in this situation?
1. Begin cardiopulmonary respiration.
2. Restrain the child to prevent injury.
3. Place a tongue

1. A safe environment promotes patient activity.

A 62-year old woman is being discharged home with her husband after surgery for a hip fracture from a fall at home. When providing discharge teaching about home safety to his patient and her husband, the nurse knows that:
1. A safe environment promotes pa

1. Place a bed alarm device on the bed.

The nursing assessment of an 80-year old patient who demonstrates some confusion but no anxiety reveals that the patient is a fall risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to pr

1. Smoking is prohibited around oxygen.
3. Do not use electrical equipment around oxygen.
4. Special precautions may be required when traveling with oxygen.

To ensure the safe use of oxygen in the home by a patient, which of the following teaching points does the nurse include? (Select all that apply.)
1. Smoking is prohibited around oxygen.
2. Demonstrate how to adjust the oxygen flow rate based on patient s

1. Completing incident reports when appropriate
2. Completing incident reports for a near miss
3. Communicating product concerns to an immediate supervisor

How does the nurse support a culture of society? (Select all that apply.)
1. Completing incident reports when appropriate
2. Completing incident reports for a near miss
3. Communicating product concerns to an immediate supervisor
4. Identifying the person

3. Takes antihypertensive and diuretics
4. History of recent fall
5. Neglect, spatial and perceptual abilities, impulsive
6. Requires assistance with activity, unsteady gait
7. IV line, urinary catheter

You are admitting Mr. Jones, a 64-year old patient who had a right hemisphere stroke and a recent fall. The wife stated that he has a history of high blood pressure, which is controlled by an antihypertensive and a diuretic. Currently he exhibits left sid

1. Prepare for an influx of patients

At 3 am the emergency department nurse hears that a tornado hit the east side of town. What action does the nurse take first?
1. Prepare for an influx of patients
2. Contract the American Red Cross
3. Determine how to restore essential services
4. Evacuat

1. Results in neurophysiological response.

When teaching a patient about the negative feedback response to stress, the nurse indicates which of the following to describe the benefits of this stress response?
1. Results in neurophysiological response.
2. Reduces body temperature
3. Causes a person

3. Chronic illness

A nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which of the following whil

1. Denial.

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "the hemoglobin A1C is wrong. My blood sugar levels have been

posttraumatic stress disorder (PTSD)

When doing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. The nurse recognizes this as ___________________.

3. An adventitious crisis

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of:
1. A situational crisis
2. A maturational crisis
3. An adventitious crisis
4. A developmental crisis

2. Since your husband has died, what have you been doing in the evening when you feel lonely?

During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions?
1. How is this flood affecting your life?
2. Since your husband has died, what have you been doing in the evening when

4. Search for identity with peer groups and separating from family

The nurse plans care for a 16-year old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following?
1. Loss of autonomy caused by health problems
2. Physical appearance, family, friends, and schoo

2. "Tell me what bothers you the most about this experience.

A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress the nurse says:
1. "Tell me who I can call to help you."
2. "Tell me what

3. A thorough physical assessment

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments include which of the following?
1. The amount of family support
2. A 3-day diet recall
3. A thorough physical assessment

3. "Would you like for me to sit down with you for a few minutes so you can talk about this?

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. The nurse's first response is which of the following?
1. "Don't be sad. People live with cancer e

1. "Are you thinking of suicide?

A 34-year old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. Your best response would be which of the following?
1. "Are you thinking of suici

4. "I'm going to attend a support group to learn more about multiple sclerosis.

The nurse is evaluating the coping success if a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says:
1. "I'm going to l

4. With silence.

A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." The nurse responds:
1. "Let's talk about something cheerful."
2. "Do other members of your family have diabetes?"
3. "I can tell that you

4. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. The supervising nurse recognizes that:
1. Nurses who feel stress usually pass the stress along to their patients.
2. A nurse who feels stress is ineffective a

2. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks

A crisis intervention nurse working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her entitlement check while the child is hospitalized can expect the mother to regain the stability after how long?
1. After

An African American youth, growing up in an impoverished neighborhood, seeks affiliation with a black gang. Soon he is engaging in theft and assault. What cultural consideration should a nurse identify as playing a role in this youth's choices?
A. Most Af

ANS: B
The nurse should identify that a tendency to remain within one's own social organization may have played a role in this youth's choice to join a black gang. African Americans who have assimilated into the dominant culture are likely to be well educ

Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of psychopathology?
A. Dissociative disorders
B. Alzheimer's dementia

ANS: C
The nurse should correlate Northern European American values, such as punctuality, hard work, and acquisition of material possessions, with stress-related disorders. Psychopathology may occur when individuals fail to meet the expectations of the cu

A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care?
A. Northern European Americans
B. Native

ANS: A
The community health nurse should anticipate that Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related

Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture?
A. Extremes of emotional expression prevent accurate assessment of this culture.
B. Suspicion of Western civilization has resulted

ANS: D
The nursing instructor's best explanation is that the Asian American culture is difficult to classify globally due to the number of countries that identify with this culture. The Asian American culture includes peoples and descendents from Japan, C

A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this client's decision?
A. Future orientation causes the client to devalue assertiveness skil

ANS: C
The nurse should identify that the Latin American woman's refusal to participate in an assertiveness training group may be influenced by the Latin American cultural definition of the female role. Latin Americans place a high value on the family whi

A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief should a nurse associate with this client's behavior?
A. Families are male dominated wit

ANS: A
The nurse should associate the cultural belief that families are male dominated with clear male-female role distinctions with the client's abusive behavior. The father in the Latin American family usually possesses the ultimate authority.

When working with clients of a particular culture, which action should a nurse avoid?
A. Maintaining eye contact based on cultural norms
B. Assuming that all individuals who share a culture or ethnic group are similar
C. Supporting the client in participa

ANS: B
The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as

To effectively care for Asian American clients, a nurse should be aware of which cultural norm?
A. Obesity and alcoholism are common problems.
B. Older people maintain positions of authority within the culture.
C. "Tai" and "chi" are the fundamental conce

ANS: B
To effectively care for clients of the Asian American culture, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. The balance of "yin" and "yang," not

A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate?
A

ANS: A
The most appropriate nursing intervention would be to try to locate a shaman who will agree to come to the ED. The nurse should understand that in the Native American culture, religion and health-care practices are often intertwined. The shaman, a

When planning client care for a Latino American, the nurse should be aware of which cultural influence that may impact access to health care?
A. The root doctor may be the first contact made when illness is encountered.
B. The "yin" and "yang" practitione

ANS: D
The nurse should understand that some Latin Americans may initially contact a curandero when illness is encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatura

In what probable way should a nurse expect an Asian American client to view mental illness?
A. Mental illness relates to uncontrolled behaviors that bring shame to the family.
B. Mental illness is a curse from God related to immoral behaviors.
C. Mental i

ANS: A
The nurse should expect that many Asian Americans are most likely to view mental illness as uncontrolled behavior that brings shame to the family. It is often more acceptable for mental distress to be expressed as physical ailments.

Which cultural considerations should a nurse identify with Western European Americans?
A. They are present-time oriented and perceive the future as God's will.
B. They value youth, and older adults are commonly placed in nursing homes.
C. They are at high

ANS: A
The nurse should identify that most Western European Americans are present oriented and perceive the future as God's will. Older adults are held in positions of respect and are often cared for in the home instead of nursing homes.

A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to come from which cultural group?
A. African Americans
B. Asian Americans
C. Native Americans
D. Jewish Americans

ANS: C
The nurse should recognize that Native American clients might have a history of missed or late medical appointments. Many Native Americans are not ruled by the clock. The concept of time is casual and focused on the present.

During the first interview with a man from Syria who has just lost his son in a car accident, in sympathy for the man's loss, the female nurse reaches out and hugs him. Which is an accurate evaluation of the nurse's action?
A. The nurse's action should be

ANS: A
The nurse's action should be evaluated as unacceptable due to breech of cultural norms. During communication, Arab Americans stand close together, maintain steady eye contact, and may touch the other's hand or shoulder but only between members of t

A nursing instructor is teaching about cultural characteristics. Which statement by the student indicates the need for further instruction?
A. "All cultures communicate freely within their group."
B. "All cultures embrace light therapeutic touch."
C. "All

ANS: B
All cultures do not embrace light therapeutic touch. In the Native American culture, if a hand is offered to another it may be accepted with a light touch; however, in the Asian culture, touching during communication has been historically considere

A nurse is preparing to establish a therapeutic relationship with a grieving family from China. Which nursing intervention would be considered most appropriate?
A. Touch each member lightly as this enhances the communication process.
B. Direct questions t

ANS: C
In the Asian culture, eye contact is often avoided as it connotes rudeness and lack of respect.

Which cultural group is correctly matched with the disease process for which this group is most susceptible?
A. African Americans are susceptible to lactose intolerance.
B. Western European Americans are susceptible to malaria.
C. Arab Americans are susce

ANS: C
A number of genetic diseases are more common in the Arab American population, including sickle cell disease, tuberculosis, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, parasitic infestations, thalassemia, and cardiovascular disea

When interviewing a client of a different culture, which of the following questions should a nurse consider asking? (Select all that apply.)
A. Would using perfume products be acceptable?
B. Who may be expected to be present during the client interview?
C

ANS: B, C, D, E
When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview, modifications of communication patterns, amount of eye contact, and hand-shaking acceptability. Given that cu

A female nurse is caring for an Arab American male client. When planning effective care for this client, the nurse should be aware of which of the following cultural considerations? (Select all that apply.)
A. Limited touch is acceptable only between memb

ANS: A, C, D
When planning effective care for this client, the nurse should be aware that limited touch within this culture is acceptable only between members of the same sex, that devout Muslim men may not shake hands with women, and that women are subor

Because of cultural characteristics, in which of the following cultural groups would a nurse's assessment of mood and affect be most challenging? (Select all that apply.)
A. Arab Americans
B. Native Americans
C. Latino Americans
D. Western European Americ

ANS: B, E
The nurse should expect that both Native Americans and Asian Americans might be difficult to assess for mood and affect. In both cultures, expressing emotions is difficult. Native Americans are encouraged to not communicate private thoughts. Asi

In response to a student's question regarding choosing a psychiatric specialty, a charge nurse states, "Mentally ill clients need special care. If I were in that position, I'd want a caring nurse also." From which ethical framework is the charge nurse ope

ANS: B
The charge nurse is operating from a Christian ethics framework. The imperative demand of Christian ethics is to treat others as moral equals by permitting them to act as we do when they occupy a position similar to ours. Kantianism states that dec

During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework?
A. "I would want to be treated in a caring manner if I were mentally ill."
B. "This job will pay the bills, and

ANS: B
The applicant's comment reflects an ethical egoism framework. This framework promotes the idea that decisions are made based on what is good for the individual and may not take the needs of others into account.

Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworker's lack of invo

ANS: A
The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. The coworker has a responsibility to report any

Group therapy is strongly encouraged, but not mandatory, on an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy pre

ANS: B
The unit manager's policy regarding voluntary client participation in group therapy preserves the ethical principle of autonomy. The principle of autonomy presumes that individuals are capable of making independent decisions for themselves and that

Which is an example of an intentional tort?
A. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome.
B. A nurse physically places an irritating client in four-point restraints.
C. A nurse makes a medication error and does

ANS: B
A tort is a violation of civil law in which an individual has been wronged and can be intentional or unintentional. A nurse who physically places an irritating client in restraints has touched the client without consent and has committed an intenti

An involuntarily committed client is verbally abusive to the staff and repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit?
A. V

ANS: D
The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client. The involuntarily committed client should be respected and has the right to assert grievances if rights are infri

Which statement should a nurse identify as correct regarding a client's right to refuse treatment?
A. Clients can refuse pharmacological but not psychological treatment.
B. Clients can refuse any treatment at any time.
C. Clients can refuse only electroco

ANS: D
The nurse should understand that health-care professionals can override treatment refusal when a client is actively suicidal or homicidal. A suicidal or homicidal client who refuses treatment may be a danger to self or others. This situation should

Which client should a nurse identify as a potential candidate for involuntary commitment?
A. A client living under a bridge in a cardboard box
B. A client threatening to commit suicide
C. A client who never bathes and wears a wool hat in the summer
D. A c

ANS: B
The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatment is a danger to self and requires emergency treatment.

A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes?
A. When the client makes inappropriate sexual innuend

ANS: C
The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making rational choices. The client's refusal to accep

A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations?
A. Refusing to give any information to the caller, citin

ANS: A
The most appropriate action by the nurse is to refuse to give any information to the caller. Admission to the facility would be considered protected health information (PHI) and should not be disclosed by the nurse without prior client consent.

A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice

ANS: A
The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian or

An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which violation of an ethical principle should a nurse recognize in this situation?
A. Autonomy
B. Benefi

ANS: D
The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally regardless of race, sex, marital status, medical diagnosis,

Which situation reflects the ethical principle of veracity?
A. A nurse provides a client with outpatient resources to benefit recovery.
B. A nurse refuses to give information to a physician who is not responsible for the client's care.
C. A nurse tricks a

ANS: C
The nurse who tricks a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients.

A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent?
A. The client is paranoid.
B. The client is 87 years old.
C. The client in

ANS: C
The nurse should question the validity of informed consent when the client incorrectly reports the spouse's name, date, and time of day. This indicates that this client is disoriented and may not be competent to make informed choices.

A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate?
A. Allow the cli

ANS: A
It is ethically appropriate for the nurse to allow the client to decline the medication and provide accurate documentation. The client's right to refuse treatment should be upheld unless the refusal puts the client or others in harm's way.

Which situation exemplifies both assault and battery?
A. The nurse becomes angry, calls the client offensive names, and withholds treatment.
B. The nurse threatens to "tie down" the client and then does so against the client's wishes.
C. The nurse hides t

ANS: B
The nurse in this situation has committed both assault and battery. Assault refers to an action that results in fear and apprehension that the person will be touched without consent. Battery is the touching of another person without consent.

A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client?
A. The client is placed in seclusion.
B. The client is placed in a geriatric chair with tray.
C. The client i

ANS: D
The least restrictive alternative for this client would be monitoring by an ankle bracelet. The client does not pose a direct dangerous threat to self or others, so neither physical restraints nor seclusion would be justified.

A brother calls to speak to his sister who has been admitted to the psychiatric unit. The nurse connects him to the community phone and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law

ANS: C
The nurse has violated the Health Insurance Portability and Accountability Act (HIPAA) by revealing that the client had been admitted to the psychiatric unit. The nurse should not have provided any information without proper consent from the client

An inpatient client, whom the treatment team has determined to be a danger to self, gives notice of intention to leave the hospital. What information should the nurse recognize as having an impact on the treatment team's next action?
A. State law determin

ANS: A
Most states commonly cite that in an emergency a client who is dangerous to self or others may be involuntarily hospitalized.

A client is concerned that information given to the nurse remains confidential. Which is the nurse's best response?
A. "Your information is confidential. It will be kept just between you and I."
B. "I will share the information with staff members only wit

ANS: C
Basic to the psychiatric client's hospitalization is his or her right to confidentiality and privacy. When admitted to an inpatient psychiatric facility, a client gives implied consent for information to be shared with health-care workers specifica

The nursing staff is discussing the concept of competency. Which information about competency should a nurse recognize as true?
A. Competency is determined with a client's compliance with treatment.
B. Refusal of medication can initiate an incompetency he

ANS: C
A competent individual's cognition is not impaired to an extent that would interfere with decision making.

A nursing instructor is presenting content on the provisions of the nurse practice act as it relates to their state. Which student statement indicates a need for further instruction?
A. "The nurse practice act provides a list of definitions of important t

ANS: C
The nurse practice act contains broad, not detailed, statements that describe the scope of practice for various levels of nursing (APN, RN, LPN), not just for the RN. This student statement indicates a need for further instruction.

Which is an accurate description of a common law?
A. A common law would be invoked to deal with a nurse who, without justification, threatens a client with restraints.
B. A common law would be invoked to deal with a nurse who touches a client without the

ANS: D
Common laws apply to a body of principles that evolve from court decisions resolving various controversies. Common law may vary from state to state. Assault (threats) and battery (touch) are governed by civil law. Stealing is governed by criminal l

The experience of being physically restrained can be traumatic. Which nursing intervention would best help the client deal with this experience?
A. Administering a tranquilizing medication before applying the restraints
B. Talking to the client at brief b

ANS: B
Restraints are never to be used as punishment or for the convenience of the staff. Connecting with the client by maintaining communication during the period of restraint will help the client recognize this intervention as a therapeutic treatment ve

There is one bed available on an inpatient psychiatric unit. For which client should a nurse advocate emergency commitment?
A. An individual who is persistently mentally ill and evicted from an apartment
B. An individual treated in the emergency departmen

ANS: C
The criteria for involuntary emergency commitment include danger to self and/or others. Of the four clients considered, the client who is delusional and has a plan to kill his wife meets this criterion as a danger to others.

What is the legal significance of a nurse's action when the nurse threatens a demanding client with restraints?
A. The nurse can be charged with assault.
B. The nurse can be charged with negligence.
C. The nurse can be charged with malpractice.
D. The nur

ANS: A
Assault is an act that results in a person's genuine fear and apprehension that he or she will be touched without consent.

In the situation presented, which nursing intervention constitutes false imprisonment?
A. The client is combative and will not redirect stating, "No one can stop me from leaving." The nurse seeks the physician's order after the client is restrained.
B. Th

ANS: B
False imprisonment is the deliberate and unauthorized commitment of a person within fixed limits by the use of verbal or physical means. Seclusion should only be used in an emergency situation to prevent harm after least restrictive means have been

After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department by police. The client threatens suicide. Which criteria would enable a physician to consider involuntary commitment? (Select all th

ANS: A, D, E
The physician could consider involuntary commitment when a client is being dangerous to others, is gravely disabled, or is suicidal. If the client is determined to be mentally incompetent, consent should be obtained from the legal guardian or

Acculturations

Process of learning norms, beliefs & behavioral expectations of a group other than one's own group

Belief

A theory accepted as true by a culture

Cultural assimilation

Process in which individuals from a minority group are absorbed by the dominant culture and take on the characteristics of the dominant culture

Cultural competence

Acquisition of knowledge, understanding, and appreciation of a culture that facilitates provision of culturally appropriate health care

Cultural diversity

Differences among groups of people that result from ethnic, racial and cultural variables

Cultural imposition

Tendency to impose one's own beliefs, values, and patterns of behavior on individuals from another culture

Culture

Dynamic network of knowledge, beliefs, patterns of behavior, ideas, attitudes, values and norms that are unique to a particular group of people

Dominant culture

Group whose values prevail within a society

Ethnic group

People within a culture who share characteristics based on race, religion, color, national origin or language

Ethnicity

An individual's identification of self as part of an ethnic group

Ethnocentrism

An assumption of cultural superiority and an inability to accept the ways of another culture

Minority group

Ethnic, cultural, racial, or religious group that constitutes less than a numerical majority of the population

Race

A grouping of people based on biological similarities; members of a racial group have similar physical characteristics, such as blood group; facial features; and color of skin, hair, and eyes

Racism

Discrimination directed toward individuals or groups who are perceived to be inferior

Stereotyping

Expectation that all people within the same racial, ethnic or cultural group act alike and share the same beliefs and attitudes

Subculture

Social group within a culture that has distinctive characteristics, such as patterns of behavior or beliefs

Values

Principles and standards that have meaning and worth to an individual, family, group, community or culture

Birth - 1 year = infancy stage

trust vs. mistrust

What is a positive outcome for infancy?

trust self and others (need to meet infants basic needs)

What is a negative outcome for infancy?

an inability to trust; withdrawal, isolation

1 yr -3 yr = Toddler stage

autonomy vs. shame and doubt (if no contact)

What is a positive outcome for a toddler?

exercises self-control and directly influences the environment, they want to do things themselves

What is a negative outcome for a toddler?

demonstrates defiance and negativism

3-6 = preschool stage

initiative vs. guilt

What is a positive outcome for a preschooler?

begins to evaluate own behavior; learns limits on influence in the environment

What is a negative outcome for a preschooler?

Demonstrates fearful pessimistic behaviors; lacks self confidence

6-12 = school age stage

industry vs. inferiority

What is a positive outcome for a school age child?

develops a sense of confidence thro achievement & accomplishments; uses creative energies to influence the environment

What is a negative outcome for a school age child?

demonstrates feelings of inadequacy, mediocrity, and self-doubt

12-20 yr = adolescent stage

identity vs. role diffusion aka prob if a kid is DM w/diet compliance b/c want to do what peers are doing

What is a positive outcome for adolescence?

develops a coherent sense of self; plans for a future of work/education

What is a negative outcome for adolescence?

demonstrates inability to develop personal and vocational identity

20-35 = young adulthood stage

intimacy vs. isolation

What is a positive outcome for young adulthood?

develops connections to work and intimate relationships

What is a negative outcome for young adulthood?

demonstrates an avoidance of intimacy and vocational career commitments

35-64 = middle adulthood stage

generativity vs stagnation (want to leave a legacy)

What is a positive outcome for middle adulthood?

involved w/est family; expands personal creativity and productivity

What is a negative outcome for middle adulthood?

demonstrates lack of interests, commitments; preoccupation w/self-centered concerns

> 65 = late adulthood stage

integrity vs. despair

What is a positive outcome for late adulthood?

identification of life as meaningful

What is a negative outcome for late adulthood?

demonstrates fear of death' life lacks meaning

African Amrerican

COMMUNICATION: Eye contact and personal questions asked on initial contact is considered rude/intrusive
HEALTH & ILLNESS: Religious beliefs profoundly affect ideas about health and illness
HEALTH RISKS: HTN, Heart Disease, Diabetes Mellitus

Asian American

COMMUNICATION: Silence is valued; eye contact and the word "no" may be considered disrespectful; head nodding does not always mean yes; no touching during convo; opposite sex do not touch; touching the head is disrespectful
HEALTH & ILLNESS: believe in yi

European-Origin(White) American

COMMUNICATION: Eye contact is viewed trustworthiness; future oriented; time is valued tend to avoid close physical contact
HEALTH & ILLNESS: Have a tendency to be social when expressing physical concerns
HEALTH RISKS: Cancer, Postpartum depression, injury

Hispanic American

COMMUNICATION: Avoids eye contact with authority as a sign of respect; may arrive late to event because relationships are valued more than being on time; comfortable when in close proximity with other people
HEALTH & ILLNESS: Results from a balance of "ho

Native Americans

COMMUNICATION: Silence and avoidance of eye contact is a sign of respect; message is used to bond mother and baby; touching a dead body is prohibited in some tribes
SOCIAL ROLES: Very family oriented; elders are honored
HEALTH & ILLNESS: Natural and relig

Amish Society

Women are not allowed to hold position of authority; outside marriages are not allowed; unmarried women remain under the authority of their fathers; wives are submissive to their husbands; physically and socially detached from from the world; Believe that

accountability

Moral concept that involves acceptance by a professional nurse of the consequences of a decision or action.

authority

Legitimate power or official right to act.

case management

health care delivery strategy that supports managed care; it is an interdisciplinary health care delivery approach that provides comprehensive client care using available resources to promote quality and cost-effective care.

delegation

process of transferring a selected nursing task in a situation to an individual who is competent to perform that specific task.

disaster

any human-made or natural event that causes destruction and devastation that cannot be alleviated without assistance; internal disasters are events that occur within a health care agency, whereas external disasters are events that occur outside the health

emergency response plan

a health care agency's preparedness and response plan in the event of a disaster

evidence-based practice

approach to client care in which the nurse integrates the client's preferences, clinical expertise, and the best research evidence to deliver quality care

leadership

interpersonal process that involves influencing others (followers) to achieve goals

management

accomplishment of tasks or goals by oneself or by directing others.

prioritizing

deciding which needs or problems require immediate action and which ones could tolerate a delay in action until a later time because they are not urgent

quality improvement

also known as performance improvement, focuses on processed or systems that significantly contribute to client safety and effective client care outcomes; criteria are used to monitor outcomes of care and to determine the need for change to improve the qua

triage

classifying procedure that ranks clients according to their need for medical care

What should you purchase for being a nurse?

your own malpractice insurance

Should the RN delegate assessment?

NO
The LPN can assist the RN in data collection, but that is not assessment in the NCLEX world

Are complex chronic diagnoses unstable?

No, if there are no changes, then they are considered stable
A client can be complex and stable
Don't let a complex chronic diagnosis make you think the client is unstable and has to be seen only by the RN

New admissions

Are priorities
Only RNs should assess the newly admitted client

5 Rights of Delegation

Right Task
Right Circumstances
Right Person
Right Direction
Right Supervision and Evaluation

Communication

The reciprocal process in which messages are sent and received between people. Verbal and nonverbal forms.

Sender

Person conveying the message.

Receiver

Individual or individuals to whom the message is conveyed.

One-way Communication

Highly structured; the sender is in control and expects and gets very little response from the receiver.

Two-way Communication

Requires both the sender and the receiver participate in the interaction.

Verbal Communication

Use of spoken or written words or symbols. Words can have different meanings, or connotations, for different people.

Connotative Meaning

Subjective and reflects the individual's perception or interpretation.

Denotative Meaning

Commonly accepted definition of a particular word.

Jargon

Commonplace "language" or terminology unique to people in a particular work setting.

Nonverbal Communication

Messages transmitted without the use of words. Include tone and rate of voice, volume of speech, eye contact, physical appearance, and use of touch.

Voice

Tone, volume, pitch, rate of speech. Fear, excitement, enthusiasm, stress, anger, comfort, concern, confidence calmness.

Eye Contact

Extended (longer than 6 sec) Aggression, intimidation, disrespect. Brief but direct (2-6 sec) Interest, respect, caring. Absent of fleeting Shyness, lack of confidence, low self-esteem, disinterest, anxiety, fear, uneasiness, hurriedness, or deference or

Physical Appearance

Size, color of skin, dress grooming, body carriage, age, sex. Professional or nonprofessional, trust or distrust, respect or disrespect, comfort or intimidation, interest or disinterest, competence or incompetence.

Gestures

Distinct movements of hands, head, body. Emphasis, clarification, pleasure, helpfulness, anger, threat, disrespect.

Posture

Open (relaxed stance, facing receiver, uncrossed arms and legs, slight shift toward receiver, direct eye contact, smile) Warmth, acceptance, caring. Closed (formal, distant stance, arms and possibly legs tightly crossed) Disinterest, coldness, nonacceptan

Assertive Communication

Ability to confidently and comfortable express thoughts and feelings while still respecting the legitimate rights of the patient.

Agressive Communication

Interact with another in an overpowering and forceful manner to meet your own personal needs at the expense of the other.

Unassertive Communication

Agrees to do what the patient requests, even though doing so will create additional problems for themselves.

Assertive Nurse

Appears self-confident and composed. Maintains eye contact. Uses clear, concise speech. Speaks firmly and positively. Speaks genuinely, without sarcasm. Is unapologetic. Takes initiative to guide situations. Gives teh same message verbally and nonverbally

Therapeutic Nurse-Patient Interaction

One in which nurse demonstrates caring, sincerity, empathy, and trustworthiness.

Active Listening

Conveys interest and caring; gives patient full attention; allows feedback to verify understanding of the message.

Maintaining Silence

Allows time to organize thoughts and formulate an appropriate response; often conveys respect, understanding, caring, and support; allows observation of patient's nonverbal responses.

Minimal Encouragement

Communicates to the patient that the nurse is interested and wants to hear more.

Touch

Often conveys warmth, caring, comfort, support, and understanding.

Conveying Acceptance

Demonstrates acceptance of patient's rights to current beliefs and practices without condoning them; nonjudgemental, therefore encourages honesty and openness on the part of the patient; provides an opportunity to bring about change in health behaviors wh

Closed Questioning

Focused and seeks a particular answer; usually requires and elicits only a "yes" or "no" or one- to two-word answer. Provides a very specific answer to a very specific question.

Open-Ended Questioning

Does not require a specific answer and cannot be answered by "yes", "no" or a one-word response; usually begins with words like "how", "what", "can you tell me about", "in what way". Allows the patient know if the nurse heard what was said; encourages the

Restating

Repeating to the patient what the nurse believes to be the main paint that the patient is trying to communicate; tone of voice rises slightly at the end of the phrase as if asking a question. Let the patient know if the nurse heard what was said; encourag

Paraphrasing

Restatement of the patient's message in the nurse's own words. Verifies that the nurse's interpretation of the message is correct.

Clarifying

Seeks to understand the patient's message by asking for more information or for elaboration on a point; expressed as a question or statement or paraphrasing of part of the patient's message. Allows the patient to verify that the message received is accura

Focusing

The nurse encourages the patient to select one topic over another as the primary focus of discussion. Allows the nurse to gather more specific information when the patient's message is too vague; focuses on specific data.

Reflecting

Assists the patient to reflect on inner feelings and thoughts rather than seeking answers and advice from another. Promotes independent decision making; allows the patient to see that her or his ideas and thoughts are important.

Stating Observations

The nurse makes observations of the patient during an interaction and communicates these observations back to the patient. Allows for clarification of the intended message when verbal cues do not match nonverbal cues; allows for more accurate interpretati

Offering Information

Nurse provides the patient with relevant data and asks for feedback to determine the patient's level of understanding. Useful for patient teaching; promotes informed decision making.

Summarizing

Concise review of main ideas from a discussion. Focuses on key issues and allows for additional information that was perhaps omitted; particularly useful when interaction has been lengthy or has covered several topics.

Use of Humor

Can enhance feelings of well-being, reduce anxiety, and encourage a sense of hope. Use it with caution and discretion. It is never apporpriate to laugh at - only with - a person.

Posture and Positioning

Most therapeutic is to the same position and level as the patient, or as close to it as feasible.

Space and Territoriality

Comfort zone, intangible personal space (18inches - 4 feet in western culture). Intimate zone, nurses often are in this zone because of duties they carry out (0-18 inches). Social zone, appropriate when speaking to a small group of people (4 - 12 feet). P

Trust

Gain a patient's trust before expecting to have a meaningful or therapeutic interaction. Without trust interaction will not progress past superficial social interaction.

Culture

The effect of culture on communication is immense.

Age and Gender

Significant age differences between you and your patients will, in some cases, raise a barrier to communication. Male and female patterns of communication are often closely related to cultural familial and lifestyle patterns developed over a lifetime.

Physiologic Factors

Pain (difficult to communicate about anything except the pain) Altered cognition (because of stroke, medication, dementia and developmental delays)

Psychosocial Factors

Patient feels vulnerable, defensive, angry, verbally abusive, depressed and withdrawn.

Partially Fluent in English

Assess the patient's nonverbal as well as verbal communication. Keep your eyes at the same level as patient's and assess if they are comfortable with the eye contact. Speak slowly and never loudly. Use pictures when possible. Avoid using technical terms.

Non-English Speaking w/Interpreter

Use dialect-specific interpreters, give patient and interpreter time alone together, build time for translation and interpretation, avoid using children and relatives as interpreters, select same-age and same-sex interpreters, and address your questions t

Non-English Speaking w/o Interpreter

Use a translator, determine if there is a 3rd language that can be used, nonverbal communication is more important than verbal communication, be attentive to both your own and the patient's nonverbal messages, pantomime simple words and actions, and use p

Cognitively Impaired

Reduce environmental distractions, get patient's attention before speaking, use simple sentences and avoid long explanations, ask one questions at a time, allow time for patient to respond, be an attentive listener, and include family and friends in conve

Hearing Impairment

Check for hearing aids and glasses, reduce environmental noise, get patient's attention before speaking, face patient with your mouth visible, do not chew gum, speak at a normal volume do not shout, rephrase rather than repeat, and provide a sign language

False Reassurance

Using falsely comforting phrases in an attempt to offer reassurance.

Giving Advice or Personal Opinions

Making a decision for a client; offering personal opinions; telling a patient what to do with phrases such as "should do," "ought to".

Biomedical

Treatment focuses on the use of physical and chemical interventions.

Folk "Third-World

Treatment is done by carrying out rituals, repentance, or giving in to the supernatural force's wishes.

Holistic

Treatment is designed to restore balance with physical, social, and metaphysical worlds. It may extend beyond treating the person to treating the environment to decrease pollution or prevent hunger, homelessness, etc.

False Assumptions

Making an assumption without validation; jumping to conclusions.

Approval or Disapproval

Trying to impose the nurse's own attitudes, values, beliefs, and moral standards on a patient about what is right and wrong.

Automatic Responses

Stereotyped or superficial comments that do not focus on what the client is feeling or trying to say.

Defensiveness

Responding negatively to criticism; often in response to feelings of anger or hurt on your part; usually involves making excuses.

Arguing

Challenging or arguing against the patient's statements or perceptions.

Asking for explanations

Asks the patient to explain her or his actions, beliefs, or feelings with "why" questions.

Changing the Subject

Inappropriately focusing the discussion on something other than the patient's concern.

Aphasia

Listen and wait, do not shout or speak loudly, short questions, facial gestures, speak of things familiar, ask yes or no questions, offer picture board, give patient time, avoid patronizing and childish, collaborate with a speech pathologist, encourage sp

Expressive Aphasia

Unable to send the desired verbal message

Receptive Aphasia

Inability to recognize or interpret the verbal message being received.

Culture

Set of learned values, beliefs, customs, and practices that are shared by a group and are passed from one generation to another.

Subculture

Shares many characteristics with the primary culture, but has characteristic patterns of behavior and ideals that distinguish it from the rest of a cultural group.

Variations

Age, Religion, Dialect, Gender identity, Socioeconomic, Geographic location, Amount and type of interaction, and Degree to which values in current country are adopted.

Stereotype

Generalized expectation about forms of behavior, an individual, or a group.

Ethnic Stereotype

Fixed concept of how all members of an ethnic group act or think.

Ethnocentrism

Most people look at the world from their own cultural viewpoint They often believe that the beliefs and practices of their particular culture are best.

Cultural Competence

Aware of your own cultural beliefs and practices and how they relate to those of others, which will be different.

Transcultural Nursing

Understanding these variables and integrating your understanding into all aspects of nursing care is what we term.

Race

A group of people who share biologic physical characteristics and hereditary factors.

Ethnicity

Refers to a group of people who share a common social and cultural heritage based on shared traditions, national origin, and physical and biologic characteristics.

Silence for Considering

American Indian, Chinese and Japanese.

Silence as Consensus

Russians, French, Spanish.

Silence to Disagree

Mexicans

Eye Contact = Invasion of Privacy

Asian cultures and American Indians.

Eye Contact = Class

East Indian

Eye Contact = Hostility

Appalachian

Eye Contact = Openness

Western

Space

Most comfortable when they can maintain 3 to 6 feet between them.

Jewish Birth

Named by father. Circumsized.

Jewish Women

Impure on period.

Jewish Diet

Kosher, no mixing of milk and meat. Slaughtered specially. Passover, no leavened products. 24-hr fast. Pray over meal.

Jewish Sabbath

Friday sunset to Saturday sunset. Cannot turn lights or tv on or off.

Jewish Death

Euthanasia is forbidden. Family visits before death. Body untouched for 8 to 30 minutes. Some do not approve of autopsies. Buried within 24 hrs for orthodox. 7 day mourning period. All of the body must be returned to the earth.

Jewish Birth Control

Artificial methods no encouraged. Vasectomy is not allowed. Abortion is permitted only to save the mother's life.

Jewish Organ Transplant

Not permitted, but sometimes with rabbinical consent.

Jewish Shaving

Beard is piteous, with scissors or electric razor.

Jewish Head Covering

Men wear skullcaps at all times. Women cover their hair after marriage.

Jewish Prayer

Required

Roman Catholic Birth

Infant baptism mandatory.

Roman Catholic Eucharist

Abstinence from solid food and alcohol is required for 15 minutes before.

Roman Catholic Anointing Sick

Given before death or immediately after.

Roman Catholic Diet

Fasting excused during hospitalization. No meat on Friday in lent and on ash wednesday.

Roman Catholic Death

Shrouded after sacraments. Anointing and eucharist. Buried or cremated whole body.

Roman Catholic Birth Control

Prohibited except through abstinence or natural family planning. Sterilization prohibited except for overriding medical reason.

Roman Catholic Organ Donation

Acceptable as long as no harm to donor.

Roman Catholic Religious Objects

Rosary, medals, relics, statues.

Eastern Orthodox Birth

Baptized within 40 days. Done by ordained priest or deacon.

Eastern Orthodox Diet

Fasting from meat and dairy on Wednesdays of Fridays during lent. Exempt if detrimental to health.

Eastern Orthodox

Not permitted.

Predominant Health Belief System

...

A client needs to learn to use a walker. Acquisition of this skill will require learning in the:

Psychomotor domain

The nurse plans to teach a client about the importance of exercise:

When the client's pain medications are working

A client newly diagnosed with cervical cancer is going home. The client is avoiding discussion of her illness and postoperative orders. In teaching the client about discharge instructions, the nurse:

Provides only the information the client needs to go home

The school nurse is about to teach a freshman-level health class about nutrition. To achieve the best learning outcomes, the nurse:

Develops topics for discussion that require problem solving

A nurse is going to teach a client how to perform a breast self-examination. The behavioral objective that best measures the client's ability to perform the examination is:

The client will perform breast self-examination correctly on herself before the end of the teaching session

A client who is having chest pain is going for an emergency cardiac catheterization. The most appropriate teaching approach in this situation is the:

Telling approach

The nurse is teaching a parenting class to a group of pregnant adolescents and has given the adolescents baby dolls to bathe and talk to. This is an example of:

Role play

An older adult is being started on a new antihypertensive medication. In teaching the client about the medication, the nurse:

Allows the client time to express himself or herself and ask questions

A client needs to learn how to administer a subcutaneous injection. The nurse knows the client is ready to learn when the client:

Expresses the importance of learning the skill

A client who is hospitalized has just been diagnosed with diabetes. He is going

Demonstration

When teaching is viewed as communication, then a specific learning objective can be said to be developed from:

The referent

The client who is most ready to begin a client teaching session is the client who has:

Voiced a concern about how insulin injections will affect her lifestyle

Which of the following is an example of an appropriately stated learning objective?

Demonstrates correct finger placement and counts the beats correctly

What is an example of an appropriately stated learning objective?

The client will state three factors that affect cholesterol by the end of the teaching session.

The nurse is demonstrating the proper technique for using a glucometer to a group of clients newly diagnosed with diabetes. The nurse smiles and praises one of the clients when she correctly performs a finger stick. This teaching approach is referred to a

Reinforcing

When teaching older adults, the nurse should:

Begin and end with the most important information.

The assessment phase of the teaching process includes:

Determining learning needs

What is most complex behavior in the psychomotor learning domain?

Performing activities of daily living after acquiring left-sided paralysis due to a brain injury

HMO health maintenance organization

health care agency provide basic health and trx to voluntary enrollees who prepay a fee for in or out patient on a agreed on package.

staff model, independant practice association, group model, network model

four types of HMO's

staff model

physicians are HMO employees and are paid a salary is this type of HMO

independent practice association

physician maintain individual or group practice but contract with HMO with a fee

group model

HMO contracts multispecialty group to provide service with negotiated fee

network model

HMO contracts with two or more IPA to provide a monthly fee called capitation

managed care

a health care plan that brings finance and delivery of care into one entity, to enhance cost, and quality of care

case management

organizes client care by major diagnoses and focuses on attaining predetermined client outcomes within specific time, interdisciplinary outcomes, and continutity of care

fragmentation of care

what is one disadvantage of functional nursing where RN, LPN and UAP are coordinated by charge nurse

primary nursing

nurse designs, implements, and is accountable for nursing care with delegation oof to associate nurse

team nursing

most common nursing care delivery system, where rn personnel provides total care to a group

time management

organization skill allow nurse to prioritize client care, decide outcomes and interventions

ABC's, maslow herarchy of needs, policies

what are the top three priorities of care

maslow heirarchy of needs first priority

physiological needs - ABC, water, food (O2 therapy, circulatory support, IV hydration, nutrition, crtical lab values, treatment)

maslows second priority

still primary needs - safety and security needs, prevent falls, re-orient abnormal high or low value, client teaching

maslow third priority

activities that care support, love and belonging, self esteem(self-care), self-actualizaion, teaching and psychosocial support

policy and procedures

activities governed by agency such as restraints, scheduled meds or dressings, checking code carts

board of nursing

this authority defines delegation as transferreg to a competent person a selected nursing task

responsibility

nurse leaders can delegate authority but cannot delegate this __ so must ensure staff works competently

assessment, rn judgement, diagnoses, care goals and progress plans, teaching

what are 6 nursing diagnoses that can not be delegated to UAP

right task, circumstance, person, direction, supervision or evaluation

what are the 5 board of nursing rights of delegation

under delegate

the delegator does not think team member can perform or complete assignment

reverse delegation

team member request that nurse leader complete task because of inability or unwilling

over delegation

delegator becomes overwhelmed by situation and loses control by delegating authority and responsiblity to delegatee

formal leadership

job described as legitmate leader, power of position and ability to reward and punish

informal leadership

no organiaation title but can influence others through thoughtful and convincing ideas.

autocratic leader

belief people are motivated by power, authority, and need for approval, uses coercion and punishment

democratic leader

belief people are motivated by internal drives and impulses, active participation in decisios, desire to get it done

laissez faire leader

belief people are motivated by internal forces, need to be left alone, and gives no direction.

beureaucratic leader

belief people are motivated by external forces, trust followers or self for decisions. relies of policies.

223.1 Define organizational effectiveness.

Organizational Effectiveness is the attaining or surpassing of objectives and tasks dealing with mission accomplishment.

223.2 Describe each of the following situational factors:
a. Interpersonal
b. Structure of the job or organization
c. Time
d. Outside influences
e. Awareness of self

a. Interpersonal factors include personal relationships among supervisors and subordinates, supervisors and superiors, and supervisors and other supervisors. They affect and influence leadership under the following conditions:
1) a strong personality enco

224.1 Describe directive behavior.

Directing refers to the extent to which a leader engages in one-way communication. The supervisor spells out the follower's role and clearly tells subordinate what to do, where to do it, how to do it, and when to do it, and closely supervises the subordin

224.2 Distinguish between the Situational Leadership concepts of competence and commitment.

Competence is the degree of knowledge or skills possessed by the subordinate. It is gained from education, training and/or experience. IT should also include any transferable skills the subordinate may have such as abilities developed in other jobs which

224.3 Explain each of the four Situational Leadership development levels.
a. D1
b. D2
c. D3
d. D4

a. D1 - low competence/high commitment: the D1 lacks or has little skill and knowledge to do the task, but is eager to try it anyway. For example, a subordinate diagnosed as a D1 could be compared to an individual who recently arrived at his first duty st

224.4 Explain each of the four Situational Leadership styles of leadership.
a. Directing
b. Coaching
c. Supporting
d. Delegating

a. "Directing" implies that the manager will exhibit more directive behavior; provide specific instructions, control task accomplishment, make most of the decisions and closely supervise workers. Using the SI style assumes the leaders/managers/supervisors

224.5 Describe situations in which the directing style is appropriate.

Use the directing style when you have a D1, someone who is low in competence, but motivated. You could also use Style 1 when: You're in an emergency situation. There is a short timeline and your follower is a D2 or D3. A D2 is working on a complicated and

224.6 Describe situations in which the coaching style is appropriate.

Use the coaching style when dealing with a D2, a person with some competence, but not all the skills, knowledge or information needed, and who is also unmotivated and/or unsure of their ability. A subordinate has some skills and experience to contribute,

224.7 Describe situations in which the supporting style is appropriate.

Use the supporting style when the person has the skills needed to do a task, but is a little insecure or lacks confidence. It could also be used with someone who has the skills relevant to doing the task, but doesn't care.

224.8 Describe situations in which the delegating style is appropriate.

Use the delegating style with D4s--motivated, confident, educated, experience, self-directing, self-supporting persons--subordinates with high competence and high commitment. Other appropriate situations are with D3s, who have all the skills for the task

225.1 How does the subordinate benefit when Situational Leadership is practiced?

It cultivates overall positive behavior--Subordinates react to their supervisor's behavior. If provided specific goals and proper direction and support, they'll respond positively. Development--By taking people through the Situational Leadership developme

225.2 How does the organizational benefit when the Situational Leadership model is followed?

Training and development of subordinates will be more organized. Production will be easier to manage because everyone will know the goals, understand what they need to do to reach those goals, and when they reach the D3 and D4 levels, will contribute more

226.1 What are the two objectives of performance management?

The first objective is to provide appropriate and effective performance feedback. The second objective is to provide a long term record of subordinate performance for use in making personnel management decisions.

226.2 Give an example of each objective of performance management.

Conducting the initial, mid-course, or follow-up performance feedback is an example of the first objective. A completed EPR is an example of the second objective.

227.1 How does knowing yourself contribute to performance management?

Knowing yourself will help you to deal with your subordinates because you know ho you are going to respond to likely situations in your work center.

227.2 In regards to knowing your people, why is it important to match personal interests with jobs?

Matching interests with jobs can help to prevent problems such as boredom or complacency, by putting the right people into the right job. Along with interests, special skills or aptitudes should be considered before any job assignment is made.

227.3 Explain how supervisors can get to know their subordinates.

Supervisors can acquire biographical information by communicating with the subordinate and asking them about interests, past experiences, previosu employment, needs and values, and their own expectation of the job and work center.

228.1 Explain the limitations of a job description.

First job descriptions are actively oriented rather than result oriented. This is a limitation because something else, feedback, must be used to address the results expected. The other limitation is subordinates may see the job description as defining the

228.2 What elements should be addressed in order to write an effective performance standard?

Performace standards need to be specific, observable, and measureable.

228.3 Why should you monitor over a period of time long enough to determine your subordinates typical performance?

Determining the subordinates typical behavior will give the evaluator a more accurate picture to make decsions on. It also makes it easier to provide effective feedback because the supervisor will kno the behavior and performance levels of the subordinate

228.4 How do common evaluation pitfalls impact your evaluations?

Pitfalls bring bias, closed mindedness, and logical errors into the actual evaluation. These pitfalls essentially result in an unclear, inaccurate evaluation of the subordinate's performance.

229.1 How does preventative feedback helps your subordinate?

Preventative feedback helps to start a new relationship off right. It provides the expectations and standards in which the subordinate will be measured by. This type of feedback sets the subordinate up for success by helping him adjust to his new environm

229.2 Explain how properly conducting the feedback session strengthens organizational effectiveness.

A properly conducted feedback session will let the subordinate know if they are meeting, exceeding, or failing to meet the standardsthat have been established. The session will also let the subordinate know why it is happening and a plan to continue to mo

229.3 When should you refer your subordinate to other people or other agencies for follow-up feedback?

When you determine the problem is too much for you to handle or you do not know enough about the issue to help the subordinate make a solid informed decision, you should refer the person to the agency best able to help.

230.1 What is the difference between performance feedback and counseling?

Performance feedback's main focus is how well the person is doing in regards to assigned tasks and fulfilling the elements defined in the job description. Counseling serves to address job performance as well as items such as personal issues, discipline pr

230.2 Explain why the non directive counseling approach is often the preferred method of counseling.

The nondirective approach is often preferred because it puts the responsibility for a solution on the shoulders of the subordinate. This is effective because if conducted properly, this approach usually results into a higher level of open, honest communic

230.3 How does effective counseling strengthen organizational effectiveness?

Effective counseling is the vehicle that provides guidance and direction for the subordinate resulting in them becoming a more well rounded and fully developed member of the Air Force. Counseling fosters teamwork and opens the lines of communication neces

231.1 Explain how you can improve your subordinate when developing an improvement plan.

You can improve your subordinate by building on their strengths to develop a good foundation of motivation. Building on strengths helps to minimize and elminate weaknesses in the subordinate.

231.2 How does job rotation contribute to the development of the improvement plan?

Job rotation is helpful because it prevents complacency and boredom. It also helps you to make full use of your subordinates because they are able to learn about more areas within the work center and their career field.

231.3 What are some things to consider as a supervisor to improve the situation while developing an improvement plan?

You should make sure you are not over or under supervising; also you should maintain good situational awareness of the happenings with your subordinates and your work center.

232.1 Briefly describe each of the change levels.

There are four levels of change: knowledge, attitudinal, behavioral, and group/organizational. A process as simple as reading a publication, manual or AFI can effect change at the knowledge level. Attitudes, because they are normally emotionally charged,

232.2 Explain why organizational change is a challenge for a manager/supervisor.

At this level, you are responsible for effecting changes in a multitude of people. One major hurdle will involve changing the "But we've always done it this way! mindset. Change at this level will generally be more difficult and therefore take more time t

233.1 Briefly describe each of the change cycles.

There are two change cycles--directive and participative. The directive change cycle is the "from the top down" approach, while the participative change cycle works "from the bottom up".

233.2 Provide an example of when you would implement each of the change cycles.

Military managers would use directive change in most cases. However, participative change should be used whenever possible. In a work section comprising achievement-oriented individuals with a high degree of knowledge, the preferred method would be partic

233.3 What are some advantages/disadvantages of each of the change cycles.

If you choose the wrong change cycle, it can tend to demotivate your subordinates. In a highly-motivated, well-educated and task-oriented work section comprising seasoned hard-chargers, directive change may not be the best approach. In like fashion, parti

234.1 Identify each of the roles in a change process and describe the responsibility of each.

During the change process, people usually fill three roles. The change sponsor is the individual responsible for initiating the change and supervising it through each of the three processes. The change agent is the individual responsible for implementing

234.2 What are the organizational norms? What comprises each?

There are four orgaznizational norms. The technology norm includes computers, test equipment, weapons systems, etc.; the task norm includes general procedures, job steps, checklists, etc.; the structure norm includes administrative procedures, evaluation

234.3 What role might the core values play in effecting change?

Service Before Self" encourages faith in the system; "Integrity First" encourages responsibility and loyalty; "Excellence In All We Do" encourages a quality effort.

234.4 What are the stages of the change process? Briefly, describe each.

There are three stages in the change process: unfreezing, changing and refreezing. The unfreezing stage involves creating a need for the change; the changing stage involves moving the four organizational norms from the old state to the new; the refreezing

234.5 Explain the responsibility an NCO has to each subordinate during the change process.

You have a responsibility to create a positive atmosphere through which each of your subordinates will feel that change is needed and will be supportive of the process. Concurrently, as NCO supervisors, managers and leaders, you must anticipate and deal w

235.1 In Step 1 of the six-step problem solving process, how does recognizing the problem contribute to work center effectiveness?

The proper completion of Step 1 is very important because it breaks down the element of the individual, goal, and obstacle, and identifies the problem that needs to be solved. By knowing what the problem is, those involved can begin to find a workable, pe

235.2 Why is it important to gather data at the right point during the six-step problem solving process?

Facts are known truths (concrete information) used to make sound decisions. By gathering these facts and data early in the process, you are better equipped to make these sound decisions regarding possible solutions. You are also better equipped to be more

235.3 In Step 3 of the six-step problem solving process, which two techniques are used to generate a list of possible solutions?

Brainstorming is a very effective technique used to generate many possible solutions to a problem in a very short period of time. Creative thinking, like brainstorming, promotes freethinking of ideas by changing or recombining old ideas into new possible

235.4 How do you know if a possible solution is feasible?

If resources such as time, money, and material are available, a solution may be feasible. You must also ensure you have the authority to implement a solution in order for it to be a feasible proposal.

235.5 What should you do if you have more than one feasible and acceptable solution to choose from after performing Step 4?

If you have more than one solution once you reach Step 5, you may want to get input from others to help choose the best solution. You can also consider combining the ideas to find the best solution.

235.6 Describe the impact that not following-up on the implementation of solution to a problem (Step 6) would have on a workcenter.

Not following-up on the implementation of the solution could result in not ever determining if the solution chose in Step 5 actually worked. It may also result in the loss of opportunities to learn from mistakes made because of a poorly chosen solution or

235.7 Explain how your use of the six-step approach to problem solving can impact you as a supervisor.

By properly utilizing the problem solving process, you will be better able to resolve problems with your subordinates. This will result in your credibility being reinforced and open lines of communication between you and your subordinates. Using this proc

236.1 According to Hersey, Blanchard and Johnson, what three skills are requisite to leading?

According to Hersey, Blanchard and Johnson diagnosing, adapting and communicating are the three skills indicated as being requisite to leadership.

236.2 What two key aspects should you focus on when you are diagnosing an organization?

When diagnosing an organization, the two key aspects are; the status of the people and the status of the environment.

236.3 What four categories are used by the U.S. Marine Corps to gain a complete picture of the status of its people?

The Marines list morale, esprit de corps, discipline and profiency as being good indicators of its peoples' status.

236.4 As a leader, what two areas must you look at when assessing the organizational environment?

A leader would be looking at resource availability (human, financial, physical and information), as well as leadership actions (establishing direction and priorities, creating policy, making decisions and providing information).

236.5 What type of leader exhibits a high task, low relationship style?

The Authoritarian leader exhibits a high task, low relationship style. This type of leader tends to be autocratic and rigid, allowing for little deviation from the schedule.

236.6 What type of leader exhibits a high task, high relationship style?

The Team leader exhibits a high task, high relationship style. This type of leader is not afraid to dive right in and usually leads by example.

236.7 What type of leader exhibits a low task, low relationship style?

The Impoverished leader exhibits a low task, low relationship style. This type of leader is notorious for delegating, then disappearing, leaving subordinates to fend for themselves.

236.8 What type of leader exhibits a low task, high relationship style?

The Country Club leader exhibits a low task, high relationship style. This type of leader uses reward power as a motivating force.

237.1 What are the two categories of leadership power?

The two categories of leadership power are personal and position.

237.2 Name and describe the four types of position power?

The first, coercive power is founded in your authority to use sanctions in response to poor performance. Connection power, the second type is based on your association with influential people or organizations. Your ability to provide things people like is

237.3 What AFI states that NCOs are delegated authority necessary to exercise leadership commensurate with their rank and responsibility?

AFI 36-2618, The Enlisted Force Structure.

237.4 Name and describe the three types of personal power.

Referent power--it is determined by how your followers feel about interacting with you. This power depends on your charisma, character, self-concept and interpersonal skills. Information power--access to or possession of useful information and your abilit

238.1 What are three key attributes of a role model?

The three key attributes that are essential to the Air Force are integrity and commitment (character traits) and mentoring (a supportive relationship).

238.2 What term is used to describe a supportive relationship, where a senior member of an organization counsels, coaches, teaches, and provides feedback to a junior member? What is the term used to describe the subordinate in this relationship?

Mentoring; proteges.

239.1 Technical proficiency, as a leadership tenet, is most closely related to which AF Core Value?

The core values "Excellence in all we do" is most closely related to the technical proficiency tenet.

239.2 When should you understand the capabilities and limitation of your organization?

When developing objectives, creating priorities and assigning tasks.

240.1 Into what two categories is planning usually divided?

Planning is commonly divided into two categories, strategic and operational.

240.2 Which planning category will most commonly be used by NCOs on a daily basis?

Operational planning, since it will be used most often by NCOs on a day-to-day basis.

240.3 What are the five steps in the planning process?

Analyze the mission; establish goals; identify alternatives; select the best alternative; implement the plan.

240.4 As an Air Force supervisor, you will manage budgets at different organizational levels and with varying degrees of control. Identify and describe the two areas mentioned in the text.

The Responsibility Center, an organizational department under the direct supervision of a single individual solely responsible for its activities, the Cost Center, the lowest level where supplies are used, is usually the flight or work center in an organi

240.5 Describe the purpose of the Unit Personnel Management Roster (UPMR).

Which organizational document lists the people assigned, projected losses and gains, and should accurately reflect the Unit Manning Document (UMD).

240.6 What does the Unit Manning Document (UMD) tell you?

This document tells you the number of people authorized, the Air Force Specialty Codes (AFSCs), position numbers and total number assigned to your work center.

240.7 What are the primary professional development programs for enlisted people?

The primary professional development programs for enlisted people are the Professional Military Education (PME) Courses.

241.1 Define organizing as it pertains to the functions of management.

Organizing is the process of dividing work into manageable sections and coordinating the results to serve a purpose.

241.2 What three approaches to job design are discussed in your text?

The three approaches to job design are: job rotation, job enlargement and job enrichment.

241.3 Briefly describe job rotation.

Job rotation is the practice of periodically shifting workers through a set of jobs in a planned sequence.

241.4 Briefly describe job enrichment.

Job enrichment is the process of upgrading the job-task mix in order to increase the potential for growth, achievement, responsibility and recognition.

241.5 Briefly describe job enlargement.

Job enlargement is the allocation of a wider variety of similar tasks to a job in order to make it more challenging.

242.1 What is the main purpose of the controlling function?

In the controlling function, organizational activities are regulated so that the elements of performance remain within acceptable limits.

242.2 What are the four steps in the controlling process?

Establish standards of performance; measure actual performance; compare performance standards; evaluate performance and take action.

243.1 How does your text describe the leading function?

Leading involves harnessing our personal and professional traits to influence others to accomplish the mission.

243.2 What is effective planning?

In order for planning to be effective, it requires vision and the ability to communicate that vision to other people.

243.3 How would you describe effective organizing?

In order for organizing to be effective, it requires, first, an understanding of the organizational structure and second, an ability to convince your people that cross utilization is best for them and the Air Force.

243.4 What does effective controlling require?

In order for controlling to be effective, it requires an understanding of performance standards as they pertain to mission accomplishment and an ability to see what kind of controlling mechanisms are best. There is a balance between over-control and under

What are the prioritization principles?

1. Systemic before local (life before limb)
2. Acute before chronic
3. actual problems before potential/future problems
4. listen before assuming (pain after post op might be due to another problem other than expected surgical pain)
5. recognize and respo

What is Maslow's Hierarchy of needs?

1. Physiological needs
2. Safety and Security needs
3. Love and Belonging Needs
4. Self esteem
5. self actualization
Pedro Sang Lullaby So Softly

In Maslow's Hierarchy, what are examples of physiological needs?

Body temperature, elimination, fluids, nutrition, oxygen, sex, shelter
But prioritize ABC
(we are talking about any body process- start with ABC..and then you will remember the rest)

In Maslow's Hierarchy, what are examples of Safety and security needs?

physical safety, psychological safety.
but prioritize physical safety.

ABC stands for:

Airway, Breathing, Circulation
(sometimes, a major circulation problem may be addressed before a very minor breathing problem) KEEP THIS IN MIND

In Triage or emergency situations, priority is given to those who

have the highest chance of living

what are the five rights of delegation?

-What tasks should be delegated (right task)
-under what circumstances (right circumstance)
-to whom (right person)
-what information should be communicated (right direction/communication)
-how to supervise/evaluate (right supervision/evaluation)

The performance improvement process begins with

identification of standards and outcome indicators based on evidence

what do outcome, or clinical indicators reflect? (quality improvement)

desired client outcomes related to standard under review

what do structure indicators reflect (quality improvement)

the setting in which care is being provided and the available human and material resources

what do process indicators reflect? (quality improvement)

how client care is provided and are established by policies and procedures (clinical practice guidelines)

what are benchmark goals in quality improvement?

goals that are set that determine at what level the outcome indicators should be met

step 1 in performance improvment process (quality improvement)

1. a standard is developed and approved by facility committee

Step 2 in performance improvement process

-standards are made available to employees via policies and procedures

step 3 in performance improvement process

-quality issues are identified by staff, management, or risk management dept.

step 4 in performance improvement process

-interdisciplinary team reviews the issue

step 5 in performance improvement process

-current state of structure and process is analyzed

step 6 in performance improvement process

-data collection methods are determined

step 7 in performance improvement process

-data is collected, analyzed and compared with benchmark

step 8 in performance improvement process

-if benchmark not met, determine why

step 9 in performance improvement process

-potential solutions or corrective actions are analyzed and one is selected for implementation

step 10 in performance improvement process

-education or corrective action is implemented

step 11 in performance improvement process

-issue is re-evaluated at a pre-established time to determine efficacy of corrective action

what is a structure audit? (Data collection methods--step 6)

evaluates the influence of elements that exist separate from or outside of the client-staff interaction

what is process audit? (data collection methods--step 6)

review how care was provided and assume relationship exists between nurses and quality of care provided

what is outcome audit? (data collection methods--step 6)

determine what results, if any, occurred as a result of nurse care provided

what does a root cause analysis do?

-investigates the consequence and possible causes of a situation
-analyze the possible existing causes and relationships
-determines additional influences at each relationship level
-determines the root cause(s)

as a coordinator of care, what is the nurse responsible for?

-admission, transfer, discharge, and post discharge orders
-initiation, revision, and eval of plan of care
-report clients status to other nurses and PCP
-coordinate discharge plan
-facilitate referrals and utilize community resources

as a case manager, nurse is responsible for?

-coordinating care (esp if complex needs)
-facilitating continuity of care
-improving efficiency of care and utilize resources
-enhance quality of care
-limit unnecessary costs and length stays-
-advocating for client and fam

what is a referral?

formal request for a special service by another care provider

nurses role in regards to referrals is to

-begin discharge planning upon clients admission
-evaluate client/family competencies in relation to home care prior to discharge
-involve the client and family in care planning
-collaborate with other health care professionals to ensure all health care n

nurses role in discharge

-type of discharge (ordered by physician, AMA)
-actual date and time of discharge, who accompanied client, and how client transported
-where was the client discharged (home, facility)
-a summary of clients condition at discharge
-any unresolved difficulti

what is/are the name(s) of the tool used by various health care team members to direct and focus a clients care?

critical pathway, clinical pathway, or care map

Consent is considered to be informed when client has been provided with, and understands...

1. reason the treatment/procedure is needed
2. how the treatment/procedure will benefit the client
3. the risks involved in treatment
4. other options to treat problem

what is the nurses role in consent process?

-to witness the clients signature
-ensure provider gave necessary info
-ensure client understood info
-notify physician if client has further questions
-document reinforcement of info originally given by provider, questions were clarified, and if interpre

What is the provider's role in consent process?

-give a complete description of treatment
-describe professionals involved in treatment
-describe potential harm, pain and discomfort that may occur
-other treatment options
-right to refuse treatment

the client's role in consent process?

-give consent voluntarily
-be competent
-be of legal age, or emancipated minor

How many types of torts are there?

3

what are the there types of torts?

Unintentional
quasi-intentional
Intentional

What are examples of unintentional torts?

-Negligence
-Malpractice (professional negligence)

What are examples of Quasi-intentional torts?

-breach of confidentiality
-defamation of character

what are examples of intentional torts?

-assault
-battery
-false imprisonment

what is an example of negligence ?

A nurse fails to implement safety measures for a client who has been identified as at risk for falls

what is an example of malpractice?

a nurse administers a large dose of medication due to a calculation error. the client has a cardiac arrest and dies

what is an example of breach of confidentiality?

a nurse releases the medical diagnosis of a client to the press

What is an example of defamation of character?

a nurse tells a coworker that she things a client has been unfaithful to a spouse

what is an example of assault?

the conduct of one person makes another person fearful and apprehensive (threatening to place an NG tube in a client who is refusing to eat)

what is an example of Battery?

intentional and wrongful physical contact with a person that involves an injury or offensive contact (restraining a client and administering an injection against wishes)

What is an example of false imprisonment?

a person is confined or restrained against his will

when taking a telephone order, provider must sign the order

within 24 hours

death is determined by one of two criteria:

-an irreversible cessation of circulatory and respiratory functions
-irreversible cessation of all functions of the entire brain, including the brain stem

the rights of individuals in health care settings is outlined in

Patient Care Partnership

what is patient care partnership?

document writte in in plain language and translated to several languges about rights of individuals

what is the Patient Self Determination Act?

federal legislation that requres all clients admitted to a health care facility to be asked if they have advance directives

in an emergency situation, where a nurse needs to apply restraints, the nurse must obtain an order for restraints within

1 hour

how often does the provider need to rewrite the prescription for restraints?

every 24 hours

when a client is in restraints, the frequency of client assessment with regard to food, fluids, comfort, and safety should be performed and documented every

15-30 minutes

What is the RACE sequence?

-Rescue:
-Alarm
-Contain
-Extinguish

in RACE, what to do in Rescue stage?

protect and evacuate clients in close proximity to the fire

in RACE, what to do in Alarm stage?

Report the fire by sounding the alarm

in RACE, what to do in Contain stage?

Contain the fire by closing doors and windows as well as turning off any sources of oxygen. clients who are on life support are ventilated with a bag-valve mask

in RACE, what to do in Extinguish stage?

Extinguish the fire if possible using an appropriate fire extinguisher
Class A- paper, wood, upholstery, rags, or other types of trash fires
Class B- flammable liquids and gas
Class C- electric fires

To use a fire extinguisher, follow PASS sequence. what is that?

Pull
Aim
Squeeze
Sweep

crib slats should be no more than ___ inches apart

23/8

until what age should you use a backward facing car seat?

1 year old and weighs at least 20 pounds

at what age do you use booster seats?

children who are less than 4 feet 9 inches and weight less than 40 pounds (4-8yr olds)

water heater should be set to no higher than

120 degrees F.

when using restraints, what kind of knot should you use?

quick release knot (as opposed to a square knot)

when moving a patient in bed, face

the direction of movement

if a nurse suspects child abuse, he/she is

legally mandate to report it to appropriate legal authority (police, etc)

discharge planning for a client includes:

-identification of available community resources
-providing for continuity of care
-verifying that arrangements for medical equipment have been made
-coordinate care with other disciplines

telephone orders should be transcribed directly on

providers order sheet in the medical record

What are the order of steps in post mortem care?

-a specially trained professional should be contacted right away for organ procurement
-specimens should be collected before d/c lines and tubes
-remove tubes and lines
-cleanse body
-apply name tag before shrouding (dressing for burial)

what kind of behavioral technique is journaling?

cognitive behavioral

if a preschooler is apprehensive when other children cry,

may be suggestive of physical abuse

at what angle should an infant car seat be placed?

45 degrees

what can be used to ensure proper fit of car seat?

foam rolls

where do you secure baby's harness?

at baby's armpits to ensure proper placement of safety straps

if two nurses are talking about patient information publicly,

approach them right away to avoid further release of information

what is the purpose of filling out an incidence report?

to identify factors that contribute to the occurrence of the problem

in assertive communication, what kind of statements should you use?

I statements

how does an autocratic leader function?

direct and issue commands necessary to promulgate a successful response to a situation

how does a transformational leader function?

gives group members responsibilities that will enhance their professional development

participative leadership is the same as

democratic leadership

intrapersonal conflict

tension or stress that exists within an individual as a result of unmet needs, expectations, or goals
Example: A nurse wants to move up on the career ladder but is finding that time with her family is subsequently compromised

interpersonal conflict

between two or more people who disagree in regards to an issue or belief

inter-role conflict

when an individual is associated with more than one group role and these roles are incompatible

what are the steps to take in a sexual harassment case?

1. immediately confront the harasser and state that the behavior is unwanted and should be stopped.
2. The incident should then be reported to the supervisor,
3. documented in detail, and maintained in a secure file that is not kept at the place of employ

informed consent is based on the ethical principle of

autonomy

when communicating with a patient, nurse should always address _____ first

clients feelings

the goal of negotiation is to create a

win-win situation in which all parties are satisfied

is a nurse permitted to witness a clients signature on a living will?

yes

is a nurse allowed to witness a living will

no because of nurse/client relationship

what is a critical pathway

outlines the actions that all members of a health care team must complete in a timely manner to achieve desired client outcomes and appropriate length of stay

what is nonmaleficence

to do no harm and protect patients when they cannot protect themselves

what is paternalism?

type of relationship between clients and healthcare providers in which the healthcare provider believes they know what is best for the clients

a client says they want to see their medical chart. what is nurses best response?

you could do soo with the guidance of the health team member designated by hospital policy

Authority

The right to direct others given to a person by the employer through an authorized position such as a manager or administrator

External Customers

People in need of services from an organization who are not employed by the organization(including patients, family members, doctors, students, payers, discharge planners, and other groups that are a source of patient referrals)

Health Care Organization

Any business, company, institution, or facility engaged in providing health care services or products.

Internal Customers

People who are employed by the organization to provide services to various groups an individuals across the organization (Nurses, social workers, administrators, dieticians, therapists, housekeeping, and clerical support staff)

Leadership

The act of guiding people to achieve desired outcomes. Occurs anytime a person attempts to influence the beliefs, opinions, or behaviors of an individual or group.

Management

Coordination of resources, such as time, people, and supplies, to achieve outcomes; involves problem-solving and decision-making process

Organizational Chart

A visual picture of the organization that identifies lines of communication and authority.

Productivity

The amt of output of work produced by a specific amount of input or resources.

Resources

Personnel, time, and supplies needed to accomplish the goals of the organization.

Reward Power

Comes from the ability to reward others for complying and may include rewards such as money, desired assignments, or acknowledgment of accomplishments.

Coercive Power

Opposite of Reward Power, is based on fear and punishment for failure to comply.

Legitimate Power

Based on an official position in the organization. the manager has the right to influence staff members, and staff members have an obligation to accept that influence.

Referent Power

(Leading by Example) Comes from the followers' identification with their leaders. The admired and respected nurse manager for example is able to influence other nurses because of their desire to be like their nurse manager.

Expert Power

Based on knowledge, skills, and information. For example, the nurse who has expertise in an area will gain respect and compliance from others.

Information Power

Is based on a person's possession of information that is needed by others. An example would be a nursing instructor.

Connection Power

Based on a person's relationship or affiliation with other people who are perceived as being powerful.

Leadership Trait Theory

Based on the assumption that leaders are born with certain traits and characteristics that make them ideal leaders.

Transactional Leader

Leader who is concerned with the day-to-day operations of a facility. They wait until problems occur and then deal with them. They often reward staff for desired work in a trade-off type of way (I'll do X if you do Y).

Transformational Leader

Leader who is committed to organizational goals, has a vision, and is able to empower others with that vision. They are admired and mentor individual staff members based on need.

Leadership Skills

1. Technical Skills: Clinical expertise and nursing knowledge
2.Human Skills: Ability and judgement to work with people in an effective leadership role.
3.Conceptual skills: ability to understand the complexities of the overall organization and to recogni

Authoritarian/Autocratic (Management Style)

Determines policy and makes all decisions. Ignores subordinates' ideas or suggestions and gives little feedback for work. Tend to make fast decisions and are successful with employees having little training or education.

Democratic/Participative (Management Style)

Encourages staff participation in decision making and involves staff in planning and developing new ideas and programs. Communicates effectively and provides regular feedback thus building responsibility in people. Works best with highly motivated people.

Laissez-Faire (Management Style)

Does not provide guidance or direction and is unable/unwilling to make decisions. Does not provides feedback and imitates little change. Tends to communicate using memos or email instead of personal interaction. May work well with professional people.

Weber's Theory of Bureaucracy

emphasized rules instead of individuals and competency instead of favoritism as being important for effective organizations. His ideas revolve around the role of authority.

Systems Theory

Views the organization as a set of interdependent parts that together form a whole. If something affects on factor in the system, the entire system will also be affected.

Chaos Theory

States that variation is a normal part of managing health care systems. Attempts to account for the complexity and randomness in organizations. It suggests that a degree of order can be attained by viewing complicated behaviors and situations as predictab

Management Functions

1. Planning
2. Organization
3.Staffing
4.Directing
5. Controlling

Planning

1.defining goals and objectives
2.identify resources
3.determine action steps
4.Establish a timeline for action goals and goal achievement

Organization

Is necessary to establish a formal structure that defines the lines of authority, communication, and decision making within an organization. It involves developing policies and procedures to help outline how work will be done and establishing position qua

Staffing

1.Determine the number and the type of staff needed based on goals and budget
2.Recruit, interview, select, and assign personnel based on job description requirements and performance standards
3.Offer an excellent orientation, training, and socialization

Directing

involves issuing assignments and instructions that allow workers to clearly understand what is expected and to additionally coach workers to achieve planned goals

Controlling

Requires the nurse manager to establish performance or outcome standards, determine action plans to improve performance, and to evaluate employee performance through appraisals and feedback. The goal is to ensure that employees accomplish goals while main

Stages of Change

1.Unfreezing stage:Problem identified and awareness of need to change
2.Moving Stage:Defines goals and plans the change
3.Refreezing Stage: Change integrates into the organization and is recognized as new status quo.
*If the refreezing stage does not occu

Change Agent

Refers to the changing health care environment, and that change is an unavoidable occurrence in health care organizations.

benchmarking

a process for measuring products, practices, and services against best performing organizations; allows nurse managers to compare staffing and plans across like units or organizations

patient classification system (PCS)

measurement tool used to determine the nursing workload for a specific patient or group of patients over a specific period

patient acuity

the measure of nursing workload generated for each patient

full-time equivalent

measures the work commitment of a full time employee; the unit's forecasted workload is used to calculate the number of FTEs needed for the unit's staffing plan wich may comprise full-time and part-time employees; a conversion of hours to a standard base

Factor Evaluation System

FES is the most popular patient classification sytem in use because of it's ability to project needs for individual patients and groups of patients; used to determine each patient's acuity rating, depending on hospital policy, several times through out th

Prototype Evaluation System

considered subjective and descriptive and is based on diagnostic related groups (DRGs-a grouping of similar patients with similar diseases or conditions); used less frequently than FES
Advantage: reduction of the RN's duty of completing the acuity rating

Nursing Hours Per Patient Day

Total nursing hours worked by nursing staff in a 24 hour period divided by the patient census at the end of that 24 hour period.

Scheduling

primary concerns include patient acuity, volume of patients, state licensing standards, needs and experience of the staff, the environmental layout of the unit, the organization's mission, philosophy and policies

decentralized scheduling

when the nurse manager develops the schedule separate from other units within the hospital

centralized scheduling

done by staffing coordination

nursing care delivery model

method used to provide care to patients
Goals:
1)Deliver nursing care effectively and efficiently to patients
2)Nurse manager must ensure to achieve both patient and nurse satisfaction as an outcome measure
3)Should enhance communication between staff and

case method/total patient care model

model of care delivery in which one nurse provides total care for an individual patient during an entire work period; oldest model commonly seen on hospital units where the nurse will provide patient centered, comprehensive, continuous, and holistic care

functional nursing model

a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients (may be seen during a mass casualty event)

team nursing model

a small group of licensed and unlicensed personnel, with a team leader, responsible for providing patient care to a group of patients

primary nursing

a model of patient care delivery whereby one registered nurse functions autonomously as the patient's main nurse throughout the entire hospital stay

nursing case management

the process of a nurse coordinating health care by planning, facilitating, and evaluating interventions across levels of care to achieve measurable cost and quality outcomes; patient focused and outcome oriented

critical path/critical pathway

a component of care MAP that is specific to diagnosis-related group reimbursement; the purpose is to ensure patients are discharged before insurance reimbursement is eliminated

clinical pathway

outline the expected clinical course and outcomes for a specific patient type; generally outline the normal course of patient care, and the patient's progress is measured against expected outcomes

variance

anything that alters a patient's progress through a normal care path

quality management (QM)

a corporate culture emphasizing customer satisfaction, innovation, and employee involvement in quality improvement activities; often used interchangeably with total quality management, continuous quality management, quality improvement, and performance im

quality improvement

systematic process to improve outcomes; based on customer needs; proactive approach; responsibility of all; "doing the right thing;" continuous process

quality assurance

a process that focuses on the clinical aspects of a provider's care, often in response to an identified problem; inspection approach to ensure that minimum standards of care existed in health care institutions

8 Common steps of Quality Improvement

1) Establish a clear and defined aim or purpose
2) Reviewing the literature
3) Examining current resources to facilitate quality improvement
4) Mapping the current processes
5) Analyzing the root causes
6) Selecting appropriate tools for process analysis

regulatory requirements

measuring organizational performance against standards from regulatory/accrediting organizations

PDSA/PDCSA

Plan Do Study Act/Plan Do Check Study Act

Plan

define the objective, questions, and predictions; plan data collection to answer the questions: who? what? where? when?; devise a plant to address the problem

Do

identifying the steps in a plan; carry out the plan; collect the data; begin analysis of the data--implementation

Study

complete the analysis of the data; check: compare data to predictions; summarize what was learned

Act

plan the next cycle; decide whether the change can be implemented; examine outcomes; consider modifications for initiating the cycle again for refinement of the process; continue seeking improvements

storyboard

method for sharing work with others; takes the major steps in the improvement methodology and visually outlines the progression of each step; can be displayed on a chart in a high traffic area of the organization to inform other staff of the improvement e

dashboards

time series data; allows a quality improvement team to see change in quality over time; time series chart used to look for trends, shifts, and unusual data

safety

freedom from accidental injury (patient stay free of complications and expected outcomes reached)

safety culture

the outgrowth of the larger organization culture and emphasizes the deeper assumptions and values of the organization toward safety

safety climate

the shared perception of employes about the importance of safety within the organization

error

the failure of a planned action to be completed as intended (error of execution) or the use of the wrong plan to achieve an aim (error in planning); directly related to outcomes

active error

type of incident that is non-compliant with procedure, or making a mistake such as not assuring the correct identification of the patient before administering the medication

latent error

condition involves problems within the system; may lie dormant within the system for a long time; pose the greatest threat to safety in a complex system

adverse event

an injury resulting from medical intervention; not due to the patient's underlying condition

misuse

avoidable complications that prevent patients from receiving full potential benefit of a service (patient receives a med that is not prescribed & conflicts w/his allergies causing anaphylaxis)

overuse

the potential for harm from the provision of a service that exceeds the possible benefit

near miss

recognition that an event occurred that might have led to an adverse event

sentinel event

an event that had a negative patient outcome (unexpected death, serious physical or psychological injury, or serious risk)

root cause analysis

the process used to identify all possible causes of a sentinel event and all appropriate risk-reduction strategies; an in-depth analysis of an error to asses the event & identify causes & possible solutions

culture of safety

a blame free environment in which staff can practice & openly discuss potential errors or near-misses as well as actual errors---just culture: No shame No Blame

just culture

culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action

Patient Safety: Principles in Action in an Organization

organizational structure-encourage accountability; maximize communication; communicate and focus priorities at all levels

Patient Safety: Leadership Roles

clearly communicate expected standards of care; encourage followers to be actively involved in the QI process

Patient Safety: Management Functions

Establish a clear-cut measurable standards of care and determine the most appropriate method for measuring if those standards have been met; keeps abreast of current government and licensing regulations that affect QI; determines discrepancies between car

risk management

serves to provide a safe and effective environment for patients, visitors & employees while averting/decreasing loss to the organization
Focus: identification, analysis, treatment, and evaluation of actual or potential hazards

Responsibilities of risk management

loss prevention and reduction, claims management, financial risk, risk regulatory and accreditation compliance

Failure Mode & Effect Analysis (FMEA)

a method to analyze reliability problems proactively to avoid negative outcomes; risk management tool; proactive identification and risk reduction

flowcharts

a graphical representation of a process, depicting inputs, outputs and units of activity; represents the entire process, allowing analysis and optimization of workflow

safe harbor act

a process that protects a nurse from employer retaliation & licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in violation of t

autonomy

personal freedom, right to choose: informed consent, progressive discipline with employees, HN decision about unit operations, staff decisions regarding patient care

beneficence

promote good, doing good to others; consists of mercy, kindness & charity deed; taking actions to benefit & promote the welfare of people; doing good; help prevent or remove harms or improve situation of others: educating community about STD prevention; p

non-maleficence

do no harm; correlates to beneficence; obligated not to harm anyone-intentionally refraining from actions that harm a patient; principle most helpful when balanced against beneficence--risk of treatment (harm) must be understood in light of the potential

justice

fairness, treating people equally and without prejudice

paternalism

allowing a person to make a decision for another; deliberate overriding of patient's opportunity to exercise autonomy b/c of perceived obligation of beneficence: mandatory flu vaccine, not giving bad information about a terminal diagnosis

veracity

truth: informing family of sentinel event or error; completing incident report for a near miss

fidelity

keeping one's promise: maintaining staff vacation request, keeping promise made to patient/family

respect for others

highest ethical principle; acknowledges rights of the individual to make decisions and live by the decisions; patient centered focus

Ethical Decision-Making Framework

-gather data & identify conflicting moral claims
-identify key participant
-determine moral perspective and phase of moral development of key participants
-determine desired outcomes
-identify options
-act on the choice
-evaluate outcomes of the action

ethical committees

groups of persons who provide structure and guidelines for potential healthcare problems, serve as an open forum for discussion, and function as patient advocates; provide education, policy and guideline recommendations, and case review

moral distress

a type of distress that occurs when faced with situations in which two ethical principles compete, such as when the nurse is balancing the patient's autonomy issues with attempting to do what the nurse knows is in the patient's best interest

ethical issues encountered in practice

technology (when to use, stop using, or who can use); cost containment; Patient's rights; staffing issues; impaired nurses; confidentiality; refusal of treatment...

barriers to cultural competence

lack of diversity in healthcare's leadership and workforce; systems of care poorly designed to meet the needs of diverse patient populations; poor communication between providers and patient of different racial, ethnic, or cultural backgrounds; lack of ed

Cultural Care Theory

theory explicitly focused on the close relationships of culture and care on well-being, health, illness, and death; it is holistic and multidimensional, generic (emic, folk) and professional (etic) care has a specifically designed research method (ethnonu

cultural destructiveness

eliminates the cultures of others

cultural incapacity

trivialize other cultures and make other cultures appear to be wrong

cultural blindness

do not see or acknowledge the culture of others

cultural precompetence

increasing awareness of what you do, do not know about working in diverse settings

cultural competence

including values, beliefs, and attitudes that are new or different from your culture to render effective nursing care

cultural proficiency

lifelong learning of cultural groups to create a socially just democracy

multiculturalism

refers to maintaining several different cultures simultaneously

cross-culturalism

refers to mediating between two cultures (one's own and another)

transculturalism

denotes bridging significant differences in cultural practices

organizational culture

the values and behaviors that contribute to the unique social and psychological environment of an organization; a shared value system developed over time that guides members to problem solve, adapt to the external environment, and manage relationships; th

acculturation

process by which a person becomes a competent participant in the dominant culture

role development

choosing to change role expectations and/or role performance

role discrepancy

a gap between role expectations and role performance

role internalization

stage at which a person has learned behaviors that maintain a role so thoroughly that the person performs them without consciously considering them; energy once spent on establishing these behaviors can be redirected to other goals

role negotiation

resolving conflicting expectations about personal management performance through communication

role strain

the subjective feeling of discomfort experienced as a result of role stress, may manifest through increased frustration, heightened emotional awareness, or emotional fragility to situations

role stress

a social condition in which role demands are conflicting irritating, or impossible to fulfill

role transition

the process of unlearning an old role and learning a new role; transforming one's identity from being an individual contributor as a staff nurse to being a leader as a nurse manager

ROLES

an acronym used to identify the components of a role: responsibilities, opportunities, lines of communication, expectations, and support

Hartman Value Profile

measures patterns of decision making used when processing information about the world & self; profile places emphasis upon thinking, not behaving

role exploration

similar to honeymoon phase

Role transition Process

Role preview
Role Acceptance
Role Discrepancy
Role Development
Role Internalization
Unexpected Role Transition

360 Degree Feedback

a process in which an individual is assessed by a variety of people in order to provide a broader perspective; nurses asked to evaluate their peers need orientation to the process and to the specific tool being used

clinical ladder

programs encouraging nurses to earn promotion, gain recognition, and to increase pay by meeting specific requirements

time management

a set of related common-sense skills that helps you use your time in the most effective and productive way possible; the use of tools, techniques, strategies, and follow-up systems to control wasted time and to ensure that the time invested in activities

outcome orientation (time management)

more is achieved than with an emphasis on task completion; determine long-term goals, then break them down into achievable outcomes that are the steps toward those goals; flexibility

main time management concepts

the relative effectiveness of the effort (20% effort for 80% outcome results); the importance of outcome vs process orientation; the value of organizing how time is currently being used

establishing priorities

1st priority: a life-threatening or potentially life-threatening occurrence
2nd priority: activities essential to safety (life saving medications, assisting others with lifting)
3rd priority: activities essential to the plan of care (symptom management, o

research utilization

Process of synthesizing, discriminating, and using research-generated knowledge to make an impact or change in existing practices

evidence-based practice

integration of individual clinical expertise, built from practice, with the best available evidence from systematic research applied to practice

practice based research network

originally formed to address research issues in primary care, PBRNs are increasingly being used in large healthcare organizations having the capability of integrating systems across multiple practice sites; practice-based research networks in nursing exis

translating research into practice (TRIP)

approaches that integrate the use of evidence into patient care; the science of how research is best translated into practice

Asking the right question: PICOT format

Patient population
Intervention/interest area
Comparison
Outcome
Time

impact of EBP (positive)

constraining healthcare costs; reducing geographic variability; improving quality; promoting consumer-directed healthcare; making health coverage decision

clinical practice guidelines

statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options

social justice

evolves from values of impartiality and objectivity at a systems or governmental level and founded on principles of fairness, equity, respect for self and human dignity, and tolerance; fair treatment regardless of economic status, race, ethnicity, age, ci

market justice

based on the principle that the benefits & burdens of a society should be distributed among its members according to the members' individual efforts & abilities

IOM 6 Aims STEEEP

Safe healthcare
Timely healthcare
Effective healthcare
Efficient healthcare
Equitable healthcare
Patient-centered healthcare

collective action

a mechanism for achieving professional practice through group decision making; activities undertaken by a group of people with a common interest

shared governance

flat type of organizational structure with decision making decentralized; democratic, egalitarian; shared decision making and accountability

workplace advocacy

refers to acting on or in behalf of another who is unable to act for himself or herself to effect change about workplace conditions; activities aimed at addressing nursing challenges faced by nurses in their practice setting

collective bargaining

mechanism for settling labor disputes by negotiation between the employer and representatives of the employees; process which organized employees participate w/their employers in decisions about their pay, hours of work, & other terms and conditions of em

Magnet Status

only national designation built on and evolving through research; this program is designed to acknowledge nursing excellence; designed for healthcare organizations to achieve recognition of excellent nursing care through a self-nominating, self-appraisal

budget

detailed financial plan, stated in dollar, for carrying out the activities of an organization wants to accomplish within a specific period

cost

the amount spend on something; national healthcare costs are a function of the price and utilization of healthcare services; a healthcare provider's costs are the expenses involved in providing goods or services

capitation

a reimbursement method in which healthcare providers are paid a per-person-per-year (or month) fee for providing specified services over a period of time

revenue

money earned by an organization for providing goods or services (before expenses are deducted)

profit

an excess of revenues over expenses and obligations;

budget variance

change in expected revenue or change in expected expense may be due to changes in price, volume, acuity, and wage

operating budget

a financial plan for day to day activities of an organization

capital budget

budget for purchasing major capital items, such as equipment or a physical plant, with a useful life greater than 1 year and exceeding a minimum cost set by the organization

cash budget

a plan for an organization's cash receipts and disbursement, how bills are paid month to month

regulatory organization

set standards for the operation of healthcare organizations, ensure compliance with federal and state regulations developed by governmental administrative agencies, and investigate and make judgements regarding complaints brought by consumers of the servi

informatics

the use of knowledge technology; nursing science, computer science and information science; identifying, collecting, processing, and managing data and information; supporting nursing practice, administration, education, research, and the expansion of nurs

focus of nursing informatics

handling information in nursing practice; making sure nurses' needs are taken into consideration when automated systems are designed and purchased; developing processes to help bedside nurses manage patient data at the bedside; teaching other nurses about

clinical information system (CIS)

a collection of software programs and associated hardware that supports the entry, retrieval, update, and analysis of patient care information and associated clinical information related to patient care; primarily a computer system

biomedical technology

the technological devices and systems that relate to biologic and medical sciences; involves the equipment in the clinical for diagnosis, physiologic monitoring, testing, or administering therapies to patients

information technology

the use of computer hardware and software to process data into information to solve problems

knowledge technology

the use of expert and decision support systems to assist in making decisions about patient care delivery; provide clinical decision support

PLEASED

Purpose for which the site was created
Links and their accuracy and reliability
Editorial or site content: accuracy, bias, comprehensiveness, currency
Author: credentials, expertise
Site: design, navigability, ease of use
Ethics: disclosure of author, spo

Ten C's for evaluation of internet sources

Content
Credibility
Critical thinking
Copyright
Citation
Continuity
Censorship
Connectivity
Comparability
Context

power

the ability to influence others in the effort to achieve goals; ability to create, get and/or use resources to achieve one's goals

personal power

based on one's reputation and credibility

expert power

results from the knowledge and skills one possesses that are needed by others

position power

possessed by virtue of one's position within an organization or status within a group

perceived power

results from one's reputation as a powerful person

information power

stems from one's possession of selected information that is needed by others

connection power

gained by association with people who have links to powerful people

empowerment

sharing of power and control with the expectation that people are responsible for themselves; also, the process by which we facilitate the participation of others in decision making within an environment in which power is equally distributed

politics

a process of human interaction within organizations; predominantly a process by which people use a variety of methods to achieve their goals; involves some level of competition, negotiation, and/or collaboration

leadership

influences or inspires actions and goals or others

doesnot require position of authority

leadership

Do the right thing

leadership

part of management-not a substitute

leadership

do things right

management

process of interaction in which leader influences others toward goal and achievement

leadership

includes vision and goals for what the organization can become then getting cooperation and teamwork from others to achieve goals

leadership

formal leadership

demonstrated in assigned role within organization

a person is in a position of authority or in a sanctioned, assigned role within an organization that connotes influence, such as clinical nurse specialist

formal leadership

informal leader

an individual who demonstrates leadership outside the scope of a formal leadership role, such as a member of a group rather then the head or leader of the group.

skilled, self directed employees

valuable followers

active participants in needs of the group

valuable followers

good communicators

valuable followers

work well with others

valuable followers

Leadership

about creating change and involves establishing direction and aligning people through empowerment

Management

about controlling complexity to bring order and consistency

Involves planning, budgeting, organizing, staffing, solving problems,and controlling complexity

management

human relations theory of management

Differs from earlier approaches because it demonstrates improved performance through participative management.

Leadership desirable traits

intelligence, self-confidence, determination, integrity, and sociability

leadership characteristics

guiding vision
passion
integrity

caring, responsibility, trustworthiness, and flexibility

desirable traits of leadership

leadership values

visionary
enthusiastic
supportive
knowledgeable

leadership values

possess high standards and expectation

leadership values

values education and professional development

leadership values

demonstrates organizational power and status

leadership values

communicates openly

leadership values

visible and responsive

How are leaders different from non leaders

Drive
desire to lead
honesty and integrity
self confidence
cognitive ability
knowledge of the business

leadership theories

behavioral
contingency
contemporary

behavioral theories*****

autocratic leadership
democratic leadership
laissez-faire leadership

(auto)cratic leadership

centralized decision making with leader making decisions and using power to command and control others

employee centered leadership

focuses on human needs of subordinates

job centered leadership

focused on
schedules
costs
efficiency

initiating structure

planning, directing others, and establishing deadlines

focusing on employees and creating trusting relationships

consideration

high initiating structure, high consideration

delivers better performance and satisfaction outcomes
develops clear assignments and works considerately with employees to achieve quality outcomes

five leadership styles are apart of the

managerial grid

impoverished leader

low production and people concern

authority compliance leader

high production concern and low people concern

country club leader

high people concern and low production concern

middle of the road leader

moderate concern in both directions

Team leader

high production and people concern

contingency approach

acknowledges that (other) environmental factors influence outcomes as much as leadership style

contingency approaches

leader effectiveness contingent on something other than leaders behavior

contingency approach theories

fielders contingency
hersey and blanchard situational leadership
pathgoal
substitute for leadership

Fielder's contingency theory

Leadership effectiveness dependent on interaction of personality of leader and needs of situation

what does needs of the situation involve

leader-member relationships
degree of task structure
leaders position of power

when is there a good leader member relationship

when followers have trust, respect, and confidence in leader.

hersey and blanchard

situational leadership theory

situational leadership theory

addresses followers readiness as factor in determining leadership style

considers task and relationship behaviors

situational leadership theory

situational leadership theory "styles

telling
selling
participating
delegating

telling

for low maturity groups who need direction

selling

for moderate maturity groups who are unable but willing and need direction

participating

for moderate maturity groups who are able , but unsure and need support

delegating

for high maturity groups who are able and need little direction

path- goal theory

leaders motivate followers and influences goal accomplishment

based on expectancy theory

path goal model

what are the leadership styles according to the path-goal theory

directive
supportive
participative
achievement-oriented

directive

leader provides structure through direction, focusing on task to be done

supportive

leader provides encouragement and attention

achievement oriented

leader provides high structure and high support

substitute for leadership

variables that may influence followers to same extent as leader behavior

variables that may influence followers to same extent as leader behavior

followers characteristics
organizational characteristics

structured routine task

theory suggests that nurses and other professional with significant experience do not need direction and supervision

serves as leadership substitute

knowledge

intrinsic satisfaction in the work

substitutes for support and encouragement of relationship oriented leader

organizational characteristics

presence of a cohesive groups
formal organization
rigid adherence to rules
low position power

contemporary approaches

address leadership functions necessary to develop learning organizations and lead process of transforming change

contemporary approaches

charismatic leadership
transformational leadership
knowledge workers
wheatley's new science of leadership

characteristics of charismatic theory

self confidence
strength in conviction
communication of high expectations
confidence in others

transformational theory

leaders and followers raise one another to higher levels of motivation and morality

transformational theory

leaders motivate others to behave in accordance with mutual values and empower others to contribute

transformational theory characteristics

change agents
life long learners
believe in others
courageous
value driven
able to deal with complexity

How can nurses develop leadership and management skills

continuing education
increasing expertise in patient care

what are the five basic competencies of emotional intelligence

self awareness
self regulation
motivation
empathy
social skills

new science of leadership functions

guiding organization using vision
make choices based on mutual values
Engage in culture to provide meaning and coherence

fosters growth and unity between individuals and group members

new science of leadership

strong relationships improve autonomy at all organizational levels

new science of leadership

managers

continuously seek information
constantly engage in interactions with others who need information

management

work driven in random order

has range of importance and urgency

management

management roles

information processing
Interpersonal
decision making

The management process

Gulick and urwick
POSDCORB

According to Maslow, when does motivation occur

It results if needs are not met

Theory X

Nurse prefer job security and need direction

motivation

Explain why people act the way they do and how a nurse manager can relate to individuals as human beings and workers

motivation theories

Maslow heirarchy of needs
alderfers growth relatedness existence theory
herzberg two factor theory
mcclelland manifest needs theory

powerful tool to assist managers in motivating behavior

feedback

feedback

should be
valuable
frequent
timely
useable
consistent
correct
diverse

provides framework to facilitate professional development

Benners Novice to expert model

can view own actions as part of long range goals set for patients

competent

Novice nurse

task oriented
focus on rules and direction form telling style leader

demonstrate marginally acceptable independent performance

advanced beginner nurse

proficient nurse

perceives whole situation rather than series of tasks

evidenced based care

evidenced based care and your experience as an RN are invaluable for quality patient care

EBC

process further involves the integrating of both clinician-observed evidence and research directed evidence

Improves outcomes affecting health

EBC

1. Scientific management

Focuses on goals and productivity/organization is a machine to run efficiently to increase production. Uses time & motion studies to make work efficient.

1. Theory X

leaders must direct control, as motivation results from reward & punishment. Employees need coercion & threats to get the job done

2. Theory Y

Workers have self control & self-discipline-workers reward is their involvement & opportunity to be creative.

1. Theory Z

collective decision making, long-term employment, mentoring, holistic concern, this is a humanistic style of motivation based on Japanese organizations.

5. Physiological:

adequate salary, breaks and working conditions.

Safety

: to meet inflation, safe working conditions, salary increases medical in`rance

Social needs (love & belonging)

3. : needs are meet through interaction with others, to be accepted, to have friends, etc

Self-esteem:

2. meet needs through titles, pay raises, recognition, etc.

Self-actualization:

1. organization meets the needs by development of employee's skills, chance to be creative, achievement & promotions, & to have complete control over their job.

Resource Dependence

: emphasizes the need to secure necessary resources and provides reliable and valid data on

Strategic managmeent

: fit or alignment between organizational strategy, external environment, and internal structure and capabilities

Population ecology:

external environment pressures are primary determinants

Complex Adaptive systems:

Interrelated unpredictable elements
Constantly interacts with its environment
Encourages staff to look at their activities on one unit as part of a larger picture they may affect other units
Innovation and rapid information sharing

Conflict is all of the above except ______.
a. normative
b. to be avoided at all costs
c. a metaphor for difference
d. often ideological
e. due to intellectual differences

b. to be avoided at all costs

Embedded in the fear of conflict are issues of all of the following except ____.
a. personal security
b. identity
c. safety
d. relational integrity
e. All of the above are true.

e. All of the above are true.

The early identification of conflict is important to help prevent escalation. Many stressors are manifested in particular modes of ______.
a. communication
b. relationships
c. interactions
d. expression of personal emotions
e. All of the above are true.

e. All of the above are true.

The next stage of conflict is seen with _____.
a. verbalizations
b. snide remarks
c. statements of discomfort
d. cynicism
e. negative assessments
f. b, c, and d are true.
g. All of the above are true.

g. All of the above are true.

All of the following are true except _____.
a. Challenges that differences in personalities create need to be addressed.
b. Values must have a voice, and that voice must be honored, respected, and included.
c. All problems can be solved.
d. Challenges tha

c. All problems can be solved.

The leader needs to be comfortable with conflict. Factors which are important to this occurring are the following:
a. The leader must be comfortable with self-expression of feelings, personal insights, and challenges to prevailing views and circumstances.

e. All of the above are true.

Creating a context of trust is the essential framework for ____.
a. a place where the employee can share with you all of their problems.
b. a truly safe place where conflict can be dealt with as easily and effectively as any other function, process, or re

b. a truly safe place where conflict can be dealt with as easily and effectively as any other function, process, or relationship.

The sense of lack of justice comes from what is considered ___.
a. unfair work conditions
b. unfair procedures
c. unfair relationships
d. All of the above are true.

d. All of the above are true.

Examples of poor communication in fully sharing personal views, insights, or opinion include all of the following except ___.
a. Staff vocalizes affirmatively.
b. You see people nodding their heads or sitting in silence in response to a statement or quest

a. Staff vocalizes affirmatively.

10. Alienation____.
a. is encouraged by permitting the reflective work of the profession to be sacrificed by unrelenting work expectations.
b. is encouraged when team members are kept busy doing without the opportunity to think about what they're doing.
c

e. All of the above are true.

11. Five personal barriers that have a dramatic impact on the individual leader's ability to understand, engage, and manage conflict include ____.
a. willingness to confront conflict
b. uncertainty about the capacity to handle the conflict emotionally and

g. a, b, c, d, and e are true.

12. Steps in handling conflict include ___.
a. identifying the problem
b. immediately reporting the problem to hospital administration
c. making sure issues are expressed
d. a and c are true.

d. a and c are true.

The five types of conflicts are ___.
a. relationship conflicts
b. information conflicts
c. interest conflicts
d. organizational conflicts
e. values-based conflicts
f. conflicts with administration
g. a through e are true
h. All of the above are true.

g. a through e are true

14. Values conflicts ______.
a. are the easiest to address in the workplace
b. are difficult to resolve because they relate to who people are
c. are difficult to resolve because they relate to what people believe
d. b and c are true

d. b and c are true

15. Areas to include in the mediation process as relationship issues are explored include all of the following except ___.
a. mutual respect
b. needs versus wants
c. compassion and empathy
d. blaming others.

d. blaming others.

Patient workforce management includes five highly interconnected and interrelated components, which include all of the following except ____.
a. Establishment of a patient care delivery model.
b. Patient needs and nurse interventions identification.
c. Cr

d. Daily staffing process that is consistent each day.

A patient care delivery model ___.
a. is the method or system of organizing and delivering nursing care.
b. includes work delegation and resource utilization.
c. emerges from the organizational mission, vision, values and structures.
d. All of the above a

d. All of the above are true.

Areas of focus necessary to get the work done in healthcare settings include a system that requires ____.
a. clear delineation and assignment of work based on skills.
b. licensure and competence.
c. recruitment and retention of competent caregivers.
d. as

f. All of the above are true.

The historical usage approach to staffing involves___.
a. looking at usage from the year before.
b. the assumption that all patients are similar in needs.
c. identifying nurse-to-patient ratios based on experiences and perceptions of nurses.
d. use of a p

a. looking at usage from the year before.

5. Patient care needs categories include___.
a. cognitive needs.
b. pain and comfort needs.
c. family information and support needs.
d. treatments and interventions.
e. a and c
f. All of the above are true.

f. All of the above are true.

Times and motion studies involve _____.
a. sampling activities at systematic or random intervals.
b. continuous timed observations of a single person during a typical time period or shift of work.
c. asking the individual to log the work performed using a

b. continuous timed observations of a single person during a typical time period or shift of work.

The expert opinion or expert panel technique to measure work _____.
a. identifies time requirements for certain work.
b. is a consensus approach.
c. uses professional judgment to determine staff required.
d. provides a flexibile approach that focuses on a

f. All of the above are true.

8. Validity measures___.
a. the extent to which data is reproducible.
b. the extent to which a workforce management system measures what it is designed to measure.
c. the ability to quantify and/or predict patient needs for nursing care.
d. b and c
e. All

d. b and c

One of the problems with patient classification systems has been low validity. This problem includes the following:
a. failing to account for the full scope of nursing practice.
b. belief that patient classification systems are a vehicle to increase or de

a. failing to account for the full scope of nursing practice.

The problems with prospective versus retrospective prediction of patient care needs includes___.
a. the amount of staff and skill mix has been nearly impossible to determine without an acceptable error range without using a computerized solution.
b. it is

c. a and b

The following are important considerations in constructing the basic core schedule:
a. anticipated patient needs volume.
b. shift length.
c. experience.
d. available research evidence for staffing effectiveness.
e. All of the above are true.

e. All of the above are true.

All of the following are true about nursing staff skill mix except ____.
a. it consists of the numbers of licensed and nonlicensed staff.
b. it is determined based on who is available to work.
c. it is determined based on the work that needs to be done.
d

b. it is determined based on who is available to work.

The role of advanced practice nurse providers and clinical experts includes___.
a. writing orders.
b. providing general patient care oversight.
c. providing care.
d. assisting staff in the care of more complex patients using the latest evidence in a cost-

e. All of the above are true.

Variance management is____.
a. analysis of the difference between actual hours of staff and required hours of care and then using this information to create effective workload management systems.
b. using multiple indicators to evaluate staffing effective

a. analysis of the difference between actual hours of staff and required hours of care and then using this information to create effective workload management systems.

Examples of interventions to address the gap between needs and actual staffing are the following ___.
a. reevaluating patient acuity ratings.
b. postponing admissions.
c. postponing nonemergent patient care,
d. floating existing staff to the unit of need.

e. All of the above are true.

Autonomy is ___.
a. The right to self-determination
b. the duty to do good
c. a problem that confronts one, with a choice of solutions that seem or are equally unfavorable
d. duty to keep one's promise

a. The right to self-determination

Ethics is ____.
a. the elimination of arbitrary distinctions and the establishment of a structure of practice with a proper share, balance, or equilibrium among competing claims
b. duty to keep one's promise
c. the philosophical study of right and wrong a

c. the philosophical study of right and wrong action

A problem that confronts one, with a choice of solutions that seem or are equally unfavorable is a (n) ___.
a. ethical erosion
b. ethical dilemma
c. ethical fading
d. boundary crossing

b. ethical dilemma

When a health care professional performs favors for a patient that are outside the therapeutic relationship, this is called _____.
a. boundary violation
b. boundary crossing
c. ethical fading
d. whistle-blowing

a. boundary violation

Bioethics is__.
a. the sum total of individual and collective experience, knowledge, and good sense
b. guidelines for behavior specific to a moral framework for professional practice
c. supporting and promoting patients' healthcare rights and enhancing co

d. a subdiscipline of applied ethics that studies questions surrounding biology, medicine, and the health profession

Care at the end of life for which there is little hope of benefit is an example of ____.
a. medical futility
b. organizational integrity
c. nonmaleficence
d. rationalization

a. medical futility

An American school of philosophy that rejects the esoteric metaphysics of traditional European academic philosophy in favor of more down-to-earth, concrete questions and answers is ____.
a. morality
b. utilitarianism
c. pragmatism
d. bioethics

c. pragmatism

All of the following are true about the ethics of care moral theory except ____.
a. it is based on the insights of Carol Gilligan
b. it is a process that obscures the ethical dimension of a decision
c. it rejects the traditional male-centered ethics that

b. it is a process that obscures the ethical dimension of a decision

Examples of resources for ethical decision making would include ____.
a. ethics committees
b. ethics textbooks
c. ethics journals
d. All of the above are true.

d. All of the above are true.

Sources of ethical dilemmas include ____.
a. values
b. diversity
c. political views
d. All of the above are true.

d. All of the above are true.

Inappropriate communication with patients could involve all of the following ethical issues except ____.
a. autonomy
b. betrayal
c. pragmatism
d. nonmaleficense

c. pragmatism

Legislative issues could impact the following ethical issues ___.
a. boundary violations
b. betrayal
c. code of ethics
d. rationalization
e. a, b, and c
f. a, c, and d

f. a, c, and d

You have just witnessed an incident where a patient could have been harmed by the care of another nurse. The type of ethical dilemma you are facing is a ____.
a. boundary crossing
b. nurse-nurse ethical dilemma
c. whistle-blowing
d. nurse-patient ethical

b. nurse-nurse ethical dilemma

All of the following are examples situations that could lead to nurse-patient ethical dilemmas except ____.
a. pain management
b. patient restraint
c. patient privacy
d. All of the above are true.

d. All of the above are true.

Practice breakdown is ____.
a. disruption or absence of any of the aspects of good practice
b. brief excursions from an established boundary for a therapeutic purpose
c. a process that obscures the ethical dimensions of a decision
d. when a person knows w

a. disruption or absence of any of the aspects of good practice

All of the following are true about evolution of interdisciplinary teams except ____.
a. Digital technology has helped to create the demand for interdisciplinary teams.
b. The complexity-based biopsychosocial model lends itself to health along a continuum

c. The physician is always the team leader and therefore guides the team.

Elements essential for viable team construction are___.
a. purpose
b. goals
c. roles
d. relationships
e. activities and functions
f. a, b, and d
g. All of the above are true.

g. All of the above are true.

The purpose for creating teams is all of the following except ___.
a. to provide a general framework for care delivery
b. to advance the capacity of professionals to fully engage particular planning activities
c. to guide problem solving in a way that add

d. To make staffing ratios easier to calculate

The following is true about goals _____.
a. they give the team clear and specific direction
b. they create a point of reference where teams can evaluate their progress and determine movement toward completion
c. they are generally frowned upon by hospital

e. A, b, and d are correct.

The following is information to be gathered by the team leader prior to assigning roles _____.
a. discerning the character of the work
b. discerning the distribution of the work
c. determining the best way to break down elements of the work into meaningfu

d. All of the above are true.

The following elements need to be included in the assignment of work ___.
a. individuals charged with responsibility for a particular goal need to be clear about the specifics and the expectations.
b. members working on an activity need to be clear about

e. A, b, and d are correct.

All of the following are team fables except ____.
a. team members are not always committed to implementing a good team process
b. all team members are created equal
c. team members generally use good critical thinking to resolve their questions and issues

a. team members are not always committed to implementing a good team process

Team progress related response strategies that the team leader could initiate within the team process are all of the following except ____.
a. reaffirm specific goals and activities that were identified as essential to the team's progress toward fulfillme

d. All of the above are true.

Collaboration ___.
a. is the essential central methodology through which the diverse team stakeholders
work
b. advances the interactions that define the team's response to patient needs
c. advances the team's competence in serving their population well
d.

e. All of the above are true.

Setting the table means ___.
a. knowing how all the decisions need to be served
b. making all of the decisions for the team
c. selecting team members based solely on how well they work together
d. limiting the diversity of the group

a. knowing how all the decisions need to be served

Terms of engagement contain all of the following elements except ____.
a. each member of the team will have an opportunity to speak
b. avoid the use of judgment terms, such as "I agree" or "I disagree"
c. team members should never use "I" statements
d. th

c. team members should never use "I" statements

Major factors that are critical to the effectiveness of the team leader's role relate specifically to ____.
a. the adequate structuring of the team
b. the type of health care setting
c. the use of good process
d. the progress of the team toward its goals

e. a, c, and d

The impact of technology on the team process means that ____.
a. communications become available to team members more quickly
b. communication may be more succinct
c. body language and emotions are not available to factor in with electronic communication

d. All of the above are true.

All of the following are team fables except ____.
a. team members usually do not use good critical thinking to resolve their questions and issues
b. each team member fully understands why they act the way they do
c. people always want to work with others

a. team members usually do not use good critical thinking to resolve their questions and issues

All of the following are true about the team leader and their role except ___.
a. It is the role of the team leader to both monitor and moderate the effect of progress and challenges to an effective team dynamic.
b. The team leader must not be overwhelmed

d. The leader should never point out signs of progress until a goal is totally achieved.

Major resources in a healthcare organization include ____.
a. fiscal support
b. physical setting
c. supplies
d. technology
e. All of the above.

e. All of the above.

Healthcare economics is ___.
a. a branch of economics focused on efficiency, effectiveness, and behavior in production and consumption of healthcare goods and services.
b. the study and science of how human needs are perceived in relationship to what supp

d. a and b

All of the following are true about price except ____.
a. It is based on available dollars and the need for a good or service.
b. Prices are considered from the perspective of actual costs of services.
c. The seller of goods does not determine the price f

c. The seller of goods does not determine the price for the goods.

Supply of healthcare goods and services includes ___.
a. people
b. supplies
c. technology
d. time
f. funds to pay for services
g. All of the above.

g. All of the above.

Material supply levels are impacted by ___.
a. types of services provided
b. available staff
c. access to supplies
d. cost of supplies
e. a, c, and d
f. All of the above

e. a, c, and d

The process of recruiting nurses ___.
a. involves identifying and selecting individuals who closely match the needs of the unit and organization
b. involves defining or anticipating needs for services
c. includes advertising, interviewing, selecting, and

d. All of the above are true.

Insured individuals include ____.
a. those with employer-sponsored health plans
b. older citizens
c. military
d. illegal aliens
e. a, b, and c

e. a, b, and c

The following is not true about material resources ___.
a. Material resources include those resources needed for the environment and supplies and equipment to provide the required patient care.
b. There is significant variation in material resources and c

c. Material resources comprise a small percentage of the cost of health care.

The following are strategies for assessing one's time management ___.
a. Determine what your personal abilities are in managing your work across s span of time.
b. Take into consideration both your own personal assessment and the feedback from others on y

d. All of the above are true.

The following are true about productivity ____.
a. It is a ratio comparing what is produced to what is required to produce it.
b. It is a measure of output from a production process, per unit of input.
c. Aggregate productivity ratios are helpful in deter

d. All of the above are true.

Examples of productivity metrics include___.
a. registered nurse hours/day
b. admissions, discharges, and transfers/shift
c. new staff orientation hours/ total worked hours
d. All of the above are true.

d. All of the above are true.

A balance sheet is ___.
a. a financial statement that includes assets, liabilities, and equity.
b. a financial statement that includes information about revenue sources and expenses at a specific point in time.
c. a financial report that shows the cash in

a. a financial statement that includes assets, liabilities, and equity.

Cash flow operating activities is ______.
a. a financial statement that includes assets, liabilities, and equity.
b. a financial statement that includes information about revenue sources and expenses at a specific point in time.
c. a financial report that

c. a financial report that shows the cash inflow and outflow activities of financial stability of the organization.

Criteria for assessing and monitoring meaningful measures includes ____.
a. Prioritize consumer and purchaser needs.
b. Focus measurement on areas where there is a potential for improvement in outcome quality.
c. Require that all patients fitting clinical

e. All of the above is true.

Dashboards are ___.
a. a combination of graphics and numbers to quickly display important data elements.
b. a discrepancy between needs and resources.
c. financial statements that include information about revenue sources.
d. a way to chart medications gi

a. a combination of graphics and numbers to quickly display important data elements.

Structure in the healthcare system that best supports healthcare leadership is ____.
a. resource-effective
b. timely
c. value-based
d. works to advance the mission and vision of the healthcare system
e. All of the above are true.

e. All of the above are true.

Complex adaptive systems theory ____.
a. is grounded in work generating out of biology, mathematics, physics, and complexity science
b. as applied to human behavior is represented in the study of a number of different approaches to understanding the relat

c. Both are true.

All of the following fall within the realm of complexity science except ___.
a. behavioral economics
b. linguistics
c. gaming theory
d. nonlinear dynamics

b. linguistics

Of the following statements ____ is true.
a. Optimization in the system is a reflection of the strong goodness of fit between the human organizational dynamics and the technological functional processes that comprise the overall structure of the work envi

a. Optimization in the system is a reflection of the strong goodness of fit between the human organizational dynamics and the technological functional processes that comprise the overall structure of the work environment.

In complex adaptive systems, power is ____.
a. located in the formal structure.
b. closely-aligned with the point-of-care decision making.
c. Both of the above are true.
d. Neither of the above is true.

b. closely-aligned with the point-of-care decision making.

Individuals at the point of service will need to be ___.
a. more self-directed
b. more collaborative
c. more reliant on management
d. a and b

d. a and b

Significant shifts underway in health care include ___.
a. Tertiary care is slowly being deconstructed.
b. Digital technology is making it possible to create an increasingly portable diagnostic, therapeutic, and interventional environment making it increa

e. All of the above are true.

Critical influences that are creating shifts in health care include all of the following except ___.
a. Change forces are usually just seen on a local level.
b. The financial model now reflects a strong emphasis on value rather than the volume.
c. Focus o

a. Change forces are usually just seen on a local level.

All of the following are true about a shift to the health model except ___.
a. The health model requires a network.
b. A preventive health service structure is key.
c. Patients must access services earlier.
d. Patients are seen only when ill.

d. Patients are seen only when ill.

The foundations of shared governance include ___.
a. ownership
b. accountability
c. vertical structures
d. partnership
e. equity
f. a, b, and c
g. a, b, d, and e

g. a, b, d, and e

Reasons why shared governance organizational structure operates effectively in complex adaptive systems like the healthcare environment include ___.
a. The sustainability of healthcare services fully depends on how the point-of-service professionals funct

d. All of the above are true.

For complex adaptive systems to thrive, the following principles must operate ___.
a. The whole is never greater than the parts.
b. A problem in one part of the system ultimately affects the whole system.
c. All disciplines serve the user and/or serve som

f. b, c, and d

For a system to be effective the following considerations must be addressed ___.
a. Complex adaptive system providers are integrated in a collaborative and linked relationship that synthesizes well around the needs of the user.
b. The primary driving poin

e. All of the above are true.

All of the following are true about accountability in shared governance except ___.
a. Accountability drives the work of professionals.
b. Accountability is the foundation for all knowledge work performance.
c. Every member of a complex adaptive system ha

e. All of the above are true.

The role of management in shared governance is ___.
a. stewardship
b. unilateral decision making
c. servant leadership
d. assure seamless interface between the system's purpose and resources
e. a and c
f. a, c, and d

f. a, c, and d

Nursing is ____.
a. a scientific process founded on a professional body of knowledge.
b. a learned profession based on an understanding of the human condition across the lifespan.
c. an art dedicated to caring for others.
d. a dynamic discipline that incr

e. All of the above are true.

Transition to nursing practice is sometimes difficult because ____.
a. an adequate support system for new graduates may not be in place.
b. subtle hazing may occur to a new employee.
c. new ideas they present are quickly dismissed and discouraged.
d. a an

e. All of the above are true.

Settings where nursing opportunities may be found include all of the following except ___.
a. healthcare organizations
b. community centers
c. outpatient settings
d. insurance industry
e. All of the above are true.

e. All of the above are true.

The novice to expert skill acquisition model for nursing was developed by ___.
a. Pat Benner
b. Florence Nightingale
c. Madeline Leininger
d. Dorothea Orem

a. Pat Benner

The underlying reasons for advancing to management and leadership positions are ____.
a. the desire to advance quality practices
b. to advance excellence
c. because of a dislike for the clinical role
d. to introduce new ideas for a better work environment

e. a, b, and d

Informatics and related technology include ___.
a. researching new medications
b. designing complex documentation and monitoring systems
c. electronic monitoring of patients from remote locations
d. a and b
e. b and c
f. All of the above are true.

e. b and c

Applying for a new position leads to the following changes ___.
a. It changes the individuals you socialize with.
b. It changes your abilities to manage policies and practices.
c. It changes your salary and benefits.
d. It changes your work location.
e. A

e. All of the above are true.

Maintaining one's competence as a professional nurse includes ___.
a. role
b. licensure
c. technology
d. completing a graduate degree
e. a, b, and c
f. All of the above is true.

e. a, b, and c

The multistate licensure ___.
a. allows a nurse to have one license in a primary state of residence and be able to practice in other states with multistate statutes.
b. increases the cost of licensure fees when nurses practice in more than one state.
c. i

e. a and c are true.

Challenges with technology include ____.
a. computer and technology competency
b. identification of the boundaries between employer and personal electronic products
c. use of social media
d. All of the above are true.

d. All of the above are true.

All of the following are examples of elements of a professional nurse portfolio except ____.
a. continuing education records
b. attendance record
c. committee contributions
d. contributions to the community

b. attendance record

Nurses are encouraged to avoid relationships in which individuals are known to have the following characteristics ____.
a. bully and harass others
b. engage in routine gossip
c. be unreliable and need constant reminders to complete work
d. All of the abov

d. All of the above should be avoided.

Strategies to enhance personal balance include ____.
a. minimizing negative thoughts
b. specific time for reflection and planning for the future
c. being mindful of self within or after professional practice situations
d. stress management
e. All of the a

e. All of the above are helpful.

A coach is ___.
a. a wise and trusted advisor who guides others on a particular journey.
b. one who assists others to develop viable solutions, prioritize them, and then act on them.
c. a unit manager or leader.
d. None of the above.

b. one who assists others to develop viable solutions, prioritize them, and then act on them.

Mentors and coaches address ___ with the mentored nurse.
a. professional role behaviors
b. appearance
c. attitude
d. conflict management
e. All of the above are true.

e. All of the above are true.

The study of healthcare policies includes ___.
a. national or state legislation initiatives and processes
b. organizational policies necessary for order and progress
c. external agencies
d. All of the above are true.

d. All of the above are true.

The Federal Register is ___.
a. a policy that refers to rules that govern the workplace
b. the official daily publication for rules, proposed rules, and notices of the federal government and an unbiased source of information
c. a document that regulates n

b. the official daily publication for rules, proposed rules, and notices of the federal government and an unbiased source of information

Social policy is ___.
a. policy intended to enhance public welfare
b. laws passed by the legislature
c. policies that are authoritative rulings related to those decisions made by government
d. policy directed toward promoting the health of citizens

a. policy intended to enhance public welfare

<p>The provision of tangible recognition of professional achievement in a defined functional or clinical area of nursing is ___.</p>
<p>a. the state nurse practice act</p>
<p>b. nursing certification</p>
<p>c. nursing licensure</p>
<p>d. none of the above

b. nursing certification

<p>Policies that are authoritative rulings relating to those decisions made by government are ___.</p>
<p>a. social policy</p>
<p>b. organizational policy</p>
<p>c. public policy</p>
<p>d. institutional policies</p>

c. public policy

<p>Organizations providing healthcare services are required to have policies specific to ___.</p>
<p>a. provider roles</p>
<p>b. patient care procedures</p>
<p>c. safety practices</p>
<p>d. equipment management</p>
<p>e. staffing and scheduling</p>
<p>f.

f. All of the above.

<p>Policies are generated from ___.</p>
<p>a. state legislatures</p>
<p>b. state agencies authorized by legislation</p>
<p>c. state professional associations</p>
<p>d. All of the above.</p>

d. All of the above.

<p>The federal statute enacted in March 2010 that was designed to ensure that all Americans have access to health care is ___.</p>
<p>a. the Patient Protection and Affordable Care Act</p>
<p>b. the Future of Nursing: Leading Change, Advancing Health</p>
<

a. the Patient Protection and Affordable Care Act

<p>The committee of Future of Nursing: Leading Change, Advancing Health developed the following key messages ___.</p>
<p>a. Nurses should practice to the full extent of their education and training.</p>
<p>b. Nurses should achieve higher levels of educati

d. a and b

<p> The law passed in 1996 which focused on the patient's right to confidentiality and the improvement of the portability and continuity of health insurance coverage is ___.</p>
<p>a. the Good Samaritan Law</p>
<p>b. the Health Insurance Portability and A

b. the Health Insurance Portability and Accountability Act

<p>Activities which all nurses should embrace as they become more involved in the profession include ___.</p>
<p> </p>
<p>a. becoming competent in the processed of policy development and the differing approaches that are effective at the local, state, and

e. All of the above are true.

<p>Considerations in being "media ready" include ___.</p>
<p>a. practicing with internal public relations staff</p>
<p>b. avoiding off-the-record comments</p>
<p>c. defining key messages and staying on message</p>
<p>d. All of the above.</p>

d. All of the above.

<p>The agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care in the U.S. is ___.</p>
<p>a. the Agency for Healthcare Research and Quality</p>
<p>b. the Commonwealth Fund</p>
<p>c. the Institute of Medicine</p

a. the Agency for Healthcare Research and Quality

<p>The Institute of Medicine is ___.</p>
<p>a. an organization that serves to promote health care that emphasizes access, quality, and greater efficiency, particularly for society's most vulnerable people</p>
<p>b. a non-profit organization that works out

b. a non-profit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public

<p>The following is true about the APRN role ___.</p>
<p>a. there is currently no uniform model of regulation across the states</p>
<p>b. each state independently determines the APRN legal scope of practice</p>
<p>c. education, accreditation, certificatio

d. All of the above are true.

<p>Delegation is ___.</p>
<p>a. required whenever there is a hierarchal order of individuals working together to accomplish goals.</p>
<p>b. both a management and a legal concept.</p>
<p>c. discussed in terms of authority, responsibility, and accountabili

d. All of the above are true.

<p>Autonomy is all of the following except ____.</p>
<p>a. the power to do a job.</p>
<p>b. the right to do a job.</p>
<p>c. embedded in a job description.</p>
<p>d. is identified within the expectation for specific work.</p>

b. the right to do a job.

<p>All of the following are true about accountability except___.</p>
<p>a. It is being answerable for actions or inactions of self or others.</p>
<p>b. It is the obligation to account for or explain the events.</p>
<p>c. There is individual accountability

d. It describes the distribution of work that each staff member is to accomplish in a given period of time.

<p>Critical thinking takes ___ into consideration when deciding what to believe or do.</p>
<p>a. focus</p>
<p>b. reasoning</p>
<p>c. assignments</p>
<p>d. implications</p>
<p>e. a, b, and d</p>
<p>f. All of the above are true.</p>

e. a, b, and d

Decision making ___.
a. is a complex cognitive process.
b. involves choosing a particular course of actions from among alternatives.
c. is an essential component of the problem-solving process.
d. All of the above are true.

d. All of the above are true.

Supervision ___.
a. is the provision of guidance or direction, evaluation, and follow-up by the delegator for accomplishment of a task delegated to another.
b. is to watch over a particular activity or task being carried out by people and ensure that it i

d. a and b

The delegator is responsible for all of the following except ____.
a. accepting only those tasks or assignments for which he or she is qualified.
b. assessment of the situation.
c. ascertaining the competence of the delegate.
d. follow-up supervision.
e.

a. accepting only those tasks or assignments for which he or she is qualified.

Step one of the basic actions in delegation is assessing the patient or client, the situation, and the appropriateness for delegation. Important considerations within this step are ___.
a. Knowing your personal delegation strengths and weaknesses as well

d. All of the above are considerations.

The following is true__.
a. Physicians cannot delegate physician work to nurses.
b. Physicians can delegate physician work to nurses.
c. If the activity or task is not within the nurse's scope of practice, it can be delegated by the nurse.
d. Delegation i

a. Physicians cannot delegate physician work to nurses.

Step three in the delegation process is planning for the work to occur. The following are steps which provide guidelines for preparing with the delegate ____.
a. Clearly identify the work that needs to be done.
b. Clearly identify the importance of reques

e. All of the above are steps.

The following is not true ___.
a. The nurse is accountable for selection and delegation of tasks to the delegate.
b. The delegator is responsible for the actual work of the delegate.
c. The delegate is fully responsible for his or her work.
d. The delegat

b. The delegator is responsible for the actual work of the delegate.

The delegation can be improper if any of the five rights are violated. These include ___.
a. right task
b. right patient
c. right circumstance
d. right directions
e. right supervision
f. All of these are rights.

f. All of these are rights.

Underdelegation is when __.
a. not enough work is delegated.
b. the workload is beyond what the delegate can reasonably do in the assigned time.
c. the delegator is constantly looking over the shoulders of those asked to do the work.
d. any of the five ri

a. not enough work is delegated.

<p>The following are strategies to support effective delegation ___.</p>
<p>a. Clearly identify the importance of requesting assistance when needed.</p>
<p>b. Gain an understanding of personal delegation competence.</p>
<p>c. Provide feedback on tasks acc

e. b and d

All of the following are principles of delegation from the ANA or NCSBN website except ___.
a. delegation to competent individuals.
b. care coordination and the use of assistants in providing patient care.
c. ensuring the integrity of the physical plant.

c. ensuring the integrity of the physical plant.

All of the following are true about negotiation except ___.
a. Effective negotiation is a skill one is born with.
b. Negotiation is learned through the process of discipline and application.
c. Much of the skill and talent necessary to negotiate well can

a. Effective negotiation is a skill one is born with.

An essential characteristic of negotiation is ___.
a. Win-lose
b. Win-win
c. Lose-lose
d. None of the above.

a. Win-lose

Core skills that must be developed and refines in order to assure successful negotiation include(s) ___.
a. It is important that the individual can discern, identify, and declare specific goals for which the risk of negotiation is worth undertaking.
b. Th

d. All of the above are true.

The following are phases of negotiation ___.
a. readying for negotiation
b. establishing the framework for negotiation
c. intensive interaction
d. bargaining
e. closing the interaction
f. a and c
g. All of the above.

g. All of the above.

All of the following are elements of readying for negotiation except ___.
a. understanding the issues at the table
b. determining the personal bottom line
c. understanding the bottom line of each participant
d. practicing the approach to the interaction
e

e. determining how to defeat the opponent

Establishing the framework for the negotiation and the terms of the engagement satisfies the goals of ___.
a. providing a structured and positive environment as the negotiation requires
b. allowing the parties to more clearly establish expectations with r

d. All of the above are true.

The following is a major element of the role of dialogue ___.
a. have limited breaks
b. negative language is acceptable
c. establish rules of speaking without interruption
d. remind the parties of prior failures

c. establish rules of speaking without interruption

The following is true about negotiation sessions ___.
a. each session stands on its own merits and reflects only the activities that occurred within that session
b. subsequent sessions always build on previous sessions
c. early agreements on particular is

d. All of the above were true.

The leader completely orchestrates and manages ____ associated with the negotiation.
a. the atmosphere
b. the discussions
c. the space
d. the processes
e. a, c, and d
f. All of the above are true.

e. a, c, and d

Nonverbal signs the leader must be able to read include ___.
a. body language
b. gestures
c. eye movements
d. facial expressions
e. All of the above are true.

e. All of the above are true.

The following are included in the guidelines for interaction in negotiation ___.
a. never say "never"
b. make many concessions early in the negotiations
c. do listen carefully to all parties
d. a and c
e. All of the above are true.

d. a and c

Bargaining is ___.
a. the phase of negotiation that emphasizes the give and take related to the variety of positions at the table
b. the work of exchange
c. initiates the serious give and take necessary to determine which legitimate positions emerge and t

d. All of the above are true.

At the closure of negotiations the following should have occurred ___.
a. new positions should be clarified and well-defined
b. trade-offs noted
c. bargaining trades clearly articulated
d. both sides dissatisfied with the results
e. a, b, and c
f. All of

e. a, b, and c

Collective bargaining is protected by ___.
a. the Department of Commerce
b. the Nation al Labor Relations Act
c. the Taft-Hartley Act
d. Public Law 93-360
e. a and b
f. b, c, and d
g. All of the above.

f. b, c, and d

<p>Collective bargaining agreements include all of the following except ___.</p>
<p>a. salaries</p>
<p>b. benefits</p>
<p>c. working conditions</p>
<p>d. health care costs</p>

d. health care costs

The obligation for social accountability represents the social contract between the society that licenses the profession and ___.
a. those who practice a profession
b. the persons who act in the best interests of the society
c. employees of a healthcare i

b. the persons who act in the best interests of the society

The debate related to nursing as a profession relates to ___.
a. the predominant level of minimum education of the majority of the profession
b. its dependency role in relationship to other disciplines
c. its lack of clarity with regard to its specific co

f. All of the above are true.

Issues related to the development of professionalism in the 20th century include ___.
a. political equity of women
b. changes in women's role expectations
c. advances in women's educational opportunities
d. All of the above are true.

d. All of the above are true.

Responsibility ___.
a. is embedded in work
b. sees the individual from the perspective of the work
c. assumes some level of intensity of the individual and any investment and ownership of the role, tasks, and activities
d. a and b
e. All of the above are

d. a and b

For professionals ____ is the definitive foundation for work.
a. accountability
b. responsibility
c. competence
d. functionalism

a. accountability

Performance evaluations review the worker within the context of the capacity to function and ___.
a. the ability to do the work
b. the ability to get the job done
c. the ability to get along with others who are doing their jobs
d. All of the above are tru

d. All of the above are true.

The following is true ---.
a. The relationship between the individual and the workplace unfolds through the lens of job categorization.
b. The job is the contextual framework for the relationship between the individual and the workplace.
c. Creating a job

d. All of the above are true.

Leadership must create an organizational context that doesn't impede membership and ownership of the work. For this to happen, the following circumstances and conditions need to be present: ___.
a. Professional ownership implies that the ownership of the

d. All of the above are true.

Critical elements of professional ownership include ___.
a. The individual nurse values his or her specific gifts, talents, and skills and agrees to commit to the full application of them in undertaking the work of the profession.
b. The individual profes

d. All of the above are true.

The following is true about teams ___.
a. Teams can't be constructed simply because people want to meet or work together.
b. Teams are purposeful.
c. Accountable teams are relational bodies.
d. The work of teams is the sum total of its members contributio

f. All of the above are true.

Job descriptions ___.
a. have been used historically as a vehicle for delineating role functions, tasks, and activities of the nurse.
b. do not always match the dynamic nature of the work of nursing.
c. are written so that they fit all possibilities in th

d. a and b

The primary point of accountability is ___.
a. to be responsible for a stated task.
b. to be able to demonstrate impact and results.
c. to achieve long-term viability.
d. b and c

d. b and c

Value is about ___.
a. doing the right work rather than doing a good job
b. work that is informed by purpose
c. the product of a measured and defined relationship between effective process and meaningful outcome
d. All of the above are true.

d. All of the above are true.

Risk is ___.
a. a sign of the continuous and dynamic reach of the human experience in new directions in new ways
b. exploring new territory in a way that advances the human experience and improves it in important ways
c. to be avoided in the healthcare ar

e. a, b, and d

The central characteristics of accountability that are nonnegotiable for the profession represent the following principles ___.
a. Accountability generally reflects the individual professional commitment to performance and to action.
b. Accountability dem

d. All of the above are true.

The role of the leader in an era of change is ___.
a. helping the staff to anticipate change
b. translate change into a language that colleagues can understand
c. actively engage in change
d. All of the above are true.

d. All of the above are true.

Healthcare reform involves ___.
a. move from a volume service framework to a value-driven model
b. a change to user-driven healthcare service
c. increasing the use of digital technology
d. decreasing the number of people on Medicare
e. a, b, and c
f. All

e. a, b, and c

The following is true about conflict and conflict management ___.
a. Principles of conflict management are essential to navigating the landscape of transformation and change.
b. Conflict is a normative dynamic.
c. A good conflict process includes identify

e. All of the above are true.

Accountability is ___.
a. the cornerstone of professional expression
b. the same as responsibility
c. to be avoided by professionals
d. All of the above are true.

a. the cornerstone of professional expression

Accountability needs ____ for it to be expressed.
a. autonomy
b. responsibility
c. authority
d. competence
e. a, b, and c
f. a, c, and d

f. a, c, and d

All of the following are true about accountability except ___.
a. Accountability can be delegated.
b. Accountability is invested in individuals, not group.
c. Accountability is about the products of work, not the processes of work.
d. Accountability impli

a. Accountability can be delegated.

All of the following are essentials that evidence a good fit between supporting infrastructure and the capacity for sustainable professional practice except ___.
a. Professionals organize around decisions, not positions.
b. Decisions are never driven from

b. Decisions are never driven from the point of service.

Issues that impact ethics in health care include ___.
a. the values of the patient
b. the values of the caregivers
c. errors in the clinical setting
d. moral courage
e. All of the above are true.

e. All of the above are true.

Approaches to staffing decisions include ___.
a. nurse-patient ratios
b. patient classification systems
c. legislative requirements
d. different skill levels
e. All of the above are true.

e. All of the above are true.

The following is not true about change ___.
a. Learning how to thrive in the presence of continual change requires both art and science in the healthcare environment.
b. All change is urgent.
c. Not all change is value laden.
d. Some good ideas just don't

b. All change is urgent.

Policy making takes place ___.
a. at the national level.
b. at the state level
c. at the local level
d. within agencies
e. All of the above is true.

e. All of the above is true.

Nurses should know ___.
a. the source of healthcare policies
b. the content of healthcare policies
c. the consequences of healthcare policies
d. the role of the professional in providing feedback to policy makers when policies are no longer effective
e. A

e. All of the above is true.

Effective delegation ___.
a. distributes the workload equitably
b. distributes the workload effectively
c. enhances collaboration with other healthcare providers
d. All of the above is true.

d. All of the above is true.

Nursing career management includes all of the following except ___.
a. maintaining a current license
b. maintaining continuing competence
c. participating in professional organizations
d. exploring alternative careers

d. exploring alternative careers

Knowledge workers (professionals) ___.
a. a need a very specific organizational context in order to facilitate good practice and positive outcomes
b. are intrinsically motivated
c. see their work as more than simply a job
d. a and b
e. All of the above ar

e. All of the above are true.

STEEEP

6 IOM quality aims
Safe
Timely
Effective
Efficient
Equitable
Patient-Centered

Clinical Microsystem

smallest system; building blocks of healthcare; patient + caregivers; produce quality, safety, & costs outcomes; ex: medicine unit, surgical unit, oncology unit, OR, cardiac cath lab, pharmacy, radiology dept.

mesosystem

collection of interrelated microsystem (linked clinical and supporting microsystems); collaboration to achieve desired patient outcomes; information flows forward and backward; regulatory systems

9 success characteristics

clinical microsystem leadership, culture, organizational support
process improvement; performance patterns
patient focus, staff focus, interdependence of care team
information and information technology

macrosystem

comprised of interdependent micro- and mesosystems; ex: hospitals, integrated healthcare systems

environment

geography, market, political jurisdiction, regulatory and legislative requirements, biomedical knowledge and technology

effective communication

transfer of information and understanding from one person to another; timely, accurate, complete, unambiguous, & understood by the recipient: reduces error, and results in improved patient safety

group

number of individuals assembled together and have some unifying relationship

primary group

informal; consists of people who share a common bond; evolves naturally from social interactions; usually has no written rules for membership; can begin or end at any point

secondary group

formal; held together with formal rules and regulations; has procedures for maintenance of the group and association policies; meets fro an organized purpose, for a specific project for a specific time frame

team

small number of people with complementary skills who are committed to a common purpose or goal; have a set of performance goals and approaches for which they hold themselves mutually accountable; membership is based on specific skills required to accompli

committee

work group with a specific task or goal to accomplish s defined by the organization; a group formed to assist an organization with communication and decision making

ad hoc committee

temporary; dissolves once issue is resolved

standing committee

organization; such as recruiting and retention committee

stages of group and team development

1. forming: orientation; team aquaints and establishes team rules
2. storming: conflict; members resist control by group leaders and show hostility
3. norming: cohesion; members work together developing close relationships ad feeling so comaraderie
4. per

team structure

delineates fundamentals such as team size, membership, leadership, composition, identification and distribution

leadership

ability to coordinate the activities of team members by ensuring team actions are understood, changes in information are shared, and that team members have the necessary resources

situation monitoring

process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team

mutual support

ability to anticipate and support other team members' need through accurate knowledge about their responsibilities and workload

communication

process by which information is clearly and accurately exchanged among team members

brief

short session prior to start to discuss team formation; assign essential roles; establish expectations and climate; anticipate outcomes and likely contingencies

huddle

ad hoc planning to reestablish situation awareness; reinforcing plans already in place; and assessing the need to adjust the plan

debrief

informal information exchange session designed to improve team performance and effectiveness; after action review

situation awareness

knowing what is going on around you

STEP

Status of the patient
Team members
Environment
Progress toward goal

feedback

information provided for the purpose of improving team performance; should be timely, respectful, specific, directed towards improvement, and considerate

CUS

I am Concerned
I am Uncomfortable
This is a Safety issue

DESC script

constructive approach for managing and resolving conflict
Describe the specific situation or behavior; provide concrete data
Express how the situation makes you feel/what your concerns are
Suggest other alternatives and seek agreement
Consequences should

SBAR

situation
background
assessment
recommendation (by you)

call-out

strategy used to communicate important or critical information

check-back

process of employing closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended

leadership

process of influence whereby the leader influences others toward goal achievement

management

process of coordinating action and allocating resources to achieve organizational goals

Veterans (66+yrs)

conservative, loyal to the organization and authority, reluctant to use technology

Boomers (47-65 yrs)

idealistic, hard-working, dedicated, value promotions, position & title; see Gen X as the "wild generation" without a sense of social commitment

Gen X (32-48yrs)

seek balance between work and family, realistic, team-oriented, advanced technology skills, work independently & seek work experiences where they apply their ability & expertise; see Boomers as domineering

Gen Y (16-31yrs)

dynamic, confident, straight-forward and opinionated, "Linked" generation

Leadership

process of influence whereby the leader influences others toward goal achievement--leaders motivate and enliven

Management

process of coordinating actions and allocating resources to achieve organizational goals

trait theory of

leaders have a certain set of physical and emotional characteristics that are crucial for inspiring others toward a common goal; some theorist believe that traits are innate and cannot be learned others believe they can be developed

Style theories

Autocratic: dictator
Democratic: majority will be listened to but may not rule
Laissez-Faire: hands-off

Contingency (Situational) theories

leader adjusts based on situation and individual

Scientific Management

all about production; based on the idea that there is one best way to accomplish as task

Bureaucratic management

rules and policies to abide by, specific roles, hierarchy, top=boss; bottom=workers

Human relations

more workers involvement in management; derived from motivation theories

motivation theories

motivation is a process that occurs internally to influence and direct a person's behavior in order to satisfy his or her needs; but environment can be created to motivated someone

Maslow's hierarchy

People are motivated by a hierarchy of human needs, beginning with physiologic needs and then progressing to safety, social, esteem, and self-actualizing needs. In this theory, when the need for food, water, air, and other life-sustaining elements is met,

Hertzberg's Two Factor

Hygiene factors, such as working conditions, salary, status, and security, motivate workers by meeting safety and security needs and avoiding job dissatisfaction. Motivator factors, such as achievement, recognition, and the satisfaction of the work itself

McGregor's X & Y

X-workers have to be constantly supervised
Y-workers see work as equal to rest and extra curricular activities

Equity Theory

work has to be equitable to motivate; inequity will lead to job dissatisfaction

Transformational Leader

identifies common values; is committed; inspires others with vision; has long-term vision; looks at effects; empowers others

transactional leader

focuses on management tasks; is a caretaker; uses trade-offs to meet goals; does not identify shared values; examines causes; uses contingency reward

servant leadership

serves the workers and uses that to get job done; undying loyalty of their workers

Emotional Intelligence

Monitoring emotions in a situation to guide actions and inform thought processes

Mission Statement of organization

a formal expression of the purpose or reason for existence of the organization