Authoritative Leader
Makes decisions for the group
motivates by coercion
Effective for employees with little or no formal education
Democratic Leader
Includes the group when decisions are made
motivates by supporting staff achievements
Laissez-Faire
Makes few decisions and does little planning
motivation largely the responsibility of staff
Effective with professional employees
Characteristics of Leaders
initiative
inspirational
energetic
positive attitude
good communication skills
respect
problem-solving and critical thinking
Transformational leaders
empower followers to assume responsibility for a communal vision , and personal development in a secondary outcome
good in a lower level of staff
Transactional leaders
focus on immediate problems maintaining the status quo and using rewards to motivate followers
Emotional Intelligence
ability of an individual to perceive and manage the emotions of self and others
Emotionally Intelligent Leaders
has insight into emotions of members of the team
understands the perspective of others
is able to maintain focus while multitasking
Management functions
planning
organizing
staffing
direction
controlling
Planning
What will be done
organizing
determines the lines of authority, channels of communication and where decision are made
staffing
who will do it
directing
manager/delegator
controlling
regulation/evaluation
Characteristics of Managers
hold formal positions
possess clinical expertise
network with members of the team
coach subordinates
make decisions
Critical thinking
analyzing the clients issues and problems
Prioritization Principles in Client Care
Systemic before local
acute before chronic
Actual problems before potential
listen to patients and do not assume
trends before transient findings
medical emergencies and complications before expected findings
Maslow's Hierarchy
Bottom to Top
Physiological
safety and security
love and belonging
self-esteem
self-actualization
ABC's & D E
Airway
Breathing
Circulation
Disability
Exposure
Survival Potential
Mass Casualty/Disaster Triage
priority goes to the clients who have a reasonable chance of survival with prompt interventions. The lowest priority goes to patients who have a small chance or surviving or need large amounts of resources
Assigning
process of transferring the authority, accountability, and responsibility of client care to another member of the team
delegating
transferring the authority and responsibility to another team member to complete a task but retainting the accountability
supervising
process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team
Nursing Role in Client Rights
ensure clients understands their rights
Basic Client rights
be informed about all aspects of care and take an active role in the decision-making process
accept, refuse, or request modification to the plan of care
receive care that is delivered by competent individuals who treat the client with respect
Refusal of Treatment
if patient refuses have them sign a paper saying they understand the risks of refusing
The Patient Self-Determination Act
stipulates that on admission to a health car facility , all clients must be informed of their right to accept or refuse care.
requires that all clients admitted to a health care facility be asked if they have advance directives
AMA (against medical advise)
the nurse notifies the provider and discusses with the client the potential risk associated with leaving facility prior to discharge.
Documents the information that was provided
have patient sign AMA form
if client refuse to sign document it
Advocacy
supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care
Nursing Role in advocacy
ensure that clients are informed of their rights
assist in making decisions and not direct
mediate on the clients behalf
Informed Consent
it is only informed with the client understands:
Reason for treatment
how the treatment will benefit clients
risk involved if the client chooses to receive
other options to treat problem (including no treatment)
risk involved if the client choose no treat
Implied consent
Example: Patient needs a TB test and sticks out their arm
Individuals authorized to grant consent for another person
parent or legal guardian
court-specifed rep
clients health care surrogate
spouse or closets available relative
Nurse responsibilities of informed consent
witnesses informed consent
ensure that provider gave the client the necessary information
ensure that the client understood the information
have the client sign the informed consent
notify the provider if the client has more questions or does not understa
Documentation for informed consent (nurse)
reinforcement of information originally given by the provider
that question the client had were forwarded to the provider
use of an interpreter
Advance directives
communicate the clients wishes regarding end-of-life care should the client become unable to do so
2 Components fo advance directives
Living Will
Durable power of attorney for health care
Living Will
legal document that expresses the clients wished regarding medical treatment in event the client becomes incapacitated and is facing the end-of-live
Examples: CPR, DNI, DNR , artificial feeding
Durable power of attorney for health care
legal document that designates a health care surrogate
National Patient Safety Goals
identification of patient
effective staff communication
safe medicate use
infection prevention
safety risk identification
preventing wrong-site surgery
incivility
action that is rude , intimidating, and insulting
(teasing, joking, dirty looks, and uninvited touching)
lateral violence
horizontal abuse or horizontial hostility
occurs between individuals who are at the same level within the organization
(verbal abuse, gossip, undermining activities, sabotage )
Bullying
behavior that is persistent and relentless, aimed at an individual who has limited ability to defent themself (nurse manager to staff)
Cyberbullying
disruptive behavior using the internet or other electronic means
ethics
expected behavior of a certain group in relation to what is considered right and wrong
morals
values and beliefs held by a person that quite behavior and decision -making
Utilitarianism
decision -making based on what provides the greatest good for the greats number of individuals
deontological theory
decision -making based on obligations, duty, and what one considers to be right or wrong
Autonomy
ability of the client to make personal decisions
beneficence
care that is in the best interest of the client
Fidelity
keeping ones' promise to the client about care that was offered
justice
fair treatment in matters related to physical and psychosoical care and use of resources
utility
ethical principle in when the nurse's actions bring the most to the greatest number of people
nonmaleficence
do no harm
veracity
nurses duty to tell the truth
Death is determined by one of Two criteria
(the uniform determination of death act) (UDDA)
irreversible cessation of circulatory and respiratory functions
irreversible cessation of all functions of the entire brain , including brain stem
Root cause Analysis
use during quality control to assess why a standard is not being met
Time Management
-Organizing/Prioritizing/Delegating Care
-Safety/Facility Protocols
-Use an organizational sheet to plan care
-Document as soon as possible for accuracy and thoroughness
-Group activities to prevent walking
-Estimate activity times and plan
-Mentally envi
Supervision VS Delegation
Delegation is the transfer of authority and responsibility of a client or for the performance of an activity while accountability for the outcome is retained
** What can be delegated
-ADL's
-Vital signs
-Showers
-I&O's
**What cannot be delegated
-Nursing
5 Rights of Delegation
- Right task: Appropriate level of team member by established guidelines (Only an RN can initiate and complete a new plan of care.)
-Right circumstances: Health status of client, capability of team member and work-load of nurse (If the patient's condition
Staff Education
- Orientation - translate the knowledge, skills and attitudes learned in nursing school into practice
- Orientation to Institution - Classroom: Mission, philosophy, goals, policy and procedures, computer system, safety and security protocols
- Orientation
5 Stages of Nursing ability
Novice Nurse
Advanced Beginner
Competent Nurse
Proficient Nurse
Expert Nurse
Steps in progressive disciple
1st - informal reprimand. Manager and employee meet to discuss issue and suggestions for improvement
2nd - written warning. Manager/employee meet to review written warning, review rule/policy violations and discuss consequences
3rd - Employee placed on su
Categories of Conflict
Intrapersonal - internal struggles (desires higher job level but conflicts with family time)
Interpersonal - between 2 or more people with differing values, goals or beliefs (nurses, clients, client family, team - bullying incivility)
- Nurse is given a h
Stages of Conflict
** Latent Conflict - conflict not developed yet but causative factors present
- New scheduling policy, change is a common cause of conflict
** Perceived Conflict - problem perceived though actual conflict not present
- Nurse misunderstanding scheduling da