Short Answer Essays
-worth 15 pts.
-1: review 16 personalities / leadership styles
-2: components necessary for technology to be classified as informatics
Constitutions
-little direct involvement in the area of malpractice
Statues
-affects malpractice
Administrative agencies
-health and safety boards, Labor Relations Board affect nursing practice
Court decisions
-most malpractice laws are addressed in court
Criminal Law
- must be guilty beyond reasonable doubt, incarceration, probation, fines
Civil Law
-burden of proof based on a preponderance of evidence, monetary damages
Administrative Law
-guilty based on violation of a clear and convincing standard, suspension or loss of licensure
Joint liability
-the current position of the legal system in which nurse, physician, and employing organization are all held liable
Personal liability
-every person is responsible for his or her own conduct
-"Nurses should also purchase their own liability insurance. It will not prevent a malpractice suit but can protect a nurse from financial ruin.
5 elements that must be present for a Professional to be held Liable for Malpractice
1.
Duty to use due care
defined by standard - what a reasonably prudent nurse would have done
2.
Failure to meet standard of care
/breech of duty - not giving the care that should be given under the circumstances
3.
Forseeability of harm
- the nurse must
How to Reduce the Likelihood of Being Sued as a Nurse
-Practice within scope of Nurse Practice Act
-Observe agency policies and procedures
-Model practice after established standards using EBP
-Always put patients right and welfare first
-Be aware of law and legal doctrines and psychological and social scien
Respondent superior
-the master(hospital) is responsible for the acts of his servants(nurses)
Malpractice Elements
-
Plaintiff
- injured party (patient)
-
Defendant
- nurse
Negligence
-omission to do something that a reasonable person, guided by the considerations that ordinarily regulate human affairs, would do or as doing something that a reasonable and prudent person would not do
Malpractice
- the failure of a person with professional training to act in a reasonable and prudent manner also referred to as professional negligence
Torts
-legal wrongs committed against a person/property
-Unintentional or Intentional
Intentional Torts
-Assault, battery, false imprisonment, invasion of privacy, defamation, slander
Informed Consent
-Nurses are obligated to provide teaching and clarify information given to patients by their physicians, nurses CANNOT give new information
-Nurses are not responsible for explaining the procedure
-Nurses should advocate for the patient by determining the
Good Samaritan Law
-Nurses NOT required to stop
-Generally limited to emergencies
-Provided that actions are not grossly negligent
-Health care worker cannot exceed his training or scope of practice while performing emergency services
HIPPA
-
Administrative Simplification Plan
- simplify the digital exchange of information among HCP to improve efficiency
-
Privacy rules
- ensure strong privacy protections for patients without threatening access to care
-Impact on nursing - telephone calls, n
Daily Planning / Priority Setting
-Consider interruptions, subcomponents of a task, length of time required for tasks, unintended problems, materials necessary, other people involved.
-Without adequate planning individuals find it difficult to get started and manage by crisis.
Planning fallacies
-the optimistic hopeful attitude that even though the time allowed to carry out tasks is continually shown to be inadequate, that time will be enough for their next attempt
-Don't do, do later, do now
Time Wasters and Interventions
-Technology, Socializing, Paperwork overload, A poor filing system, Interruptions
- Interventions: do not make yourself overly accessible (don't get distracted), Interrupt (get to the point), Avoid promoting socialization, Be brief, Schedule long-winded p
Effects of Email, Internet, Telecommunication
-
Benefits
- instant communication between multiple parties, unlimited access to knowledge
-
Disadvantages
- random usage of social media sites/gaming (distraction), the need to check & respond to so many (emails, voicemail, pagers, etc), difficult to fin
Total patient care
-oldest type of care
-nurses assume total responsibility for meeting all needs of assigned patients including bathing, feeding, toileting, etc.
Functional nursing
-use of unskilled workers who have been trained to complete certain tasks rather than care for specific patients
-Care is assigned by task rather than by patient
-RNs become managers
Team nursing
-Led by an RN, a team of 2-3 people who provide total care to assigned patients
-Requires extensive team communication and regular team planning conferences
-democratic leadership
-(modular = mini team nursing)
Primary nursing
-nurse assumes 24 hour responsibility for planning the care of one or more patients from admission to discharge
-total care, high job satisfaction
-difficult to implement because of high degree of responsibility and autonomy
Case management
-collaborative process of assessment, planning, facilitation, advocacy for options and services to meet and individuals health needs through communication and available resources to promote quality cost-effective outcomes
-nurses address each patient indi
Patient Care Organization
-should be based on patient acuity not on economics alone.
-The knowledge and skill required for particular activities with specific populations should always be the true driver in determining appropriate care delivery models.
Goals of Case Management
-Decreased hospital readmissions, Decreased length of stay, Adherence to therapeutic regimens, Achievement of desired outcomes, Decreased resource use, Improved quality of life, Improved functional status, Increased patient satisfaction, Decreased symptom
Critical Competencies need for Patient Care
-Critical thinking, Collaboration/multidisciplinary relationships, Communication, Coordination, Negotiation, Leadership, Delegation, Evaluation, Conflict management
Scheduling
-should be based on existing research that correlates staffing mix, numbers of staff need and patient outcomes.
Centralized Staffing
-staffing decisions are made by personnel in a central office or staffing center
-
Advantages:
Provides organization-wide view of staffing needs, more consistent application of staffing policies, More cost effective, Frees the mid-level manager's time
-
D
Decentralized Staffing
-staffing decisions made by the unit manager or their representative
-
Advantages:
Unit manager understands needs of unit and staff, Staff feel more in control of their environment,Increased autonomy and flexibility
-
Disadvantages:
Unequal treatment or i
Flextime
- a system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities
-Greater employee choice, but difficult for managers to coordinate and could easily result in under/overstaffing
Self-scheduling
- allows nurses in a unit to work together to construct their own schedules rather than by management
-Greater employee control, not easy to implement because success depends on leadership skills of manager
For / Against Mandatory Minimum Staffing ratios in acute care hospitals
-
For
- necessary because low staffing results in negative patient outcomes and affects nurses health and safety
-
Against
- the nursing shortage makes it difficult to fill slots, "just a band-aid", numbers alone do not ensure quality patient care, increa
Veteran/Traditionalists (1925-1942)
-5% of nursing workforce, Lived through several international military conflicts and Great Depression, Risk averse, Respectful of authority, Supportive of hierarchy, Disciplined, Support status quo (Silent Generation), Seek employment in structured settin
Baby boomers (1943-1960's)
-40% of nursing workforce, Traditional work values, Materialistic, Willing to work long hours (workaholics), Caring for family members from both sides, Flexibility and autonomy in work scheduling important, Volunteer for causes, Best suited for work that
Generation X (Early 1960's -1980's)
-40% of nursing workforce, Smaller cohort, Lack interest in lifetime employment at one place, Value greater work hour flexibility and opportunities for time off, Less economically driven than boomers, Define success differently than previous generations,
Generation Y (Early 1980's - 1986)
-15% (and rapidly increasing) of the nursing workforce, First cohort of global citizens, Optimistic, self-confident, relationship oriented, Digital natives, Greater multicultural ease, Eco-awareness, Volunteer minded and social consciousness, Altruistic,
3 basic steps of time management
1. Take Time to Plan
2. Priority Settings
3. Reprioritization
The 5 Rights of Delegation
-Right Task, Right Circumstances, Right Person, Right Direction/Communication, Right Supervision
Delegating to Unlicensed AP
-Know job description, knowledge base and skills of each person
-NCSBN decision tree for delegation
-RN has ultimate responsibility for ensuring appropriate, high-quality patient care.
Common Delegation Errors
-Under-delegating, Over-delegating, Improper Delegating
Strategies for Successful Delegation
-Plan ahead, Match the task to the education and skill level of the person, Select capable people, Communicate goals clearly, Empower the delegate, Set deadlines and monitor progress, Monitor the role and provide guidance, Evaluate performance, Reward acc
Components Necessary for Technology to be classified a Informatics (short answer)
1. Clinical care
2. The Health System
3.Information and Communications Technology
Motivation
-The force within an individual that influences or directs behavior
-can be intrinsic or extrinsic
Intrinsic Motivation
-Within the person
-Can be impacted by others (Parents and Peers)
-Cultural background
-Directly related to person's level of aspiration
Extrinsic Motivation
-Outside motivators
-Enhanced by work environment
-Material rewards
Choice Theory
-states that all we do is behave, that almost all behavior is chosen, and that we are driven by our genes to satisfy five basic needs
-survival, love and belonging, power, freedom and fun
Seven Caring Habits
Supporting, encouraging, listening, accepting, trusting, respecting, and negotiating difference
Seven Deadly Habits
criticizing, blaming, complaining, nagging, threatening, punishing, bribing / reward for control
Creating a Motivating Environment
Understand employee values, Devise a reward system that is consistent, Recognize each worker as uniquely motivated and act on those differences, Generational differences, Positive reinforcement, Consistency, Predictable and spontaneous
Strategies to create a motivational environment
-Clear communicated expectations, Fair and consistent, Firm decision-making, Teamwork, Integrate team needs/wants with organizations interests/purpose, Know individual employees, Remove traditional blocks between employee and their work, Provide "stretchi
McGregor Theory X and Theory Y
includes: attitude, direction, responsibility, motivation, and creativity
Theory X: negative
Theory Y: positive ways to think about each category
McClelland's Theory
-focuses on achievement (effort over luck), affiliation (focus on relationships), and power (passion for influence)
Maslow's Hierarchy of Needs
-r/t Motivation
-must move up the pyramid of physiological needs, safety, love / belonging, esteem, and self-actualization
Communication
the exchange of thoughts, messages, or information by speech, signals, writing, or behavior.
Internal vs. External Climate of Sender and Reciever
-
Internal:
Values, Feelings, Temperament, Stress level
-
External:
Weather conditions, Temperature, Timing, Organizational climate, Status, Power, Authority
Assertive Communication
-Use of "I" statements, Verbal and nonverbal message are congruent, Conveying a message that insists on being heard, Respectful of the receiver
Passive Communication
Silence when the person has a message
Aggressive Communication
Direct and hostile
GRRRR Model of Listening
-
G
reeting- respectful
-
R
espectful listening
-
R
eview- summarize information to ensure message is understood
-
R
ecommend / Request more Information
-
R
eward- respectful conclusion to the exchange
Group Communication
-Forming: relationships formed, expectations defined, directions given
-Storming: Competition and attempts to establish individual identities
-Norming: Establish rules and design work
-Performing:Work gets done
-Termination or closure
SBAR and ISBAR
-Structured orderly approach to provision of accurate, relevant information
-Reduction of communication errors
-Increase patient safety
Conflict
-internal or external discord that result from differences in ideas, values, or feelings
-can produce growth or destruction
Interpersonal Conflict
-includes bullying, incivility, mobbing, and workplace violence
-between 2 or more people
Conflict Process
1. Latent
2. Perceived
3. Felt
4. Manifest
5. Conflict Aftermath
Intrapersonal Conflict
-Conflict w/in oneself
Destructive Negotiation Tactics
-ridicule, ambiguous / inappropriate questioning, flattery, helplessness
Conflict Management Techniques
Compromising, Competing, Cooperating, Smoothing, Avoiding, and Collaborating
Performance Appraisal
-as
employee:
level of YOUR job performance
-as manager, this is the
greatest tool used in the organization to develop and motivate their staff
Performance Appraisal Accuracy and Fairness
- The appraiser needs to guard against the following common pitfalls:
-halo effect (good)
-the horns effect (bad)
-central tendency (average)
-Matthew effect (same every year)
Competences
-evaluate whether an individual has the knowledge, education, skills and experiences to perform the tasks needed to care for patients.
-part of a performance appraisal
Performance evaluations
-are used to examine how well an individual can actually complete tasks that are put before them.
-part of a performance appraisal
Trait rating scales
-when the appraiser rates the person against a set standard, which can be the job description, desired behaviors or personal traits.
-part of a performance appraisal
Signature on Performance Appraisal
-only means you have: Received it and Read it
-It does
not mean you agree with it.
Marginal employees
-only meeting minimal standards.
Impaired employees
-are unable to accomplish their work at expected level
Constructive Discipline
-Uses discipline to help the employee grow.
-Not punishment
-Punishment may be applied for improper behavior but it is done in a supportive, corrective manner.
McGregor's Hot Stove Rules for Fair and Effective Discipine
Forewarning, Immediate Consequence, Consistency, Impartiality
Disciplinary Conference
Step 1- Reason for Disciplinary Action
Step 2- Employee's Response to Action
Step 3- Rationale for Disciplinary Action
Step 4- Clarification of Expectations for Change
Step 5- Agreement / Acceptance of Action Plan
Termination Conference
1. Calmly state the reasons for dismissal.
2. Explain the employment termination process.
3. Ask for employee input.
4. End the meeting on a positive note, if possible.
Confronting the Chemically Impaired Employee
-Phase 1: Gather as much data as possible before confronting
-Phase 2: Discuss with employee about performance deficits through direct confrontation
-If employee is currently impaired then, immediate alcohol and drug screen will be done before employee le
State Board of Nursing Treatment Programs
-Voluntary, confidential program for nurses with chemical dependency or mental illness
-
Goal:
protect the public by early intervention and providing treatment programs
-Refusal of diversion programs could lead to disciplinary action or license revocation
Hallmarks of Effective Quality Control Programs
1. Support from top-level administration
2. Committment by the organization in terms of fiscal and human resources
3. Quality goals reflect search for excellence rather than minimums
4. Process is on-going / continuous
Process Audits
-used to measure how nursing care is provided and assumes a connection between the process used by the nurse and the quality of care
-task oriented
-Ex: critical pathways, standardized clinical guidelines
Structure Audits
-assume that a relationship exists between quality care and appropriate structure
-includes the environment
-ex: staffing ratios, staffing mix, emergency dept. wait times, etc.
Outcome Audits
-determine what results, if any, occurred as a result of specific nursing interventions for patients
-assumes that the outcome accurately demonstrates the quality of care provided
Transformational Leader (r/t short answer)
-identifies common values
-is committed
-inspires others w/ vision
-has long-term vision
-looks at effects
-empowers others
Servant Leadership (r/t short answer)
-concept that successful leaders meet the needs of and empower their followers instead of the organization
-serving others as the first priority
-serving to empower others, listen and truly understand, open minded w/ no judgement, deal w/ complex issues,
My personality type (short answer)
-The Protagonist
-Extraverted, Intuitive, Feeling, Judging, and Assertive (ENFJ-A)
-reliable, tolerant, charismatic, a natural born leader, and altruistic.
-weaknesses are being too selfless and sensitive
-thrive in stressful situations, control emotions
Before, During, and After Negotiation
Before:
mentally prepared, determine incentives of person your negotiating with, determine your starting point, trade-offs, and bottom line, and look for hidden agendas
During:
maintain composure, ask for what you want assertively, role model good communi