Define leadership:
ability to influence people to work toward the meeting of stated goals
Define management:
act of planning, organizing, staffing, directing, and controlling to achieve organizational goals
Define total patient care:
model of care in which RN assumes full accountability for care of a group of patients
Define case management:
model of care in which RN integrates delivery of clinical services in combination with financial services
Define primary nursing:
model of care in which one RN assumes accountability for care delivered by another personnel in 24hr period
Define team nursing:
model of care in which a group of staff members led by a nurse provides care
Define functional nursing:
model of care in which nursing work is allocated according to specific tasks/skills
What traits do leaders need?
future oriented, visionary, focus on purposes, empower others to set/achieve organized goals
What are the characteristics of management?
1)produces a degree of predictability/order
2)produce short term results, administers
What are the characteristics of leadership?
1)produces change, often to a dramatic degree
2)potential to produce extreme useful change
3)has long range perspective, innovator
What is transactional leadership?
1)an exchange between leader and the employee
2)needs of employee are identified & the leader provides rewards exchange for performance
3)takes place in HIERARCHAL ORGANIZATION
What is hierarchal organization?
is one where decision making occurs at the top of the structure and is communicated to the employees
What is transformational leadership?
1)consultative & collaborative
2)contains 5 basic practices
3)shared governance
What are the 5 basic practices in transformational leadership?
1)challenging the process, questioning the ways that things have always been done, and creatively thinking in new ways of doing things
2)motivating & inspiring shared vision or bringing everyone together
3)empowering others to act
4)modeling change
5)prai
What does a flat organizational structure signify?
the removal of hierarchy layers, demonstrating that the authority for action occurs at the point of service
Employees of functional structures:
1)report to manager or VP
2)professional expertise
What are product line structures?
functions necessary to produce a specific service--under the control of single manager
What are the benefits of product line structure?
coordination of al services within the speciality & a similarity of focus
What are matrix structures?
1)they combine both function and service line in an integrated service structure
2)need collaboration between both
What factors are used to deciding on the type of organizational model?
financial, staffing, capabilities, patient population, organizational mission, philosophy
What are the fundamental elements of any patient care delivery system?
clinical decision making, work allocation, communication, management, coordination, accountability
What is total patient care?
1)oldest model of providing care
2)1 RN assumes accountability for the complete care of the group ("primary nursing")
3)care responsibility doesn't extend past shift
3)seen in private duty nursing/ICUs
What are the advantages of total patient care?
1)quality of care
2)continuity of care for a given shift
3)high pt satisfaction
4)decrease hand off time
5)reduces need for supervision
6)allow 1 person to do more than 1 task
What are the key steps in decision making?
id the problem, evaluate the potential solutions to problem, seek alternative solutions, select the best solution for everyone
What are the three levels of management?
1)nurse manager-higer/fire, complaints, watch 1 unit
2)director-looks over multi units
3)chief nurse officer-advocate for others,establish RN goals, set up budgeting
What are the disadvantages of total patient care?
1)may not be cost effective
2)RNs dislike doing "CNA" tasks
What is functional nursing?
1)work is allocated according to specific tasks/tech skills
2)Charge id task/work assigned
3)efficient during RN shortage
What are the advantages of functional nursing?
1)large # of tasks completed in a shift
2)efficient financially
3)staff trained to master one task (i.e iv therapy)
What are the disadvantages of functional nursing?
1)decreased pt/RN satisfaction
2)fragmented communication/accountability
3)unit coordination = charge responsibility
What is team nursing?
a delivery approach that uses a group of staff members led by a RN--supports group work & productivity
What are the advantages of team nursing?
1)supervision of new RN
2)increase quality of care
3)1 person coordinates care
What are the disadvantages of team nursing?
1)need increase time to communicate
2)more staff = more expenses
3)increased time needed to supervise, coordinate, delegate
What is modular nursing?
1)based on the physical layout of the unit
2)have a group of staff & group of pt
3)pt grouped by floor plan clustering
4)standardized assignment
What is primary nursing?
1)one to one approach to pt care
2)24hr responsibility for care during hospital stay
3)primary RN works with RN on other shifts to coordinate care
4)decision making at pt bedside
5)care can be delegated to other staff
What are the advantages of primary nursing?
1)improved quality of care
2)simplified communication
3)increased RN satisfaction
4)pt feels care is more personalized
What are the disadvantages of primary nursing?
1)increased # of RN
2)pt satisfaction results inconclusive
3)difficult to implement with pt that has multi unit transfers
What are the advantages of case management?
1)provide professional practice model for nurses
2)is cost effective
What are the disadvantages of case management?
1)fragmented communication
2)needs to be integrated into care delivery model
Define first level manager:
manager responsible for supervising non managerial personnel & day to day activities of specific work units
Define middle level manager:
1)supervises first level manager within a specified area
2)responsible for people & activity in those areas
3)acts as a liaison between 1st & upper level management
Define upper level manager:
1)middle manager reports to
2)responsible for establishing organizational goals & strategic plans for entire division
Define accountability:
assumption of responsibility for actions, decisions & policies within the scope of practice
Define delegation:
transferring the authority to perform a selected nursing task in a selected situation to a competent individual
Define assignment:
delegation of work to a selected group of caregivers--retaining accountability for the outcome
Define supervision:
active process of directing guiding & influencing the outcome of an individuals performance
Define unlicensed assistive personnel:
not licensed by the state & are trained to assist RNs by performing pt care tasks
Define direct patient care activities:
hygiene care, feeding patient, taking v/s, BS, EKG, ambulation
Define indirect patient care activities:
routine activities of the patient unit that deal with the day to day function of the unit -- restock supplies
What are the 5 rights of delegation? BOX 3-2
1)right task
2)right circumstance
3)right person
4)right direction/communication
5)right supervision
What are the 4C's of communication?
be clear, concise, correct, and complete
What is a concise communication
is one in which the right amount of communication has been given
What can be delegated?
1)noninvasive/nonsterile treatments - foley care
2)collection/report of data - v/s, weight, BS
3)hygiene care, ambulation
4)socialization activity
What can't be delegated?
1)pt assessment
2)planning/evaluation of care
3)development of care
4)pt teaching
What are some issues associated with delegation?
1)lack of training on how to delegate
2)poor communication/interpersonal skills
3)lack of resources
4)insecure delegator
5)unwilling delegate
6)lack of trust in others
Define what a novice RN is:
limited experience with tasks and needs rules to guide actions
Define what an advanced RN is:
1)has enough experience to recognize patterns in work nut continues to need help in setting priorities
2)relies on rules/protocols
Define what a competent RN is:
1)has been practicing 2 to 3 years- can prioritize/cope with various contingencies
2)needs help with situations not yet experienced
Define what a proficient RN is:
1)has enough experience to see the big picture
2)decision making is efficient/accurate
3)able to prioritize/plan even more challenging care
Define what a expert RN is:
1)no longer relies on rules to understand a situation
2)focuses quickly on viable situation
3)able to lead a team efficiently
4)can organize others work/supervise them
What are the 3 I's used to help manage your workplace?
1)identify your priorities
2)Interact differently with others
3)Initiate action
To set realistic goals be S.M.A.R.T.
specific, measurable, attainable, relevant, time bound
Define communication:
process by which information is shared between and among individuals
Define computerized physician order entry:
process by which the clinician orders are entered through electronic information systems
Define SBAR:
communication mechanism useful for framing any conversation, especially those requiring a rapid response from a clinician
Define change of shift report:
process by which patient information is shared by nurses who have taken care of the patient for the previous shift and are reporting to the incoming caregivers
What are the variables in the number of medical errors that occur in hospitals?
1)communication
2)lack of a consistent process of communication of patient condition
5 principles of effective communication:
1)sender of communication is responsible for clarity & the receiver has to translate the message
2)use simple, exact language
3)communication encourages feedback
4)sender must have credibility (trustworthy/reliable)
5)use of direct communication channels
10 rules of email etiquette:
1)use it the way u want everyone to use it
2)take another look before u send an email
3)quote original messages properly in replies
4)avoid sarcasm, irony, & emotional tones
5)clean up emails before forwarding
6)send plain text
7)writing in all caps is sh
When communication with patients/staff the RN must remember:
1)patients/families are customers and should be communicated to your honesty & respect
2)need to find a balance between medical jargon & too simple
3)provide angry guests with a place to communicate concerns
4)provide interpreter services
5)learn the cult
What items should be made available when speaking with a MD?
1)patient chart
2)list of current meds, allergies, IV fluids & labs
3)most recent v/s, EKG
4)lab results- provide date/time when completed
5)code status
S.B.A.R. stand for?
1)situation: id self, unit, pt/room #, state the problem, when it happened, & severity
2)background: admitting dx & date of admission, list of meds, allergies, IV fluids, labs, recent v/s, lab results, code status
3)assessment: most recent assessment
4)re
What are the ways to give report?
1)change of shift- face to face review of pt
2)tape recorded reports- give pertinent info
3)walking reports- walk to pt room to give report
Advantages of face to face and walking reports:
1)allow for questions to be exchanged between RNs
2)two RNs assessing the pt's situation & pt's participation
Disadvantages of face to face and walking reports:
can be costly to the hospital if they are not completed in a timely manner
Disadvantages of taped reports:
there is little opportunity for questioning and sharing the information
What pointers/info may assist the oncoming RN?
1)report vital info (allergies, code status, dx, critical labs)
2)review current status & therapeutics
3)discuss upcoming plans
4)review discharge plan
5)pertinent info to care
Define health:
1)state of complete physical, emotional, mental wellbeing
2)resource of everyday life, not the object of living
Define health care system:
all the structures and organizations and serves designed to deliver professional health and wellness services to consumers
Define health care network:
refers to interconnected units that are owned by the institution or have cooperative agreements with other institutions to provide a full spectrum of wellness and illness services
Define health maintenance organization:
geographically organized system that provides an agree on package of health maintenance and treatment services
Define medicare:
1)health insurance program for people aged 65 +
2)those under 65 with certain disabilities
3)any age with end stage renal disease
Define medicaid:
joint federal and state assistance program design to pay for medical long term care assistance for individuals and families with low income and limited resources
Define private agencies:
1)have volunteering governing bodies
2)not governed by US government
3)required to meet state licensing requirements and regulations
4)for profit or not for profit
Define for profit organizations:
organizations with stated financial structures that include profit goals and tax liabilities
Define not for profit organizations:
organizations with financial structures that project financial goals with particular tax and legislative protection
Define preferred provider organization (ppo)
managed care company that contracts with HCP and payers to provide HC to a defined population for predetermined fees
Define centers for medicare and medicaid services (CMS)
federal agency that administers medicare, medicaid, state children's health insurance program and other health related programs
Define managed care:
linkage between the financing and delivery of services in such a way as to permit payers to exercise control over the delivery of services
Define continuum of care:
matching an individuals ongoing needs with the appropriate level & type of medical, psychological,health or social services care
Define veterans health administration:
serve the needs of america's veterans by providing primary care, specialized care and related medical/social support services
Define world health organization:
1)specialized agency of the UN that acts as a coordinating authority on international public health
2)est in 1948
What is the foundation for managed care organizations?
the primary care provider--serves as the gate keeper to coordinate/manage the pt's use of resources, referrals
Part A Medicare Program Criteria:
1)hospital admission must be at least 3 days
2)nursing home admission must be for a condition that was diagnosed in the hospital
3)care in the nursing home must be skilled
What does Medicare part A cover?
1)covers hospital stays or extended stays at a skilled nursing facility
2)max length is 100 days: first 20 days completely covered remaining 80 require a co pay
3)hospice & home health
Part B Medicare Program:
1)optional program that covers services not covered in part a
2)vaccinations, diagnostic testing covered
3)medication administration covered only in MD administers during an office visit
4)covers durable medical equip. (walkers, wheelchairs & prostheses)
Part C Medicare Program:
1)patients are able to chose to receive their medicare benefits through private insurance plans
2)known as medicare advantage plan
Part D Medicare Program:
1)effective jan 1, 2006
2)eligible if have medicare a or b
3)can be enrolled in a stand alone prescription drug plan
4)is NOT standardized
5)plans/insurance co decided what is(not) covered
6)for people 65+, some disabled & people with end stage renal dise
What does Part D medicare not cover?
benzodiazepines, cough suppressants, barbiturates
Define accreditation:
determination by an accrediting body that an eligible health care organization complies with applicable standards of the joint commission
Define american osteopathic association (AOA)
osteopathic accreditation program that ensures osteopathic students receive their training with the provision of high quality patient care
Define centers for disease control and prevention:
agency charged with the promotion of health and quality of life by preventing and controlling disease, injury, and disability
Define compliance:
to act in accordance with stated requirements/standards
What are the levels of compliance?
1)noncompliance
2)partial compliance
3)substantial compliance
Define JCO:
accreditation organization that strives to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations
Define national instate for occupational safety and health (NIOSH):
federal agency responsible for conducting research and making recommendations for the prevention of work related injury and illness --part of the cdc
Define OSHA:
us department of labor agency that ensures the safety and health of america's workers by setting and enforcing standards
Define state departments of health and human services:
foster accessible and high quality health and senior services to help all people to achieve optimal health, dignity and independence
Define US department of health and human services:
us government principle agency for protecting the health of all americans and providing essential human services
What are the benefits of the JCO?
1)leads to improved pt care
2)demonstrates organizations commitment to safety
3)offers an educational on site survey experience
4)supports and enhances safety and quality improvement efforts
5)strengthens and supports recruitment
6)helps secure managed ca
The JCO standards that address performance are:
patients rights, patient treatment, and infection control
Management of pain & JCO:
document assessment of pain, document assessment of pain relief, use of therapeutics to manage pain, assessment of therapeutics
Define autonomy:
provides for the privilege of self determination in deciding what happens to one's body in health care
Define bioethics:
ethics specific to health care
Define ethics:
1)science that deals with the principles of right and wrong and of good and bad
2)governs our relationships with others
3)is based on personal beliefs/values
Define beneficence:
duty to do good to others--maintain a balance between benefits & harm
Define IRB:
group that has been formally designated to approve, monitor, & review biomedical and behavioral research involving humans with the alleged aim to protect the rights/wellfare
Define nonmaleficence:
principle of doing no harm
Define justice:
principle of fairness
Define morality:
behavior in accordance with custom or tradition and usually reflects personal or religious beliefs
Define fidelity:
duty to keep ones word
Define respect for others:
right of people to make their own decisions
Define veracity:
obligation to tell the truth
Define utilitarianism:
decision based on what will provide the greatest good for the greatest # of people
Define teleology:
1)values of a situation is determined by its consequences
2)the outcome is what counts not the actions
3)"the end justifies the means
Define deontology (formalism):
1)act is good only if it springs from good will
2)does not allow for actions based on concepts
The international council of nurses code of ethics: (p103)
respect for human rights, including the right to life, to dignity and to be treated with respect
What is an advanced directive:
1)an end of life decision made by a patient in advance of the actual need
2)"living will
Religious views
p106