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Leadership Exam 3
Leadership Exam Chapters 6-7, 14
| Question | Answer |
|---|---|
| #1 mistake new nurses make? | Failure to respond/react |
| Keys to communication? | patient-centered care, teamwork & collaboration, & safety |
| The person who begins the transfer of information | Sender |
| the process the sender uses to transmit the message (verbal, nonverbal, voice inflection, & body language) | Encoding |
| The information or content | Message |
| The manner in which the message is sent (facial expression, body language) | Sensory Channel |
| The person or persons whom the sender intended to receive the message | Receiver |
| the process of interpreting the message | Decoding |
| Determines whether the message was received as intended | Feedback |
| Fatal flaw is overlooking the feedback. What should be done to avoid this mistake? | clarify the message |
| Conscious method of communication. Includes many different types: all must maintain professional & understandable language, grammar, & clarity | Verbal communication |
| Encompasses behaviors, actions, & facial expressions | Nonverbal communication |
| Good position to hear information clearly | Receiving (the info) |
| Engagement in the conversation, positive body language, facial expressions, & gestures | Attending (be present/engaged) |
| Gaining an understanding of what is being said, & what may not be said | Understanding (clarify if needed) |
| Nonjudgmental manner & being aware if anything may have upset him/her | Responding (don't assume the worst or best) |
| Recalling previous conversations with patient to establish a starting point with re-engaging | Remembering |
| Gender- different styles: | Men more assertive & more verbal, women more collaborative & nonverbal cues & metaphors |
| Personal vs texting: | Generation |
| to whom do you communicate & how? Sensitive to teaching | Culture (& religion) |
| differences to avoid miscommunication | Values & perceptions |
| parameters (be aware of how close you get) | personal space |
| A type of verbal presentation or document intended to share info & which conforms to established professional rules, standards & processes & avoids using slang terminology | Formal |
| Casual form of information sharing typically used in personal conversations w/ friends or family members | Informal |
| Flows quickly & haphazardly at all levels of the organization & becomes more & more distorted as it moves along | Grapevine |
| to convey the same message across the entire system | Organizational communication |
| Fosters patient-centered care & results in quality outcomes. Refers to workers across healthcare professionals to cooperate, collaborate, communicate, & integrate care in teams to ensure that care is continuous & reliable | Interpersonal communication |
| Enhancing communication among health-care professionals producing quality outcomes, increasing patient satisfaction, reducing error rates & improving patient safety | Intraprofessional communication |
| Inter/intra = | similar |
| Intra = | smaller unit |
| Inter = | incorporates more (respiratory, etc.) |
| Evidence-based teamwork system developed by the U.S. Department of Defense in collaboration w/ the Agency of Healthcare Research & Quality (AHRQ). | Team Strategies & Tools to Enhance Performance & Patient Safety (Team STEPPS) |
| TeamSTEPPS aim: | to optimize patient safety outcomes by improving communication |
| Nurse to voice concern at least twice to receive acknowledgement from another team member. Standard of care not followed | Two-challenge rule |
| Simultaneously informs team members of important information & assigns tasks during a critical event or situation (rapid response: calling out meds, dose, route of medications given) | Call out |
| Use closed-looped communications & verify the information that is being received is correct | Check-back |
| C.U.S = | Concerned, Uncomfortable, Safety issue |
| SBAR = | Situation, Background, Assessment, Recommendation |
| These transactions in care occur when a patient is transferred from one unit to another | Handover |
| The institute for Patient-And-Family-Centered Care identified 4 concepts that apply during nurse-to-nurse (intra) handovers | Respect & dignity, information sharing, participation (being present) |
| an injury to a patient caused by medical management rather than the patient's underlying condition is called | adverse event or a patient safety event |
| a blame-free environment in which staff members feel comfortable reporting errors & near misses | A culture of safety |
| when an action is not taken or omitted, such as when a nurse does not assess a patient after surgery or does not administer a medication | Error of omission |
| a culture that is fair to those who make an error | just culture |
| the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim | Medical error |
| a potential error that was discovered before it was carried out | near miss |
| indicators that reflect elements of patient care that are directly impacted by the quality & quantity of nursing care | Nursing-sensitive quality indicators |
| relate to the results of nursing care & include changes in a patient's health status related to nursing care, such as pressure ulcers & patient falls. Improve when there is greater quality/quantity of nursing care | Outcome indicators |
| resembles a bar chart- Designed to look at various causes of a specific problem. A tool to help determine the small portion of causes that account for a large amount of the variance in a process | Pareto Chart |
| Promotes continuous QI (quality improvement); cycle is used to identify issues & improve care | Plan-do-study-act (PDSA) cycle |
| a formalized investigation & problem-solving approach focused on identifying & understanding the underlying causes of an event as well as potential events that were intercepted | root cause analysis (RCA) |
| a patient safety event that results in any of the following: death, permanent harm, & severe temporary harm & intervention required to sustain life; signals the need for immediate investigation & response | Sentinel event |
| a rigorous method that encompasses 5 steps: define, measure, analyze, improve, & control. Used in QI to define the # of acceptable errors produced by a process. Involves improving, designing, & monitoring processes to minimize or reduce waste | Six Sigma Model "don't mess around in clinical" |
| focuses on unsafe acts of health-care professionals & errors as the result of human behaviors, such as inattention, forgetfulness, negligence, & incompetence (you made the mistake) | Human errors: personal approach |
| acknowledges that errors happen because humans are not perfect (what went wrong?) | human errors: systems approach |
| what accounts for most preventable adverse events? | Unintentional Human Errors & System Errors |
| What should a nurse do if their patient has never taken a certain medication before? | Stop & clarify before giving it |
| Stage one of creating a culture of safety: | safety management is based on rules & regulations |
| Stage 2 of creating a culture of safety: | Good safety performance becomes an organizational goal |
| stage 3 of creating a culture of safety: | safety performance is seen as dynamic & continuously improving |
| the process of developing, agreeing on & implementing uniform criteria, methods, processes, designs, or practices that can improve patient safety & quality care | Standardization |
| Mission to make health care safer, higher quality, more accessible, equitable, & affordable | Agency for Healthcare Research & Quality |
| 1994: launched an initiative to investigate the impact of health-care restructuring on the safety & quality of patient care & the nursing profession | American Nurses Association |
| A nonprofit organization established in 1999N in response to the recommendations from the Advisory Commission on Consumer Protection & Quality in the Health Care Industry | National Quality Forum (NQF) |
| member states agreed on a resolution on patient safety in 2002 & recognized patient safety as a global health-care issue in 2004 | World Health Organization (WHO) |
| accredits & certifies approximately 20,000 health-care organizations in the U.S. based on established standards | The Joint Commission (TJC) |
| collaborates with the health-care improvement community to remove improvement roadblocks & launch innovations that improve patient care | Institute of Healthcare Improvement (IHI) |
| relate to the care environment & include staffing levels, hours of nursing care per patient day, nursing skill levels, & education of staff | Structure indicators |
| relate to how nursing care is provided & include elements falling under the nursing process (assessment, diagnosis, planning, intervention, & evaluation of nursing care) & job satisfaction | Process indicators |
| NQF identifies the following 3 goals as critical in making health care safer for Americans: | reduce preventable hospital admissions & readmissions; reduce the incidence of adverse health-care-associated conditions; reduce harm from inappropriate or unnecessary care |
| Goal is to reduce morbidity & mortality significantly in the American health-care system | 1,000 Lives Campaign |
| defines patient safety as "the absence of preventable harm to a patient during the process of health care" | World Health Organizations |
| developed between 2007 & 2014 to address the following issues: medication accuracy at transitions of care; correct procedure at the correct body site | 5 standard operating protocols |
| any quality management program that addresses all areas of an organization, emphasizes customer satisfaction, & uses continuous improvement methods & tools | Total Quality Management (TQM) |
| All QI programs incorporate 4 key principles: | QI works as systems & processes; there is a focus on patients; there is a focus on being part of the team; there is a focus on the use of data |
| First part of the IHI Model of Improvement: | fundamental questions |
| 2nd part of the IHI Model of Improvement: | Plan-Do-Study-Act (PDSA) |
| the Pareto chart is a tool to help determine the "small portion of causes that amount for a large amount of the variance" in a process, according to what? | 80/20 principle |
| A dynamic process that results in altering or making something different | Change |
| purposeful, calculated, & collaborative, & it includes the deliberate application of change theories | Planned change |
| occurs when the need for change is sudden & necessary to manage a crisis (ex: car breaks down --> buy a new one) | Unplanned change |
| successful leaders & managers manage unplanned change through: | effective communication, adaptability, coordination, & the ability to remain grounded |
| the process of creating something new after thoughtful analysis of a phenomenon (ex: studying) | Innovation |
| most widely used 3 step model: | Lewin's force-field model (1951) |
| according to Lewin, change results from what 2 fields or environmental forces? | driving forces (helping) that attempt to facilitate the change & move it forward; restraining forces (hindering) that attempt to impede change & maintain the status quo (ex: self doubt, stress) |
| Lewin's force-field model (1951) involves what 3 stages? | Unfreezing stage, Moving stage, & Refreezing stage |
| stage that determines change is needed: | Unfreezing stage |
| stage that begins initiation of the desired change: | Moving stage |
| stage that involves stabilizing the change & achieving equilibrium: | Refreezing stage |
| cyclical rather than linear & require organizations to react with speed & flexibility | Emerging theories |
| The newer emerging change theories proved another perspective from which to view change & innovation based on what? | complexity science |
| recognizes that the world is a continual motion & that a change in one area can result in numerous changes in other areas | complexity science |
| nonlinear & unpredictable, & it explains why a small change in one area can have a large affect across an organization. Known as the "butterfly effect"; ex: shortage of nurses leads to increased errors & burnout | Chaos theory |
| Senge (1990): to excel, future organization will need to "discover how to tap people's commitment & capacity to learn at all levels in an organization" | Learning Organization Theory |
| organization where people continually expand their capacity to create results they truly desire, where new & expansive patterns of thinking r nurtured, where collective aspiration is set free, & where people are continually learning how to learn together | Learning Organization |
| 4 competencies for facilitating change: | personal knowledge of & accountability; understanding the essence of change; the ability to collaborate & fully engage team members; competence in embracing vulnerability & risk taking |
| One who leads & manages the change process, including management of group dynamics, resistance to change, continuous communication, & the momentum toward the desired outcome. "cheerleader" | change agent |
| how threatened a person feels by change | resistance |
| forces on the relationship needs of staff members, uses peer pressure, & relies on staff members' desires to have satisfactory work relationships | Normative-reeducative strategy |
| assumes that staff members are essentially self-interested & providing info & education will assist staff in changing behavior & adopting the change or innovation | empirical-rational strategy |
| based on power & authority & assumes that staff will respond to authority & threats of job loss. This strategy is used when resistance is expected. Results in rapid change & is often perceived by staff as they must accept the change or find new work | power-coercive strategy |
| change initiative typically fail due to: | poor coordination, ineffective communication, lack of staff cooperation |
| a state of disharmony among people & occurs when people have differing views | conflict |
| a little conflict can result in what? | organizational growth |
| internal conflict, or a conflict coming from within a person | Intrapersonal conflict |
| a disagreement between or among 2 or more people | interpersonal conflict |
| occurs between groups of people (ER staff vs ICU staff) | intergroup conflict |
| disagreement between staff & organizational policies & procedures, standards, or changes being made (worker bee against management) | organizational conflict |
| withdrawing or hiding from conflict. Postpones conflict. Not resolved. | Avoiding |
| sacrificing one's own needs or goals & trying to satisfy another's desires, needs, or goals. Does not resolve conflict. | accommodating |
| pursue own needs, desires, or goals at the expense of others. Power driven & can result in aggression. | competing |
| effecting conflict resolution. Everyone gives something up & everyone gets something they want in return. Must be on an even playing field. | Compromising |
| best strategy. Shared goals, commitment to working together. Time consuming, best chance for resolution | collaborating |
| remind respect & focus on the issue & not the other person | mutual respect |
| differentiate between what they need & what they want | needs vs wants |
| understanding each other & hearing the other person's position | compassion & empathy |
| remind those involved to focus on "I" statements & avoiding using "you" statements & avoid blaming | staying in the "I" |
| which term describes the sound, timely, smooth, unfragmented, & seamless transmission... | continuity of care |
| which action most likely to promote continuity of care? | referring client to home health visits... |
| which is not a breach in patient health info confidentiality? | charge nurse discusses patient's condition during shift report |
| Celebrity is patient, what actions by other nurse violates patient's privacy? (SATA) | Takes photo when walking past patient's room, using photo taken & client's name to enhance hospital image, unassigned nurse goes through patient's chart |
| which of the following is a primary task to have an effective control system? | identify the values of the department, improving safety precautions within the workplace |
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