Leadership Exam Chapters 6-7, 14
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| #1 mistake new nurses make? | Failure to respond/react
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| Keys to communication? | patient-centered care, teamwork & collaboration, & safety
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| The person who begins the transfer of information | Sender
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| the process the sender uses to transmit the message (verbal, nonverbal, voice inflection, & body language) | Encoding
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| The information or content | Message
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| The manner in which the message is sent (facial expression, body language) | Sensory Channel
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| The person or persons whom the sender intended to receive the message | Receiver
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| the process of interpreting the message | Decoding
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| Determines whether the message was received as intended | Feedback
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| Fatal flaw is overlooking the feedback. What should be done to avoid this mistake? | clarify the message
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| Conscious method of communication. Includes many different types: all must maintain professional & understandable language, grammar, & clarity | Verbal communication
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| Encompasses behaviors, actions, & facial expressions | Nonverbal communication
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| Good position to hear information clearly | Receiving (the info)
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| Engagement in the conversation, positive body language, facial expressions, & gestures | Attending (be present/engaged)
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| Gaining an understanding of what is being said, & what may not be said | Understanding (clarify if needed)
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| Nonjudgmental manner & being aware if anything may have upset him/her | Responding (don't assume the worst or best)
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| Recalling previous conversations with patient to establish a starting point with re-engaging | Remembering
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| Gender- different styles: | Men more assertive & more verbal, women more collaborative & nonverbal cues & metaphors
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| Personal vs texting: | Generation
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| to whom do you communicate & how? Sensitive to teaching | Culture (& religion)
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| differences to avoid miscommunication | Values & perceptions
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| parameters (be aware of how close you get) | personal space
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| A type of verbal presentation or document intended to share info & which conforms to established professional rules, standards & processes & avoids using slang terminology | Formal
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| Casual form of information sharing typically used in personal conversations w/ friends or family members | Informal
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| Flows quickly & haphazardly at all levels of the organization & becomes more & more distorted as it moves along | Grapevine
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| to convey the same message across the entire system | Organizational communication
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| 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
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| Enhancing communication among health-care professionals producing quality outcomes, increasing patient satisfaction, reducing error rates & improving patient safety | Intraprofessional communication
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| Inter/intra = | similar
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| Intra = | smaller unit
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| Inter = | incorporates more (respiratory, etc.)
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| 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)
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| TeamSTEPPS aim: | to optimize patient safety outcomes by improving communication
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| Nurse to voice concern at least twice to receive acknowledgement from another team member. Standard of care not followed | Two-challenge rule
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| 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
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| Use closed-looped communications & verify the information that is being received is correct | Check-back
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| C.U.S = | Concerned, Uncomfortable, Safety issue
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| SBAR = | Situation, Background, Assessment, Recommendation
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| These transactions in care occur when a patient is transferred from one unit to another | Handover
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| 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)
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| 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
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| a blame-free environment in which staff members feel comfortable reporting errors & near misses | A culture of safety
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| 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
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| a culture that is fair to those who make an error | just culture
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| the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim | Medical error
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| a potential error that was discovered before it was carried out | near miss
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| indicators that reflect elements of patient care that are directly impacted by the quality & quantity of nursing care | Nursing-sensitive quality indicators
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| 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
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| 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
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| Promotes continuous QI (quality improvement); cycle is used to identify issues & improve care | Plan-do-study-act (PDSA) cycle
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| 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)
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| 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
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| 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"
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| 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
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| acknowledges that errors happen because humans are not perfect (what went wrong?) | human errors: systems approach
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| what accounts for most preventable adverse events? | Unintentional Human Errors & System Errors
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| What should a nurse do if their patient has never taken a certain medication before? | Stop & clarify before giving it
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| Stage one of creating a culture of safety: | safety management is based on rules & regulations
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| Stage 2 of creating a culture of safety: | Good safety performance becomes an organizational goal
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| stage 3 of creating a culture of safety: | safety performance is seen as dynamic & continuously improving
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| the process of developing, agreeing on & implementing uniform criteria, methods, processes, designs, or practices that can improve patient safety & quality care | Standardization
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| Mission to make health care safer, higher quality, more accessible, equitable, & affordable | Agency for Healthcare Research & Quality
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| 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
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| 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)
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| 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)
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| accredits & certifies approximately 20,000 health-care organizations in the U.S. based on established standards | The Joint Commission (TJC)
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| collaborates with the health-care improvement community to remove improvement roadblocks & launch innovations that improve patient care | Institute of Healthcare Improvement (IHI)
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| relate to the care environment & include staffing levels, hours of nursing care per patient day, nursing skill levels, & education of staff | Structure indicators
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| 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
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| 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
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| Goal is to reduce morbidity & mortality significantly in the American health-care system | 1,000 Lives Campaign
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| defines patient safety as "the absence of preventable harm to a patient during the process of health care" | World Health Organizations
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| 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
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| any quality management program that addresses all areas of an organization, emphasizes customer satisfaction, & uses continuous improvement methods & tools | Total Quality Management (TQM)
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| 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
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| First part of the IHI Model of Improvement: | fundamental questions
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| 2nd part of the IHI Model of Improvement: | Plan-Do-Study-Act (PDSA)
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| 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
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| A dynamic process that results in altering or making something different | Change
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| purposeful, calculated, & collaborative, & it includes the deliberate application of change theories | Planned change
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| occurs when the need for change is sudden & necessary to manage a crisis (ex: car breaks down --> buy a new one) | Unplanned change
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| successful leaders & managers manage unplanned change through: | effective communication, adaptability, coordination, & the ability to remain grounded
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| the process of creating something new after thoughtful analysis of a phenomenon (ex: studying) | Innovation
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| most widely used 3 step model: | Lewin's force-field model (1951)
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| 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)
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| Lewin's force-field model (1951) involves what 3 stages? | Unfreezing stage, Moving stage, & Refreezing stage
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| stage that determines change is needed: | Unfreezing stage
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| stage that begins initiation of the desired change: | Moving stage
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| stage that involves stabilizing the change & achieving equilibrium: | Refreezing stage
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| cyclical rather than linear & require organizations to react with speed & flexibility | Emerging theories
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| The newer emerging change theories proved another perspective from which to view change & innovation based on what? | complexity science
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| recognizes that the world is a continual motion & that a change in one area can result in numerous changes in other areas | complexity science
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| 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
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| 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
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| 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
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| 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
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| 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
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| how threatened a person feels by change | resistance
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| forces on the relationship needs of staff members, uses peer pressure, & relies on staff members' desires to have satisfactory work relationships | Normative-reeducative strategy
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| 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
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| 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
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| change initiative typically fail due to: | poor coordination, ineffective communication, lack of staff cooperation
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| a state of disharmony among people & occurs when people have differing views | conflict
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| a little conflict can result in what? | organizational growth
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| internal conflict, or a conflict coming from within a person | Intrapersonal conflict
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| a disagreement between or among 2 or more people | interpersonal conflict
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| occurs between groups of people (ER staff vs ICU staff) | intergroup conflict
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| disagreement between staff & organizational policies & procedures, standards, or changes being made (worker bee against management) | organizational conflict
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| withdrawing or hiding from conflict. Postpones conflict. Not resolved. | Avoiding
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| sacrificing one's own needs or goals & trying to satisfy another's desires, needs, or goals. Does not resolve conflict. | accommodating
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| pursue own needs, desires, or goals at the expense of others. Power driven & can result in aggression. | competing
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| effecting conflict resolution. Everyone gives something up & everyone gets something they want in return. Must be on an even playing field. | Compromising
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| best strategy. Shared goals, commitment to working together. Time consuming, best chance for resolution | collaborating
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| remind respect & focus on the issue & not the other person | mutual respect
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| differentiate between what they need & what they want | needs vs wants
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| understanding each other & hearing the other person's position | compassion & empathy
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| remind those involved to focus on "I" statements & avoiding using "you" statements & avoid blaming | staying in the "I"
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| which term describes the sound, timely, smooth, unfragmented, & seamless transmission... | continuity of care
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| which action most likely to promote continuity of care? | referring client to home health visits...
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| which is not a breach in patient health info confidentiality? | charge nurse discusses patient's condition during shift report
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| 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
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| 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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