Leadership & Management Final Study Guide, Exams of Nursing

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LEADING/PLANNED CHANGE Pp.188-197 (Chapter 8) Differentiate Between Planned Change And Change By Drift ● Planned Change: results from a well-thought-out and deliberate effort to make something happen ● Accidental change (“change by drift”) Change Agent ● Change agent – a person skilled in theory and implementation of planned change - to deal appropriately with conflicted human emotions and to connect and balance all aspects of the organization taht will be affected by that change ● develop strategies for unfreezing, movement, and refreezing ● Lewin’s Change Theory fo Unfreezing, Movement, and Refreezing (p.194) ○ Unfreezing ■ The change agent convinces members of the group to change ■ People become discontent and aware of a need to change ■ Leader encourages transformational conversations instead of avoiding the real issue or problem ○ Movement ■ The change agent identifies, plan, and implements appropriate strategies, ensuring that driving forces exceed restraining forces ○ Refreezing ■ The change agent assists in stabilizing the system change so that it becomes integrated into the status quo ■ The change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change assess driving and restraining forces for change in given situations ● Lewin’s Change Theory of Driving and Restraining Forces ○ Driving Forces – forces that push the system toward change ○ Restraining Forces – forces that pull the system away from change apply rational–empirical, normative–reeducative, and power–coercive strategies for effecting change ● Rational-Empirical: ○ Provide evidence or factual information as evidence of the need for change Leadership & Management Final Study Guide 2 ● Normative-Reeducative: Leadership & Management Final Study Guide 2 ETHICS Pp.85-102 (Chapter 4) define ethics and ethical dilemmas ● Ethics ○ The systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment ○ The justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are ● Ethical Dilemmas ○ Making a choice between two or more equally undesirable alternatives Moral Issues Faced by Nurses ● Moral indifference: an individual questions why morality in practice is even necessary ● Moral uncertainty: an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is ● Moral distress: occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action Two Common Approaches to Ethical Decision Making ● Deontological—duty-focused normative approach centered on rules from which all action is derived ● Teleological—outcome-focused approach that places emphasis on results and protects the interest of the majority compare and contrast the utilitarian, duty-based, rights-based, and intuitionist frameworks for ethical decision making Utilitarian (teleological): Provide the greatest good for the greatest number of people. Duty-based (deontological): Individuals have basic inherent rights that should not be interfered with. Rights-based (deontological): A duty to do something or to refrain from doing something Intuitionist (deontological): Each case is weighed on a case-by-case basis to determine relative goals, duties, and rights. identify and define nine different principles of ethical reasoning ● Nine Principles of Ethical Reasoning ○ Autonomy: Promotes self-determination and freedom of choice Leadership & Management Final Study Guide 2 ○ Beneficence: Actions are taken in an effort to promote good ○ Nonmaleficence: Actions are taken in an effort to avoid harm ○ Paternalism: One individual assumes the right to make decisions for another ○ Utility: The good of the many outweighs the wants or needs of the individual ○ Justice: Seeks fairness; treats “equals” equally and treats “unequals” according to their differences ○ Veracity: Obligation to tell the truth ○ Fidelity: Need to keep promises ○ Confidentiality: Keeps privileged information private use a systematic problem-solving or decision-making model to determine appropriate action for select ethical problems ● MORAL Decision-Making Model ○ M—Massage the dilemma: Collect data about the ethical problem and who should be involved in the decision-making process. ○ O—Outline options: Identify alternatives and analyze the causes and consequences of each. ○ R—Review criteria and resolve: Weigh the options against the values of those involved in the decision. This may be done through a weighting or grid. ○ A—Affirm position and act: Develop the implementation strategy. ○ L—Look back: Evaluate the decision making. evaluate the quality of ethical problem solving in terms of both outcome and the process used to make the decision ● If a structured approach to problem solving is used, data gathering is adequate, and multiple alternatives are analyzed, even with a poor outcome , the manager should accept that the best possible decision was made at that time with the information and resources available. distinguish between legal and ethical obligations in decision making ● Legal ● Ethical identify strategies leader-managers can use to promote ethical behavior as the norm ● Separate legal and ethical issues. ● Collaborate through ethics committees. ● Use institutional review boards appropriately. ● Foster an ethical work environment. American Nurses Association (ANA) Code of Ethics for Nurses With Interpretive Statements and current professional standards ● A code of ethics is a set of principles, established by a profession, to guide the individual practitioner Leadership & Management Final Study Guide 2 LEGAL ASPECTS Pp. 110-127, 129 (Chapter 5) identify the primary sources of law and how each affects nursing practice ● Primary Sources of Law ○ The Constitution ○ The Statues ○ Administrative agencies ○ Court decisions Type Burfen of Proof Required for Guilty Verdict Likely Consequences Criminal Beyond a reasonable doubt Incarceration, probation, fines Civil Based on a preponderance of the evidence Monetary damages Administrative Clear and convincing standard Suspension or loss of licensure identify specific doctrines used by the courts to define legal boundaries for nursing practice ● Stare decisis ● Res judicata describe the five elements that must be present for a professional to be held liable for malpractice Elements of Liability Explanation Example: Giving Medications 1. Duty to use due care (defined by the standard of care) The care that should be given under the circumstances reflects what a reasonably prudent nurse would have done. A nurse should give medications accurately, completely, and on time. 2. Failure to meet standard of care (breach of duty) The care that should have been given, was not. A nurse fails to give medications accurately, completely, or on time. 3. Foreseeability of harm The nurse must have reasonable access to information about whether the possibility of harm exists. The drug handbook specifies that the wrong dosage or route may cause injury. 4. A direct relationship between failure to meet the standard of care (breach) and injury can be proved. Patient is harmed because proper care is not given. Wrong dosage causes the patient to have a convulsion. Leadership & Management Final Study Guide 2 ORGANIZATIONAL STRUCTURE Pp.297-302, 305-308, 309-316 (Chapter 12) Bureaucracy ● it was an institutional method for applying general rules to specific cases, thereby making the actions of management fair and predictable. ● Clear division of labor ● Well-defined hierarchy of authority ● Impersonal rules and impersonality of interpersonalrelationships ● System of procedures for dealing with work situations ● System of rules coverings the rights and duties of each position ● Selection for employment and promotion is based on technical competence identify line-and-staff relationships, span of control, unity of command, and scalar chains on the organization chart ● Span of control ○ Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her ● Unity of command ○ Best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible ● Scalar chain ○ The decision-making hierarchy, or pyramid, is often referred to as a scalar chain. describe components of the informal organization structure including employee interpersonal relationships, the formation of primary and secondary groups, and group leaders without formal authority ● Centrality ○ The extent to which an employee is integrated into the network of interpersonal relationships within the work system differentiate between first, middle, and top levels of management ● Top-level managers ○ Board of directors ○ Chief executive officer ○ Chief nursing officer ○ Administrators ● Middle-level managers ○ Nursing supervisors ○ Nursing directors Leadership & Management Final Study Guide 2 ○ Department heads ● First-level managers ○ Team leaders ○ Charge nurses ○ Primary care nurses ○ Case managers Top Level Middle Level First Level Examples Chief nursing officer Chief executive officer Chief financial officer Unit supervisor Department head Director Charge nurse Team leader Primary nurse Scope of responsibility Look at organization as a whole as well as external influences Focus is on integrating unit-level day-to-day needs with organizational needs Focus primarily on day- to-day needs at unit level Primary planning focus Strategic planning Combination of long- and short-range planning Short-range, operational planning Communication flow More often top-down but receives subordinate feedback both directly and via middle-level managers Upward and downward with great centrality More often upward; generally relies on middle-level managers to transmit communication to top- level managers contrast centralized and decentralized decision making ● In centralized decision making , decisions are made by a few managers at the top of the hierarchy. ● In decentralized decision making , decision making is diffused throughout the organization, and problems are solved at the lowest practical managerial level. describe common components of shared governance models and differentiate shared governance from participatory decision making ● Shared Governance ○ Nurses at every level play a role in the decisions that affect nursing activity throughout the system. ○ Nurse-managers move out of traditional industrial model roles into collegial models, Leadership & Management Final Study Guide 2 becoming moderators of the service process. ○ Usually defined by a structure of rules or bylaws ● Participatory decision making ○ Although participatory management lays the foundation for shared governance, they are not the same. ○ Participatory management implies that others are allowed to participate in decision making over which someone has control. Thus, the act of “allowing” participation identifies for the participant the real and final authority. contrast individual authority, responsibility, and accountability in given scenarios ● Authority: the official power to act and direct the work of others. ● Responsibility: related to job assignment and must be accompanied by enough authority to accomplish the assigned task. ● Accountability: the moral responsibility that accompanies a position. identify appropriate strategies the leader-manager may take to create a constructive organizational culture ● Success in building a new culture often requires new leadership and/or outside analysis. Groupthink ● Occurs when group members fail to take adequate risks by disagreeing, being challenged, or assessing discussion carefully Five Model Components of Magnet-designated health-care organizations 1. Transformational leadership 2. Structural empowerment 3. Exemplary professional practice 4. New knowledge, innovation, and improvements 5. Empirical quality results The 14 foundational forces required to achieve Magnet status 1. Quality of nursing leadership 2. Organizational structure 3. Management style 4. Personnel policies and programs 5. Professional models of care 6. Quality of care 7. Quality improvement 8. Consultation and resources 9. Autonomy 10. Community and the hospital 11. Nurses as teachers Leadership & Management Final Study Guide 2 ● delineate new roles that are expanding the role of nurses beyond caregivers to key integrators, care coordinators, and efficiency experts such as case managers, nurse navigators, and clinical nurse-leaders (CNLs) ● describe the role competencies expected of the CNL, as described by the American Association of Colleges of Nursing ● Role Competencies differentiate between case management and population-based health-care management ● Case Management – work design proposed to meet patient needs ○ A colaborative process of assessment, planning, facilitaion, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes ● Population-based health-care differentiate between nurse case managers and nurse navigators ● Nurse Case Managers ● Nurse Navigators ○ Help patients and families navigate the complex health-care system by providing information and support Leadership & Management Final Study Guide 2 ORGANIZATIONAL INTERPROFESSIONAL AND GROUP COMMUNICATION Chapter 19 describe the relationship between communication and team building ● Communication – impacts all management activities and cuts across all phases of the management process. ○ The ability to communicate effectively often determines success as a leader-manager. ● Team building identify the relationship between the sender, message, and receiver in communication ● Sender ● Message ● receiver differentiate between the internal and external climate in which communication occurs ● Internal climate – includes internal factors such as the values, feelings, temperament, and stress levels of the sender and the receiver ● External climate – includes external factors such as the weather, temperature, timing,status, power, authority, and the organizational climate itself identify barriers to effective organizational communication ● Barriers: ○ Number of levels that need to communicate ○ Gender ○ Power and status describe strategies managers can take to increase the likelihood of clear and complete organizational communication ● Clear, simple, and precise communication ● Senders should seek feedback whether communication is received ● Multiple communication methods should be used ● Unnecessary information should not be disclosed choose appropriate communication modes for specific situations and messages differentiate among assertive, passive, aggressive, and passive–aggressive communication ● Assertive ○ Direct, honest, appropriate; “I” statements; congruent verbal and nonverbal messages ● Passive ○ Person suffers in silence; avoid conflict Leadership & Management Final Study Guide 2 ● Aggressive ○ Direct, threatening, condescending; “winning at all costs” or demonstrating self- excellence ● Passive-Aggressive ○ Limited verbal exchange; feigns withdrawal to manipulate the situation diagram upward, downward, horizontal, and diagonal communication ● Upward: subordinate to superior ● Downward: superior to subordinate ● Horizontal: peer to peer ● Diagonal: individuals at differing hierarchy levels and job classifications ● Grapevine: informal, haphazard, and random, usually involving small groups recognize ISBAR, SBAR, ANTICipate, and I-PASS as structured, orderly approaches in providing accurate, relevant information, in emergent patient situations as well as routine handoffs ● SBAR ○ Situation, Background, Assessment, Recommendation ● ISBAR ● ANTICipate ● I-PASS GRRRR Listening Tool ● Greeting ● Respectful Listening ● Review ● Recommend or request more information ● Reward describe the opportunities as well as the challenges new technologies pose for communication in contemporary organizations recognize the potential benefits of social media as a communication tool as well as the potential risks and identify principles for social networking use that minimize those risks 1. Nurses must not transmit or place online individually identifiable patient information. 2. Nurses must observe ethically prescribed professional patient–nurse boundaries. 3. Nurses should understand that patients, colleagues, institutions, and employers may view postings. 4. Nurses should take advantage of privacy settings and seek to separate personal and professional information online. 5. Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities. Leadership & Management Final Study Guide 2 PATIENT, SUBORDINATE, WORKPLACE, AND PROFESSIONAL ADVOCACY Pp.154 (Chapter 6) differentiate between the manager’s responsibility to advocate for patients, for subordinates, for the organization, for the profession, and for self ● Defined as protecting and defending what one believes in for both self and others ● The actions of an advocate are to inform others of their rights and to be sure they have adequate information on which to base their decisions ● Nurses must advocate for themselves, clients, subordinates, and their profession. ● Nurses often are expected to advocate for patients when they are unable to speak for themselves ● Nurses may act as advocates by helping others make informed decisions, by acting as an intermediary in the environment, or by directly intervening on behalf of others. Nursing Values central to advocacy ● Advocacy – helping others to grow and self-actualize 1. Every individual has a right to autonomy in deciding what course of action is most appropriate to meet his or her health-care goals. 2. Every individual has a right to hold personal values and to use those values in making health- care decisions. 3. All individuals should have access to the information they need to make informed decisions and choices. 4. The nurse must act on behalf of patients who are unable to advocate for themselves. 5. Empowerment of patients and subordinates to make decisions and act on their own is the essence of advocacy. differentiate between controlling patient choices and assisting patients to choose ● Controlling = domination and dependence ● Assisting = allowing freedom describe the core concepts of person- and family-centered care ● an innovative approach to the planning, delivery, and evaluation of health care that emphasizes partnerships between clinicians and individuals where the values, needs, and preferences of the individual are honored; the best evidence is applied; and the shared goal is optimal functional health and quality of life. Thus, it humanizes, personalizes, and demystifies the patient experience ● Patient care is organized first and foremost around the needs of patients. ● Patient and family perspectives are sought out, and their choices are honored. ● Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into Leadership & Management Final Study Guide 2 the planning and delivery of care. ● Health-care providers communicate openly and honestly with patients and families to empower them to be effective partners in their health-care decision making. ● Patients and families are encouraged and supported in participating in care and decision making at the level they choose. ● Patients, families, and health-care providers collaborate in policy and program development, implementation, and evaluation; in research; in facility design; and in professional education as well as in the delivery of care. ● The voice of the patient and family is represented at both the organizational and policy levels as well as at the health system’s strategic planning. identify how the Patient’s Bill of Rights protects patients ● Helps patients feel comfortable in the system ● Stresses strong patient–provider relationship ● Stresses key role patients play in staying healthy describe ways a manager can advocate for subordinates ● Workplace advocacy ● Ensures the work environment is both safe and conducive to prodesional and personal growth for subordinates ● Assure the OSHA guidelines for worker safety are followed identify both the risks and potential benefits of becoming a whistleblower ● Internal – within an organization, reporting up the chain of command ● External – reporting outside the organization, such as to the media or an elected official ● Whistleblowers are often considered disloyal and experience negative repercussions for their actions specify both direct and indirect strategies to influence legislation that promotes advocacy ● Write a letter to a legislator describe strategies nurses can use to successfully interact with the media ● Get media training ● Respect and meet reporter deadlines ● Assume, until proven otherwise, that the reporter will be fair and accurate in his or her reporting ● Have key facts and figures ready for the interview ● Limit your key points tot wo or three adn frame them as bullet points ● Avoid technical or academic jargon ● Speak confidently but do not be afraid to say when you do not have the expertise toa answer a question or when a question is better directed to someone else ● Avoid being pulled into inflammatory arguments or blame setting and repeat key points if you are pulled off into tangents Leadership & Management Final Study Guide 2 ● Provide the reporter with contact information for follow-up and needed clarifications THE IMPAIRED NURSE P. 702 Substance misuse involves maladaptive patterns of psychoactive substance abuse, with the substance user continuing use in the face of recurrent occupational, social, psychological or physical problems, and/or dangerous situations. . An impaired registered nurse (RN) is defined as a licensee who is unable to practice with professional skill and safety by reason of habitual or excessive use or abuse of drugs, alcohol, or other substances that impair ability or by reason of a mental disorder or physical ability (Jason, 2015). Effective management demands that organizations take an active role in ensuring patient safety by immediately removing these employees from the work setting. However, managers also have a responsibility to help these employees deal with their disease so that they can return to the workforce in the future as productive employees. When nurses take drugs designated for patient use, it is known as diversion. SAFETY AND INFECTION CONTROL ATI Module 49-62 ACCIDENT/ERROR/INJURY PREVENTION: Determine client/staff member knowledge of safety procedures CASE MANAGEMENT: Initiate, evaluate, and update client plan or care MAINTAINING A SAFE ENVIRONMENT-INFECTION CONTROL HANDLING INFECTIOUS AND HAZARDOUS MATERIAL Pp.51-59 Culture of Safety – promotes openness and error reporting Service occurrences Near misses - negative outcomes almost occurs Serious incidents - includes minor injuries, loss of equipment or property, or a significant service is interrupted Sentinel event: unexpected death or major injury Failure to rescue: MOST SEVERE – client develops a complication that leads to death FALLS P. 53 Leadership & Management Final Study Guide 2 Carbon monoxide Food poisoning Disasters REPORTING OF INCIDENT/EVENT ATI p65 Incident reports are records of unexpected or unusual events that affected a client, employee, volunteer, or visitor in a healthcare facility ● Unusual occurrence or quality variance reports Examples of when an incident report should be filed ● Med errors ● procedure/treatment errors ● Equipment-related injuries/errors ● Needlestick injuries ● Client falls/injuries ● visitor/volunteer injuries ● Threat mafe to client or staff ● Loss of property (dentures, jewelry, personal wheelchair) Incident report should be completed within 24h Not in client health care record DISASTER PLANNING ATI 65-72 Disaster – an event that can cause serious damage, destruction, injuries, and death Mass casualty incident (MCI) – a catastrophic event the overwhelms local resources Categories of triage during mass casualty ● Emergent/immediate (Class I, RED TAG) ● Urgent/delayed (Class II, YELLOW TAG) ● Nonurgent/minimal (Class III, GREEN TAG) ● Expectant (Class IV, BLACK TAG) Leadership & Management Final Study Guide 2 Review Quiz Utilitarianism - doing for the greater good Nonmaleficence - to do no harm Fidelity - to keep promise Veracity - to tell the truth Autonomy - patient makes their own decisions Justice - fairness Paternalism - 1 person makes decision for someone else Tort - wrongful act Assault Battery False imprisonment Invasion of Privacy 1. Opioid pain med PRN. metastatic breast cancer. Med might hasten death. Principle? a. Nonmaleficence 2. Medsurg nurse. Transfer to ICU. Completes online critical and emergency nursing course. a. Nonmaleficence 3. Surgeon on medsurg unit. Another nurse asks about surgeon’s med diagnosis. Says can’t provide info. a. Nonmaleficence 4. Nurse manager info on facility’s risk management . client lawsuit. Deposition a. Discovery phase 5. Nures teaching class on torts. Instruct that giving abx to a client who refuses is a tort. a. Assault 6. A nurse is preparing to administer prescribed med to client. What following actions. Client advoacy a. Encourage client to verbalize questions 7. Nurse works with clt woh has terminal diagnosis. Difficult decisions. How to best advocate for client. a. Ensure the client receives all the materials needed to make a well-informed decision 8. Preparing to be discharged. Would like to read his medical record. a. Confirm the facility’s policy around providing medical records to clients Leadership & Management Final Study Guide 2 9. Clt provides infomed consent. Assessed. What statement should prompt the nurse to contact the sureg a. Do you think this surgery is actually safe and necessary 10. Patient Self-Determination act a. Determine if patient has advanced directive 11. Long-term facility. Functional model of care? a. RN perform assessments while UAPs provide all feeding and hygiene. (task oriented) 12. Prioritizing client care. Primary focus? a. Assessing client’s needs individually 13. Newly licensed nurse preparing to insert an IV. which following sources should the nurse use to review the procedure and the standard at which it should be performed? a. Institutional policy and procedure manual 14. A nurse administers an incorrect med to a client. Following an assessment of the client. The nurse determines that th e client has experienced no untoward effects as a result of the med. Does not complete incident report becasue no harm came to client. Principle? a. Veracity 15. Nurse caring for clt w eating disorder. Which ethical concept when clt refuses to drink between meal protein and calorie supplement? a. Autonomy 16. Urse accidentally administer wrong med. Severe allergic reaction. Prolongs stay. Could rightfully sue. a. Malpractice 17. Preceptor. Personal professional liability insurance. Which of the following statement should the preceptor make? a. Personall liability is not mandatory but you should consider 18. Which is true about a Learning Organization a. Shared vision b. Learning itself enhances a team c. Creates positive and needed organizational change d. Promotes collective learning 19. Nurse manager provides info about ensuring client rights. Which regulation outlines the rights pf individuals in health care settings? a. Patient Care Partnership (ATI p. 35) Leadership & Management Final Study Guide