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NR 446 Collaborative Healthcare.docx NR 446 Collaborative Healthcare.docx
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Can an LPN hang electrolytes? - ANSWER -NO- requires assessment Can an LPN hang TPN? - ANSWER -No Can an LPN hang NS with K? - ANSWER -Yes - diluted Can an LPN hang blood? - ANSWER -No Can an LPN hang a bolus? - ANSWER -No Can an LPN do an IV push? - ANSWER -No UAP assignments - ANSWER -stable patients with chronic conditions
Who should UAP's not work with? - ANSWER --no vitals on: acute cardiac, new patient - depending on status, post-op (not stable patients), if RN is in room, UAP can help but RN needs to be in room reactive planning - ANSWER -occurs after a problem exists, goal is just to get back to normal inactivism - ANSWER -another type of conventional planning, seeks the status quo, not going to do anything, prevent change from occurring, standing firm, slow incremental change preactivism - ANSWER -utilize technology to accelerate change and are future oriented. Unsatisfied with the past or present, preactivists do not value experience and believe that the future is always preferable to the present. interactive or proactive planning - ANSWER -Planners who fall into this category consider the past, present, and future and attempt to plan the future of their organization rather than react to it. Because the organizational setting changes often, adaptability is a key requirement for proactive planning. Proactive planning occurs, then, in anticipation of changing needs or to promote growth within an organization and is required of all leader- managers so that personal as well as organizational needs and objectives are met. Forecasting - ANSWER -involves trying to estimate how a condition will be in the future.
MIssion statement - ANSWER -a statement of the organization's purpose - what it wants to accomplish in the larger environment, the reason why the organization exists Philosophy - ANSWER -comes out of vision and mission, about values and beliefs -organizational philosophy -nursing service philosophy Goal - ANSWER -a desired end toward which efforts are directed, the aim of a philosophy -SMART Objectives - ANSWER --more specific and measurable -gets you towards the goal process objectives - ANSWER -written in terms of the method to be used ex: 100% of staff nurses will orient new patients to the call-light system, within 30 minutes of their admission, by first demonstrating its appropriate use and then asking the patient to repeat said demonstration. results-focused objective - ANSWER -specify the desired outcome ex: 95% postoperative patients will perceive a decrease in their pain levels following the administration of parenteral pain medication.
Policies - ANSWER -plans reduced to statements, direct organizations in their decision making -limit setting, boundary setting Implied policies - ANSWER -neither written nor expressed verbally, have usually developed over time and follow a precedent. Expressed policies - ANSWER -delineated verbally or in writing Procedures - ANSWER -how to get things done within that policy, instruct you how to do things Rules - ANSWER --define actions -form policies and procedures -allow only once choice of action strategic planning - ANSWER -Long-term planning that provides broad goals and directions for the entire business. Contemporary Adaptation of Lewins Model - Stages of Change MOdel - ANSWER -Stage 1: Pre-contemplation: no current intention to change Stage 2: Contemplation: individual considers making a change Stage 3: Preparation: there is intent to make a change in the near future Stage 4: Action: individual modifies behavior
cost containment - ANSWER -procedures used to control costs or expenses, efficiency, not having waste, provide care and still yield a profit cost effective - ANSWER -not the same as being inexpensive, producing good results for money spent, the product is worth the price The workforce or personnel budget - ANSWER -largest of budget expenditures, because health care is labor intensive, operating budget - ANSWER -how the facility can operate, bills that need to get paid. supplies are a big expense capital budget - ANSWER -plan for the purchase of buildings or major equipment, assets, big-ticket items, capital is another word for investment, investment in "stuff" incremental budgeting - ANSWER -flat percentage increase method, multiplying current year expenses by a certain figure, usually the inflation rate or consumer price index, the budget for the coming year may be projected. Doesnt assess current coniditon of patient budget -giving a raise Zero-based budget - ANSWER -justify budget every year, labor- intensive for nursing managers flexible budgeting - ANSWER --flexes with the census
-volume based -money allocated in real time performance budgeting - ANSWER --emphasizes outcomes and results instead of activities or outputs (earn your keep) -efficiency -a good way to motivate critical pathways - ANSWER --clinical pathways -a strategy for assessing, implementing, evaluating the cost- effectiveness of patient care -everything that needs to occur in care -if you dont hit the timeframe, there is a variance (positive or negative) -standard of care, EBP Medicare - ANSWER -A federal program of health insurance for persons 65 years of age and older, or have specific catastrophic illnesses, have to pay into medicare, not for free -Part A: inpatient hospital -Part B: supplemental for outpatient care (80/20 - not completely free) -Part C: allows to join some sort of managed care program to cover 20% of copay of part B. -Part D: prescription meds Medicaid - ANSWER -A federal and state assistance program that pays for health care services for people who cannot afford them.
Where does decision making start? - ANSWER -yourself, values and beliefs How do you come up with a decision? - ANSWER -generate alternatives Decision making Tier - ANSWER -decision making -> problem solving -> critical thinking -> clinical reasoning Decision making - ANSWER -making a snap decision Problem solving - ANSWER -the process of finding solutions to difficult or complex issues, some analysis Critical thinking - ANSWER -deeper than problem solving, analyzing the past, future, looking at everything, looking in 360 Clinical reasoning - ANSWER -critical thinking at the bedside Management Functions - ANSWER -planning, organizing, staffing, directing, controlling Theory X - ANSWER -assumes that workers are basically lazy, error-prone, and extrinsically motivated by money and, thus, should be directed from above.
Theory Y - ANSWER -The assumption that employees like work, are creative, seek responsibility, and can exercise self-direction. Worker will do a good job. Theory Z - ANSWER -everybody is in right spot, everyone will work together, everyone trusts what is going on Human Capital - ANSWER -the investment in human knowledge and skills for future profit ex: formal educational attainment generally increases human capital because the returns are in the form of wage, salary, or other compensation. Code of Ethics - ANSWER -written by the ANA(professional organization), tells us how we should act but is not legally binding Breach of Duty - ANSWER -board of nursing sets standards for reasonable and prudent behavior, nursing scope of practice decison making - ANSWER -a complex, cognitive process often defined as choosing a particular course of action. problem solving - ANSWER -part of decision making and is a systematic process that focuses on analyzing a difficult situation. Problem solving always includes a decision-making step. Many educators use the terms problem solving and decision making synonymously, but there is a small, yet important, difference between the two. Although decision making is the last step in the problem-solving process, it is possible for decision making to occur without the full analysis required in problem solving.
-Emphasize control, decision making, decision analysis, and results -Manipulate people, the environment, money, time, and other resources to achieve the goals of the organization -Have a greater formal responsibility and accountability for rationality and control than leaders -Direct willing and unwilling subordinates Leader - ANSWER -those individuals who take risks, attempt to achieve shared goals, and inspire others to action. -Leaders often do not have delegated authority but obtain their power through other means, such as influence. -Leaders have a wider variety of roles than do managers. -Leaders may or may not be part of the formal organization. -Leaders focus on group process, information gathering, feedback, and empowering others. -Leaders emphasize interpersonal relationships. -Leaders direct willing followers. -Leaders have goals that may or may not reflect those of the organization. The Management process - ANSWER -planning, organizing, staffing, directing, controlling Authoritarian - ANSWER --Strong control is maintained over the work group. -Others are motivated by coercion. -Others are directed with commands.
-Communication flows downward. -Decision making does not involve others. -Emphasis is on difference in status ("I" and "you"). -Criticism is punitive. Laissez-faire - ANSWER --Takes a hands-off approach. -Is permissive, with little or no control. -Motivates by support when requested by the group or individuals. -Provides little or no direction. -Uses upward and downward communication between members of the group. -Disperses decision making throughout the group. -Places emphasis on the group. -Does not criticize. Democratic - ANSWER --Less control is maintained. -Economic and ego awards are used to motivate. -Others are directed through suggestions and guidance. -Communication flows up and down. -Decision making involves others. -Emphasis is on "we" rather than I and you. -Criticism is constructive.
5 Components of Emotional Intelligence - ANSWER -1. self- awareness
Veracity - ANSWER -obligation to tell the truth Fidelity - ANSWER -Need to keep promises, faithfulness Confidentialty - ANSWER -keep privileged information private ANA Code of Ethics - ANSWER --written by the ANA -outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse. Although not legally binding, the code functions as a guide to the highest ethical practice standards for nurses and as an aid for moral thinking. 4 Strategies of Ethical Behavior - ANSWER -1. Separate legal and ethical issues.
Duty to Use Care - ANSWER -A nurse should give medications accurately, completely, and on time. Failure to Meet Standard of Care - ANSWER -A nurse fails to give medications accurately, completely, or on time. forseeability of harm - ANSWER -The drug handbook specifies that the wrong dosage or route may cause injury. A direct relationship between failure to meet the standard of care (breach) and injury can be proved. - ANSWER -Wrong dosage causes the patient to have a convulsion. Injury - ANSWER -Convulsion or other serious complication occurs. Incident Reports - ANSWER -records of unusual or unexpected incidents that occur during a client's treatment When are incident reports filed? - ANSWER --medication errors -procedure/treatment errors -equipment related injuries/errors -needlestick injuries -client falls/injuries -visitor/volunteer injuries -threat made to client or staff -loss of property (dentures, jewelry, personal wheelchair)
How is the incident report completed? - ANSWER --completed by the person who identifies event -complete within 24 hours -confidential and not shared with the client -not placed in medical record -forwarded to risk management department after being reviewed by nurse manager -include clients name and hospital number along with date, time, location of incident -provide factual description of incident and injuries involved -provide name of witnesses to event or witness comments to incident -provide corrective actions that were taken -provide name and dose of meds or equipment identification number Assault - ANSWER -conduct that makes a person fearful and produces a reasonable apprehension of harm, Battery - ANSWER -an intentional and wrongful physical contact with a person that entails an injury or offensive touching False Imprisonment - ANSWER -occurs when a person (who doesn't have legal authority or justification) intentionally restrains another person's ability to move freely
