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NUR4590 Focused Review – (Final) ch 1,2,3,4,7,9,12,13,18,,20,22,, Define the following terms: Clinical Decision making: involves clinical judgments that result in interventions at the point of patient care. Clinical Judgment involves forming, refining, and evaluating hypotheses based upon recognizing and analyzing cues. The interpretation of the information of patient problems and needs. Q: For BOTH clinical decision making and judgment. A client becomes confused after surgery. He is in a room farthest away from the nurses' station. The client tries to get out of bed several times during the shift. The nurse informs the physician and obtains an order for soft restraints. In addition, she moves the client close to the station and assigns a sitter to watch him. Which of the following did the nurse utilize? (Select all that apply.) a. Clinical judgment b. Clinical decision-making c. Autocratic decision d. Financial decision e. Unjustified restraint use Planned Change: a decision to make a deliberate effort to improve a system. Q: The development of new practices in response to new evidence is called: a. altered direction. b. organizational flux. c. planned change. d. status revision. Rapid Cycle Change: is used in health care to improve patient safety and quality. Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change. Q: A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of: a. Rapid response teams. b. Failure Modes and Effects Analysis. c. Root Cause Analysis. d. Rapid Cycle Change.

Change Agent:The change agent is a person or thing that produces a particular effect or change. The change agent can be a person who functions as a change facilitator. The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the: a. resister. b. innovator. c. change agent. d. strategist. Shared Governance: an organizational structure that promotes empowerment and autonomous decision making at the point of care, accountability that is shared among all parties in a decision, and organizational processes that promote an egalitarian environment in decision-making processes. Q: A long-term care facility has been busy for several months with patients who have a very high acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making tool? a. Pilot project b. Simulation c. Shared governance d. Data analytics Six Sigma: a quality and decision support technique that uses data to build process improvement models. The goal is to eliminate defects in safety and quality in health care delivery. Essentially Six Sigma is a variant of the plan-do-study-act (PDSA) cycle promoted by the Institute for Healthcare Improvement. Q: Effective managers utilize a wide array of data in making decision. Which of these techniques is used to build process improvement models? a. Incrementalism b. Scenario planning c. Six Sigma d. Budgetary model Social awareness: an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others. Q: Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as:

a. social awareness. b. self-awareness. c. self-management. d. relationship management. Laggards: group of people who will take the longest to adapt to a change. Q: Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change? a. Early adopters b. Late majority c. Innovators d. Laggards Innovation: is the use of a new idea or method. Q: The use of a new idea or method is the definition of: a. change. b. innovation. c. resistance. d. stereotyping Variable staffing: units are staffed below maximum workload conditions and staff is then supplemented when needed. Q: The staffing method used when units are staffed below maximum workload conditions and staff is then supplemented when needed is called: a. Fixed staffing. b. Variable staffing. c. Strategic staffing. d. Staffing by acuity Team STEPPS: was initially developed to address communication issues between nurses and providers during critical patient events. Q: A communication system developed originally to address communication patterns in critical situations is: a. VERA framework. b. NVC model. c. Crucial conversations. d. TeamSTEPPS.

VERA Framework: for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties. Q: A communication model that focuses on compassion, expression of emotion, and providing validation via support is the: a. Validation, Emotion, Reassurance, Activity (VERA) framework. b. Situation, Background, Assessment, and Recommendation (SBAR) Communication Theory. c. Nonviolent Communication (NVC) model. d. Human Relationship Model Accountability: being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard. Q; Being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard is: a. Accountability. b. Authority. c. Supervision d. Delegation Persuasion: is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading. Q: A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: a. Advisement. b. Consultation. c. Persuasion. d. Suggestion Specialization: The division (or differentiation) of work by occupation or by function.The extent to which work is divided and assigned to positions and divisions Q: The division of work by occupation or function is a form of: a. Specialization. b. Interdependence. c. Uncertainty. d. Technology.

Horizontal Violence: A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker's performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload. Q: Jenna, a registered nurse (RN), has been accused of gossiping and bullying a new graduate RN on her unit. This type of workplace violence is called _____ violence. a. Horizontal b. Co-worker c. Threatening d. Nurse-to-nurse Skill Mix:is the proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff. Q: The provision of quality nursing care to clients, wherever delivered, depends on the: a. Appropriate nursing diagnoses. b. Current wage scale. c. Number of nurse leaders. d. Right skill mix. The proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff, is called _____. skill mix Resistance: Resistance to change should be expected as integral to the process of change. It may be rooted in anxiety or fear. Q: _____ is an expected part of change and is often related to fear and anxiety. a. Depression b. Resistance c. Acceptance d. Denial Fishbone chart: The fishbone diagram resembles diagramming sentences. The effect is illustrated in a box at the end of a midline (or head of the fish). The causes are generally four or five categories of elements that might contribute to the effect (e.g., machines, methods, people, materials, and measurements) and the specific activities. Under each of these category headings, individual items that might lead to the effect are listed. By diagramming all of the possible contributors, the predominant or root causes may be found more readily. Q:

The risk manager wants to illustrate the causes that have been leading to an increase in patient misidentification. The most appropriate tool to use is a: a. Pareto chart. b. Control chart. c. Fishbone diagram. d. Detailed flowchart. Nursing informatics: Nursing informatics is a "specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice Q: Nursing informatics includes the: a. Coding and billing of hospital and physician services. b. Management and communication of data, information, knowledge, and wisdom in nursing practice c. Organization and selection of quality medical information. d. Support and troubleshooting of computer software issues. Practice Based Evidence: Collecting and extracting data that describe the processes and outcomes of nursing care electronically has provided evidence for the design of care protocols and delivery models (Horn & Gassaway, 2010). The formal process of using these patient data for providing this evidence is termed practice-based evidence Q: The formal process of using patient data for providing evidence for the design of care protocols is termed: a. evidence-based practice. b. practice-based evidence. c. data analysis. d. effectiveness research Delegation: "the process for a nurse to direct another person to perform nursing tasks and activities The process for a nurse to direct another person to perform nursing tasks and activities is: a. Authorization. b. Delegation. c. Empowerment. d. Supervision Staffing Pattern: A The staffing management plan provides the structured processes to identify patient needs and then to deliver the staff resources as efficiently and effectively as possible. An effective plan first focuses on stabilizing the unit core staffing. A staffing pattern, or core coverage, is determined through a forecasted workload and a recommended care standard *A forecasted workload and a recommended care standard determine the: a. Staffing pattern. b. Skill mix of the unit.

c. Nurse-to-patient ratios. d. Staffing management plan. Scheduling: the process of assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time Assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time is known as: a. scheduling. b. staffing effectiveness. c. nursing direct-care hours. d. human resources staffing strategy. List the following: Transformational Leadership attributes: use charisma to produce greater effort and are able to motivate followers to perform to their full potential over time. Transactional Leadership Attributes: a leader or manager who functions in a caregiver role and is focused on day-to-day operations. Such leaders survey their followers' needs and set goals for them based on expectations. They are also leaders who are focused on the maintenance and management of ongoing and routine work. Q: for both transformational and transactional leaders A transactional leader is defined as a leader or manager who functions in the role listed below and is focused on day to day operations a. motivator b. caregiver c. performer d. enhancer Which of the following traits describe a transactional leader? (Select all that apply.) a. Functions in a caregiver role. b. Surveys their followers' needs and sets goals for them. c. Uses charisma to produce greater effort in followers. d. Focuses on the maintenance and management of ongoing and routine work. e. Motivates followers to perform to their full potential. Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges.

e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety. The transformational leader engages staff by: a. Punishing errors. b. Sharing vision and decision making c. Taking a top-down approach to leadership. d. Making unilateral decisions for the team. Nursing Informatics specialist role: Nursing informatics specialists assist practitioners by providing information and evidence-based knowledge to support clinical decision making and delivery of safe patient care. Although these specialists may not be directly involved with care delivery, their effort is integrally related to reengineering work flow for clinical and administrative practice. Nursing informatics specialists participate in analysis, design, and implementation of information and communication systems; effectiveness and informatics research; and education of nurses in informatics and information technology Q: What are the roles of nursing informatics specialists? (Select all that apply.) a. Data analysis and reporting to governmental agencies b. Participation in education of nursing staff c. Providing direct patient care d. Providing information and evidence-based knowledge e. Supporting clinical decision making When delegating a task as a RN what is your responsibility and what are the delegate responsibilities? With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation.The delegatee accepts accountability for his or her own acts, accepts the delegation, uses appropriate notification and reporting, and accomplishes the task. Q: When the licensed nurse makes a determination to delegate a task, which of the following occurs in the process? (Select all that apply.) a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. c. The needs of the nurse are considered. d. The nurse determines the available resources and patient safety. e. Accountability is transferred to the manager. With regard to delegation, what organizational principles are considered? (Select all that apply.) a. Legal guidelines and policies b. Patient safety and accountability

c. Relationship management and patient support d. Cost containment e. Knowledge and education Which of the following are the responsibilities of the delegatee in a situation? (Select all that apply.) a. Corrective action b. Own acts c. Accepting the delegation d. Appropriate notification and reporting e. Accomplishing the task Who is ultimately accountable for the appropriateness and supervision of the delegated task? a. The nurse who delegated the task b. The UAP who accepted the task c. The nursing manager d. The hospital CEO What is the purpose of EHR and Why are EHRs beneficial? The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the continuity of care document from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care Q: What are the primary purposes and benefits of EHRs? (Select all that apply.) a. Single source of clinical, financial, and legal record b. Electronic format supports the storage and exchange of continuity of care c. Available within the health care facility to ensure confidentiality d. Originate from a single place e. Virtual record of retrospective, concurrent, and prospective information Why should a RN have strong interpersonal communication skills? Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis. Q: A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about: a. Interpersonal communication.

b. Clarity. c. Image. d. Intention. How do Employee assistance programs aid in mitigation of violence? Employee assistance programs provide a range of services to help employees cope with stressors that occur at home and at work.The implications for management of the threat of workplace violence vary depending somewhat on the source of violence. In dealing with someone who has a personal relationship with an employee, employee assistance programs can be especially useful.Employee assistance programs can be very useful in preventing or mitigating loss caused by domestic violence that extends to the workplace. Q: _____ may be useful in preventing loss caused by domestic violence that extends to the workplace. a. Employee assistance programs b. Stress leave for up to 6 weeks c. Termination of the perpetrator d. Arrest and conviction of the perpetrator Employee assistance programs: a. Allow employers to place staff into anger management programs designed to help control potentially violent behavior. b. Encourage employees to provide assistance to co-workers experiencing workplace violence. c. Provide services to help employees cope with stressors that occur at home or work. d. Train employees to deescalate violent situations. Employee assistance programs can be especially useful when mitigating which source of violence? a. Patients b. Current or former workers c. Criminals with no connection to the employer d. Someone who has a personal relationship with an employee How is culture/climate best described? Culture is described as shared beliefs and values. It provides a common belief system among its members but is not expected to hold similar views and opinions of its members.The purpose of culture is to provide a common bond so that members know how to relate to one another and to show others outside the organization what is valued.The manner in which staff perceives culture, manages boundaries, and translates values has an impact on patient care.Climate is defined as the perceptions that individuals have about a particular unit or environment. Q: Culture is best defined as (the): a. deviation from the majority. b. differences in likes and dislikes. c. shared beliefs and values. d. similar views and opinions.

Climate is best defined as the: a. health and well-being of the structure of a facility. b. perceptions that individuals have about an environment. c. style in which individuals treat each other. d. temperature in the nursing units of an institution. Organizational _____ affects the quality of nursing care and patient outcomes. a. culture b. climate c. fiscal stability d. case mix What does a Threat assessment team do within a healthcare organization? A threat assessment team (TAT) with diverse representation can serve as a central convening body to make sure that independently observed warning signs are not overlooked. The TAT makes a holistic assessment of the threat itself and an evaluation of the person making the threats. The TAT assessment may also identify the most likely targets of the violence. Last, the TAT assessment will recommend an appropriate course of action such as referral to law enforcement, admonishment, counseling, termination, or whatever action might seem appropriate (Farkas & Tsukayama, 2012; FBI, 2015). Still another procedural approach for the TAT would be to circulate generalized information such as typical profiles of perpetrators of extreme workplace violence, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. Posters have been distributed with information about workplace violence such as typical profiles of workplace killers, characteristics of disgruntled employees, motivations for violent actions, and factors that contribute to the problem. This approach is completed by: a. The FBI. b. Threat assessment team. c. Human resources. d. Senior leadership. An evaluation of a specific threat of violence and an evaluation of the person making the threat is conducted by ______.

• threat assessment teams* HIPPA – What is HIPPA and why do nurses need to abide by it? HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality. Q: Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n): a. Breach of beneficence. b. Example of maleficence.

c. Potential assault and battery charge. d. Violation of the Health Insurance Portability and Accountability Act (HIPAA). What are a few De-escalation techniques staff can utilize when in a difficult situation? De-escalation is a long-standing mental health nursing tool. De-escalation is defined as "a gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance and non-confrontational limit setting that is based on respect" Q: A long-standing mental health nursing tool may be used in an aggressive or violent situation. The use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting is known as: a. De-escalation. b. Chemical restraint. c. Stress management. d. Emergency assistance programs. When Delegating what steps does a nurse need to take before delegating a task? In making a decision to delegate nursing tasks, the following five factors can be assessed: potential for harm, complexity of the task, amount of problem solving and innovation required, unpredictability of the outcome, and the level of patient interaction. Q: When determining that delegation of an element of patient care needs to occur, the nurse delegates with a clear, concise description of the task, including its objectives, limits, and expectations. The nurse allows the delegate to clarify without fear of repercussion. Which of the following five rights of delegation is being demonstrated? a. Right task b. Right circumstance c. Right person d. Right direction/communication e. Right supervision/evaluation Which principles are important to consider when a Registered Nurse delegates tasks to the UAP? (Select all that apply.) a. Tasks are delegated that will challenge the UAP to use critical thinking. b. Assess the condition and stability of the patient. c. Delegate tasks that are within the expertise of the RN, particularly if the UAP is a student nurse. d. Evaluate the complexity of the task. e. Determine the potential for harm to the patient.

Why is reflection beneficial to RN’s? Reflection is key to refining the capabilities of clinical

judgment. As a nurse gets more experience, the intuitive component of judgment follows.

Nurses do not require management experience or nursing expertise to refine clinical judgment.

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Which of these concepts is key to refining clinical judgment capabilities? a. Critical judgment b. Reflection c. Management experience d. Nursing expertise Which attribute leads to higher nurse satisfaction rates within healthcare systems? Effective leadership is important in nursing because of the impact on nurses' work lives, it being a stabilizing influence during change, and for nurses' productivity and quality of care. Q: A medical-surgical unit reports higher rates of patient satisfaction coupled with high rates of staff satisfaction and productivity. Which of the following is attributed to the data findings? a. Effective leadership b. Management involvement c. Mentoring d. Rewards and recognition What does Staffing effectiveness entail? Staffing effectiveness is the evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes. Q: Evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes is known as: a. Patient acuity. b. Staffing effectiveness. c. Nurse-to-patient ratio. d. Nursing workload. Why should RN’s report near-misses or adverse events? Safety climate refers to keeping both patients and nurses safe. Part of a safety culture encourages nurses to report adverse events as well as near- misses of adverse events. Factors that influence avoidance of errors include staffing levels, excess fatigue, education, and experience. Q: Which of the following exemplifies a safety climate within a nursing unit? a. Asking nursing staff to work a double shift b. Encouraging nurses to take the blame when a medication error occurs

c. Asking staff to report medication errors only d. Asking staff to report near-misses of adverse events DECIDE acronym.: The first step in the decision-making process using DECIDE is to define the problem and determine why anything should be done about it and explore what could be happening. The final step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback Q: Which of the following is the final step in the process when utilizing the DECIDE method for decision making? a. Establishing the criteria we want to accomplish b. Development and implementation of an action plan c. Defining the problem and determining why d. Evaluating the decision through monitoring, troubleshooting, and feedback What is Magnet Status? Characteristics of a Magnet hospital include nursing autonomy, practice control, and collaboration. Nursing support, collaborative partnerships with physicians, and nursing practice are other aspects. Q: Which program can help identify a hospital as having a gold standard of nursing? a. Six Sigma b. HCAHPS c. American Nursing Credentialing Center d. Magnet Recognition Program e. OSHA How does the responsibility and accountability of the nurse flow? Responsibility is the allocation and acceptance of a task. Responsibility is the obligation to take on and accomplish work and to secure the desired results. In accepting the obligation of an assigned task, the staff person is accepting responsibility to accomplish the task. Accountability is the liability for task performance and is determined in a retrospective analysis of what occurred. The assignment of responsibility and the granting of authority create accountability. Accountability flows upward or outward: from staff to manager or from provider to client. Q: Which of the following statements are accurate when describing responsibility and accountability? (Select all that apply.) a. The assignment of responsibility assumes accountability. b. A manager is assigned responsibility by a subordinate. c. Accountability is the liability for task performance. d. The assignment of responsibility and the granting of authority create accountability. e. Accountability flows upward or outward. Does staffing directly correlate with organizational outcomes?

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Staffing management is one of the most critical activities for nurse leaders at every level of the health care organization today because it affects: a. Delegation and supervision. b. Unit leadership productivity. c. Organizational outcomes. d. Professional development and quality control. Negotiation? Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes. Q: Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity. Who are the people most likely to promote violence in the workplace? Customers, clients, patients, or students are regarded as the most prevalent source of violence against nurses Q: The most prevalent source of violence against nurses is from: a. A current or former employee. b. Customers, clients, or patients. c. Criminals with no other connection to the workplace but who simply intend to commit a crime. d. Someone who is not employed at the workplace but has a personal relationship with an employee. What is NVC? NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding. Q: NVC communication processes are grounded in: (Select all that apply.) a. confrontation b. empathy c. compassion d. honesty e. assertiveness What can happen when communication is poor? The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors

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The number one cause of preventable medical errors is: a. Hostile work environments. b. Poor communication. c. Ineffective leadership. d. Staff competency. This is developed after teamstepps? To address the "communication arm" of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation. Q: Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing) Examples of delegation scenarios Q: Which staff member should be assigned to a dying client who is experiencing symptoms of emotional distress? a. UAP who can be spared to sit with the client b. LPN/LVN who has grown attached to the family c. RN who has experience as a hospice nurse d. Newly graduated RN The charge nurse is making assignments on a surgical unit. Which client should be assigned to the least experienced nurse? a. Client who had a vaginal hysterectomy and still has an indwelling catheter b. Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag c. Client who had a hip replacement and stated that something popped while walking d. Client who had a Whipple procedure and is reporting being thirsty all the time Delegation rights : The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation.

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The five rights of the delegation are right task, right circumstance, right person, right direction and communication, and right: a. Interaction. b. Outcome. c. Supervision. d. Time. Inappropriate delegation: The RN is responsible for assessment, evaluation, and nursing judgment, and should not delegate these professional responsibilities Q: The nurse has asked a nurse's aide to greet a postoperative patient who has just arrived on the unit and to determine whether he is in stable condition. This act of delegation is an example of a nurse inappropriately delegating: a. Assessment of the patient. b. Evaluation of an intervention. c. Nursing judgment. d. Teaching to a delegate. JCO and Staffing and data collection? TJC standards include the human resources function of verifying that nurses are qualified and competent to ensure that the hospital determines the qualifications and competencies for staff positions based on its mission, populations, care, treatment, and services. Hospitals must also provide the right number of competent staff members to meet the patients' needs.The collection of data to measure performance is a requirement of TJC. Q: The collection of data to measure performance is required by: a. The Health Insurance Portability and Accountability Act (HIPAA). b. The Centers for Medicare & Medicaid Services. c. The Joint Commission (TJC). d. Health Information Technology The Joint Commission's (TJC's) staffing regulation states: a. Staffing ratios are recommended in perinatal and critical care areas. b. Nurse managers may determine the nurse-to-patient ratio as long as the patient's needs are being met. c. Hospitals must also provide the right number of competent staff members to meet the patient's needs. d. Hospitals may limit the number of admissions to ensure there are an adequate number of staff members to meet patient needs.

Purpose of organizational chart: Hierarchy reflects the formal structure of the organization, which can be identified on an organizational chart. An organizational chart is a visual display of the organization's positions and the intentional relationships among positions. The organizational chart reflects the various positions and the formal relationships between and among the positions and, by extension, the people who are a part of the organization. Q: An organizational chart is used to depict: (Select all that apply.) a. A visual display of the organization's positions. b. The intentional relationships among positions. c. Open positions within human resources. d. Flow of authority. e. Advisory committees. Centralized v decentralized models: The CEO makes a top-down decision, and lower-level managers and staff have little decision-making discretion. Q: Which is an advantage of centralized organizations? a. increased access to managers and organizational resources b. makes management harder c. reflects the interests of the worker d. allows quick decisions or actions In an organization that has a decentralized organizational philosophy, decision-making authority rests in levels closer to the point of service rather than in the executive levels. Benefits of a decentralized organizational philosophy include: (Select all that apply.) a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. d. permitting a narrower span of control. e. allowing for more levels of management. What is recongized by ANA? Q: _____ was recognized by the American Nurses Association (ANA) as a nursing specialty in 1992 and is one of the fastest growing practice areas in health care.* a. Nurse anesthesia b. Nursing informatics c. Nurse-midwifery d. Clinical nurse specialist

Nurse managers supporting staff empowerment and education. Q: During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members? (Select all that apply.) a. Reframe difficult questions. b. Communicate facts through e-mail. c. Provide active listening. d. Promote action steps and solutions. e. Keep staff informed of decisions. f. Communicate with participation. The nursing staff on a critical care unit thought that professional growth could be enhanced. Which of the following interventions would support empowerment of the nursing staff? (Select all that apply.) a. Eliminating computers and reverting back to paperwork b. Increasing pay wages for ancillary and professional staff c. Providing various methods for ongoing education and continuing education units d. Working to make equipment and medications readily available How to calculate staffing? The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The workload standard commonly used is nursing care hours per patient day, although the validity of this measure is disputed. Q: The workload standard commonly used in nursing when calculating staffing patterns is: a. patient days. b. patient acuity system. c. average length of stay. d. nursing care hours per patient day Barriers to change? Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes e. Safety culture The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.) a. Explain the rationale for a change so that individuals understand it.

b. Simply announce the change without laying a foundation. c. Give participants all the information they need. d. Rely only on formal authority in implementing change. e. Help individuals cope with change. Disruptive communication.Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff. _____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing Examples of privacy breeches. Which of the following are examples of patient privacy or security breaches? (Select all that apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient's diagnosis e. Discharge summary given to patient's spouse Parts of effective communication Trust, respect, and empathy are the three ingredients needed to create and foster effective communication. Effective communication is fostered through which of the following ingredients? (Select all that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy Parts of violence prevention program The main components in a violence prevention program are: (Select all that apply.) a. a written plan. b. worksite analysis. c. criminal control. d. security staff training. e. record keeping and evaluation of the program.

Elements of professional practice model Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization. The core elements of a PPM include: (Select all that apply.) a. goals. b. values. c. leadership. d. collaborative relationships. e. care delivery model. When to not use email? E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.) a. When you are mad. b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing Role of OSHA The agency that oversees the safety and health of health care workers is: a. The Joint Commission (TJC). b. The Department of Public Health (DPH). c. OSHA. d. CMS.