Nursing Leadership Exam 2
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Questions and Answers

What is the primary reason change is considered essential in healthcare settings?

  • To ensure compliance with evolving regulatory standards.
  • To foster innovation and prevent stagnation in patient care. (correct)
  • To minimize the need for specialized training among staff.
  • To reduce operational costs and maximize profits.

Which statement best describes the role of a change agent in an organization?

  • A person with expertise in the change process who facilitates understanding and implementation. (correct)
  • An individual who primarily enforces new policies without needing to explain them.
  • Someone who resists alterations to maintain existing systems and traditions.
  • A manager who delegates the change process to external consultants.

In an organization undergoing a significant change, what should a leader expect regarding employee reactions?

  • Primarily neutral reactions as employees adapt quickly to new circumstances.
  • Universally positive responses as change leads to improvement.
  • A mix of positive and negative reactions as a natural part of the change process. (correct)
  • Overall acceptance, provided the changes are communicated clearly.

An LVN is part of a team implementing a new electronic health record system. What role can the LVN effectively fulfill during this change?

<p>Serving as a change agent by training colleagues on the new system. (B)</p> Signup and view all the answers

An organization implements a new policy requiring all staff to use a new patient identification protocol. Which approach would best address inevitable negative reactions to this change?

<p>Providing training and support while addressing concerns to facilitate smoother adoption. (C)</p> Signup and view all the answers

In Lewin's Change Theory, what is the primary goal of the 'Unfreezing' phase?

<p>To prepare individuals affected by the change by helping them understand the need for it and addressing potential resistance. (B)</p> Signup and view all the answers

Which of the following best describes 'Change by Drift'?

<p>An unplanned change resulting from systemic imbalances, often met with resistance. (B)</p> Signup and view all the answers

An LVN is asked to implement a new patient documentation system. According to the principles of planned change, what initial step should the change agent prioritize?

<p>Discuss the benefits and rationale behind the new system with the nursing staff to foster understanding and reduce resistance. (A)</p> Signup and view all the answers

Which of the following actions exemplifies the 'Refreezing' stage of Lewin's Change Theory?

<p>Developing a new policy outlining the steps for the improved process. (A)</p> Signup and view all the answers

How do 'driving forces' influence behavior in the context of Kurt Lewin's Change Theory?

<p>They motivate individuals to behave in a certain way. (A)</p> Signup and view all the answers

In the context of Evidence-Based Practice (EBP), what is the role of patient preferences and values?

<p>Patient preferences and values are integrated with current evidence and clinical expertise to deliver optimal health care. (D)</p> Signup and view all the answers

What is the purpose of restraining forces in the unfreezing stage of Kurt Lewin's change model?

<p>To allow people affected by the change to understand what’s going on. (A)</p> Signup and view all the answers

When implementing changes at the bedside, what key action should an LVN take to facilitate the 'Moving' phase of Lewin's Change Theory?

<p>Provide support, maintain open communication, and encourage feedback to facilitate adaptation. (A)</p> Signup and view all the answers

A nurse leader is addressing a conflict that arose due to perceived inequities in workload distribution. Which initial action best demonstrates effective conflict management?

<p>Facilitating a mediated discussion where each nurse can express their concerns and perspectives. (A)</p> Signup and view all the answers

A patient with a history of falls is insistent on ambulating without assistance, despite the nursing staff's concerns. How should the nurse best uphold the ethical principle of autonomy while ensuring patient safety?

<p>Providing the patient with comprehensive education on fall risks and collaboratively developing a safe ambulation plan. (B)</p> Signup and view all the answers

A new graduate nurse is consistently delegating tasks to a more experienced LPN, even when the tasks are within the new graduate's scope of practice. What is the most appropriate initial intervention by the nurse manager?

<p>Providing the new graduate nurse with additional training and mentorship on time management and prioritization. (A)</p> Signup and view all the answers

During a severe weather event, a hospital experiences a surge in patient admissions while simultaneously facing a shortage of essential medical supplies. Applying the ethical theory of utilitarianism, which action would be most justifiable?

<p>Prioritizing the allocation of limited resources to patients with the highest likelihood of survival, even if it means others may not receive necessary treatment. (D)</p> Signup and view all the answers

A nurse discovers that a colleague is diverting narcotics for personal use. According to the nurse practice act and ethical guidelines, what is the nurse’s primary responsibility?

<p>Documenting the incidents and reporting the colleague to the appropriate authorities, such as the nurse manager or state board of nursing. (D)</p> Signup and view all the answers

A nurse manager is tasked with creating a staffing schedule that balances patient needs with budgetary constraints. Which strategy best incorporates the principles of ethical nurse staffing?

<p>Collaborating with bedside nurses to assess patient acuity and staffing needs, advocating for adjustments based on data and patient safety concerns. (A)</p> Signup and view all the answers

A patient is scheduled for a surgical procedure but expresses uncertainty about the potential risks and benefits. Which action best demonstrates the nurse's role in upholding the principle of informed consent?

<p>Answering the pt's questions about the procedure and verifying they understand the information before signing the consent form. (C)</p> Signup and view all the answers

A hospital implements a new electronic health record system. Several nurses express frustration due to increased workload and technical difficulties. How should the nurse manager address this organizational change to minimize conflict and promote staff morale?

<p>Providing comprehensive training and ongoing support, soliciting feedback, and addressing concerns promptly. (B)</p> Signup and view all the answers

A nurse witnesses a colleague making a disparaging remark about a patient's ethnicity. What action should the nurse take to promote justice and address this ethical issue?

<p>Reporting the incident to the nurse manager or other appropriate authority, advocating for a fair and respectful environment for all patients. (A)</p> Signup and view all the answers

A patient is readmitted to the hospital shortly after discharge with the same complications. Upon review, it's discovered that the patient did not receive adequate discharge teaching. Which legal concept does this scenario primarily implicate?

<p>Negligence (A)</p> Signup and view all the answers

A nurse administers a medication to a patient based on a verbal order from a physician, but the order was unclear and results in an adverse reaction. Which of the following statements is most accurate regarding the nurse's legal responsibility?

<p>Both the nurse and the physician share responsibility for the patient's well-being. (B)</p> Signup and view all the answers

During a home visit, a nurse observes unsanitary living conditions and suspects that a child is being neglected. What is the nurse's ethical and legal obligation in this situation?

<p>Reporting the suspicion of neglect to the appropriate child protective services agency. (A)</p> Signup and view all the answers

A state Board of Nursing (BON) is responsible for which of the following actions?

<p>Enforcing the nurse practice act and licensing nurses within the state. (A)</p> Signup and view all the answers

A nurse provides emergency care at the scene of a car accident. Which law protects the nurse from liability as long as the care was provided in good faith and within their scope of practice?

<p>Good Samaritan Law (D)</p> Signup and view all the answers

An LVN, unsure about performing a new procedure after an organizational change, is encouraged to:

<p>Request supplementary education on the specific change for clarity. (B)</p> Signup and view all the answers

A nurse is prioritizing care using the CURE framework. Which patient situation would be classified as 'Urgent'?

<p>Administering a PRN pain medication for a patient reporting moderate discomfort. (C)</p> Signup and view all the answers

A newly licensed nurse is struggling to manage their patient assignments during a busy shift. What strategy BEST exemplifies cognitive stacking to improve efficiency?

<p>Delaying the administration of a new medication during peak medication pass time to allow for focused monitoring afterward. (C)</p> Signup and view all the answers

What is the MOST important initial action a nurse should take when encountering a patient exhibiting signs of clinical deterioration?

<p>Immediately initiating interventions to address the life-threatening symptoms. (B)</p> Signup and view all the answers

A nurse is caring for a patient who is experiencing severe pain. According to prioritization frameworks, which level of priority does this represent?

<p>Critical (B)</p> Signup and view all the answers

A nurse precepting a student is explaining the importance of using evidence-based practice. Which action BEST demonstrates the application of this principle?

<p>Implementing interventions based on the latest research findings and clinical guidelines. (A)</p> Signup and view all the answers

Which scenario exemplifies an interpersonal conflict between a nurse and a healthcare provider (HCP) that could negatively impact patient care?

<p>A nurse avoids communicating with a physician due to feeling intimidated by their perceived authority, leading to delayed treatment. (A)</p> Signup and view all the answers

A nurse is prioritizing tasks at the beginning of a shift. Which activity should be considered a 'Routine' priority?

<p>Performing a focused physical assessment on a stable patient. (D)</p> Signup and view all the answers

A post-operative patient requires assistance with hygiene and mobility. According to priority setting frameworks, this need falls under which level of priority?

<p>Third Level (A)</p> Signup and view all the answers

How can conflict, when managed effectively, contribute positively to a nursing team's performance?

<p>By promoting collaboration and increasing productivity. (D)</p> Signup and view all the answers

A hospital implements a new policy regarding medication administration. According to the 'Basic Considerations' for decision-making, this decision is primarily based on:

<p>Mandates based on laws, policies, and procedure. (A)</p> Signup and view all the answers

What is the MOST significant contribution of change in healthcare?

<p>Advancing healthcare practices and preventing stagnation. (B)</p> Signup and view all the answers

What is a KEY characteristic of an effective change agent?

<p>Skill in communicating and explaining the change process to others. (D)</p> Signup and view all the answers

How should a healthcare leader primarily interpret negative reactions to a proposed change?

<p>As an inevitable part of change that should be addressed. (B)</p> Signup and view all the answers

In what capacity can an LVN serve during an organizational change?

<p>An LVN can implement change and take on the role of a change agent. (A)</p> Signup and view all the answers

An organization is undergoing a major technological change. What approach would BEST help staff adjust to the new system and minimize resistance?

<p>Provide comprehensive training and education on the new system, and involve staff in the implementation process. (A)</p> Signup and view all the answers

Following Kurt Lewin's Change Theory, what is the immediate next step after successfully creating buy-in and understanding of a proposed change among staff?

<p>Implementing the change while providing ongoing support and open communication. (D)</p> Signup and view all the answers

Which action represents the most effective way for an LVN to contribute to 'unfreezing' during a period of organizational change?

<p>Actively participating in discussions about the proposed change and voicing concerns. (B)</p> Signup and view all the answers

A hospital is transitioning to a new patient care model. Which strategy would most effectively support the 'moving' phase of Lewin's change theory?

<p>Establishing clear channels for communication, support, and addressing challenges during implementation. (B)</p> Signup and view all the answers

How could a new graduate nurse leverage their understanding of driving and restraining forces when starting their first job?

<p>By weighing the pros and cons of the job offer, considering factors that motivate and hinder their success. (A)</p> Signup and view all the answers

Which of the following scenarios involves an application of Evidence-Based Practice (EBP) in nursing?

<p>Consulting the latest research findings and patient preferences to inform a plan of care. (A)</p> Signup and view all the answers

In a healthcare setting, how can an LVN best promote the 'refreezing' stage after implementing a new patient charting system?

<p>Establishing mandatory training and integrating the new system into standard procedures. (C)</p> Signup and view all the answers

A clinic is considering implementing a new diabetes management program. Which initial step would align with the principles of planned change?

<p>Analyzing the driving and restraining forces related to the change, and involving stakeholders. (A)</p> Signup and view all the answers

What is the most significant difference between 'planned change' and 'change by drift' in a healthcare organization?

<p>Planned change is deliberate and organized, whereas change by drift is unplanned and may have an uncertain outcome. (B)</p> Signup and view all the answers

A nurse is caring for a patient who is experiencing an acute episode of anxiety alongside a chronic diagnosis of hypertension. How would you categorize the patient using the CURE framework?

<p>Urgent (D)</p> Signup and view all the answers

A newly admitted patient has several needs, among which are administering regularly scheduled oral medications, completing an admission assessment, and providing education on a new medication. Using general priority-setting principles, which should the nurse address FIRST?

<p>Calling the provider with new lab results. (B)</p> Signup and view all the answers

When prioritizing interventions using Watson's framework of caring, what action should a nurse prioritize with a patient in severe pain?

<p>Administering pain medication and creating a calming environment. (B)</p> Signup and view all the answers

A nurse is delegating tasks to other staff members. Which task should be completed first?

<p>A patient reporting difficulty breathing. (C)</p> Signup and view all the answers

Following a change in hospital policy, several nurses voice resistance and struggle to adapt. What is the most effective strategy to address this resistance and facilitate smoother adoption?

<p>Engage the nurses in open dialogue to understand their concerns. (C)</p> Signup and view all the answers

What is the primary risk of relying on 'change by drift' in healthcare management?

<p>Inconsistent practices and failure to meet evolving standards. (B)</p> Signup and view all the answers

A nurse is caring for a patient with chest pain. What should the nurse do first?

<p>Obtain an EKG. (C)</p> Signup and view all the answers

Which scenario best describes a situation of incivility between nurses?

<p>A nurse publicly criticizes a colleague's nursing skills in front of others. (A)</p> Signup and view all the answers

A team is tasked with implementing a new electronic health record system. Several team members have conflicting ideas on how to approach the rollout. What would be an appropriate tool or method to facilitate this?

<p>A retreat to improve communication. (C)</p> Signup and view all the answers

After implementing a new policy, a nurse manager wants to ensure the policy is being followed. What is the best evaluation method?

<p>Auditing patient charts and observing staff practices. (C)</p> Signup and view all the answers

What is the primary risk associated with role ambiguity in a healthcare setting?

<p>Potential for errors and decreased efficiency due to unclear expectations. (D)</p> Signup and view all the answers

Which factor least affects nurse staffing levels in a healthcare facility?

<p>The color of the walls in patient rooms. (A)</p> Signup and view all the answers

What is the most effective initial strategy for a nurse leader to address conflicts arising from limited resources?

<p>Proactively communicate resource limitations and encourage collaborative problem-solving. (D)</p> Signup and view all the answers

When managing conflict, what is the most important element for a nurse to consider to promote positive change?

<p>Addressing the conflict promptly and professionally while evaluating one's own role. (B)</p> Signup and view all the answers

An elderly patient with cognitive impairment is about to be discharged. The patient states, 'I don't want to go home.' According to ethical principles, which principle is most applicable in advocating for the patient?

<p>Beneficence, acting in the patient's best interest. (B)</p> Signup and view all the answers

A new graduate nurse is considering whether to report a medication error they observed. Which ethical principle should primarily guide their decision?

<p>Nonmaleficence. (D)</p> Signup and view all the answers

In a situation where a healthcare organization must decide how to allocate a limited supply of ventilators during a pandemic, which ethical theory would prioritize giving the ventilators to those patients most likely to survive?

<p>Utilitarianism. (D)</p> Signup and view all the answers

How does the State Board of Nursing (BON) primarily ensure safe and competent nursing practice?

<p>Overseeing nurse licensure and education. (A)</p> Signup and view all the answers

Which situation constitutes a violation of civil law?

<p>A nurse administering the wrong medication, resulting in patient harm. (C)</p> Signup and view all the answers

A nurse is asked to testify in a malpractice case. What legal standard will the court use to evaluate the nurse's actions in the situation?

<p>The standard of care expected of a reasonably prudent nurse in similar circumstances. (D)</p> Signup and view all the answers

A patient refuses a life-saving blood transfusion due to religious beliefs. What is the nurse's primary legal and ethical responsibility?

<p>Respect the patient's decision and explore alternative treatment options. (C)</p> Signup and view all the answers

A nurse posts on social media about a difficult patient, without naming the patient directly, but includes details about their medical condition. What legal concept does this action violate?

<p>Confidentiality. (A)</p> Signup and view all the answers

What is the nurse’s first action if they realize a medication order is incorrect?

<p>Contact the ordering health care provider (HCP) immediately to clarify the order. (C)</p> Signup and view all the answers

A nurse manager overhears a healthcare provider (HCP) complaining about the previous night shift nurse. What’s the most appropriate action by the nurse manager?

<p>Address the issue with the HCP privately, emphasizing professional communication standards. (B)</p> Signup and view all the answers

Which of these individuals should rely least on their intuition when faced with an ethical issue when providing patient care?

<p>A nursing student. (C)</p> Signup and view all the answers

Flashcards

Change

Altering the flow of events in any situation.

Importance of change

Healthcare advances when we are open to new ideas.

Reaction to change

Negative reactions when change is implemented.

Change agent

Someone skilled in the change process who can teach and implement.

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LVN as change agent

LVNs can lead and support implementing change.

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Planned Change

Change that is deliberate and well-organized, identifying forces for and against change.

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Change by Drift

Change that is unplanned, arising from system imbalance, and may face resistance.

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Unfreezing (Lewin)

First phase of change; preparing people for a new change, understanding what’s going on, may meet resistance.

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Moving (Lewin)

Second phase of change; people become ready to change and need support to address errors for learning.

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Refreezing (Lewin)

Third phase of change; stabilizing and integrating changes, making it part of regular work.

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Driving Forces

Factors that motivate behavior towards a certain direction or decision to take place.

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Restraining Forces

Realities that restrain or discourage a behavior or decision to take place.

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Evidence-Based Practice

Using current best evidence, clinical expertise, and patient preferences for optimal care.

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Facilitating Transitions

The process of relinquishing old roles, acquiring new skills, fostering spiritual growth, and establishing meaningful traditions.

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Setting Priorities

Priorities determined by evaluating urgency and importance, often guided by personal values and influenced by cultural, social, and philosophical factors.

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CURE Hierarchy

A prioritization framework categorizing needs as Critical, Urgent, Routine, or Extra, guiding immediate actions in patient care.

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First-Level Priorities

Life-threatening conditions demanding immediate intervention (e.g., respiratory distress).

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Second-Level Priorities

Conditions that may become life-threatening if not addressed quickly (e.g., altered mental status).

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Third-Level Priorities

Activities that can wait until the client is stable, focusing on education, counseling, and non-acute needs (e.g., post-op hygiene).

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Cognitive Stacking

The dynamic cognitive process where nurses reorganize patient care and activities, adjusting to constant changes during a shift.

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Decision-Making Steps

Step-by-step approach used to resolve issues: identify the problem, desired outcome, solutions, evaluate, implement, and reassess.

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Conflict

Disagreements arising from incivility, role ambiguity, environmental stress, nurse-to-patient ratios, and leadership styles; can foster collaboration if managed correctly.

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Intrapersonal Conflict

Conflict within oneself; acting in a way that contradicts personal values.

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Role Ambiguity

Unclear role expectations leading to stress and errors.

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Nurse Staffing

Staffing affected by census, acuity, and nurse shortages, which requires transparency.

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Limited Resources

Insufficient resources impacting the ability to perform your role effectively.

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Ethics

A branch of philosophy examining ideal human behavior.

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Ethical Dilemma

A conflict between two or more fundamental values.

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Autonomy

The right to choose one's own actions.

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Beneficence

To do what is good for the patient.

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Nonmaleficence

To do no harm.

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Justice

Being just, impartial, and fair.

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Fidelity

Faithfulness to agreements made.

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Veracity

Being truthful.

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Deontology

Represents one's duty to others; do no harm.

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Utilitarianism

Greatest benefit for the greatest number of people.

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Standard of Care

Level of care rendered by a comparable nurse in similar circumstances.

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Assault

Threat of unlawful touching of another.

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What is change?

Altering events in a situation to improve it. Essential for progress.

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Change in healthcare

Healthcare improvement relies on new ideas and processes.

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LVNs as change agents?

Yes! They can support and implement changes effectively.

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Purpose of Planned Change

Deliberate and organized change to reduce unexpected issues.

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Unfreezing

Allowing those affected by change to understand the need to change.

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Moving stage support

Supporting individuals through the change process, as they adapt.

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Refreezing implementation

Formalizing changes into policies and regularly evaluating their effectiveness.

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Driving Forces defintion

Factors that encourage movement toward a new behavior or decision.

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Evidence-Based Practice definition

The use of research, data, and patient input to guide clinical decisions.

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Evidence-Based Practice includes

Integrating patient values and preferences with best evidence for optimal health care.

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Evidence-Based Practice sources

Using surveys, statistics, research, and written records to decide plan of action .

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Reliable Websites

Websites that are peer-reviewed and updated regularly by governmental or professional organizations.

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Types of Priorities

Daily tasks to complete, efficient decisions, and personal values to help guide.

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Setting Priorities (In Nursing)

Use Maslow's Hierarchy of Needs, always prioritizing the most critical patient first, within Watson's caring framework.

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CURE Acronym

Critical, Urgent, Routine, Extra.

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CURE Definitions

Critical (life-threatening), urgent (potentially life-threatening), routine (stable), and extra (non-acute).

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Priorities of Care Levels

First level (life-threatening), second level (potentially life-threatening), and third level (stable).

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Need for Priority Setting

Knowledge, evidence-based practice, and sharing expertise with colleagues.

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Basic Considerations

Medication administration based on laws, policies, and procedures; ER decisions based on patient condition.

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Conflict in Nursing

Inevitability of disagreements.

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Organizational Conflict

Tension from incompatible personalities, ineffective leadership, demanding jobs, organizational changes, or societal factors.

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Resolving Conflict

Proactive engagement of a nurse leader when conflict arises.

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Personal Values

Underlying principles guiding ethical behavior.

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Nurse Practice Act

Sets legal requirements for LVN practice in a state.

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State BON

Enforces rules in NPA, manages licensure and education.

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Statutory Law

Laws enacted by a formal law-making body.

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Common Law

Based on customs and usage; used to sway judges or juries.

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Criminal Law

Affects public welfare; punished by imprisonment, fines, or loss of license.

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Civil Law

Laws between individuals/organizations; remedy usually involves payments.

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Duty to Seek Medical Care

Nurse must ensure patient receives safe care; act as advocate.

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Good Samaritan Law

Protects nurses offering voluntary assistance in emergencies without expecting pay.

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Fraud

Deliberate deception for personal gain.

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Study Notes

Planned Change

  • Deliberate, identifying driving and restraining forces to unfreeze, move, and refreeze the system.

Change by Drift

  • Imbalance leads to an unplanned scenario with unsure outcomes.

Kurt Lewin's Change Theory

  • A three-phase model to understand and implement change effectively.

Unfreezing

  • Understanding what is going on allows time for consideration and adaptation to change

Moving

  • People are unfrozen and concerning the proposes change, they become ready to change

Refreezing

  • The ability to stabilize and integrate after the change.

Evidence Based Practice

  • Utilizing best evidence, clinical experience, and patient preferences to customize the approach to health care.

Priorities

  • Setting meaningful priorities that align with personal values and the urgency of clinical needs.

CURE Hierarchy

  • A way to categorize patient needs to take a more thorough approach

Need for Priority Setting

  • Constant changes and the needs of the staff is always evolving

Conflict

  • Handled correctly, it can promote collaboration and increase productivity

Types of Conflict

  • Handling conflict in nursing profession, a nurse to patient level is triggered by not answering call lights, ignoring pain levels, not giving meds on time, abrasive communication

Role Ambiguity

  • Clear expectations and keys and communication

Ethics

  • Behaviors of the population
  • Enforced in the NPA state

Law

  • State BON dictates the HCP with legal duty to carry out the orders

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Related Documents

Leadership Exam 2 PDF

Description

Explore the necessity of change in healthcare, the role of change agents, and expected employee reactions. Understand planned change, including Lewin's theory stages. Examine dealing with resistance and implementing new policies.

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