Nursing Chapter 1: Managing Client Care
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Questions and Answers

According to the ABC framework, what is considered the highest priority need?

  • Circulation
  • Disability
  • Breathing
  • Airway (correct)

    • Evidence-based practice is determined by current research findings.

    True

    A severe circulation problem can take priority over a minor ________ problem.

    breathing

    What concept guides prioritization of care and interventions based on desirable outcomes from research?

    <p>evidence-based practice</p> Signup and view all the answers

    What are examples of time savers in time management? (Select all that apply)

    <p>Documenting nursing interventions as soon as possible after completion</p> Signup and view all the answers

    Poor time management can lead to omission of important tasks.

    <p>True</p> Signup and view all the answers

    Define 'Delegating' in the context of time management and teamwork.

    <p>Delegating is the process of transferring the authority and responsibility to another team member to complete a task, while retaining the accountability.</p> Signup and view all the answers

    Prior to delegating client care, it is important to consider the _________ of outcome.

    <p>predictability</p> Signup and view all the answers

    Which management function involves influencing and motivating staff to perform assigned roles?

    <p>Directing</p> Signup and view all the answers

    Effective leaders are always in a management position.

    <p>False</p> Signup and view all the answers

    What is clinical judgment?

    <p>Clinical judgment is the decision made regarding a course of action based on a critical analysis of data, considering the client's needs.</p> Signup and view all the answers

    Prioritizing interventions for a client in shock over interventions for a client who has a localized limb injury follows the principle of prioritizing systemic before __________.

    <p>local</p> Signup and view all the answers

    Match the following prioritization principles with their descriptions:

    <p>Systemic before local = Prioritize life-threatening issues first Acute before chronic = Prioritize addressing immediate issues before long-term ones Actual problems before potential = Focus on existing problems before predicting future ones</p> Signup and view all the answers

    Which of the following are examples of nursing-sensitive outcomes?

    <p>Incidence of nosocomial infections</p> Signup and view all the answers

    A root cause analysis investigates the consequences and possible causes of an issue.

    <p>True</p> Signup and view all the answers

    Core measures developed include stroke, venous infarction, and substance use to measure ____________.

    <p>outcomes</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Peer review = Evaluation of a colleague's practice by another peer Performance appraisal = Process of evaluating an employee's performance in relation to the job description Disciplinary action = Corrective action based on deficiencies identified during performance appraisals</p> Signup and view all the answers

    What is the role of preceptors in orienting newly licensed nurses?

    <p>All of the above</p> Signup and view all the answers

    Preceptors are typically assigned to newly licensed nurses for an unlimited amount of time.

    <p>False</p> Signup and view all the answers

    What is the process by which a person learns a new role and the values and culture of the group within which that role is implemented?

    <p>socialization</p> Signup and view all the answers

    The quality improvement process begins with identification of standards and outcome indicators based on evidence. Outcome indicators reflect desired client outcomes related to the standard under review. Structure indicators reflect the setting in which care is provided and the available _____ and material resources.

    <p>human</p> Signup and view all the answers

    Match the following stages of nursing ability with their descriptions:

    <p>Novice nurse = Approaches situations relying on context-free facts and rules govern practice Competent nurse = Demonstrates increasing levels of skill and proficiency and clinical judgment Proficient nurse = Conceptualizes situations holistically with well-developed critical thinking Expert nurse = Views situations holistically, makes decisions using advanced intuition and analytical ability</p> Signup and view all the answers

    What are some considerations for selecting an appropriate delegatee?

    <p>Education, training, and experience</p> Signup and view all the answers

    Delegated tasks can include nursing process, client education, and tasks requiring clinical judgment.

    <p>False</p> Signup and view all the answers

    Right task is __________, requires little supervision, and is relatively noninvasive for the client.

    <p>repetitive</p> Signup and view all the answers

    What acronym is used for nursing assistive personnel?

    <p>NAP</p> Signup and view all the answers

    Match the examples of tasks that can be delegated to practical nurses (PN) and assistive personnel (AP):

    <p>Monitoring findings (as input to the RN’s ongoing assessment) = Activities of daily living (ADLs) Performing tracheostomy care = Bathing Administering enteral feedings = Feeding (without swallowing precautions) Checking NG tube patency = Toileting Inserting a urinary catheter = Specimen collection</p> Signup and view all the answers

    The nurse cannot use the _ strategy due to the immediacy of the situation.

    <p>Avoiding/Withdrawing</p> Signup and view all the answers

    Which strategy involves one party pursuing a desired solution at the expense of others?

    <p>Competing/Coercing</p> Signup and view all the answers

    Assertive communication allows expression in direct, honest, and nonthreatening ways that infringe upon the rights of others.

    <p>False</p> Signup and view all the answers

    What does resource management include?

    <p>budgeting and resource allocation</p> Signup and view all the answers

    What are the five stages of conflict described in the provided content?

    <p>latent conflict, perceived conflict, felt conflict, manifest conflict, conflict aftermath</p> Signup and view all the answers

    What are common causes of conflict mentioned in the content?

    <p>All of the above</p> Signup and view all the answers

    Interpersonal conflict only involves disagreement among nurses.

    <p>False</p> Signup and view all the answers

    In the problem-solving process, after selecting a solution, it is important to evaluate the solution's ability to resolve the original ____.

    <p>problem</p> Signup and view all the answers

    Match the conflict resolution strategy with its description:

    <p>Collaborating = Both parties work together to achieve a new common goal. Avoiding/Withdrawing/Smoothing = A strategy to avoid conflict by smoothing over differences or withdrawing from the situation.</p> Signup and view all the answers

    What is the primary benefit of initially spending time to develop a client care plan?

    <p>It saves time later and helps avoid management by crisis</p> Signup and view all the answers

    When should a nurse offer to help other healthcare team members with client care?

    <p>When they are experiencing a period of down time</p> Signup and view all the answers

    What is a key factor to consider when determining the staffing mix for a unit?

    <p>The nurse-to-client ratio</p> Signup and view all the answers

    What is the primary goal of negotiation strategies in conflict resolution?

    <p>To find a mutually beneficial solution</p> Signup and view all the answers

    What is the primary consequence of poor time management in client care?

    <p>All of the above</p> Signup and view all the answers

    What is the primary role of a nurse in conflict resolution?

    <p>To find a mutually beneficial solution</p> Signup and view all the answers

    What is the primary consideration when selecting a delegatee for a task?

    <p>The delegatee's level of expertise</p> Signup and view all the answers

    What is the primary goal of time management in client care?

    <p>To prioritize tasks based on client needs</p> Signup and view all the answers

    What is the primary consequence of ineffective teamwork in client care?

    <p>Decreased quality of care provided</p> Signup and view all the answers

    What is the primary role of a nurse in unit staffing?

    <p>To determine the staffing mix for the unit</p> Signup and view all the answers

    What should a nurse do when they receive an unsafe assignment?

    <p>Bring the unsafe assignment to the attention of the scheduling/charge nurse and negotiate a new assignment</p> Signup and view all the answers

    What is the purpose of assigning, delegating, and supervising in client care?

    <p>To transfer authority and responsibility to another team member</p> Signup and view all the answers

    What is the primary goal of negotiation strategies in conflict resolution?

    <p>To reach a mutually beneficial solution</p> Signup and view all the answers

    What is an important consideration when selecting a delegatee for a task?

    <p>The delegatee's ability to perform the task independently</p> Signup and view all the answers

    What is the primary role of a nurse in unit staffing?

    <p>To coordinate client care and allocate staff</p> Signup and view all the answers

    Study Notes

    Managing Client Care

    • Managing client care requires leadership, management skills, and knowledge to effectively coordinate and carry out client care.
    • Effective management involves planning, organizing, directing, and controlling the work within an organization.

    Leadership

    • Leadership is the ability to inspire others to achieve a desired outcome.
    • Effective leaders possess good communication, problem-solving, and critical-thinking skills.
    • Leaders influence willing followers to move toward a goal.
    • Characteristics of leaders include:
      • Initiative
      • Inspiration
      • Energy
      • Positive attitude
      • Respect
      • Problem-solving and critical-thinking skills

    Leadership Styles

    • Autocratic/authoritarian:
      • Makes decisions for the group
      • Motivates by coercion
      • Communication occurs down the chain of command
      • Work output is usually high, but not suitable for all situations
    • Democratic:
      • Includes the group when making decisions
      • Motivates by supporting staff achievements
      • Communication occurs up and down the chain of command
      • Work output is usually of good quality when cooperation and collaboration are necessary
    • Laissez-faire:
      • Makes very few decisions and does little planning
      • Motivation is largely the responsibility of individual staff members
      • Communication occurs up and down the chain of command and between group members
      • Work output is low unless an informal leader evolves from the group

    Management Functions

    • Planning:
      • Decides what needs to be done, how it will be done, and who is going to do it
    • Organizing:
      • Determines the organizational structure, lines of authority, and channels of communication
    • Staffing:
      • Acquires and manages adequate staff and staffing mix
    • Directing:
      • Influences and motivates staff to perform assigned roles
    • Controlling:
      • Evaluates staff performance and unit goals to ensure identified outcomes are being met

    Characteristics of Managers

    • Hold formal positions of authority and power
    • Possess clinical expertise
    • Network with members of the team
    • Coach subordinates
    • Make decisions about the function of the organization

    Critical Thinking and Clinical Reasoning

    • Critical thinking:
      • Analyzes client issues and problems
      • Uses interpretation, analysis, evaluation, inference, and explanation to make informed decisions
    • Clinical reasoning:
      • Analyzes the elements of a clinical situation and makes decisions based on analysis
      • Uses nursing knowledge to make decisions about client care

    Prioritization

    • Prioritization principles:
      • Prioritize systemic before local (life before limb)
      • Prioritize acute (less opportunity for physical adaptation) before chronic (greater opportunity for physical adaptation)
      • Prioritize actual problems before potential problems
    • Priority-setting frameworks:
      • Maslow's hierarchy of needs
      • Airway, breathing, circulation (ABC) framework
      • Disability and exposure (D and E) framework

    Time Management

    • Organize care according to client care needs and priorities
    • Determine what must be done immediately and what can be done by a specific time to ensure client safety

    Evidence-Based Practice

    • Select interventions that maintain client safety while posing the least amount of restriction to the client
    • Use a variety of sources of research to keep current on new practices
    • Change traditional nursing practice with new research-based practices### Managing Client Care

    Time Management

    • Prioritize tasks based on client needs and available resources
    • Use time-saving strategies to facilitate accurate and thorough documentation
    • Avoid time wasters, such as documenting at the end of the shift and making repeated trips to the supply room
    • Estimate time needed for each activity and plan accordingly
    • Delegate tasks to other staff members when client care workload is beyond what can be handled by one nurse
    • Take breaks to socialize with staff and plan care to avoid procrastination

    Evidence-Based Practice

    • Use current research to guide prioritization of care and interventions
    • Make informed clinical decisions based on current data and best practices
    • Determine best practice through current research collected from several sources with desirable outcomes

    Assigning, Delegating, and Supervising

    • Assigning is the process of transferring authority, accountability, and responsibility to another team member
    • Delegating is the process of transferring authority and responsibility to another team member while retaining accountability
    • Supervising is the process of directing, monitoring, and evaluating the performance of tasks by another team member
    • Delegate tasks based on individual client needs, facility policies, and job descriptions
    • Consider legal and ethical concerns when assigning and delegating tasks

    Delegation Factors

    • Predictability of outcome: will the task have a predictable outcome?
    • Potential for harm: is there a chance that something negative can happen to the client?
    • Complexity of care: are complex tasks required as part of the client's care?
    • Need for problem-solving and innovation: is nursing judgment required while performing the task?
    • Level of interaction with the client: is there a need to provide psychosocial support or education during the task?

    Delegatee Factors

    • Education, training, and experience: does the delegatee have the necessary knowledge and skills to perform the task?
    • Ability to communicate with others: can the delegatee communicate effectively as part of the task?
    • Demonstrated competence: has the delegatee demonstrated competence in performing the task?
    • Agency policies and procedures: are the delegatee's skills and abilities in line with agency policies and procedures?

    Delegation and Supervision Guidelines

    • Use the five rights of delegation: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation
    • Use nursing judgment and knowledge related to the scope of practice and the delegatee's skill level when delegating

    Licensed Personnel and Assistive Personnel

    • Licensed personnel: nurses who have completed a course of study, passed the NCLEX-PN or NCLEX-RN exam, and have a nursing license
    • Assistive personnel: specifically trained to function in an assistive role to licensed nurses in client care activities

    Examples of Tasks That Can Be Delegated

    • To Practical Nurses (PNs): monitoring findings, reinforcing client teaching, performing tracheostomy care, suctioning, and administering medication

    • To Assistive Personnel (APs): activities of daily living (ADLs), bathing, grooming, dressing, toileting, ambulating, and vital signs for stable clients### Delegation and Supervision

    • Delegate a task to an AP (assistant personnel) when the client has a stable condition, such as measuring vital signs of a postoperative client.

    • Right direction and communication: delegate an AP to assist a client in a specific room with a specific task, such as a shower or morning hygiene.

    • Wrong task: delegate an AP to administer a nebulizer treatment to a client who has pneumonia, which requires a licensed nurse.

    • Right circumstance: delegate an AP to assist a client who is postoperative and stable, providing clear directions and expectations.

    • Wrong circumstance: delegate an AP to measure vital signs of a client who is postoperative and received naloxone to reverse respiratory depression, requiring close supervision.

    Supervision

    • Observe the AP to ensure safe ambulation of a client, providing positive feedback after completion.
    • Continually review the performance of the AP and determine care competency.
    • Assess team member performance based on standards, and when necessary, take steps to remediate a failure to meet standards.

    Nursing Leadership and Management

    • The nurse leader has a responsibility to maintain competent staff and respect the diversity of the health care team.
    • Staff education, or staff development, is the process by which a staff member gains knowledge and skills to ensure they meet the needs of clients.
    • The quality improvement process focuses on assessment of outcomes and determines ways to improve the delivery of quality care.

    Quality Improvement Process

    • The quality improvement process begins with identification of standards and outcome indicators based on evidence.
    • Structure indicators reflect the setting in which care is provided and the available human and material resources.
    • Process indicators reflect how client care is provided and are established by policies and procedures (clinical practice guidelines).
    • Outcome indicators reflect desired client outcomes related to the standard under review.
    • Benchmarks are goals that are set to determine at what level the outcome indicators should be met.

    Audits

    • Audits can produce valuable quantitative data.
    • Types of audits: structure audits, process audits, and outcome audits.
    • Nursing-sensitive outcomes are those that are directly affected by the quality of nursing care.
    • Examples of nursing-sensitive outcomes include client fall rates and the incidence of nosocomial infections.

    Nurse's Role in Quality Improvement

    • Serve as a unit representative on committees developing policies and procedures.
    • Use reliable resources for information (Centers for Disease Control and Prevention, professional journals, evidenced-based research).
    • Enhance knowledge and understanding of the facility's policies and procedures.
    • Provide client care consistent with these policies and procedures.

    Management Functions

    • The five major management functions are: planning, organizing, staffing, directing, and controlling.

    Staffing

    • Acquisition and management of adequate staff and staffing mix.
    • Determine client outcomes desired and/or achieved as indicated by evidence-based practices.

    Directing

    • Leadership role assumed by a manager that influences and motivates staff to perform assigned roles.

    Controlling

    • Evaluation of staff performance and evaluation of unit goals to ensure identified outcomes are being met.
    • Priority setting requires decisions about the order in which tasks are completed, maintaining client safety.

    Characteristics of Managers

    • Hold formal positions of authority and power.
    • Possess clinical expertise.
    • Network with members of the team.
    • Coach subordinates.
    • Make decisions about the function of the organization.
    • Manage emotions and channel them in a positive direction.

    Effective Management

    • Work output by staff is usually high in crisis situations and bureaucratic settings.
    • Effective for employees with little or no formal education.
    • Committed to the delivery of high-quality client care.
    • Refrains from judgment in controversial or emotionally-charged situations until facts are gathered.

    Nursing Leadership and Management

    • Clinical judgment is the decision made regarding a course of action based on a critical analysis of data.
    • Clinical judgment considers the client's needs when deciding to take an action, or modify an intervention based on the client's response.

    Planning

    • Decisions regarding what needs to be done, how it will be done, and who is going to do it.

    Organizing

    • Organizational structure that determines the lines of authority, channels of communication, and where decisions are made.
    • Assigning is performed in a downward or lateral manner with regard to members of the health care team.

    Time Management

    • Time management is a cyclic process.
    • Set goals and plan care based on established priorities and thoughtful utilization of resources.
    • Complete one client care task before beginning the next, starting with the highest priority task.
    • Reprioritize remaining tasks based on continual reassessment of client care needs.

    Client Factors

    • Condition of the client and level of care needed.
    • Specific care needs (cardiac monitoring, mechanical ventilation).
    • Need for special precautions (isolation precautions, fall precautions, seizure precautions).
    • Procedures requiring a significant time commitment (extensive dressing changes or wound care).

    Health Care Team Factors

    • Knowledge and skill level of team members.
    • Amount of supervision necessary.
    • Staffing mix (RNs, PNs, APs).
    • Nurse-to-client ratio.
    • Experience with similar clients.
    • Familiarity of staff member with unit.

    Time Management and Teamwork

    • Be cognizant of assistance needed by other health care team members.
    • Offer to help when unexpected crises occur.
    • Assist other team members with provision of care when experiencing a period of down time.

    Time Management in Healthcare

    • Assigning tasks in a downward or lateral manner can lead to feelings of being overwhelmed and stressed, omission of important tasks, and dissatisfaction with care provided.
    • Effective time management involves developing a plan, setting goals, and prioritizing tasks based on established priorities and thoughtful utilization of resources.
    • It is essential to complete one client care task before beginning the next, starting with the highest priority task, and continually reassessing client care needs.

    Client Factors Affecting Time Management

    • Client's condition and level of care needed
    • Specific care needs (e.g., cardiac monitoring, mechanical ventilation)
    • Need for special precautions (e.g., isolation precautions, fall precautions, seizure precautions)
    • Procedures requiring a significant time commitment (e.g., extensive dressing changes or wound care)

    Health Care Team Factors Affecting Time Management

    • Knowledge and skill level of team members
    • Amount of supervision necessary
    • Staffing mix (RNs, PNs, APs)
    • Nurse-to-client ratio
    • Experience with similar clients
    • Familiarity of staff member with unit

    Time Management and Teamwork

    • Be aware of assistance needed by other healthcare team members
    • Offer to help when unexpected crises occur
    • Assist other team members with provision of care when experiencing downtime

    Staffing and Management

    • Staffing involves the acquisition and management of adequate staff and staffing mix
    • Directing involves leadership and motivation of staff to perform assigned roles
    • Controlling involves evaluating staff performance and unit goals to ensure identified outcomes are being met

    Characteristics of Effective Managers

    • Hold formal positions of authority and power
    • Possess clinical expertise
    • Network with team members
    • Coach subordinates
    • Make decisions about the function of the organization

    Prioritization and Time Management

    • Nurses must continuously set and reset priorities to meet client needs and maintain client safety
    • Priority setting involves deciding on the order of tasks, including:
      • Seeing clients
      • Completing assessments
      • Providing interventions
      • Completing steps in client procedures
      • Completing components of client care

    Additional Factors Affecting Time Management

    • Self-care: schedule time for breaks and meals, take physical and mental breaks from work
    • Addressing unsafe assignments: bring concerns to the attention of the scheduling/charge nurse, negotiate a new assignment, and file a written protest if necessary

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    Description

    This quiz covers the basics of managing client care, including decision making, staff motivation, and communication in nursing.

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