Leadership Exam 2 PDF

Leadership Exam 2 Chapter 12: Understanding the benefits of change ❖ CHANGE (very important): advances healthcare; without it we’d become stagnant o What it is: involves altering the flow of events in any given situation- life, patient’s lives, organizations o Covey:...

Leadership Exam 2 Chapter 12: Understanding the benefits of change ❖ CHANGE (very important): advances healthcare; without it we’d become stagnant o What it is: involves altering the flow of events in any given situation- life, patient’s lives, organizations o Covey: believed that effective people make changes o Negative reactions to change are INEVITABLE ❖ Change agent: someone with experiences and skill about the change process; must be able to work well with others and can teach/explain; can implement change o CAN BE AN LVN!!! (look at Box 12.1)- LVNs can implement change and offer advice/ideas about changes Planned Change: deliberate, most Change by Drift: imbalance in the system, desirable, well organized, identify driving unplanned, outcome is unsure and restraining forces (unfreeze, move, and refreeze) NEEDS a change agent NO change agent is necessary; accidental or unplanned change Comes from a committee or administrative Occurs because people have not been group taught the change Well thought out Can occur from imbalance in system or other groups LVN receives instructions of change and Generally met with resistance will be asked to implement the change at bedside ❖ Kurt Lewin’s Change Theory: 3 phases o Unfreezing: people affected by change; allows ppl to understand what’s going on; may meet resistance ▪ Consider driving and restraining forces ▪ DO NOT try to implement change until this has taken place ▪ Share knowledge of change and provide psychological safety ▪ Allow time for consideration and adaptation to change o Moving: after people have been unfrozen and concerning the proposes change, they become ready to change ▪ Hyper-energy: sense of imbalance; indicates a readiness to change ▪ Support is needed because mistakes will happen which provide good learning opportunities ▪ Keep communication lines open and listen m to ALL feedback  ▪ Refreezing: actual change has been implemented; ability to stabilize and integrate changes so that it becomes a part of regular work Formalize the change: formal policy, train new employees, evaluate the change periodically o 2 concepts (TEST?: when new grads are weighing pros and cons about a new job) ▪ Driving forces: “there’s a reason for every behavior”; things that urge or motivate you to behave in a certain way Ex: the way we dress, what we drive, or what career we choose ▪ Restraining forces: realities that tell you to behave a certain way ❖ Evidence-Based Practice: helps provide best care possible o QSEN stated, “Best current evidence with clinical experience and patient/family preferences and values for delivery of optimal health care” o How to: written records, research, statistics, surveys, etc. o Make sure to use PEER REVIEWED and monitored websites that are kept up to date by governmental and professional agencies ❖ Transitions: o Facilitating transitions: let go of roles, develop new skills, develop spiritual self, create meaningful rituals Chapter 13: Setting meaningful priorities ❖ What kinds of priorities: o Something you do daily o Make meaningful and efficient decisions o Change by drift may happen when you fail to set priorities o Personal values help create priorities (cultural, social, philosophical backgrounds) ❖ Setting priorities: o Determine based on which ones are urgent or merely important (MASLOWS) o ALWAYS THINK- the most ill gets most immediate care o Meet the priority within Watson’s framework of caring ❖ CURE: Critical, Urgent, Routine, Extra (type of hierarchy) o Critical: patient with difficulty breathing, severe pain, drastic change in vitals o Urgent: PRN meds, verifying medication orders o Routine: patient teaching, physical assessments o Extra: getting drinks for family members, bringing a warm blanket ❖ Priorities of care: o First level: critical findings, clinical deterioration, life threatening and require urgent action; take action immediately ▪ Ex: respiratory distress with tachypnea, intercostal retractions, hemodynamic instability o Second level: MAY become life threatening; take prompt action quickly ▪ Ex: altered mental status o Third level: patient education, counseling, things that can wait until client is stable; not acute in nature ▪ Ex: post op patients who are needing hygiene and mobility assistance; new patient diagnosed with diabetes needs explanation about monitoring their blood glucose ❖ Need for priority setting: o One constant in healthcare: tomorrow it will all change o You must be a lifelong learner o Share all your knowledge and skills with colleagues o Use “best evidence-based practice” o Be a role model o Fewer nurses= poorer patient care o Cognitive stacking: nurses need to know how to reorganize their patient and activities which will constantly change during the shift ▪ Ex: giving a new medication during peak med pass time (be sure you have time to monitor for any adverse reactions) ❖ Ability to make good decisions depends on your knowledge base o Basic considerations  ▪Made based on laws, policies, and procedure mandates (med admin) ▪Made in ER setting based on knowledge (change in pt’s condition) ▪Made when you have time to process it before making a set decision (which nursing school to attend) ❖ Decision making steps o Define problem o Determine most desirable cause o Identify solutions for problem o Evaluate all solutions for effectiveness o Select and implement solution o Evaluate solution selected for effectiveness (start over if not effective) Chapter 14: Handling conflict in nursing profession ❖ Conflict is INEVITABLE o R/T: incivility, role ambiguity, environmental stress, nurse to pt ratio, ambivalent leadership o If handled correctly, it can promote collaboration and increase productivity ❖ Types of conflict o Intrapersonal: thinking or acting in a way that’s not congruent with values of an individual o Interpersonal: most common; conflict with another person ▪ Nurse to patient: when pt and families don’t feel heard or provided with shared decision making Triggers: not answering call lights, ignoring pain levels, not giving meds on time, abrasive communication ▪ Nurse to nurse: bullying, lateral violence, incivility Uncivility leads social or emotional distancing or avoidance Make sure to address behaviors if there are negative feelings Report all workplace violence and bullying incidents ▪ Nurse to HCP: power difference, one feeling more superior Teamwork and collaboration is necessary to promote patient safety, quality outcomes, and reduction of patient harm Goal: patient centered care!!! Imbalanced power can affect morale, turnover rates, negativity affecting patient care ❖ Organizational conflict o Incompatible employee personalities  o Ineffective leadership o Demanding job o Organizational change o Societal factors ❖ Role ambiguity: unclear role expectations (COMMUNICATION IS KEY) ❖ Nurse staffing o Affected by: census, acuity, seasons/holidays, workload patterns o Should be: created with input from bedside nurses, based on patient number and acuity o Budgetary restrictions and nurse shortages may lead to non-ideal staffing scenarios (always be transparent) ❖ Limited resources o Not having resources to perform role (ex: pandemic, lack of PPE) o Not enough funds (ex: adequate nursing staff, supplies, room availability, medical equipment) o As a leader (be proactive and communicate effectively) ❖ Resolving conflict: effective communication, resolution techniques, leadership styles, self-reflection, be open to feedback ❖ Conflict resolution: be proactive and contact nurse leader if conflict is occuring o Managing conflict: it’s unavoidable and cause produce growth if used in correct way; address conflict as soon as it arises; evaluate your role in managing conflict and always be professional ▪ Strategies: new understanding, clear communication, help identify resolution strategies, consult with higher leadership if needed Chapter 16: Ethics and law in nursing management ❖ Ethics: branch of philosophy that examines ideal human behavior o Ethical dilemma: conflict between 2 or more fundamental values ▪ Ex: Parkinson's pt who wants to be independent, but you know it’s unsafe; however, pt does have a right to choose their care o Ethical behavior: depends on era, culture, setting, and the people involved ❖ Personal values: underlying principles of ethical behavior o Values: personal beliefs about the truth, thoughts, and behaviors of a person ❖ Understanding ethics o Intuition: feeling that you should or shouldn’t do something; not an acceptable way for a novice nurse to make an ethical decision ❖ Ethical principles o Autonomy: right to choose one’s own actions (ex: pt can refuse meds)  o Beneficence: do what is good for patient (ex: giving pain meds) o Nonmaleficence: do no harm (ex: keep sick staff members at home) o Justice: being just, impartial, and fair (ex: spend equal time with patients) o Fidelity: faithfulness to agreements made (ex: keep promises to patients) o Veracity: being truthful (ex: answer questions fully and don’t withhold info) ❖ Ethical issues o Genetics: technology to let us know what diseases we’re prone to develop o Stem-cell research: helps treat certain conditions; ethical discussions on how to obtain these stem-cells o Bioethics: ability to genetically modify cells (ex: cryogenics, in vitro) ❖ Ethical theories o Deontology: represent one’s duty to others; do no harm (human dignity) o Utilitarianism: greatest benefit for greatest number of people; values the needs of group over each individual ❖ Legal issues o To neglect to do so is a criminal act ❖ Nurse practice act: sets the legal requirements in state that the LVN practices ❖ State BON: enforces rules in NPA; responsible for licensure and education of the state; dictates that the nurse has a legal duty to carry orders given by HCP ❖ Law o Statutory law: enacted (formal law-making body like legislature), regulatory laws (made by agencies- state BON) o Common law: based on common usage and customs; used to sway judges or juries to choose something o Criminal law: affect public welfare; punished by imprisonment, probation, loss of license, or fines (ex: LVN who poses as an RN) o Civil law: laws between organizations or individuals; court will decide how to correct the wrongdoing (usually payments) ▪ Tort: violation of civil law ❖ Legal issues specific to nursing o Standard of care: level of care that would be rendered by a comparable nurse in a similar circumstance o Duty to seek medical care for patients: duty to make sure each patient receives safe and competent care; be their advocate o Good Samaritan law: nurses who provide voluntary assistance in emergency situations without expectation of payment; would not win a lawsuit if you work within your practice; obtain consent if possible  o Confidentiality: HIPPA; info shared with care team only; share with right person at the right time and place (DON’T share info with other patients) o Permission to treat: pt must sign consent but can refuse care at any time; promote compliance while respecting values and beliefs (explain IV procedure to pt before doing anything) o Informed consent: pts must receive info and understand all outcomes possible; HCP has to consent to medical procedures o Defamation of character: sharing info about others that is malicious and false; either written (libel) or oral (slander) o Negligence: must meet standard of practice; damage or injury has resulted due to nurse’s negligence o Malpractice: negligence committed by a professional person with a license (giving wrong med and leading to adverse reactions within a pt) o Fraud: deliberate deception for the purpose of personal gain (LVN pretending to be an RN) o Assault: threat of unlawful touching of another; willful attempt to hurt one o Battery: unlawful touching of another without consent, justification, or excuse o False imprisonment: preventing movement or making a person stay in a place without consent; physical or non-physical; every patient has the right to leave a facility at any time- even against medical advice (AMA) ▪ Ex: threaten to sedate or take away a patient’s clothing so they cannot leave ❖ Advance directives: durable POA will make health-care decisions for a patient ❖ Guidelines for preventing lawsuit o Knowledge: know pt needs and words, organizational policies and procedures, know standards of care o Record and report: record truth in objective record, report any patient or family problems o Question: ask questions so you can determine proper approaches to resolving conflicts Texas Jurisprudence information (NEED TO KNOW & was on the exam): ❖ AOG (affidavit of graduation): completed by Tracey Cooper ❖ Nursing Jurisprudence exam (NJE): 50 questions, have to make a 75%, have 2 hours to take it, can retake after 2 hours ❖ Continuing education: 20 hours  ❖ Temporary permit: expires “when NCLEX-PN results are recorded” whether you pass or fail ❖ Board rule 214: education for licensed vocational nursing Specific questions that were on the exam: ❖ If med order is wrong, contact HCP immediately and refuse to give if necessary ❖ If HCP complains to you about the previous night shift nurse before you, go to nurse manager; DON’T talk about that nurse behind their back or go to them face to face ❖ 80% of nurses face incivility, NOT 50% (she threw this question out though) ❖ Nurse not taking pulse before giving medication is UNETHICAL ❖ DON’T offer to stay with a pediatric patient if parent has to leave, simply ask if there is another family member who can come stay with the patient ❖ If you are unsure or uncomfortable about performing a new procedure after change, ask for more education on the specific change, DON’T go back to your old ways ❖ If nurses complain about schedule, nurse manager should use negotiation (she threw this question out as well) ❖ Nursing students DON’T have intuition, so for ethical issues they should ask their instructors or clinical preceptors ❖ If an individual hasn’t thought about their own beliefs, there will be DELAY in decision making ***You both got this, and I believe in y'all. I love y'all so much. y'all will be okay***