Livs Exam 1 Review PDF

LEADERSHIP AND MANAGEMENT EXAM 1 BLUEPRINT / OBJECTIVES LEADER – MANAGER MODULE (6 ITEMS) Define the following key terms: management, leader, management processes, participative management, Hawthorne effect, Theory Y, Theory X, trait theories, authoritarian leader, democratic leader...

LEADERSHIP AND MANAGEMENT EXAM 1 BLUEPRINT / OBJECTIVES LEADER – MANAGER MODULE (6 ITEMS) Define the following key terms: management, leader, management processes, participative management, Hawthorne effect, Theory Y, Theory X, trait theories, authoritarian leader, democratic leader, laissez-faire leader, situation leadership, contingency leadership, interactional leadership, transactional leadership, transformational leadership, servant leadership, emotional intelligence, authentic leadership, reflective thinking and practice, Maslow, self-actualization, motivation-hygiene theory, two-factor theory, worker empowerment, incentives & rewards. o Manager vs Leader Manager Leader Managers are assigned a position Obtain power through influence Have a legitimate source of power Leaders may not have delegated authority Have specific dues and responsibilities Lea8o79l,,,ders have a wider variety of roles Emphasis on control, decision making, May or may not be a part of the hierarchy decision analysis Emphasis on interpersonal relationships Manipulate people, money, environment, time, etc. to achieve goals Focus on feedback, processes, information gathering, and empowerment Greater formal responsibility and accountability Direct willing followers Direct willing and unwilling subordinates o Management Process ▪ “Effective leadership is putting first things first, effective management is discipline, carrying it out.” ▪ Management is about planning, organizing, staffing, controlling complexity, and coordinating to bring about order, consistency and predictability ▪ Leadership is about expressing a vision, establishing a sense of direction, aligning people through empowerment, motivating and inspiring others to achieve the vision o Authoritarian Leadership ▪ A leadership style where the leader exercises significant control and makes decisions unilaterally, without much input from team members ▪ Centralized Authority: the leader has absolute control and expects strict compliance from subordinates ▪ Limited Participation: employees have little to not involvement in decision-making processes ▪ Clear Directives: instructions and expectation are clearly communicated and must be followed without question ▪ Strengths: can be effective in situations requiring quick decisions or when dealing with inexperienced teams ▪ Weaknesses: may lead to low morale, lack of creativity, and high turnover rates o Democratic / Participative Leadership ▪ A leadership style that involves team members in decision-making processes, encouraging collaboration and input from everyone ▪ Shared Decision-Making: leaders seek input from the group and consider their opinions before making decisions ▪ Encourages Collaboration: team members are encouraged to participate and contribute ideas ▪ Balanced Authority: while the leader still has the final say, decisions are made more collectively ▪ Strengths: often leads to higher employee satisfaction, better team cohesion, and more innovative solutions ▪ Weaknesses: can be time consuming and may result in slower decision- making, which can be challenging in fast-paced environments o Laissez-Faire Leadership ▪ A hands-off leadership style where the leader provides minimal direction and allows team members to make their own decisions ▪ Minimal Supervision: employees are given a high degree of autonomy and freedom in how they complete their work ▪ Trust in Team: leaders trust that their team members are capable and will take responsibility for their own tasks ▪ Limited Interference: the leader avoids micromanaging and only intervenes when necessary ▪ Strengths: can be effective with highly skilled, self-motivated teams who thrive on independence ▪ Weaknesses: may lead to lack of direction, low productivity, and poor performance if team members are not self-motivated or require more guidance o CONTINGENCY LEADERSHIP ▪ Theories account for other factors beyond the leader’s ability to influence the teams and or organizational outcomes ▪ In simple terms: contingency leadership is a theory that suggests the effectiveness of a leader depends on how well their leadership style matches the situation. Unlike a “one size fits all” approach, contingency leadership acknowledges that different circumstances require different types of leadership. ▪ There are multiple models within this theory: ▪ Fidler’s Contingency Theory ▪ Developed by Fred Fidler. The model evaluates situational favorableness based on leader/member relationships, task structure, and the Leader’s positional power ▪ Leader/Member Relations: A leader who is more trusted and has more influence is key ▪ Task Structure: Is the task clear and structured? Is it the opposite? Tasks where both the team and leader have very little knowledge is unfavorable ▪ Leader’s Position in Power: The more power you have, the more favorable your situation  ▪ Hersey-Blanchard Situational Theory ▪ Developed by Paul Hersey and Ken Blanchard. This model suggests that leaders should adjust their style based on the maturity level of their followers. The maturity level is determined by the follower’s ability and willingness to perform a task. The leader should adapt their approach from directing to coaching and supporting. This model has three variables: task behavior, relationships behavior, and maturity level. ▪ Path Goal Theory ▪ Developed by Robert House. This theory insists that a Leader’s role is to clear the path for followers to achieve their goals. Leaders then adapt their style to the following depending on the needs of their followers and nature of the tasks: ▪ Directive: Specific instructions and guidance ▪ Supportive: Relationship building, friendly and supportive ▪ Participative: Actively seeking input and feedback, valuing their opinions ▪ Achievement Oriented: Goal setting and encouragement ▪ Substitutes for Leadership ▪ Leaderships substitutes: subordinates, task, or organizational characteristics that make leaders not needed or unnecessary ▪ Example: Highly skilled, experienced, and motivated nurses require less guidance from a leader. ▪ Leadership neutralizers: subordinates, task, or organizational characteristics that interfere with a leader’s actions ▪ Example: Disengaged, resistant to change, unskilled nurses may be more difficult to guide or motivate CONTEMPORARY APPROACH o Charismatic Theory ▪ Charismatic leadership is characterized by a leader’s ability to inspire and motivate followers through their personal charm, vision, and communication skills. ▪ Articulate a clear vision based on values ▪ Model values consistency with the vision ▪ Communicates high performance expectations ▪ Displays confidence in follower’s abilities ▪ Examples: Steve Jobs, MLK Jr ▪ Ethical Charismatics – provide development opportunities, open to both positive and negative feedback, recognize other’s contributions, share information, and are concerned with the interest of the team ▪ Unethical Charismatics – control and manipulate their followers, incredibly selfish, only want positive feedback, and are motivated by self-interest. Example: Jonestown Massacre, Cult Leaders o Transformational Theory ▪ Transformational Leadership focuses on inspiring and motivating followers to achieve exceptional outcomes and engage in personal and organizational growth. Transformational leaders seek to create significant change by aligning followers’ values and goals with the organization’s vision ▪ Connecting followers to the mission ▪ Being a role model for followers that inspires ▪ Challenging followers to take greater ownership for their work ▪ Understanding the strengths and weaknesses of followers so the leader can align followers ▪ Examples: Nelson Mandela o Servant Leadership ▪ Developed by Robert K. Greenleaf. Servant leadership is a philosophy and set of practices that enriches the lives of individuals, builds better organizations, and ultimately creates a more just and caring environment. ▪ There are 9 Qualities of a Servant Leader ▪ Values diverse opinions ▪ Cultivates a culture of trust ▪ Develops more leaders ▪ Helps people with life issues ▪ Encourages others ▪ Sells instead of tells ▪ Selfless ▪ Thinks “long-term” ▪ Acts with humility ▪ Example: Mother Teresa o Knowledge Workers ▪ Individuals whose primary jobs involve handling and creating information or knowledge, such as in technology, research, or consulting fields. Leadership in this context focuses on fostering innovation, managing intellectual capital, and creating an environment conductive to knowledge sharing and development ▪ Encourages continuous learning and innovation ▪ Facilitates knowledge sharing and collaboration ▪ Provides autonomy and support for intellectual or creative work ▪ Example: Eric Schmidt (Google CEO) MANAGEMENT THEORIES o Scientific Management – Taylorism ▪ Developed by Frederick W. Taylor. Scientific management focus on improving efficiency and productivity through the application of scientific methods to management and work processes. Taylor emphasizes optimizing work processes, standardizing tasks, and using time-and-motion studies to find the most efficient ways of performing tasks. ▪ Standardization of Work: developing standardized procedures for tasks to increase efficiency ▪ Time and Motion Studies: analyzing work tasks to determine the most efficient way to perform them ▪ Specialization: assigning specific tasks to workers based on their skills to increase productivity ▪ Performance Based Pay: linking pay to performance to motivate workers ▪ Examples: Ford Motor Company ▪ Strengths: Increased productivity and efficiency, clear procedure and roles reduce ambiguity in task performance ▪ Weaknesses: Dehumanization of workers focuses more on efficiency than employee satisfaction. Overlooks the complexity of human behavior and the need for motivation beyond financial incentives o Bureaucratic Management – Weberian Bureaucracy ▪ Developed by Max Weber. Bureaucratic management emphasizes a structured, formal approach to management and organization, characterized by clear hierarchies, strict rules and procedures, and impersonal relationships. Weber’s theory aimed to create an efficient and rational organizational structure. ▪ Formal Hierarchy: clear chain of command where each level controls the level below it. ▪ Rules and Procedures: well defined rules and procedures ensure consistency and fairness ▪ Impersonality: decisions and interactions should be based on objective criteria rather than personal relationships ▪ Specializations: employees should be specialized in their roles and tasks to increase efficiency ▪ Examples: Government agencies, large corporations ▪ Strengths: Provides clear structure and well-defined roles which can lead to efficiency and predictability. Ensures fairness and consistency through established roles and procedures ▪ Weaknesses: Can lead to rigidity and lack of flexibility, making it difficult to adapt to change, may create an impersonal work environment that could reducing employee morale and motivation  o Human Relations Management Theory – Mayo and Hawthorne ▪ Developed by Elton Mayo and the Hawthorne Studies. Emphasizes the importance of human factors in the workplace, such as motivation, interpersonal relationships, and employee well-being. It arose from the recognition that worker satisfaction and social interactions significantly impact productivity. ▪ Employee Motivation: understanding that social factors, such as recognition and belonging, affect employee motivation and performance ▪ Workplace Environment: creating a supportive work environment that fosters good relationships among employees ▪ Leadership Style: leaders should be approachable and supportive to enhance employee satisfaction and productivity ▪ Group Dynamics: recognizing the influence of group behavior on individual performance ▪ Examples: Hawthorne Studies, which was research, conducted at Western Electrics Hawthorne Works by Elton Mayo, showed that worker productivity increased when workers were given attention and felt valued, highlighting the impact of social and psychological factors on performance. Modern HR practices. ▪ Strengths: Enhances employee satisfaction and motivation by addressing social and emotional needs. Can improve productivity through better interpersonal relationships and a supportive work environment. ▪ Weaknesses: May overlook the importance of efficiency and structure in favor of employee well-being. Can lead to conflicts if not balance with organizational goals and productivity concerns. MOTIVATIONAL THEORIES o Maslow’s Hierarchy of Needs ▪ Developed by Abraham Maslow. Psychology theory that proposes a hierarchical structure of human needs. According to Maslow, individuals are motivated by a progression of needs starting with the most basic and advancing to higher-level psychological needs ▪ Physiological Needs: basic necessities for survival such as food, water, shelter, and sleep ▪ Safety Needs: security and protection from physical and emotional harm, including job security and health safety ▪ Love and Belongingness Needs: social relationships, love, and a sense of belonging to a group or community ▪ Esteem Needs: self-esteem, respect from others, recognition, and a sense of accomplishment ▪ Self-Actualization Needs: the realization of personal potential, self-fulfillment, seeking personal growth, and achieving one’s full potential ▪ Weaknesses: The hierarchical order may not apply universally; people may pursue higher level needs without fully satisfying lower-level ones. The theory itself is somewhat abstract and may not account for individual differences in needs o Hertzberg’s Two Factor Theory (AKA Motivator – Hygiene Theory) ▪ Developed by Frederick Herzberg. Suggests that there are two distinct sets of factors that impact employee motivation and job satisfaction: ▪ Hygiene Factors: these are factors necessary to prevent dissatisfaction but do not necessarily motivate employees. They are related to the work environment and conditions such as: ▪ Salary and Benefits ▪ Job security ▪ Working conditions ▪ Company policies ▪ Relationships with supervisors and peers ▪ Examples: Improving workplace safety, competitive salaries, ensuring fair polices ▪ Improving Hygiene Factors DECREASES Job Dissatisfaction ▪ Motivator Factors: these factors contribute to higher levels of motivation and satisfaction and are related to the nature of the work itself such as: ▪ Achievement ▪ Recognition ▪ Responsibility ▪ Work itself ▪ Advancement ▪ Personal Growth ▪ Examples: Providing challenging work, recognizing achievements, and offering opportunities for advancement ▪ Improving Motivational Factors INCREASES Job Satisfaction ▪ Weaknesses: The theory may oversimplify the complex nature of job satisfaction and motivation. Different individuals may react differently to the same factors o McGregor’s X and Y Theories ▪ Developed by Douglas McGregor. Describes two contrasting views of employee motivation and management ▪ Theory X: Assumes that employees are inherently lazy, need to be controlled, and are motivated primarily by money and security. Mangers who subscribe to Theory X believe: ▪ Employees avoid work when possible ▪ They require strict supervision and control ▪ They are motivated mainly by rewards and punishments ▪ Example: Micromanaging employees, using strict rules and close supervision ▪ Theory Y: Assumes that employees are motivated by more than just money, are self-motivated, and seek responsibility and personal growth. Managers who subscribe to Theory Y believe: ▪ Employees are motivated by intrinsic factors such as satisfaction and achievement ▪ They can be trusted to take responsibility and are capable of self- direction ▪ They seek opportunities for personal growth and self-fulfillment ▪ Example: Encouraging employee autonomy, providing opportunities for professional development, and involving employees in decision-making  ▪ Weaknesses: This theory might be seen as too binary, with many management styles falling between these extremes. Not all employees fit neatly into either category, as motivation can be complex and context dependent o Equity Theory ▪ Developed by John Stacey Adams. Focuses on the balance between an employee’s inputs (efforts, skills, and experience) and outcomes (rewards, recognition, and compensation.) The theory assumes that employees are motivated when they perceive fairness in the workplace, comparing their “input- output” ratio to that of others. ▪ Inputs: what employees contribute to their work such as: skill, effort, experience, and time ▪ Outputs: what employees receive from their work such as: salary, benefits, recognition, and promotions ▪ Equity Sensitivity: employees assess fairness by comparing their input-output ratios to others. If they perceive inequity, they may feel demotivated o Weaknesses: Perceptions of fairness can vary widely, theory focuses mainly on tangible rewards like salary, overlooking intangible factors such as personal growth and satisfaction. o Dr. Benner’s Stages of Clinical Competence ▪ A model that describes the progression of nursing skills and expertise through five levels of proficiency. This model is widely used in nursing education and practice to assess and support the development of clinical skills. ▪ 1. Novice: Beginners with no experience in the situations they are expected to handle. They follow rules and guidelines strictly and require close supervision. Their actions are typically rigid and inflexible because they lack experience ▪ 2. Advanced Beginner: Nurses who have some experience, including observation and limited real-life application. They begin to recognize recurring meaningful patterns in clinical situations. They start applying rules and guidelines but still need help with prioritizing tasks and managing more complex situations ▪ 3. Competent: Nurses with 2-3 years of experience in similar job situations. They have more confidence in their actions and can plan and make decisions based on long-term goals. They can manage their time effectively and handle patient care with more efficiency and organization ▪ 4. Proficient: Nurse who see situations as whole parts rather than in isolation, with a deep understanding of clinical situations. They can adapt plans based on patient needs and are more flexible in their approach. They can anticipate potential problems and intervene more effectively, relying on their intuition and experience ▪ 5. Expert: Nurses with extensive experience who no longer rely on rules or guidelines to connect their understanding of the situation to appropriate action. They have an intuitive grasp of each situation and can quickly zero in on the problem without wasting time on unnecessary analysis. They are highly efficient, fluid, and effective in their care, often serving as mentors to less experience nurses o Emotional Intelligence ▪ The ability to understand, recognize, manage, and use emotions effectively in oneself and others.  o Authentic Leadership ▪ A leadership style that emphasizes being genuine, transparent, and true to one’s values and beliefs ▪ Self-Awareness ▪ Relational Transparency ▪ Balance processing (making decisions considering multiple perspectives) ▪ Internalized Moral Perspective (leading with integrity) o Reflective Thinking and Practice ▪ The process of continuously analyzing and evaluating one’s actions, decisions, and experiences to improve future performance. This encourages learning from experience, improves problem solving skills, and enhances growth o Self-Actualization ▪ The realization of one’s full potential, often considered the highest level of Maslow’s Hierarchy of Needs, Personal growth, fulfillment, creativity, and autonomy are key characteristics o Worker Empowerment ▪ Giving employees the autonomy, resources, and authority to make decisions and take actions with their roles. Benefits include increased motivation, enhanced productivity, and improved job satisfaction o Incentives and Rewards ▪ Tools used to motivate and reward employees for their performance and behavior. Could be monetary or non-monetary. Analyze the current key theories related to leadership and management, comparing them to older theories. ABOVE Compare and contrast the roles, characteristics, and responsibilities of nursing leaders and nursing managers. Examples of tasks of shift charge nurse: 1. Planning: coordinating number of patients w/ number of staff members, replace call-ins, overtime + agency nurses 2. Organizing: looking at patient’s status, possible discharges, surgeries, admission + staffing 3. Staffing: look at capabilities + competencies of staff available + match to patients 4. Directing: supervise + oversee, make sure the admissions + discharges are completed 5. Controlling + coordinating: keep team on track, remove obstacles, calling doctors, redistribute work prn, help new staff Describe strategies for developing and thriving as a leader. ABOVE Identify the generational differences that challenge nursing leaders and nursing managers. o Aging of baby boomers o Demographic profile of nursing o Access, cost and quality of healthcare o Evolving technology o Reality of dealing with change constantly Describe the management process/functions as they relate to nursing. ABOVE QUALITY MANAGEMENT AND SAFETY (9 ITEMS) Describe the Six Aims for Healthcare and the IHI Quadruple Aim. Safe – avoiding injuries to patients from the care that is intended to help them Timely – reducing wants and sometimes harmful delays for patients and providers Effective – providing the appropriate level of services based on scientific knowledge Efficient – avoiding waste of equipment, supplies, ideas, and energy Equitable – providing care that does not vary in quality because of personal charact. Patient – Centered – providing care that is respectful of and responsive to individual Explain the current national patient safety goals. Identify patients correctly Improve staff communication Use medicines safely Use alarms safely Prevent infection Identify patient safety risks Improve health care quality Prevent mistakes in surgery Distinguish quality improvement and quality assurance. Quality Improvement: Use of data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Systematic Process, continuous, prospective approach, doing the right thing, responsibility Example: a hospital reviews patient falls and implements new safety protocols, like adding more bed alarms to reduce falls over time Quality Assurance: Refers to the systematic processes used to ensure that healthcare services meet established standards of care, patient safety, and regulatory compliance. The primary goal is to provide high-quality that is safe, effective, patient-centered, timely, efficient, and equitable. Inspection approach, retrospective, reactive, standards met, responsibility of a few Example: a hospital regularly audits staff to ensure they are following infection control guidelines, like hand hygiene and sterilization, to meet established standards Describe the healthcare customer and the ways they are empowered. Explain the how the public is empowered in seeking healthcare services. Explain the Donabedian Model of Quality. Structure: internal characteristics Examples: supply of staff, skill level, education and certification of staff Process: aspects of nursing care… are activities being done appropriately, effectively, and efficiently Examples: assessment, intervention, RN job satisfaction Outcomes of Nursing Care: did the service make a difference Falls, pressure ulcers, IV infiltrations Patient Safety Indicators: a set of measures that screen for adverse events Examples: decubitus ulcer, failure to rescue, foreign body left during procedure, fall scores, transfusion reactions, post-op sepsis, post-op wound dehiscence Apply the concept “standards of care.” Standards of Care are the legal requirements for nursing practice that describe minimum acceptable nursing care. Apply the basic steps of quality improvement 1. Identify the problem or opportunity for improvement a. Can you identify data for this issue to prove it exists? b. Is this issue important to patient care, organizational goals, etc.? 2. Identify the metric associated with the problem a. Examples: pressure ulcer rates, incidence of falls, etc. 3. Examine historical data on the metric to assemble evidence that the problem actually exists 4. Align the problem with Donabedian’s Quality Framework a. Donabedian’s Framework: Structure, Process, Outcomes 5. Notify the chain of command and seek approval to assemble the improvement team a. Organizational Assessment helps to determine readiness b. Develop QI Project Charter to contract with the organization to determine who, what, when, where, how, goals, and boundaries c. Set goals in SMART format  6. Determine the extent of the problem (benchmarks, gap analysis, fishbone, system process diagrams etc.) a. Collect Data: Surveys, interviews, complaints, regulatory agencies, quality metrics b. Internal Benchmarking: using data from within the organization as a comparison. c. External Benchmarking: compares what you are doing against what others are doing 7. Consider the financial aspect of the problem a. How does the problem impact the organization financially? b. Return on investment? 8. Search the literature for interventions (evidence-based-practice) a. Create an evidence table with the interventions b. Follow the research evidence to determine the best interventions to address the problem 9. Rapid Cycle Testing (PDSA) of the interventions a. PDSA: Plan, Do, Study, Act 10. Develop a sustainment plan a. Champions: encourage staff to maintain gains and continuously improve b. Quality Assurance Monitoring: consistently checking Delineate general categories of errors and hazards in care ( i.e. error, active error, latent error, adverse event, sentinel event, misuse, overuse, never-event, near-miss, workarounds, failure to rescue, & variance/incident reports) To Err is Human: 100k/year Error: The failure of a planned action to be completed as intended or use of wrong plan to achieve an aim Active Error: type of incident that is non-compliant with procedure, or making a mistake such as not assuring the correct ID of patient before med admin Latent Error: condition involves problems within the system Misuse: Avoidable complications that prevents patients from receiving full potential benefits of a service Example: Patient receives a medication that is not prescribed and that conflicts with his allergies causing anaphylaxis Overuse: The potential for harm from the provision of a service exceeds the possible benefit Example: An elderly patient is on multiple meds and his multiple healthcare providers do not know the meds have been prescribed by different specialists Adverse Event: Injury resulting from medical intervention. Not due to the patient’s underlying condition Example: A nurse fails to activate the bed alarm and the patient falls getting out of bed Never Event: Errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients and that indicate a real problem in the safety and credibility of the healthcare facility Example: A surgical procedure is done on the wrong site Failure to Rescue: Failure to rescue from a complication of an underlying illness or complication from medical care.  Example: A post-op patient who just underwent abdominal surgery begins to show signs of sepsis and the nurse fails to recognize these signs Work-Arounds: When one does not follow the rules and or works around the rules or correct actions of patient care to save time Example: Overriding an alert from the EMAR about a potentially dangerous drug interaction Near Miss: Recognition that an event occurred that might have led to an adverse event Example: A nurse is just about to administer a medication to a patient. When the nurse scans the patients ID band, she realizes that the medication is not for the correct patient. Sentinel Event: An event that had a negative patient outcome (unexpected death, physical harm, etc.) Example: A patient commits suicide while in the hospital for treatment of DM or for treatment of depression Describe characteristics of a culture of safety, just culture, and high reliability organization. Safety: freedom from accidental injury (patient stay free of complications and expected outcomes are reached) Safety Culture: the outgrowth of the larger organization culture and emphasizes the deeper assumptions and values of the organization towards safety Safety Climate: the shared perception of employees about the importance of safety within the organization. Just Culture: “No shame, No Blame!” Incident or Variance Reports: Confidential document that describes any patient, staff accident or incident while the person is on the premises Barriers to Error Reporting Inability to recognize errors Burdensome documentation Lack of anonymity Hesitancy Unclear reporting requirements for errors with adverse outcomes Fear of lawsuits Perception that changes will not occur High Reliability Organizations: organizations that establish and maintain high quality and safety expectations for patient care delivery and keep rates of quality and safety failures near zero. Characteristics of an HRO Preoccupation with Failure: Be alert to near miss events, recognize weaknesses early Reluctance to Simplify: Do not focus on easy fix causes of failure Sensitivity to Operations: Have situational awareness and awareness of relationships Resilience: Anticipate failure, determine how to diminish risk, and identify strategies to recover when an adverse event occurs Deference to Expertise: Use teamwork which recognizes each member’s knowledge, skill, and expertise. Deemphasize hierarchy. Describe root cause analysis. An in-depth analysis of an error to assess the event and identify causes or possible solutions. The goal is to prevent the error from happening again. Asking WHY? WHY? WHY? WHY? WHY? What happened, why did it happen, and how do we prevent it from happening again Explain Safe Harbor in the state of Texas. Safe Harbor: Statute that is designated to help the nurse protect patients and maintain professional standards Enacted when RN believes that the requested conduct violates their duty to a patient Must be orally evoked to supervisor prior to accepting the assignment Protects nurse from retaliation, suspension, termination, discipline, and their license when a nurse makes a good faith request for peer review of an assignment/ conduct that the nurse is asked to perform but may believe it is a violation of the NPA/ board rules Good Faith: taking action is supported by reasonable, factual, legal basis, no misinterpreted facts, malice, personal animosity, or conflict of interest PRIORITIZATION AND DECISION MAKING (7 ITEMS) Define critical thinking, problem solving, decision-making, intuitive thinking, and emotional intelligence in patient and clinical setting situations Decision Making: Involves identifying and selecting a course of action from several alternatives Critical Thinking: The ability to question, examine, analyze, and recognize assumptions, values, and conclusions. Asks the “why” questions Reflective Thinking: Referring specially to the processes of analyzing, making judgements about what has happened, “thinking about thinking.” This requires individuals to reach a level of social maturity. To help achieve reflective thinking – think of watching “our two selves,” the active self and the reflective self. Try to combine both personas. Emotional Intelligence: Being able to evaluate and control emotions as well as assess their coworkers’ emotions. Those with higher levels of emotional intelligence are more satisfied with and dedicated to their jobs. Emotional Intelligence Competencies Possess Motivation Empathy Social Skills Self-Awareness Able to control emotions or impulses and redirect in a positive manner Flexible in handling change Self-control, regulation, persistence Works in non-disruptive, calm, professional manner Admits faults; able to confront inappropriate behavior Intuition: Innate feeling, “gut” feeling something is wrong Define methods to facilitate group decision-making Group Decision Making: Consider the group size and group members. Advantages: more ideas and choices generated, buy in/ acceptance, promotes ownership of ideas Disadvantages: time consuming, nonproductive, personality conflicts, individual opinions influenced by others Nominal Group Technique: Initially no discussion but can meet face to face Phase 1: Group members write out ideas Phase 2: Members then present ideas on flip chart Phase 3: Opportunity for discussion to clarify and evaluate ideas Phase 4: Private voting on ideas Delphi Method: Not meeting face to face Questions are distributed to group members then summarized Process continues until group consensus is reached WARNING – Groupthink: Goal: everyone needs to be in 100% agreement Discourages questioning Groupthink increases the cohesiveness of the group Important role of the leader is promptly ID symptoms of group think Symptoms of Group Think: Illusion of vulnerability Stereotyping outsiders (i.e. “Newbie”) Group members reassure one another that their interpretations are correct regardless of evidence Analyze the decision-making styles of Nurse Leaders Decision Making Process 1. Identify need for decision 2. Determine goal/outcome desired 3. Identify consequences/benefits of alternatives 4. Make decision 5. Evaluate decision Decision Making Grid: Ratings that compare devices, equipment to help leadership decide Example: Based on point-value system; gives rating that compare to help make a decision Decision Tree: Gives you step by step rules to guide your decision Example: CPR, ACLS, Heparin Algorithms Program Evaluation and Review Technique (PERT): Gives a graphical timeline of a project and breaks the project into individual tasks for project analysis. This is important for picking a project, planning it accordingly and is more complex and detailed compared to GANTT GANNT Chart: More simplified compared to PERT and gives a better visual that tells us the order that tasks must be completed. It is also important for picking a project and planning it accordingly Apply principles of priority setting to patient care situations Six Step Decision Making Model for Determining RN Scope of Practice 1. Is the activity consistent with the Nursing Practice Act (NPA), Board Rules, Board Position Statements, and/or Guidelines a. Yes – Continue b. No – STOP 2. Is the activity appropriately authorized by valid order/protocol and in accordance with established policies and procedures? a. Yes – Continue b. No – STOP 3. Is the act supported by either research reported in nursing and health-related literature or in scope of practice statements by national nursing organizations? a. Yes – Continue b. No – STOP 4. Do you possess the required knowledge and have you demonstrated the competency required to carry out this activity safely? a. Yes – Continue b. No – STOP 5. Would a reasonable and prudent nurse perform this activity in this setting? a. Yes – Continue b. No – STOP 6. Are you prepared to assume accountability for the provision of safe care and the outcome of the care rendered? a. Yes – Continue b. No – STOP INFORMATICS (3 ITEMS) THIS WAS A BULLSHIT LECTURE IM STEALING ALL THE REVIEW INFORMATION FROM ANDREW Quality + Safety Education for Nurses (QSEN) Informatics: use of information + technology to communicate, manage knowledge, mitigate error + support decision making Knowledge: explains why information + technology skills are required for safe pt care Identify essential information that must be available in a common database that supports pt care Contrast benefits + limitations of various communication technologies + their impact on safety + quality Describe examples of how tech + info is needed for quality pt care + safety Recognize the time, skill, effort to use computers + tech effectively for pt care Skills: seek education about how information is managed in care settings before applying care; apply technology + management tools to ensure safe process of care Use the eMAR Document + plan pt care in eMAR Use communication technologies to coordinate pt care + safety Respond appropriately to clinical making supports + alerts Use of information tools to monitor outcomes of care Use of high-quality electronic sources of info Attitudes: appreciation for HC workers to pursue the lifelong learning process of information technology skills Value technology that supports decision making, error prevention + care coordination Protect confidentiality of information in the eMAR Value our involvement in design, selection, implementation + eval of info technology to support pt care Nursing Informatics = Computer science + Information Science + Nursing science Supports consumers, pt, nurses, decision making Nursing Data Needs - 4 Domains Client: longitudinal client care/clinical care & its evaluation, clinical findings, and client outcomes Provider: Professional data, role responsibilities, caregiver outcomes and decision-make variables Administrative: Management and resource oversight, organization statistics, caregiver outcomes, and decision-making variables Research: Knowledge base development and comparative effectiveness with phenotype data dictionaries Information Systems: Collects and record information, requires us to manage large volumes of data, trends/patterns, solve problems and answer questions Electronic medical record: legal record of what happened to a patient while under your care. Confined to one point in time or range of dates Electronic health record: electronic record of patient information generated by one or more encounters in any care setting o Includes: demographics, progress, problems, meds, vitals, history, immunizations, labs + diagnostic studies o EMR must be in place for health record to exist o Aims: ▪ Use computer system as a tool to alert the healthcare provider to problems with the patient ▪ Remind the provider about allergies, potential adverse effects of medication o Suggestions: ▪ System easy to navigate ▪ Display simple & intuitive ▪ Date within the system is accurate, reliable, and native ▪ Upgrade times are minimal Personal Health Record: Controlled by pt; determines who has access for reading and data entry o Problems ▪ 2 separate health records ▪ Which is most current? Healthcare information systems (HIS): Group of systems used within HC organization to support + enhance healthcare 2 types: Clinician Information Systems + Administrative Information Systems CIS: captures clinical data to support more efficient & effective decision making + care. CIS is primarily a computer system used for: device capture (monitors), documentation, organize data, trends clinical parameter for display, scan & check (meds), provide summary of pt CIS can be: Patient Focused: Automation supports patient care processes Departmental: Meets the operational needs of a specific department Biomed technology: Clinical Equipment Diagnostic monitoring (blood gasses, pulmonary function tests, EKGs) Physiological monitoring (vitals, hemodynamics, ICP) Admin Meds, IV (Automated dispensing cabinets, IV smart pumps)’ Therapeutic treatments (mechanical ventilators, implantable infusion pumps) CDSS (Clinical Decision Support System): computerized programs to support decision making; looks at set of data + leads the user through decision making process Links information, alerts, warnings + other information; current and EBP NIS (Nursing Information Systems): Think “information” not “computers”; computers are the tool, informatic nurses are the link bet nursing info & data): documents care, review lab tests results, orders sterile supplies, enters orders Goals: Supports the way nurses’ function and work; support & enhances nursing practice Advantages of a NIS: ↑ time spent with pt Better access to info Enhanced documentation ↓ hospital cost ↑ nurse satisfaction Enhances the implementation of EBP into nursing care b/c nurses are reminded which interventions need to be implemented for specific pts The internet in Clinical Practice: It is important for nurses to develop information literacy for patient care Ability to identify when & what info is needed How info is organized ID best sources of information Impact of the Internet on Nursing Practice: Use PLEASED formula to evaluate information found on the internet Purpose for which the site was created Links and their accuracy and reliability Editorial or site content: accuracy, bias, comprehensiveness, currency Author: credentials, expertise Site: Design, navigability, ease of use Ethics: disclosure of author, sponsor, site purpose Date: Is the information current and updated regularly 10 C’s of Evaluation of Internet Sources Content Credibility Critical Thinking Copyright Citation Continuity Censorship Connectivity Comparability Context Security E-Mail  HIPPA does not prohibit communication of patient information via email Privacy risk Recommendations: avoid patient names and avoid SSN DIKW Information Management Model Data: Collection of numbers, characters, or facts that are named, collected, and organized o Example: 98.6, 68, 120, 60, 20 Information: Data that have been interpreted, organized, or structured o Example: 98.6 F Temperature, 68 pulse, 120/60 BP, 20 respirations Knowledge: Information that is synthesized so that relationships are identified and formalized based on logical process of analysis o Example: The nurse’s awareness that vital signs, such as those listed are within normal limits for an adult Wisdom: The use of data in making decision and implementing appropriate inter-professional team actions o Example: Abnormal vital signs for patients in certain situations that lead to a nursing intervention ETHICS IN NURSING PRACTICE (2 ITEMS) Define ethics Ethics: Branch of philosophy concerns distinction of right from wrong on the basis of a body of knowledge, not just on the basis of opinions Systematic study of what a person’s conduct and actions should be with regard to self, others, and the environment Provides framework for determining the right course of action in a particular situation Discuss moral issues that affect the health care agency, nurse leaders/managers and their staff. Moral Indifference: One question if morality is necessary Moral Uncertainty / Moral Conflict: One is unsure which ethical principle applies or what is the actual moral question Moral Outrage: One witnesses an immoral act but is powerless to stop it Moral Distress: Negative emotional response when HCP knows morally correct action to take but is prevented from doing so Nurse unable to provide what’s perceived to be best for the patient Involves dual loyalty to patient, healthcare institution, and agencies paying for services Examples: Inadequate staffing or communication, perceived incompetent workers, carrying out MD orders for unnecessary tests / overly aggressive treatments / or provision of futile care Considerations: Advocate for the staff and patient Moral Residue: Lingering feelings existing after morally distressing situation has passed Seriously compromised our ethics Deeply felt, long lasting Ethical Dilemma: Conflict between 2 or more ethical principles, no “correct” decision, problems when more than one choice can be made, choice is usually influenced by the values and beliefs of the decision maker A problem is an Ethical Dilemma If: It cannot be solved solely by a review of scientific data It involves a conflict between two moral imperatives  The answer will have a profound effect on the situation or client Review utilitarianism and deontological ethical theories. Analyze ethical principles including autonomy, beneficence, nonmaleficence, paternalism, utility, justice, veracity, fidelity, respect for others, and confidentiality and its relevance to the nurse leader/manager role. Autonomy: Personal freedom, right to chose Examples: Informed consent, providing all information so the patient can make informed decisions Beneficence: Promoting good/ doing good to others while maintaining a balance between benefits and harms Examples: Managing pain, staying up to date on vaccinations to keep patients safe, CPR/ACLS certified, knowing the organ donation laws Nonmaleficence: Do no harm, refrain from actions that harm a client Examples: Procedure time-outs, stopping medication or treatment that is viewed as harmful, continuing education Paternalism: Allowing a person to make a decision for another, deliberately overriding a patient’s opportunity to exercise autonomy because of perceived obligation of beneficence. This is not always a bad thing Examples: Not giving bad information about a terminal diagnosis, mandatory flu vaccination for nurses, nurse does not inform the patient about an increase in his baseline BP because she believes it will upset him Utility: The greatest good for the greatest number Justice: Fairness, treating people equally and without prejudice, regardless of social or economic background Examples: Shift rotation, holidays, conferences, float rules, vacation time, employment laws Veracity: Truth Examples: Informing a patient’s family about a sentinel event and or mistakes Fidelity: Keeping your promise and fulfilling your commitments Examples: Maintaining staff vacation request, keeping promises to return Respect for Others: Highest ethical principle, acknowledges the inherent, intrinsic, and unconditional worth of others Confidentiality: Privacy Exceptions: HIPPA authorized, reporting employee drug abuse, reporting elderly/child abuse Analyze ethical problem solving and decision making ADPIE 1. Identify whether the issue is an ethical dilemma 2. State the ethical dilemma, including all surrounding issues and individuals involved 3. List and analyze all possible options for resolving the dilemma and review implication of each option 4. Select the option that is concert with the ethical principle applicable to this situation 5. Justify why the decision was selected 6. Apply this decision to the dilemma and evaluate the outcomes Discuss the role of the nurse leader and manager in creating an ethical workplace where ethical behavior is the norm. Ethical Climate: Culture in an organization open to discussing ethical implication and are discussed, decided and identified; embodies character of the organization Leadership Role in Ethics Role model confidence in decision making Foster an ethical work environment Use of the identified agency framework Seek counsel when necessary Promote moral courage Situational awareness of staff, possible ethical concerns Provide mutual support of staff Ethical succession planning – mentor future leaders Educate staff, read articles, huddles Encourage membership on ethical committee Ethics “rounds” COMMUNICATION AND CARE COORDINATION IN HEALTHCARE (7 ITEMS) Analyze barriers to communication Identify necessary skills to be an effective communicator Upward Communication: When communicating with superiors Observe professional courtesies and arrive on time Dress professionally State your concerns clearly, concisely, accurately, and provide supporting evidence Separate your needs from your desires Listen objectively State willingness to cooperate to find solution Lateral Communication: When communicating with coworkers Interact professionally Avoid gossip / grapevine communication Give adequate handoffs Downward Communication: When communicating with subordinates Give clear/ concise instructions Delegate clearly and effectively Offer positive feedback and verify understanding through feedback Serve as a role model and support your staff in words and actions Diagonal Communication: When communicating interprofessionally Strive for collaboration and keep the discussion patient centered Present information in a straightforward manner by clearly delineating the problem and supporting the assertion with patient evidence Remain calm and objective even if physicians don’t cooperate Follow institutions procedure for getting the patient treated and document actions taken Communicating with Family Members or Patients Avoid jargon use words appropriate to the person’s level of understanding Use interpreters as needed Use touch to communicate caring Be open and honest Recognize cultural differences Mentor / Prodigy: Listen, affirm, counsel, encourage, and seek input from the novice Describe communication techniques in the workplace Cognitive Rehearsal: Prepared response that one practices ahead of time that would address a negative comment / situation in a civil manner Recommendations: Always promote environment of respect / collaboration Have respectful negotiations during disagreements Remain civil in the face of incivility Identify Joint Commission National Patient Safety Goals related to communication Improve the accuracy of patient identification Improve the effectiveness of communication among caregivers Use medicines safely Prevent mistakes in surgery Specific Goals for Communication: 2A: Verify verbal / telephone orders by “reading back” the complete order / test result 2B: Standardize list of abbreviations / acronyms/ symbols and make list of those that are not to be used o Example: IU, QD, QOD, U, 1.00,.5 2C: Assess communication and take action to improve the timeliness of reporting and receipt by the caregiver of critical test results and values 2E: Implement standardized hand-off communication, including an opportunity for asking / responding to questions 8A: Communicate a complete list of the patient meds to the next provider of service when the patient is transferred Evaluate the use of e-mail as means of communication E-mail Etiquette Answer as quickly as you would a phone message Make messages easy to read Used mixed case lettering and punctuation Avoid flaming, shouting, and sending repeat messages Include language you would be comfortable reading aloud to a jury of your peers Include cues about intended tone / intent (smiley faces, friendly closings) Remember there is no such thing as a private email, make sure not to violate HIPPA Define care coordination Care Coordination: The deliberate organization of patient care activities between 2 or more participants (can include patient) to facilitate the appropriate delivery of health care services. Explain the role and activities nurses play in care coordination Goals of Care Coordination IOM’s 6 Aims of Care o Safe, Timely, Effective, Efficient, Equitable, Patient-Centered Better care, better health, and lower costs Describe the skills needed for effective care coordination Team STEPPS SBAR Call-Out: used to communicate critical information during codes Check-Back: closing the communication loop to ensure the receiver is understood Handoff: transferring information, authority, and responsibility PROBLEM EMPLOYEE (3 ITEMS) Differentiate between constructive discipline, destructive discipline, and self-discipline. Constructive / Positive Discipline: Helps the employee to grow Carried out in supportive, corrective manner Employee reassured punishment given due to actions and not who they are as a person Primary Focus: assisting employees working together to meet organizational goals Destructive Discipline: Use threats and fear to control behavior Employee always alert to impending penalty or termination Randomly administered Unfair application of rules or resulting punishment Self-Discipline: Rules: Internalized and become part of the person’s personality Highest and most effective form of discipline Self-Discipline is possible if: subordinate knows the rules and validates them Describe the steps typically followed in progressive discipline. Progressive Discipline: Allows employees to correct identified issues through a Four Step Process First Step Informal reprimand (removal) and verbal warning Discuss performance deficiency Suggestions given for improvement Second Step Formal reprimand, written warning o No improvement since verbal meeting Specific identification of violation o Date, time, person and place violated Potential consequences if not altered to meet organizations expectations Plan of action established Third Step Suspension from work o With or without pay o Opportunity for employee to reflect on behavior Fourth Step Involuntary termination / dismissal Repeated warnings not addressed by employee Last option PIP Identify disciplinary strategies to modify problem behavior Strategies for Discipline: Investigate the situation o Was the rule clear, did the employee know, has this occurred before, etc. Consult Supervisor Anecdotal notes are essential (dates, times, etc.) Review personnel / training file Performance Deficiency Coaching o Active employer engagements, requires planning, address behavior, establish a plan, coach employee Disciplinary Conference: Used if coaching unsuccessful, more aggressive step needed. Always schedule, never impromptu, private setting 1. Discuss reason for disciplinary action a. Never apologize or be hesitant 2. Listen to employee response 3. Explain disciplinary action 4. Present performance improvement plan (PIP) a. Behavioral change, remediation, and consequences clearly state 5. Agree, accept action plan a. Employee supported to promote growth 6. Give written copy of plan, place in personnel file, inform agency P&P for how long forms remain in file Describe marginal employees Marginal Employees: “Do just enough to get by.” Disrupt unit functioning due to quantity or quality of their work o Consistently meet only minimum standards Usually do not warrant dismissal  Little contribution to organizational efficiency Employees make tremendous efforts to meet competencies yet usually meet only minimal standards Traditional discipline generally not constructive in modifying their behavior Possible Response to a Marginal Employee: Coaching, suggest early retirement or resignation. Ignoring the issue is a poor choice Recognize the risk factors, behaviors and physical signs that may indicate chemical or psychological impairment in an employee Risk Factors: Staff shortages / ratios Increased patient acuity Shift rotation Demanding administrators / providers Long hours Incivility “Invulnerable” …Caregiver mentality, self-diagnose and medicate Ease of access Fatigue, stress Behaviors: Smell of Alcohol Frequent mouthwash use Impaired coordination, sleepy, shaky, slurred speech Mood swings, memory loss Neglect personal appearance Excessive use of sick leave, tardy, absent after weekend off / holiday or payday Leave unit for short periods, leave shift early Forget to have another nurse witness-controlled substance wasted Patient reports poor pain management Documents pain meds to patient not receiving the med Prefer night shift since less supervision Prefer units where controlled substances are more frequently given Physical Signs: Personality / behavior changes Job performance changes, declines o Judgement, quality, interpersonal relationships change Time or attendance changes Discuss the manager's role in assisting the impaired employee and preventing diversion. It is important to remember that the health care worker may rarely admit to the problem, denial is common First Step: Remove from patient care Gather as much evidence as possible. Collect objective data before confrontation. Written record. o Interview others to validate observations, analyze narcotic/attendance records, appearance at work Immediate confrontation Schedule formal meeting with in 24 hours Second Step: Formal meeting Focus on employee performance Third Step: Outline plan, expectations, disciplinary plan, and timelines Diversion: transfer of a controlled substance from a lawful to an unlawful channel of distribution or use Discouraging Diversion Annual employee competency Medication diversion prevention coordinator Drug diversion response team Assistance Programs like TPAPN DELEGATION (6 ITEMS) Analyze the principles of delegation when planning care of patients. Delegation: Achieve desired care outcomes that are accountable and responsible by sharing activities with others who have appropriate authority to accomplish the work Accountability: RN is legally responsible for their actions and is answerable on legal level Responsibility: Person is responsible for and obligated to perform at acceptable level (training, role, setting) Assignment: Process of assigning duties and all aspects of care to the patient, the charge nurse assigns the RN a patient Authority: The rights to delegate, given by the Texas Nursing Practice Act Supervision: Process of directing, monitoring, and evaluating the performance of tasks by another person Power: The power to delegate, given by the organization that you work for What to Consider When Delegating Tasks: Depends on organizational policy Job description Individual performance Prior to Delegation: RN must FIRST assess the patient Assess capabilities of UAP and complexity of task  The amount of supervision needed Warning Signs of Delegation: Action may cause harm Tasks is complex and requires advanced skills Requires high level of problem solving Outcome is predictable Requires complex level of patient interaction Barriers to Delegation: Attitudes Organization skills Time management skills Uncertainty or insecure Mistrust of others Communication skills Effective delegation r/t level of clinical expertise Discuss the responsibilities of the health team members with the delegation process. Responsibilities of the RN when Delegating: Give name and room number of patient State what task is to be performed Validate that the delegate can perform this without direct supervision Provide timelines Detail any specific approach to be used Set reporting parameters Responsibilities of UAP when being delegated to: Deliver supportive care and anything that DOES NOT require judgement or analysis Do NOT practice nursing or provide total patient care Do NOT re-delegate a task to another UAP Responsibilities of LVN/LPN: Can do follow up assessments after the initial assessment is done Can teach from standard care plan Can reinforce teaching Can remove sutures Can start/ maintain IV lines IN SOME STATES AFTER ADDITIONAL EDUCATION Can administer blood IN SOME STATES AFTER ADDITIONAL EDUCATION They are licensed and held to higher standard of care Take the NCLEX RN must still do initial assessment and if the patient’s condition changes Examine the process of delegation to include the Texas Board of Nursing rules and regulations. Five Rights of Delegation 1. Right Task: One that can be delegated for a specific patient. Can the task be safely delegated? 2. Right Circumstances: Appropriate patient setting, available resources, and other relevant factors considered (is the patient stable and is the outcome predictable?) 3. Right Person: Delegating right task to right person (necessary knowledge and right skills) performed on the right person 4. Right Direction/Communication: Clear, concise description of the tasks, including its objective, limits and expectations. Appropriate instructions are given and use of respectful communication. 5. Right Supervision: Appropriate monitoring, evaluation, intervention as needed, and feedback. Providing guidance and oversight of a delegated nursing tasks. Tasks that CANNOT be Delegated: Delegation is not appropriate monitoring of unstable patients, or unpredictable outcomes Analysis Assessment Nursing Diagnoses Overall Plan Extensive teaching Evaluation Care of UNSTABLE patients Care of patients with change in status Patients with UNPREDICTABLE outcomes (postop VS changing, A&O changes, child choking, anaphylaxis, respiratory issues) Tasks that CAN be Delegated: Vitals, Input/Output, Feedings Documentation of vitals, input and output They can report vitals but cannot make nursing judgement TEAM BUILDING IN HEALTH CARE (3 ITEMS) Evaluate the differences between groups, teams, and committees Group: Is several individuals assembled and have some unifying relationship Primary Group (Informal): Consists of people who share a common bond, is informal and evolves naturally from social interactions, usually has no written rules for membership, can begin or end at any point Secondary Group (Formal): Held together with formal rules and regulations, has procedures for maintenance of the group and association policies, meets for an organized purpose, for a specific project for a specific time frame Team: Small number of people with complementary skills who are committed to a common purpose or goal. They have a set of performance goals and approaches for which they hold themselves mutually accountable. Membership is based on specific skills required to accomplish the task. Homogenous Team: Similar backgrounds and abilities (i.e. nurses) Heterogeneous Team: Interprofessional with a variety of clinical background (i.e. quality improvement team) Committee: Work group with a specific task or goal to accomplish as defined by the organization. It is a group formed to assist an organization with communication and decision making Ad Hoc Committee: Temporary, meet to develop a particular policy Standing Committee: Organization, nursing policy and procedure committee Advisory Committee: Advice/Feedback, advise the CNO/CNE Analyze the stages of group development Forming (Orientation): Team acquaints and establishes ground rules. Formalities are preserved and members are treated as strangers. Expectations, Interactions, Boundary Formation Storming (Conflict): Members start to communicate their feelings but still view themselves as individuals rather than part of the team. They resist control by group leaders and show hostility Tension, Conflict, Confrontation Norming (Cohesion): People feel part of the team and realize that they can achieve work if they accept other viewpoints Positioning, Goal Setting, Cohesiveness Performing (Working): The team works in and open and trusting atmosphere where flexibility is the key and hierarchy is of little importance Agreement, Actual work occurs, Relationships, Group Maturity Adjourning (Termination) / Reforming: The team conducts an assessment of the year and implements a plan for transitioning roles and recognizing members’ contributions Closure, Evaluation, Outcomes Review Describe the Nurse Manager’s role in creating a team Leadership style of encouragement, creativity, and participation Provide appropriate resources Get support from administration Highlight process and positive effects of project Successful Team Membership o Various abilities and personalities must be blended o Destructive behaviors must be avoided o A mixture of clinical abilities is needed Describe Team Leader skills needed to lead an effective team Effective communication skills/style Cultural sensitivity Know your team members and their abilities Planning and coordination skills Flexibility Involve others Acknowledge contributions and accomplishments of team members Be a team leader and team member TEAM STEPPS (5 ITEMS) Team STEPPS: Comprised of four teachable-learnable skills; Leadership, Situation Monitoring, Mutual Support, and Communication. What the Team Brings to the Table: Performance, Knowledge (shared mental model), attitudes (not taught, must be brought onto the team) Key Principles: Team Structure: Delineates fundamentals such as team size, membership, leadership, composition, identification, and distribution. Everything we do is about the patient, they are at the top of the pyramid Administration: Foundation of the pyramid, they support the rest of the team Core Team: Team members on the floor Contingency Team: Rapid Response Leadership: Ability to coordinate the activities of team members by ensuring team actions are understood, changes in information are understood, changes in information are shared, and that team members have the necessary resources Job Responsibilities: Must organize the team, articulate clear goals, make decisions through the input of the rest of the team, empower members to speak up and or challenge questions, promote or facilitate good teamwork, and be skillful in conflict resolution How to Promote Good Teamwork: o Brief: Occurs prior to the start of the workday o Huddle: Creates situational awareness and reinforces plans already in place and assess the need to adjust the plan o Debrief: Informal information exchange session that occurs after the work is done Situation Monitoring: Process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team Cross Monitoring: Error reduction strategy that involves monitoring the actions of other team members; provides a safety net within the team and ensures mistakes are caught (watching each other’s back) S: Status of the Patient o History, V/S, Meds, Physical Exam, LOC, Psychosocial T: Team Members o Fatigue, Workload, Task Performance, Skills, Stress E: Environment o Facility, Admin, HR, Triage Acuity, Equipment P: Progress Toward Goal o Status of Patients, Established Goals of Teams, Plan Still Appropriate? IM SAFE: Self checklist that needs to be performed to make sure that you are practicing responsibility, illness, medication, stress, alcohol/drugs, fatigue, eating/elimination Mutual Support: Ability to anticipate and support other team members’ needs through accurate knowledge about their responsibilities and workload Task Assistance: Team members help prevent work overload situations, the focus is patient safety Feedback: Information that helps to improve team performance, should be timely, respectful, specific, directed towards improvement, and considerate Advocacy and Assertion: Important to protect the patient, be firm and respectful o Two Challenge Rule: Completed when initial assertion is ignored ▪ A person must be assertive with their concern at least 2X to make sure it has been heard ▪ A team member being challenged MUST acknowledge the concern ▪ If the outcome is still not accepted, take a stronger course of action and utilize the chain of command CUS: I am Concerned or Uncomfortable with this Safety Issue DESC: Used to manage or resolved conflict o D: Describe the specific situation or behavior o E: Express how the situation makes you feel and what your concerns are o S: Suggest alternatives and seek agreement o C: Consequences should be state in terms of impact on established team goals Communication: Process by which information is clearly and accurately exchanged among team members SBAR: Situation, Background, Assessment, Recommendation Call-Out: Informs all team members simultaneously during emergent situations to acknowledge that you hear what someone said Checkback: Repeating the order to ensure that the information was correctly conveyed and understood Handoff: Transfer of information during transitions of care, allows for an opportunity for questions, clarification, and confirmation