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Leadership Flashcards

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1
Q

Healthcare delivery system
Goals; Cost-effective, high-quality care
-Decreased costs, improved outcomes for groups of clients
Healthcare providers, agencies collaborate

A

Managed Care

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2
Q

Coordinate, facilitate, follow clients use of health, social services over time
Insurance-based
Identify specific cases that most benefit
Professionals include nurse, social workers
-sometimes referred to as discharge planners

A

Case Management

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3
Q

Total Care

  • One nurse assigned to comprehensive care of clients during an 8 to 12 hr shift.
  • Client has consistent contact of one nurse during shift but different nurses on other shifts
  • Precursor of primary nursing
  • Continues to be used in intensive care nursing
A

Case method

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4
Q

Focuses on jobs to be completed
-bed making
-temperature measurement
Based on production and efficiency model giving authority, responsibility to person assigning the work
Disadvantages:
-Fragmentation of care
-Emotional needs of client may be overlooked

A

Functional Method

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5
Q

Consists of:
RN’s
LPN’s
-provide direct client care under direction of RN, physician, other licensed practitioner
UAP’s
-assume delegation aspects of basic client care

A

Team Nursing

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6
Q

One nurse responsible for overseeing total care of a number of clients 24/7
-Even if nurse does not deliver all care personally.
Uses technical knowledge, management skills

A

Primary Nursing

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7
Q

Two or more people working toward a common goal by combining skills, knowledge, and resources

  • avoiding duplication of effort
  • Goal: improve client outcomes
A

Collaboration

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8
Q

Between nurses, between healthcare providers and clients, between healthcare providers from different professional backgrounds

  • ANA standards of professional Nursing Practice
  • includes identifying and acknowledging expertise of those inside and outside nursing profession
  • includes referring client to others in order to meet client’s needs
A

The Nurse as Collaborator

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9
Q

Objectives-high quality client care and client satisfaction
Care becomes client-centered and client-directed.
Healthcare providers from variety of disciplines work in tandem with clients and communities.
Greater autonomy for both nurses, clients

A

Collaborative Practice

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10
Q

Can only be effective if each team member commits to understanding each member’s specific role, appreciates member as individual

A

Communication skills

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11
Q

When two or more individuals show, feel honor or esteem toward one another

A

Mutual respect

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12
Q

Individual confident in actions of another individual

A

Trust

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13
Q
  • Expressed verbally, nonverbally

- Magnet hospitals foster respect among professionals

A

Mutual Respect and Trust

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14
Q

Shared responsibility for outcome
Facilitated by mutual respect; timely, effective feedback
Requires full consideration of, respect for diverse viewpoints
Identify, give priority to discipline best able to address client’s needs

A

Decision Making

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15
Q
  • Conflict inevitable in workplace
  • Although viewed as negative, conflict can be impetus for better communication, stronger team relationships, healthy changes
A

Conflict Management

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16
Q

Healthy People Initiatives:

  • Focus of health care changing: clients demand comprehensive, compassionate, affordable care
  • Clients have greater knowledge, expect to be involved in decisions
  • Clients assuming more responsibility for their health, view healthcare professionals as resource
A

Collaboration and the Healthcare Consumer

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17
Q

Examine the nurses (and the student nurse) responsibility related to Chain of Command

A

Leadership Exemplar

-Chain of Command

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18
Q

Provides structure for reporting and helps employees manage supervisory relationships

  • Authority and Responsibility
  • Line Authority
  • Staff Authority
A

Chain of Command

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19
Q

Power to command

A

Authority

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20
Q

being accountable

A

Responsibility

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21
Q

Directs activities of subordinates

A

Line Authority

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22
Q

Provides advice and support

A

Staff Authority

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23
Q

Describe the need for responsibility, accountability, and authority when delegating.
Distinguish how effective delegation benefits the delegator, the delegate, and the organization.

A

Delegation

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24
Q
  • transference of responsibility, authority to competent individual
  • assumes responsibility, assigns task, retains accountability
  • Delegator can devote time to other tasks
  • Increase skills, abilities of delegate
  • Difficult leadership skill; confusion over who is allowed to do which tasks
  • Critical skills for nurses; accomplish more by using others’ help
A

Overview of Delegation

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25
RN's increasingly delegate components - To other RN's, LPN's - To "nurse extenders"; unlicensed assistive personnel (UAP) - Certified nursing aide or assistant (CNA) - Home health aide (HHA) - Client care technician - Orderly - Surgical technician
Principles of Delegation
26
- Taking vital signs - Measuring I & O - Client transfers - Ambulation - Postmortem care - Bathing - Feeding; gastrostomy feedings in established systems
Tasks that may be delegated to UAP
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``` Attending to safety Weighing Performing simple dressing changes Suctioning of chronic tracheostomies Performing basic life support (ie. CPR) ```
Tasks that may be delegated to UAP's
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``` Assessment Interpreting data Making a nursing diagnosis Creating a nursing care plan Evaluating care effectiveness ```
Care that may Not be delegated to a UAP
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``` Care of invasive lines Administering parenteral medications Inserting NG tubes Client education Performing triage Giving telephone advice ```
Tasks that May Not be delegated to a UAP
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``` Delegating to Unlicensed Assistive Personnel -Nurse must assess first -Client medically stable, or chronic -Task must: Be considered routine for this client Not require substantial scientific knowledge, technical skill Be considered safe for this client Have predictable outcome ```
Principles of Delegation
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Nurse must: - Learn agency policies - know scope of practice - Be aware of variation in ability - Observe if unsure of abilities - Clarify reporting expectations - Create positive atmosphere
Delegating to Unlicensed Assistive Personnel
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``` -Must understand for ea. client: Task to be done When task is to be done Expected outcome for ea. task -Who is available as a resource -When and in what format report expected -Specific tasks ```
Delegating to Unlicensed Assistive Personnel
33
-Benefits to the nurse More time for complex client care -Benefits to the delegate Allows delegates to gain new skills, abilities Bring trust and support -Benefits to the manager More time for tasks that cannot be delegated -Benefits to the organization Overtime, absences decrease; productivity increases
Benefits of Delegation
34
Nurses delegate work for which they have responsibility - Routine tasks - Tasks for which nurse does not have time - Lower priority tasks Defining the task -Some tasks should not be delegated. Deciding on the delegate -Lowest person in hierarchy who has requisite capabilities, allowed legally
The Delegation Process
35
Describing the task -Allow enough time to describe task, expectations Reaching agreement -Be sure delegate agrees to responsibility, authority for the task Monitoring performance and providing feedback - Monitoring too closely conveys distrust - Remain accessible - If problems, quietly investigate, explain concerns to delegate
The Delegation Process
36
Assignment patterns -Unit-based, pairing, partnering Accepting delegation -Delegate responsible for making sure he/she understands task ~Inform delegator is skills lacking ~Accept delegation; accept full responsibility ~Clarify time frame ~Keep delegator informed ~Complete as agreed
Factors Affecting Delegation
37
Obstacles to delegation - Nonsupportive environment - Delegator insecurity - Fear of competition, criticism - Fear of liability - Fear of loss of control - Fear of overburdening others - Fear of decreased personal job satisfaction An unwilling delegate
Factors Affecting Delegation
38
Ineffective delegation - Unnecessary duplication - Under delegation - Reverse delegation - Overdelegation
Factors Affecting Delegation
39
Fear often keeps nurses from delegating -State nurse practice acts Guidelines - Right task - Right circumstances - Right person - Right direction and communication - Right supervision
Liability and Delegation
40
-Group Under direction of a leader Individual accountability -Team Specialized type of group Work in tandem to accomplish common goals More flexible hierachy; combining interdisciplinary expertise through teamwork -Interprofessional teams -Multidisciplinary team approach
Groups and Teams in Healthcare
41
Changes that have led to emphasis on collaboration | -several states no longer mandate physician supervision of nurse practitioners, certified registered nurse anesthetists
Process of Interdisciplinary Collaboration
42
Common purpose, goals identified at outset Clinical competence of ea. provider Interpersonal competence Humor Trust Valuing and respecting diverse, complementary knowledge
Characteristics of effective collaboration
43
- Affordable Care Act, "Obamacare" - Increased focus on interdisciplinary collaboration - Incentives for integration of healthcare delivery - Community-based teams
The Future of Interdisciplinary Teams
44
Team Strategies and Tools to Enhance Performance and Patient Safety is an evidence-based framework to optimize team performance across the healthcare delivery system.
Team STEPPS
45
Agency for healthcare research and quality | purpose is to optimize patient outcomes by improving communication and teamwork skills among healthcare professionals
Dept of Health and Human Services
46
Concerned Uncomfortable Safe
CUS words
47
Leadership, Situation Monitoring, Mutual Support, and Communication.
The core of the TeamsSTEPPS framework is comprised of four skills...
48
These skills must interplay with the Team Competency Outcomes
Knowledge, Attitudes, and Performance.
49
Two types of Leaders
Designated and Situational
50
organizes the team; articulates clear goals; makes decisions through collective input of members; empowers members to speak up and challenge, when appropriate; actively promotes and facilitates good teamwork; and skillfully resolves conflicts.
An effective team leader
51
This is a short session for planning prior to start to discuss team formation; assign essential roles; establish expectations and climate; and anticipate outcomes and likely contingencies
Brief (Team Events)
52
When problem solving is needed, this ad hoc planning is used to reestablish situation awareness; reinforce plans already in place; and assess the need to adjust the plan.
Huddle (Team Events)
53
This informal information exchange session is designed to improve team performance and effectiveness. Feedback from the team drives future process improvement.
Debrief (Team Events)
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is the process of continually scanning and assessing what's going on around you to maintain situation awareness
Situation monitoring
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Status of the patient Team members Environment Progress toward goal
STEP
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is 'knowing what is going on around you' and knowing the conditions that affect your work
Situation awareness
57
result from each team member maintaining his or her situation awareness and sharing relevant facts with the entire team. Doing so helps ensure that everyone on the team is "on the same page".
Shared mental models
58
an error reduction strategy that involves monitoring actions of other team members; providing a safety net within the team; ensuring mistakes or oversights are caught quickly and easily; and 'watching each other's back"
Cross monitoring
59
Protect ea. other from work overload situations Place all offers and requests for assistance in the context of patient safety Foster a climate where it is expected that assistance will be actively sought and offered
Mutual Support
60
Complete Clear Brief Timely
Effective Communication
61
a technique for communicating critical information that requires immediate attention and action concerning a patient's condition and is especially important during handoff.
``` SBARQ Situation Background Assessment Recommendation and Request Questions ```
62
Using these words is one way to "stop the line" and alert other team members to your concerns.
"CUS" words I am Concerned I am Uncomfortable This is a Safety issue or I don't feel like this is Safe!
63
used to communicate important information to all team members simultaneously
Call outs
64
closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended (ie. restate what was said)
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