Leading, Managing, Delegating

Question 1

Qualities of a leader

Answer 1

SELF-DIRECTED
FLEXIBLE
KNOWLEDGEABLE
POLITICALLY AWARE

Question 2

Leadership types

Answer 2

1.Explicit: leadership based off position
2. Implied: leadership based off personality

Question 3

Just culture

Answer 3

MAG Status: THEY HAVE FOCUS ON PATIENT SAFETY AND POSITIVE PATIENT OUTCOMES

ENCOURAGED TO REPORT CLINICAL AND POTENTIAL ERRORS WITHOUT THE FEAR OF PUNITIVE ACTIONS
EVERYONE LEARNS FROM EVERYBODY’S MISTAKES
CREATES OPPORTUNITIES FOR IMPROVEMENT

Question 4

MANAGEMENT Roles

Answer 4

1. planning: pt problems
2. organizing: get resources/ skills days,
   3.directing: policies in place,
3. staffing
4. Directing
5. Controlling

Question 5

Centralized v Decentralized

Answer 5

1. Central: authoritarian style, decisions made w/ little input from others

2.DECENTRALIZED:decisions made by those most knowledgeable about issue being decided

Question 6

5 Resistance to change

Answer 6

1. THREAT TO SELF
2. LACK OF UNDERSTANDING:
3. LIMITED TOLERANCE FOR CHANGE: some ppl say no
4. DISAGREEMENTS ABOUT THE BENEFITS OF CHANGE
5. FEAR OF INCREASED RESPONSIBILITY

Question 7

8 ways to overcome resistance to change

Answer 7

1. EXPLAIN PROPOSED CHANGE TO ALL AFFECTED: give time lines
2. LISTING THE ADVANTAGES
3. RELATE THE CHANGE TO THE PERSON’S EXISTING BELIEFS AND VALUES
4. PROVIDE OPPORTUNITIES FOR OPEN
5. COMMUNICATION AND FEEDBACK
6. INDICATE HOW THE CHANGE WILL BE EVALUATED
7. INTRODUCE CHANGE GRADUALLY
8. PROVIDE INCENTIVES FOR COMMITMENT TO CHANGE

Question 8

8 Considerations when delegating

Answer 8

1. Pt condition
2. Complexitiy of task
3. potential for harm
4. predicted outcome
5. context of other pt needs
6. degree of problem solving
7. capabilites of UAP
8. amount of interaction/staffing

Question 9

Delegation

Answer 9

1. Basic care tasks can be delegated
2. Only nurses can assess, plan, educate, interpret data, adminster meds

Question 10

Phases of therapeutic relationship

Answer 10

1. Orientation: introduction, get to know pt
2. Working: providing care, solving problems, interventions
3. Termination: End relationship w/ pt: review, summarize, memories

Question 11

Therapeutic communication skills

Answer 11

1. competent, honest, skilled
2. control tone
3. knowledge on topic
4. be flexible
5. clear and concise

Question 12

6 Interviewing techniques

Answer 12

1. Open-ended questions without leading
2. Closed questions
3. Clarifying questions
4. Reflective questions: can reflect on why there, and determine what is causing emotions, etc
5. Sequencing questions : pt telling events leading up to care
6. Directing questions: circling back to get more information on topic mentioned earlier

Question 13

Barriers to communication

Question 14

Cultural considerations

Answer 14

1. Linguistic competence - Ability of caregivers (nurses) and organizations to understand and effectively respond
2. learn things about culture

Question 15

Communicating with clients that have special needs

Answer 15

1. Visual Impair: address yourself, clean glasses, orient
2. Hearing: speak facing, don’t chew gum/cover mouth, use gestures
3. Unconicous: be mindful, let them know before you touch them

Question 16

Clinical judgment

Answer 16

-outcome of critical thinking and decision making
-Involves concepts of critical thinking, clinical reasoning

Question 17

Critical Thinking

Answer 17

1. Identify purpose or goal of your thinking
   2.Make a judgment about a patient or situation and to make a decision about how best to intervene
   3.Identify alternative judgments or decisions, weigh the pros and cons of each, and reach a conclusion

Question 18

Clinical reasoning

Answer 18

Process of thinking that results in clinical judgment

Question 19

types of reasoning

Answer 19

1. Deductive reasoning (aka backward reasoning): Testing identified theories or hypotheses and predicting consequences utilizes deduction
   Inductive reasoning (aka forward reasoning)
2. Inductive reasoning:observing, then drawing conclusions, Require the ability to recognize patterns and connections and form hypotheses and theories, Requires experience, knowledge, a holistic view, intuition, and organized thinking

Question 20

Situational Awareness

Answer 20

-recognizing cues (can be subtle) that show a client is deteriorating, recognizing implications of these assessments, and implementing protocol(s) and/or notifying the health care team
-Novice nurses have a narrower focus that focuses on task and cues immediately available to them
-Expert nurses use intuition and continuously study the environment to prioritize their nursing actions.

Question 21

Tanner’s Clinical Judgment Model steps

Answer 21

1. Noticing: perceptions of the situation that are impacted by context, practical experience, knowledge of expected vs unexpected data, ethical perspectives, and client-nurse relationship
2. Interpreting: Assigning meaning to data through multiple reasoning patterns
   Responding
3. Deciding on an action or inaction and monitoring outcomes
4. Reflecting
   In-action – happens when actively engaged in the situation and during ongoing monitoring and assessment
   On-action – Similar to debrief or post-conference, occurs after the situation and creates clinical learning

Question 22

NCSBN’s Clinical Judgment Measurement Model

Answer 22

Layers 0-2: Emphasize how clinical judgment informs clinical decisions made to address the client’s needs.
Layers 3-4:Evaluation of those decisions determines if processes
Layers 3-4 need to be done again. Focus on expected behaviors of a specific case

Question 23

TEACH

Answer 23

T: tune into pt
E: edit pt info
A: act on every teaching moment
C: clarify
H: honor pt as partenr in educating

Question 24

Learning domains

Answer 24

1. Cognitive: using brain
2. Psychomotor: muscles
3. Affective: emotions/feelings

Question 25

10 Teaching Strategies/Methods

Answer 25

1. Lecture 2. Discussion 3. Demonstration 4. Discovery 5. Role playing 6. Audiovisual materials 7. Printed materials 8. Programmed instruction 9. technology 10. Teach-Back Method

Question 26

Factors affecting client learning

Answer 26

1. Age and developmental level 2. Family support networks 3. Financial resources 4. Cultural influences 5. Language deficits 6. Health literacy level

Question 27

Steps of the teaching-learning process (AID DIE)

Answer 27

Assess learning needs and learning readiness Identify learning needs Develop learning outcomes Develop a teaching plan Implement teaching plan and strategies Evaluate learning

Question 28

Promoting compliance (IIUD)

Answer 28

Instructions: support client goals and understood Include client and family in the process Utilize strategies that gets the learner to interact Develop good therapeutic relationships with the client and family

Question 29

Older adults and teaching

Answer 29

Identify learning barriers Allow extra time Plan short teaching sessions Accommodate for sensory deficits Reduce environmental distractions Relate new information to something that is familiar

Question 30

Communication in education

Answer 30

Be sincere and honest Avoid too much detail and stick to the basics Ask for questions Be a cheerleader for the client Use simple vocabulary Keep content clear Listen and do not interrupt Make sure the environment is good to learning Be sensitive to the timing of teaching sessions

Question 31

Rheumatoid Arthritis (RA)

Answer 31

Autoimmune disease Has 3 distinct characteristics: inflammation, autoimmunity, degeneration Genetic predisposition Cause unknown but reaction comes from synovial fluid becoming destructive → cartilage is destroyed Degenerative changes to muscles and bone can be eroded > Patient experiences a loss of joint motion Expect exacerbations and remissions

Question 32

Osteoarthritis (OA)

Answer 32

Non-inflammatory degenerative disorder in the joints Not autoimmune or systemic Can be primary or secondary to something else Cartilage breaks down → bone spurs created (narrowing joint space) → less movement with joint progressively deteriorating Insidoues onset

Question 33

Difference between OA & RA

Answer 33

RA: symmetric, inflammation, genetic/ autoimmune OA: asym, insidous, due to wear and tear, no inflammation

Question 34

Nursing management for RA

Answer 34

-DMARDS, NSAIDS, corticosteroids, synovectomy, joint replacement, PT -promote activity, heat, manage pain/sleep, educate and help cope

Question 35

Signs/symptoms of OA

Answer 35

pain,stiffness (less than 30), functional impairment, joint asym, aggratvated movement

Question 36

Nursing/medical management for OA

Answer 36

-NSAIDS, Glucosaimes, surgery, PT -Plan activites when less pain, assistive devices, TEACH

Question 37

Osteoporosis (OP)

Answer 37

reduced bone mass due tolow ca/vit D

Question 38

Treatment for OP

Answer 38

ca/vit D supplements, biophosphates, estrogen -weight barin exercise, self-care, high ca diet, no smoking/alc, saftey

Question 39

considerations for bisphosphonates

Answer 39

GI issues

Question 40

Major complication of osteoporosis

Answer 40

-broken bones

Question 41

Types of Leaders

Answer 41

1. Authoritarian: total control over decisions 2. Democracy: equality among leader and staff, work together 3. Laissez-Fair: no leader, power to group (good when everyone in the group is an expert) 4.Servant: pt focused 5. Quantum: organization and it's members are interconnected and collabrative 6. Transactional: money 7. Transformational: wanting to make change