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Module 7 (Critical Care) > Professional Responsibilities > Flashcards

Professional Responsibilities Flashcards

1
Q

Communication problems

A

ineffective
unaware of bias

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2
Q

Conflict problems

A

lack of training/practice
lack of motivation
uncomfortable resolving

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3
Q

Incivility problems

A

bullying
lateral/vertical violence
“nurses eat their young”

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4
Q

Change problems

A

constant
rapid
unready
chaos

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5
Q

ANA Code of Ethics states nurses are required to create what type of environment?

A

ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect

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6
Q

Confidentiality and Privacy includes

A

pt
caregiver
other team members

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7
Q

Praise in public, ________ in private

A

correct
- maintain conversations in a professional tone and manner to improve environment

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8
Q

Issues with the sender of the information

A

Unclear speech
Intricate/confused message
Poor sentence structure
Inappropriate uses of terms or jargon
Knowledge deficit regarding topic

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9
Q

Issues with the receiver of the information

A

Lack of attention
Prejudice and bias
Preoccupation with another problem
Physical factors

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10
Q

miscommunications can lead to

A

med mistakes
bad environment
mistrust
low moral
high turnover

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11
Q

Verbal communication

A

said
- build up with encouraging words, repeat,
-

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12
Q

Paraverbal communication

A

tone (silence)
- soft,
speech
volume
diction

  • blocks by yelling
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13
Q

Nonverbal communication

A

body language
- eye contact
- positive facial expressions
- personal space
- open posture
- empathy

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14
Q

Percentages of the 3 types of communication?

A

Verbal 7%
Paraverbal 38%
Nonverbal 55%

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15
Q

Assertive communication
respects

A

respects self and others

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16
Q

Assertive communication

A

honest, direct and accurately expresses the person’s feelings, beliefs, ideas, and opinions

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17
Q

In assertive communication, Disagreement and discussion are considered to be

A

healthy part of the communication process and negotiation is the positive mechanism for problem solving, learning, and personal growth.

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18
Q

Nonassertive communication is referred to as

A

submissive

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19
Q

When people display submissive behavior or use submissive communication style, they

A

allow their rights to be decided by others. I lose you win

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20
Q

Passive communication disrespects

A

self

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21
Q

Aggressive communication disrespects

A

others

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22
Q

Aggressive communication is used to

A

humiliate, dominate, control or embarrass the other person or lower that person’s self esteem – creates an I win you lose situation

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23
Q

Aggressive forms of communication are seen through

A

screaming, sarcasm, rudeness, belittling jokes, and even direct personal insults

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24
Q

Assertive Communication allows conversations that are

A

direct
honest
nonthreatening
- Acknowledges & deals with conflict
- everyone is equal

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25
Q

Passive communication traits

A

Allows rights to be violated by others
May be a protective mechanism
Dismisses own feelings as being unimportant
May be a means of manipulation by way of passive-aggressive behavior

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26
Q

Aggressive Communication

A

Asserts the speaker’s rights, ideas, and opinion with little respect for others
May be used to humiliate, dominate, control or embarrass others

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27
Q

Therapeutic communication btw

A

The patient
The family
Openness, honesty, direct, frequent, ongoing

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28
Q

Therapeutic communication is NOT

A

premature advice
minimize feelings
false reassurances
value judgements
asky “why” statements
excessive questions
approval
disapproving
change subjects

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29
Q

Examples of Effective Communication Tools

A

TeamSTEPPS
CUS model
- I am concerned
- I am uncomfortable
- This is a safety issue
DESC script - conflict mgmt
“I Pass the Baton”
Crucial conversations

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30
Q

Strategy for Difficult Conversations (STOP)

A
  • State the situation/problem
  • Tell the person what you want
  • Offer an opportunity to respond
  • Provide closure
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31
Q

Communication Strategies by nurses

A

SBAR
Call-Out
Check-Back
Handoff

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32
Q

Conflict

A

Arises from a perception of incompatibility or difference in beliefs, attitudes, values, goals, priorities, or decisions

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33
Q

Conflict impacts

A

job satisfaction, individuals, collaborative efforts, & organizational costs, and most importantly
- negative impact on patients

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34
Q

Intrapersonal

A

within a person
- THE NURSE TURNS INWARD WHEN HAVING A CONFLICT WITHIN THEMSELVES
- errors in perception

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35
Q

Organizational

A

with policies and procedures

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36
Q

Interpersonal

A

btw others

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37
Q

General Causes of Conflict

A

Personality differences
Value differences
Blurred job boundaries
Battle for limited resources
Constraints on decision-making process
Communication
Departmental competition
Unmet expectations for co-workers
Complexity of organizations

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38
Q

Positive Outcomes of conflict

A

Increased group performance
Improved quality of decisions
Stimulation of creativity
Innovation

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39
Q

Negative outcomes of conflict

A

Discontent/Burnout
Gossip
Disrupted communication
Reduced group cohesiveness/effectiveness
Fighting among group members

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40
Q

Cost of mismanaged conflict

A

Management time
Presenteeism
Absenteeism
Turnover
Litigation

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41
Q

Presenteeism

A

coming to work despite illness, injury, anxiety, etc., often resulting in reduced productivity

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42
Q

Absenteeism

A

not showing up due to avoiding others

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43
Q

Why are nurses uncomfortable with conflicts?

A
  • Fear retaliation / ridicule / alienation
  • Mistaken belief they are unable to handle the conflict situation
  • Feel like they do not have the right to speak up
  • Past negative experiences with conflict
  • Family background & experiences
  • Lack of education/skills on conflict resolution
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44
Q

Team Conflict Mgmt skills you can use

A

Accommodating
Avoiding
Collaborating
Competing
Compromising

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45
Q

Accommodating

A

One party seeks to pacify an opponent; that party is willing to be self sacrificing, they obey and serve others but feel resentment “get nothing in return”

46
Q

Avoiding

A

The party is aware of the conflict but wants to withdraw from it. They are unassertive and uncooperative, postpone dealing with the issue

47
Q

Collaborating

A

Setting aside original goals to work toward a common goal

48
Q

Competing

A

Pursuing a desired solution at the expense of others. Stand up for rights and defend important principles

49
Q

Compromising

A

Each person gives up something; the solution provides incomplete satisfaction of both parties. Assertive and cooperative. Work creatively and openly to find the solution that most fully satisfies all important goals and concerns to be achieved.

50
Q

Conflict Resolution

A

Prevent disruptive behavior
usually ongoing, escalates over time, cumulative
significant negative effects on individuals, patient care and safety, and the organization
Preserve positive culture/operations
Promote positive relationships

51
Q

Unresolved Conflict Results

A

Resentment
Backbiting
Bullying
And other dysfunctional behaviors

52
Q

Negotiation

A

Process where two or more people come to an agreement
- win win
-calm
- “homework done”
- incentives
- hidden agendas

53
Q

Conciliation

A

A 3rd person attempts to diffuse the negative emotions that are often involved in the conflict

54
Q

Mediation/Arbitration

A

When the sides are unable to reach a resolution

55
Q

key element of successful negotiation

A

Trust on both sides

56
Q

In negotiation each party gives

A

up something

57
Q

Conflict Behaviors for a good outcome

A

Recognize conflict early
Be proactive
Actively listen
Remain calm
Define the problem
Seek a solution
Listen attentively
Do not spread rumors/let it go
Confront in private when you are not angry
Maintain eye contact/good posture
Start with “I”
Focus on the positive
Be willing to negotiate/compromise
Be direct/honest
Focus on behaviors/issues
Do not interrupt
Don’t attack the person

58
Q

Conflict Resolution used as a constructive approach for managing and resolving conflict:

A

DESC

59
Q

DESC Script

A

D—Describe the specific situation
E—Express your concerns about the action
S—Suggest other alternatives
C—Consequences should be stated

60
Q

DESC script can be used to

A

communicate effectively during all types of conflict and is most effective in resolving interpersonal conflict

61
Q

DESC script are used in situations involving

A

greater conflict, such as when hostile or harassing behaviors are ongoing and safe patient care is suffering

62
Q

DESC script ultimate goal

A

consensus should be reached

63
Q

Civility

A

Having good manners & being polite
Respecting others
Recognizing that all human beings are important
Protecting others from discrimination

64
Q

Incivility

A

Lack of civility
Any type of speech or behavior that disrupts the harmony of the home, work, or educational environment
Other names in health care:
“Nurses eating their young”
“Aggressive communication”

65
Q

A hostile healthcare work environment may lead a nurse to (workplace incivility):

A

Fail to clarify an unreadable order because of fear
Lift or ambulate heavy or debilitated clients without assistance rather than asking for help
Use an unfamiliar piece of equipment without asking for instructions first
Carry out orders that the nurse did not believe were correct

66
Q

Bullying

A

“repeated, unwanted, harmful actions intended to humiliate, offend and cause distress such as a hostile remarks, verbal attacks, threats, intimidation and withholding support.”
- beyond impoliteness

67
Q

One on one bullying from peers is sometimes called

A

peer abuse or lateral (horizontal) violence

68
Q

Repeated actions of bullying intended to:

A

Coerce, intimidate, humiliate, offend, cause distress to a person

69
Q

Bullying Viscous Cycle

A

Those bullied may bully when they move into supervisory positions
Perpetuates a culture of vertical violence

70
Q

Breaking the cycle of workplace cycle

A

Name the problem
Raise the issue at staff meetings
Learn from experience – journal
Pursue a path of personal growth
Be a part of the solution not the problem
Set an example of ”civility” by your own behavior
Maintain self-care behaviors

71
Q

Break the Cycle
Naming the problem:

A

call it “horizontal violence” to refer to the situation
Raising the issue at staff meetings: bring the light of day to the problem
Asking supervisors about developing a process for dealing with incivility in the workplace

72
Q

Break the Cycle
Learning from experience:

A

keeping a journal raises self-awareness about personal values, beliefs, attitudes, and behavior; it is also a good source of documentation

73
Q

Break the Cycle
Pursuing a path of personal growth:

A

finding those things that create happiness and satisfaction and developing them goes a long way to counteract incivility
- Ensuring the nurse is part of the solution, not part of the problem

74
Q

Break the Cycle
Maintaining self-care behaviors:

A

Peer support
Good nutrition and exercise
Time – outs
Speak up about horizontal violence

75
Q

Speaking up when “horizontal violence” is witnessed
- by

A

Develop high-quality preceptor and mentoring programs for students and new nurses.
Educate people on how to recognize and deal with bullying
Recognize bullying behavior early and address it (bullying never stops by itself).
Set an example of “civility” by your own behavior.

76
Q

Civility Best Practice

A

Communicate clearly
Be respectful
Consider words & actions
Avoid gossip
Go with the facts
Collaborate
Be polite
Be open
Encourage others
Listen
Offer help
Be responsible for yourself
Do not abuse power
Be direct

77
Q

Bullying Prevention Strategies

A

Know hospital policy
Code word
Practice strategy
Address
Report
Document
Consider confrontation
Support peers
Be self aware

78
Q

TeamSTEPPS Framework

A

Team Structure
Communication
Leadership
Situation monitoring

79
Q

Team structure

A

facilitates teamwork by identifying the individuals among which information must be communicated, a leader must be clearly designated, and mutual support must occur

80
Q

Communication

A

which facilitates teamwork by enabling team members to effectively relay relevant information in a manner that is known and understood by all.

81
Q

Leadership

A

facilitates teamwork through leaders’ effective communication with their team members to ensure that a plan is conveyed, reviewed, and updated; continuous monitoring of the situation to better anticipate team members’ needs and effectively manage resources; and fostering of an environment of mutual support for role-modeling and reinforcement.

82
Q

Situation Monitoring

A

A way for team members to be aware of what is going on around them
Is moderated by communication
Is enhanced by team leadership
Allows for mutual support by anticipating other team members’ needs

83
Q

Situation Awareness

A

state of knowing the current conditions affecting one’s work

84
Q

Situation Awareness includes knowing

A

Status of the patient
Status of other team members
Environmental conditions
Current progress towardthe goal

85
Q

awareness is achieved by constantly

A

monitoring the ever-changing situation

86
Q

A loss of situation awareness results in

A

ambiguity, confusion, and a decrease in communication

87
Q

Mutual Support examples

A

task assist, share feedback, advocacy and assertion
Monitoring other team members performance to anticipate assistance requests.
Offering or requesting assistance.
Filling in for a member who cannot perform a task.
Cautioning team members about potentially unsafe situations.
Self-correcting and helping others correct their mistakes.
Distributing and assigning work thoughtfully.
Rerouting, delaying work so that the overburdened team member can recover.
Regularly providing feedback to each other.
And providing encouragement.

88
Q

Mutual support depends on

A

information gathered through situation monitoring

89
Q

Mutual support moderated by

A

communication

90
Q

Mutual support modeled by

A

team leaders

91
Q

Situation Monitoring Barriers

A

Inconsistency in Team Membership
Lack of Time
Lack of Information Sharing
Hierarchy
Defensiveness
Conventional Thinking
Complacency
Varying Communication Styles
Conflict
Lack of Coordination and Follow-up With Coworkers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity

92
Q

Situation Monitoring tools

A

Communication
SBAR
Call-Out
Check-Back
Handoff
Leading Teams
Brief
Huddle
Debrief
Situation Monitoring
STEP
I’M SAFE
Mutual Support
Task Assistance
Feedback
Assertive Statement
Two-Challenge Rule
CUS
DESC Script

93
Q

Situation Monitoring outcomes

A

Shared Mental Model
Adaptability
Team Orientation
Mutual Trust
Team Performance
Patient Safety!!

94
Q

Change

A

inevitable
accelerating
complex
adapting

95
Q

Kurt Lewin’s planned change theory

A

unfreezing-change-refreeze model that requires prior learning to be rejected & replaced

96
Q

Change Theory has three major concepts:

A

driving forces, restraining forces, & equilibrium.

97
Q

Driving forces

A

those that push in a direction that causes change to occur. They facilitate change because they push the patient in a desired direction. They cause a shift in the equilibrium towards change.

98
Q

Restraining forces

A

forces that counter the driving forces. They hinder change because they push the patient in the opposite direction. They cause a shift in the equilibrium that opposes change.

99
Q

Equilibrium

A

state of being where driving forces equal restraining forces, & no change occurs. It can be raised or lowered by changes that occur between the driving & restraining forces.

100
Q

Unfreezing

A

process of finding a method of making it possible for people to let go of an old pattern that was counterproductive. Must overcome individual resistance & group conformity

101
Q

3 methods that can lead to the achievement of unfreezing

A

Increase driving forces that direct behavior away from existing situation
Decrease restraining forces that negatively affect the change movement
A combination of the first two methods

102
Q

Change stage

A

involves a process of change in thoughts, feeling, behavior, or all three, that is more liberating or more productive.

103
Q

Refreezing stage

A

establishing change as new habit, so it becomes “standard operating procedure.” Without this final stage, it can be easy for person/organization go back to old habits.

104
Q

Resistance to change

A

rooted by anxiety/fear
expected as integral to the whole change process
not all bad - warning need to readjust/clarity
resister to the solution help reframe the issue

105
Q

Resistance

A

individual rejects proposed new ideas without critically thinking about the proposal. Change requires energy. The change process does not guarantee positive outcomes.

106
Q

Emotional Response to change

A

Fear
Sadness
Outrage
Stress
Disorientation
Eroded loyalty
Lack of commitment
Low risk taking

107
Q

Support in periods of change

A

active listening
promoting action steps and solutions
staff informed or decisions
soliciting input and encourage participation
reframe difficult messages

108
Q

Leaders as change agents

A

Articulate a clear need for change. Start a plan
Get reliable information to the implementers.
Do not promise things that cannot be delivered.
Get group participation by leaving the details to the people who must implement the change. Revise the plan prn.
Motivate through rewards & benefits.

109
Q

Active listening mnemonic

A

Sit facing pt
Uncross the arms and legs
Relaxed
Eye contact
Touch if appropriate
Your intuition

110
Q

Spiritual FICA

A

F
I
C
A

Module 7 (Critical Care) (22 decks)

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