Nursing Leadership Exam 2 [Chapters 7-14] /Questions And Answers. Complete Solution. GRADED A

Nursing Leadership Exam 2 Chapters 7-14 Chapter 7 Communication Leadership 1. The process in which information, perception, and understanding are transmitted from person to person is: a. articu lation. b. communication. c. evaluation. d. pronunciation. Communication is the process in which information, perception, and understanding are transmitted from person to person. 2. Unspoken affective or expressive behaviors best describe which type of communication? a. Effective communication b. Ineffective communication c. Non-verbal communication d. Verbal communication Non-verbal communication is unspoken. It is composed of affective or expressive behaviors. 3. A communication model that focuses on compassion, expression of emotion, and providing validation via support is the: a. validation, emotion, reassurance, activity (VERA) framework. b. situation, background, assessment, and recommendation (SBAR) Communication Theory. c. nonviolent communication (NVC) model. d. Human Relationship Model. The VERA (validation, emotion, reassurance, activity) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties (Hawkes et al., 2015). 4. A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: a. advisement. b. consultation. c. persuasion. d. suggestion. Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading. 5. Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes. 6. A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, “You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns.” This preceptor is giving advice about: a. interpersonal communication. b. clarity. c. image. d. intention. If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse’s non-verbal behavior may suggest that she is not interested in interacting with the family. 7. The transformational leader engages staff by: a. punishing errors. b. sharing vision and decision making. c. taking a top-down approach to leadership. d. making unilateral decisions for the team. Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. 8. An example of an external variable that may affect communication is: a. circumstance. b. personality. c. thoughts. d. feelings. Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own control. We have little control over others or the situation, because those are external to us. 9. communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff. 10. Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n): a. breach of beneficence. b. example of maleficence. c. potential assault and battery charge. d violation of the Health Insurance Portability and Accountability Act (HIPAA). . HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient’s privacy in health care transactions. This is an example of breach of confidentiality. 11. Interpersonal communication is defined as: a. the conscious intent by one individual to modify the thoughts or behaviors of others. b. a combination of written and spoken communication. c. a theory used to describe a manner of communicating. d. communication between two or more individuals involving face-to-face interaction. Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis. 12. Organizational tones are based mostly on: a. unspoken cultural norms. b. commitment to success. c. communication behavior. d. leadership styles. The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole. 13. Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. 14. A communication system developed originally to address communication patterns in critical situations is: a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS. Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events. 15. The number one cause of preventable medical errors is: a. hostile work environments. b. poor communication. c. ineffective leadership. d. staff competency. The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program (AHRQ, 2016). 16. Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing) To address the “communication arm” of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation. 1. Effective communication is fostered through which of the following ingredients? (Select all that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy Trust, respect, and empathy are the three ingredients needed to create and foster effective communication. 2. NVC communication processes are grounded in: (Select all that apply.) a. confrontation b. empathy c. compassion d. honesty e. assertiveness NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding. 3. A client’s wife is concerned about her husband’s declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed “no breathing machine” for long-standing care, but she is unsure of his wishes if he were to need a “breathing machine” for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client’s physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client’s concerns with the rest of the team. What type of communication technique is being utilized by the nurse? (Select all that apply.) a. Bargaining b. Negotiation c. Persuasion d. Spiritual assessment e. Collective action Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co- operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse. 4. Which of the following are examples of patient privacy or security breaches? (Select all that apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient’s diagnosis e. Discharge summary given to patient’s spouse Fax transmissions sent to the incorrect physician’s office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security. 5. Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all that apply.) a. Culture b. Beliefs c. Values d. Social e. Religious Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients’ health care decisions and preferences. 6. Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes e. Safety culture Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process. 7. Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges. e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety. Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious. Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy (Sears, 2010). 8. Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness? (Select all that apply.) a. Members are organized and secure about their roles in the forming stage. b. At the forming stage, the group needs direction in defining goals. c. During the storming period, there is more willingness to accept the group goals. d. The group becomes self-managing during the norming period. e. During the performing period, the members willingly perform the task. At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing. 9. E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.) a. When you are mad. b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing Electronic communication has assisted us to be better informed regarding our patients. However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. Warrell (2012) noted that there are four times you should never use e-mail: (1) when you are mad, (2) when rebuking or criticizing, (3) if there is any chance your words could be misunderstood, or (4) when you are canceling or apologizing. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed. Chapter 8 Team Building and Working With Effective Groups 1. Any collection of interconnected individuals working together for the same purpose is known as a(n): a. club. b. group. c. meeting. d. organization. Any collection of interconnected individuals working together for the same purpose is known as a group. 2. A type of group that is stable, meets periodically, has an identified purpose, and is part of the organizational structure is called a: a. club. b. committee. c. group. d. meeting. A committee is a type of group that is stable, meets periodically, has an identified purpose, and is part of the organizational structure. An example of a committee is a policy and procedure committee. 3. Team building is the process of a group. a. forming b. identifying c. organizing d. unifying Team building is the process of deliberately creating and unifying a group into a functioning work unit so that specific goals are accomplished. 4. A small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent is known as a: a. committee. b. group. c. team. d. unit. A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent (Katzenbach & Smith, 1993; Manion et al., 1996). 5. A collection of individuals who are led by a strong, clearly focused leader and who come together to share information and ideas and possibly make decisions is known as a: a. committee. b. pseudoteam. c. team. d. work group. A collection of individuals who are led by a strong, clearly focused leader and who come together to share information and ideas and possibly to make decisions is known as a work group. In a work group, there is little or no collective accountability. 6. In nursing, the reason groups form is: a. monetary rewards. b. mandatory obligations. c. physical needs. d. professional socialization. In nursing, the formation of groups occurs primarily for one of two reasons: (1) to provide a personal or professional socialization and exchange forum, or (2) to provide a mechanism for interdependent work accomplishment. 7. Group problem solving is known to be more effective over individual problem solving because of a larger knowledge and information base, increased acceptance of solutions, more approaches to a problem, lower economic costs, and the ability for: a. group development. b. individual expression. c. hierarchical bonding. d. organizational team building. Individual expression is one of the major advantages of group problem solving (Veninga, 1982). 8. Some of the major disadvantages to group decision making are negativity, individual focus, and: a. autonomous conclusion. b. disruptive conflicts. c. group synergy. d. inaccurate data interpretation. Ronco (2005) identified the six potential negative impacts groups can have on an organization, including negativity, passivity, individual focus, groupthink, vocal minority, and the ethical dark side. Veninga (1982) also suggested a seventh: disruptive conflicts. 9. A group of tenured nursing faculty at a major university votes on whether a faculty member should receive tenured status. This type of decision making is referred to as: a. autocratic decision procedure. b. consultative decision procedure. c. delegated decision procedure. d. joint decision making. Joint decision making occurs when the entire group makes the decision by two-thirds vote, a simple majority, consensus, or some other process. In this process, the group members have as much power as the leader. 10. Group as well as individual accountability exists within a: a. work group. b. true team. c. pseudoteam. d. committee. A true team occurs when there is a collective entity in which leadership rotates and is shared by various members of the team. There is group as well as individual accountability. 11. The hospital’s regulatory department is experiencing The Joint Commission survey. The surveyors want to review hospital policies for infection control before they leave for the evening. The regulatory team leader states that she can stay past her regular hours to wait for them and acknowledges that there will be a need for a policy change before the surveyors return the following day. All of the department managers stay to assist the regulatory team leader with the required documentation. This is an example of a: a. work group. b. committee. c. true team. d. group. A true team is a group where there are collective work products. There is group as well as individual accountability. If one member is having a problem, it is not only that person’s problem but that of the whole team to resolve. 12. A temporary group of individuals formed to carry out a specific mission or project is known as a: a. club. b. group. c. meeting. d. task force. A task force is a temporary group of individuals formed to carry out a specific mission or project. Task forces may solve a problem that requires a multidisciplinary approach. 13. The stage of group development where control issues arise and disputes or disagreements begin to emerge is the stage. a. orientation b. adaptation c. emergence d. working Emergence is the third stage of group development and occurs as control issues arise. Disputes, disagreements, confrontations, alliances, and power struggles mark this stage of determining control over the group in order to emerge with a more consolidated identity. 14. The nurse manager within a small department has requested that the staff decide department coverage over the holidays. The department is not associated with patient care and serves as a supportive role to the organization. The staff is to present the manager with the coverage plan during the month of December. This is an example of which type of decision? a. Autocratic decision procedure b. Consultative decision procedure c. Joint decision making d. Delegated decision procedure A delegated decision procedure occurs when the leader allows participants to make the final decision. An autocratic decision procedure occurs when the leader makes all of the decisions. A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the decision. Joint decision making occurs when the entire group decides by vote or consensus. 15. The critical care unit of a hospital utilizes team huddles at change of shift. This is an opportunity for the clinical supervisors to connect with team members and review the upcoming shift or any quick topics that need to be communicated. This is an example of a(n) meeting. a. information-sharing b. opinion-seeking c. problem-solving d. strategy An information-sharing meeting occurs when a group is gathered to disseminate information. 16. A multidisciplinary committee meets monthly to discuss medication safety issues within the acute care areas. The quality director consistently arrives late for meetings and spends her time in the meeting answering e-mails on her smart phone. What type of disruptive behavior does this exhibit? a. Compulsive talker b. Interrupter c. Squasher d. Unreliable Unreliable members are not committed to the work of the group and frequently arrive late, leave early, spend time checking e-mail or texting, and simply want to show up for the purpose of appearance. 1. Why is an interdisciplinary, team-based approach essential in health care? (Select all that apply.) a. Reimbursement protocols and government regulations require them. b. Diverse team’s enhanced ability to adapt to continuous or sudden change. c. A collective pool of thinking styles allows for greater exchange of information, ideas, and problem solving. d. Rapid information dissemination is most efficient with multidisciplinary teams. e. Engaging teams in this process allows for diverse points of view, creativity, and innovation. Health care leaders recognize that an interdisciplinary, team-based approach is essential for high-quality, patient-centered, coordinated, and effective health care. Teamwork allows for greater exchange of information, ideas, and problem solving to address the complex issues of health care. Engaging teams in this process allows for diverse points of view, creativity, innovation, and an enhanced ability to adapt to continuous or sudden change. 2. What are some of the positive aspects of utilizing teams in a professional setting such as health care? (Select all that apply.) a. Teams have the potential to perform at higher levels than individuals on their own. b. Teams are a way to keep decision making at the management level. c. Teams may contribute to constraints within the budget. d. Teams can motivate individual members and provide encouragement, constructive criticism, and praise. e. Teams can make individuals feel more connected to the larger organization. Groups have the potential for being a driving force for change in an organization. Ronco (2005) identified the potential positive impact groups can have on an organization: 1. Synergy: Groups have the potential to perform at higher levels than an individual would on his or her own. 2. Positive individual impacts: Groups have the potential to improve every member of the group or at least help each one reach his or her highest potential. 3. Motivation: Groups have the potential to motivate their individual members and provide encouragement, constructive criticism, and praise. 4. Diverse thinking: Groups have the potential to engage in diverse thinking, thereby identifying problems that might otherwise go unnoticed or ignored and exploring solutions. 5. Linkage to the larger organization: Groups have the potential to make individuals feel more connected to the larger organization. 3. When teams are assigned, but not designed, dysfunction can occur. What are some characteristics of a dysfunctional team? (Select all that apply.) a. Confusion over the purpose of the team b. Lacks real authority c. Effective interpersonal communication patterns d. Team needs placed above individual needs e. Lack of evaluation criteria Perils and pitfalls can occur when teams are assigned—not designed—including confusion about the team’s work, the team lacks real authority, structural team building is not done, dysfunctional behavior occurs and team members don’t know how to constructively deal with it, and team-based outcome measures and coaching are lacking. 4. Group interactions are composed of which of the following elements? (Select all that apply.) a. The unique way the group interrelates and begins to work together b. The values and norms of each individual c. The process of problem solving d. The communication that occurs among group members e. The roles played by each member Group interactions are composed of the unique way the group interrelates and begins to work together, the standards that regulate the group’s behavior, the process of problem solving and decision making, the communication patterns that occur among group members, and the roles played by each member. 5. A nursing professional practice council is being formulated within an organization. Nurses from the three acute settings will meet monthly to discuss safety, policy, and practice needs within the organization. What are some of the reasons for this group formation? (Select all that apply.) a. To provide professional socialization b. To provide an exchange forum c. To provide a mechanism for independent work accomplishment d. To allow members to test a theory e. To create a sense of status and esteem In nursing, formation of groups occurs primarily to provide a personal or professional socialization and exchange forum, or to provide a mechanism for interdependent work accomplishment. Groups are established within organizations to create a sense of status and esteem, they allow an individual to test and establish reality, and they function as a mechanism for getting a job done. 6. Work group disruption has been shown to be linked to negative outcomes. What are some factors that can contribute to work group disruptions? (Select all that apply.) a. Budget constraints b. Multidisciplinary attendance c. Reorganization d. Absenteeism e. Turnover Work groups can be disrupted by factors such as downsizing, reorganization, absenteeism, and turnover. 7. What are some of the advantages to group work related to problem solving? (Select all that apply.) a. There is greater sharing of knowledge and information. b. Individuals are less likely to accept a solution. c. Complex problems are more manageable in a group. d. Groups discourage individual expression. e. Group decision making is cost-effective. The major advantages of group problem solving over individual problem solving are greater sharing of knowledge and information, increased acceptance of solutions, complex problems are more manageable, groups allow for individual expression, and group functioning is less expensive. 8. Team dynamics can become dysfunctional over time. What are some factors that can contribute to team dysfunction? (Select all that apply.) a. Taking accountability b. Absence of trust c. Negotiating expectations d. Fear of conflict e. Lack of commitment Dysfunctional team behaviors can occur related to an absence of trust, fear of conflict, lack of commitment, avoiding accountability, and inattention to results. Articulating and negotiating expectations for healthy interpersonal behavior benefits team development. 9. Effective groups will have a variety of roles. Which of the following are examples of group-building roles? (Select all that apply.) a. Encourager b. Listener c. Summarizer d. Compromiser e. Recorder Group-building roles include initiator, encourager, opinion giver, clarifier, listener, and summarizer. 10. In planning for an effective committee meeting, what are some of the roles of the leader? (Select all that apply.) a. Allowing the group to set the agenda during the meeting b. Speaking for every member to ensure all opinions are heard c. Identifying the purpose of the meeting d. Ensuring that the meeting starts and ends on time e. Keeping the meeting directed toward accomplishing objectives An effective meeting checklist for leaders includes preparing an agenda and related materials, listen carefully and summarize discussion and assignments at the end of the meeting, ensure balanced dialogue by all members, identifying the purpose of the meeting, ensuring that the meeting starts and ends on time, and keeping the meeting directed toward established goals. Chapter 9 Delegation in Nursing 1. The process for a nurse to direct another person to perform nursing tasks and activities is: a. authorization. b. delegation. c. empowerment. d. supervision. In their Joint Statement on Delegation (NCSBN, 2005b), the ANA and the NCSBN defined delegation in nursing as “the process for a nurse to direct another person to perform nursing tasks and activities.” 2. The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is: a. authorization. b. delegation. c. observation. d. supervision. Supervision is the provision of guidance or monitoring of a delegated nursing task. It may occur in a variety of ways, including written and verbal communication (such as giving or receiving reports), observation of the performance of the delegated task, or assessing the patient for evidence that the delegated task has been completed successfully. 3. Individuals who are trained to help the registered nurse (RN) in the provision of patient-client care activities as delegated by and under the supervision of the RN are known as: a. certified assistive personnel. b. health care assistive personnel. c. medical assistive personnel. d. unlicensed assistive personnel. The NCSBN (2016) defined unlicensed assistive personnel (UAP) as any unlicensed personnel trained to function in a supportive role and to whom a nursing responsibility can be delegated. 4. When considering whether to delegate a task, the nurse needs to assess the patient and: a. how many nurses are available to supervise. b. how complex the delegated action is. c. the severity level of the patient population. d. the expiration date of the license. When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015). 5. According to the American Association of Critical-Care Nurses, there are five factors that a nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the: a. amount of time that the task will take. b. degree of comfort the delegatee has with the task. c. level of patient interaction. d. method of measuring outcomes. The level of patient interaction is the fifth factor that nurses should assess when making delegation decisions. 6. The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right: a. interaction. b. outcome. c. supervision. d. time. The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. 7. If an error occurs as a result of delegation, the nurse is accountable for supervision, follow-up, intervention, and: a. corrective action of the event. b. documentation of the event. c. evaluation of the process. d. summation of the occurrence. The nurse is also responsible for corrective action in case of an error. 8. The nurse has asked a nurse’s aide to greet a postoperative patient who has just arrived on the unit and to determine whether he is in stable condition. This act of delegation is an example of a nurse inappropriately delegating: a. assessment of the patient. b. evaluation of an intervention. c. nursing judgment. d. teaching to a delegate. The RN is responsible for assessment, evaluation, and nursing judgment, and should not delegate these professional responsibilities. 9. If a licensed practical/vocational nurse (LPN/LVN) provides discharge teaching, who is ultimately responsible? a. Chief executive officer b. Institution where the LPN/LVN works c. Risk manager d. UAP Organizational leadership in building the skills related to delegation enhances individuals and builds high-performing teams, as well as enhancing team member awareness of roles and responsibilities and their individual capabilities and limitations (Lanfranchi, 2013). The organization is accountable for the delegation processes in place and for upholding values of safe patient care and staff development. 10. Being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard is: a. accountability. b. authority. c. supervision. d. delegation. The National Council of State Boards of Nursing (NCSBN, 2016) defined accountability as being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard. 11. Which staff member should be assigned to a dying client who is experiencing symptoms of emotional distress? a. UAP who can be spared to sit with the client b. LPN/LVN who has grown attached to the family c. RN who has experience as a hospice nurse d. Newly graduated RN The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. A hospice nurse has experience in managing symptoms associated with the dying process. This is the best nurse to care for this patient. 12. The charge nurse is making assignments on a surgical unit. Which client should be assigned to the least experienced nurse? a. Client who had a vaginal hysterectomy and still has an indwelling catheter b. Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag c. Client who had a hip replacement and stated that something popped while walking d Client who had a Whipple procedure and is reporting being thirsty all the time . The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. Options b, c, and d indicate the possibility of postoperative complications, but option a does not. The least experienced nurse should have the client who is not displaying the possibility of postoperative complications. 13. When determining that delegation of an element of patient care needs to occur, the nurse delegates with a clear, concise description of the task, including its objectives, limits, and expectations. The nurse allows the delegate to clarify without fear of repercussion. Which of the following five rights of delegation is being demonstrated? a. Right task b. Right circumstance c. Right person d. Right direction/communication e. Right supervision/evaluation The right direction/communication of delegated elements of care will be a clear, concise description of the task, including its objective, limits, and expectations. The nurse allows for clarification without the fear of repercussions. 14. Who is ultimately accountable for the appropriateness and supervision of the delegated task? a. The nurse who delegated the task b. The UAP who accepted the task c. The nursing manager d. The hospital CEO Accountability in delegation means being obligated to answer for one’s actions, including the act of supervision. The nurse is ultimately accountable for the appropriateness and supervision of the delegated task. Thus the nurse may be found liable if found negligent in the process of delegating and supervising. The delegatee is accountable for accepting the delegation and for the actions in carrying out the delegated task. 15. Delegating requires clear and skillful to avoid liability. a. negotiation b. communication c. corrective action d. planning Delegating requires skillful written and verbal communication to avoid liability. If an activity is not documented, it is considered that it was not done. Clear documentation of assignments and additional clarification of the delegated tasks for each health care team member are required when delegating. 16. The nurse manager determines that communication style is contributing to problems with delegation on her unit. What tool is used to teach principles of communication, leadership, situation monitoring, and mutual support? a. American Nurses Association (ANA) b. Agency for Healthcare Quality and Research (AHRQ) c. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) d Institute for Healthcare Improvement (IHI) . Invariably there will be potential problems as the use of delegation expands in health care. The nurse leader will need to be aware of techniques to address these potential problems. One such method is the TeamSTEPPS 2.0 (Team Strategies and Tools to Enhance Performance and Patient Safety) program. The framework followed is based on a foundation of team competencies including knowledge, attitudes, and performance. The principles the program abides by include team structure and the teachable principles of communication, leadership, situation monitoring, and mutual support. 1. Which of the following colleagues would a nurse typically delegate to in the health care setting? (Select all that apply.) a. Nurse apprentices b. Personal care attendants c. Family members at bedside d. Physicians e. Nursing assistants Nurses often delegate to unlicensed assistive personnel (UAPs). UAPs include a number of health care disciplines, such as nursing assistants, medical assistants, nurse apprentices, and personal care attendants. A nurse would not delegate to a family member or a physician. 2. When making a decision to delegate a nursing task, which of the following factors are assessed? (Select all that apply.) a. Potential for harm b. Complexity of the task c. Amount of problem solving required d. Predictability of the outcome e. Level of patient interaction In making a decision to delegate nursing tasks, the following five factors can be assessed: potential for harm, complexity of the task, amount of problem solving and innovation required, unpredictability of the outcome, and the level of patient interaction. 3. When the licensed nurse makes a determination to delegate a task, which of the following occurs in the process? (Select all that apply.) a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. c. The needs of the nurse are considered. d. The nurse determines the available resources and patient safety. e. Accountability is transferred to the manager. With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation. 4. With regard to delegation, what organizational principles are considered? (Select all that apply.) a. Legal guidelines and policies b. Patient safety and accountability c. Relationship management and patient support d. Cost containment e. Knowledge and education At the core of the five rights of delegation and the roles of the UAP and nurse are three organizational principles that are present in many health care settings today. These principles include organizational and legal guidelines and policies, patient safety and accountability, and knowledge and education (Craftman et al., 2012). 5. The legal and ethical standards to consider when questioning if delegation is appropriate include: (Select all that apply.) a. accountability b. good faith c. cost efficiency d. reasonable e. prudent Nurses are held to a standard of patient care in which they use their expertise, knowledge, and skill in decision making (Wilkinson, 2016). When considering a questionable situation, the standards of “reasonable,” “prudent,” and “good faith” form the foundations for legal and ethical decision making. 6. Which principles are important to consider when an RN delegates tasks to UAP? (Select all that apply.) a. Tasks are delegated that will challenge the UAP to use critical thinking. b. Assess the condition and stability of the patient. c. Delegate tasks that are within the expertise of the RN, particularly if the UAP is a student. d Evaluate the complexity of the task. . e. Determine the potential for harm to the patient. When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015). In making a decision to delegate a nursing task, the following five factors should be assessed: 1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient. 2. Complexity of the task: The more complex the activity, the less desirable it is to delegate. 3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated. 4. Unpredictability of outcome: When a patient’s response to the activity is unknown or unpredictable it is not advisable to delegate that activity. 5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient (AACN, 2004, p.10). 7. A unit manager is utilizing her staff as a resource for educational presentations. An RN in her unit has been requested to create a PowerPoint on delegation and supervision. What resources should she include for staff to obtain additional information on delegation and supervision? (Select all that apply.) a. State nurse practice act b. Organization’s policies and procedures c. The Joint Commission (TJC) d. American Nurses Association (ANA) e. Board of Registered Nursing Nurses are accountable for following their state nurse practice act, standards of professional practice, policies of the organization, and ethical-legal models of behavior. The ANA and each state’s board of nursing regulate nursing practice. 8. Which of the following are the responsibilities of the delegatee in a situation? (Select all that apply.) a. Corrective action b. Own acts c. Accepting the delegation d. Appropriate notification and reporting e. Accomplishing the task The delegatee accepts accountability for his or her own acts, accepts the delegation, uses appropriate notification and reporting, and accomplishes the task. 9. Leadership style may be a significant barrier to effective delegation. Which of the following describes the “invincible” style? (Select all that apply.) a. Prefers to do everything themselves so as not to transfer control. b. Wants to be everyone’s friend. c. Comes across as a pushover. d. Often stays late to complete documentation. e. Micromanages the UAP. Many nurses fall into the “invincible” nurse style; they prefer to do everything themselves so as not to risk delegating to the UAP or transfer some control to someone else. This nurse often stays late after the shift completing documentation and may miss some cares that should have been completed due to trying to do everything him- or herself. The “pal” is the nurse who wants to be everyone’s friend. These nurses do not want to be viewed as pushy or demanding. This type of delegator may come across as a pushover to the UAP. The “watchdog” nurse views delegation as a real risk and is constantly monitoring and micromanaging the UAP to the point that resentment may enter the nurse/UAP team and lead to poor teamwork and outcomes. 10. The process of delegation may be undermined in the health care setting as one member of the team moves work in a downward direction. What are some of the reasons for delegatees to resist responsibility? (Select all that apply.) a. Lack of ability to direct b. Fear of criticism for mistakes c. Overwhelming workload d. Lack of confidence e. Lack of resources The delegatee may resist responsibility for a number of reasons, including fear of criticism, overwhelming workload, lack of confidence, and lack of resources. Chapter 10 Power and Conflict 1. A nurse on a medical-surgical floor has been asked to join a research committee. She agrees to this request because of her great admiration for the vice president of nursing. This is an example of dimension of power. a. dependence b. relational c. subversive d. tactical Relational dimension of power is a property of a social relationship. Many classic definitions indicate that power has to do with relationships between two or more actors in which the behavior of one is affected by the other. 2. A staff nurse frequently is providing positive comments to get the manager in a good mood before asking about additional vacation time. This influence tactic is known as: a. consultation. b. ingratiation. c. inspiration appeals. d. rational persuasion. Ingratiation occurs when the agent uses praise, flattery, friendly behavior, or helpful behavior to get the target in a good mood or to think favorably of him or her before asking for something. 3. Management offers a day of pampering at a spa if nurses agree to work 3 out of 4 weekends over the summer. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward. French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When reward power is used, most people comply because of the positive benefits of doing so. 4. The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward. French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply. 5. Subunit power is derived from: a. being independent within the organization. b. providing resources on which the organization most depends. c. supplying multiple cross-trainable functions within the organization. d. voicing unique opinions and values within the organization. Subunit power is derived from providing resources on which the organization most depends. Subunit power also is derived from dependence, coping with uncertainty, being irreplaceable, having the ability to affect the decision process, and having shared consensus within the organizational subunit. 6. A nursing manager is leading a recruitment and retention committee. She manages in a laissez-faire style. Her co-leader is a staff nurse who is very detail oriented. The nurse manager usually leads the meetings. During the meeting, the staff nurse frequently needs to interject information that has not been presented. She also creates the agenda and communicates information with other team members. This scenario depicts which type of conflict? a. Competitive b. Disruptive c. Organizational d. Task Task conflict is an awareness of differences in viewpoints and opinions pertaining to a group task. 7. A hospital nurse manager is involved in conflict management between two staff members. The process of collaborating occurs when: a. one person seeks to satisfy his/her own interests. b. both sides strive to meet the interests of both parties. c. a person chooses to withdraw from conflict. d. one party seeks to appease the other. Collaborating ensues when the parties to conflict each desire to fully satisfy the concerns of all parties. The intention is to solve the problem by clarifying differences rather than by accommodating. 8. Nurses derive much of their power from being: a. authority figures in emergent situations. b. central to the delivery of health care services. c. organized through public associations. d. the care coordinator of the health care team. Professional nurses have a high degree of centrality within health care organizations. They are critical to the operation of most health care organizations, and without nurses, many health care facilities would not be able to offer services. Nursing maintains power by being central to the actual delivery of health care services, which is the core business function. 9. A well-known talk show host presents information to a congressional committee to garner support for cancer research. This type of power refers to power. a. coercive b. expert c. legitimate d. referent Referent power is based on admiration for a person who has desirable resources or personal traits. 10. is an influence tactic where another person is given praise or sympathy in an effort to make the other person feel important. a. Assertiveness b. Ingratiation c. Rationality d. Upward appeal Ingratiation means trying to make the other person feel important—giving praise or sympathizing. Ingratiation is attempting to advance oneself by trying to make another person feel important. 11. Subunit or power refers to relationships across departments. a. vertical b. organizational c. horizontal d. exertional Subunit or horizontal power pertains to relationships across departments. 12. A disagreement or differences between the members of two or more groups over authority, territory, and resources is called conflict. a. intragroup b. intergroup c. interpersonal d. intrapersonal Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources. 13. is a personal quality that is admired in the person with referent power. a. Problem solving b. Authority c. Knowledge d. Coercive power Referent power comes from the affinity other people have for someone. They admire the personal qualities, the problem-solving ability, the style, or the dedication the person brings to the work. 14. A common source of conflict in nursing occurs when the nurse wants to perform patient teaching or counseling, but there are competing priorities and the nurse has inadequate time to spend with the patient. This type of conflict is related to: a. interpersonal conflict. b. intergroup conflict. c. intrapersonal conflict. d. intragroup conflict. Intrapersonal conflict means discord, tension, or stress inside—or internal to—an individual that results from unmet needs, expectations, or goals. It often is manifested as a conflict over two competing roles. A nursing example occurs when the nurse determines that a patient needs teaching or counseling, but the organization’s assignment system is set up in a way that does not provide an adequate amount of time. When other priorities compete, an internal or intrapersonal conflict of roles exists. 1. Nurses must use which of these to facilitate change in health care organizations? (Select all that apply.) a. Actualization b. Authorization c. Influence d. Ratification e. Power As the largest health care profession, nursing must use power and influence as a legitimate tool to facilitate change in health care organizations and the health care system. 2. What are the consequences or outcomes of nurse empowerment? (Select all that apply.) a. Increased compensation and benefits b. Decreased burnout c. Decreased job strain d. Increased job satisfaction and work effectiveness e. Increased trust in the workplace Rao (2012) summarized the consequences or outcomes of nurse empowerment as (1) the potential for improved nurse and patient outcomes, (2) decreased burnout, (3) decreased job strain, (4) increased trust in the workplace, and (5) increased job satisfaction and work effectiveness. 3. The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine have assessed progress made on recommendations for the future of nursing. What are the recommendations for nurses? (Select all that apply.) a. Remove barriers to practice and care. b. Maintain current leadership roles. c. Promote diversity. d. Transform education. e. Improve data. In 2014 the Robert Wood Johnson Foundation asked the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division) to convene a committee to assess progress made on implementing the recommendations of The Future of Nursing (IOM, 2010) and identify areas that should be emphasized over the next 5 years. This report outlines specific areas to accelerate implementation of the IOM recommendations for nurses: (1) removing barriers to practice and care, (2) transforming education, (3) collaborating and leading, (4) promoting diversity, and (5) improving data. 4. Which of the following are the formal dimensions of power? (Select all that apply.) a. Social aspect b. Relational aspect c. Dependence aspect d. Independent aspect e. Sanctioning aspect The three formal dimensions of power are the relational, dependence, and sanctioning aspects of power. The relational aspect of power suggests that power is a property of a social relationship. The dependency aspect of power suggests that power resides implicitly in the other’s dependency. The sanctioning aspect of power is the active component of the power relationship, referring to the direct manipulations of the other’s outcomes. 5. Empowerment for nurses may consist of three components. Which three of the following components may help nurses become empowered to use their power for better patient care? (Select all that apply.) a. A state in which a nurse has assumed control over his or her own practice b. A social relationship between two or more people c. A workplace that promotes opportunities for growth d. A nurse’s sense of meaning as expressed in values and work role e. Interdependence of personnel Nurse empowerment was defined as a state in which an individual nurse has assumed control over his or her practice, enabling him or her to successfully fulfill professional nursing responsibilities within an organization. Organizational antecedents to nurse empowerment include the “opportunities for mobility and growth and access to resources, support, and information provided within the nurse’s work environment.” The organizational and individual antecedents lead to psychological empowerment, including a nurse’s sense of meaning as expressed in values and work role. 6. What are the two major content dimensions of power? (Select all that apply.) a. Influence b. Integrity c. Authority d. Dominance e. Control Authority and influence are two major content dimensions of power. Influence, dominance, and control may occur in separate dimensions. 7. Which of the following statements accurately describe the varying mechanisms of power? (Select all that apply.) a. Connection power is based on the perception that the influencer has access to powerful people or groups. b. Legitimate power is based on fear. c. Expert power results from expertise, special skill, or knowledge. d. Information power refers to skill in making rational appeals. e. Referent power is based on admiration for a person. Connection power is based on another’s perception that the influencer has access to powerful people or groups. Expert power results from expertise, special skill, or knowledge. Referent power is based on admiration for a person. 8. Which of the following statements describe structural determinants of power within an organization? (Select all that apply.) a. Power is derived from independence. b. Power is derived from providing resources. c. Power is derived from certainty. d. Power is derived from being irreplaceable. e. Power is derived from the ability to affect the decision process. The following are structural determinants of power within organizations: Power is derived from dependence; power is derived from providing resources; power is derived from coping with uncertainty; power is derived from being irreplaceable; power is derived from the ability to affect the decision process; and power is derived if there is a shared consensus within the organizational subunit. 9. Organizational change is associated with both direct and indirect costs for which leaders must be prepared. Which of the following are examples of indirect costs associated with conflict? (Select all that apply.) a. Loss of team morale b. Disrupted communication c. Disability or stress claims d. Decreased management productivity related to time spent resolving conflict e. Loss of motivation for achieving team goals Dysfunctional outcomes of conflict include development of discontent, reduced group effectiveness, disrupted communication, reduced group cohesiveness, and infighting among group members, which then overrides the focus on group goals. 10. The main effects of conflict are individual effects, interpersonal relationships, and organizational effects. What are some of the positive effects of conflict within an organization? (Select all that apply.) a. Absenteeism b. Team cohesiveness c. Disrupted communication d. Stimulation of creativity and innovation e. Improved quality of decisions Positive outcomes of conflict include stronger relationships and team cohesiveness, stimulation of creativity and innovation, and improved quality of decisions. 11. Negotiation is a form of conflict resolution. Which of the following terms are associated with negotiation? (Select all that apply.) a. Conciliation b. Distributive bargaining c. Arbitration d. Mediation e. Collective bargaining Conflict resolution involves eliminating all forms of conflict. Negotiation, mediation, and arbitration are often referred to in discussions of conflict resolution. These terms are also included under the umbrella of alternative dispute resolution (ADR). According to Knickle and colleagues (2012), the resolution continuum includes negotiation, mediation, arbitration, and litigation as a spectrum of third-party dispute resolution. A conciliator is like a third friend who might attempt to intercede in an argument between two other friends. Conciliators attempt to diffuse the negative emotions that are often involved in the conflict, and they strive to establish more effective communications between the parties. 12. Which of the following are factors that influence the way conflict is handled within an organization? (Select all that apply.) a. Behavioral predispositions of individuals b. Bureaucratic hierarchy c. Social pressure in the environment d. Rules and procedures e. Position power A structural model of conflict exists that examines four factors that seem to influence the way conflict is handled in organizations: behavioral predispositions of individuals, social pressure in the environment, the organization’s incentive structure, and rules and procedures. Chapter 11 Workplace Diversity 1. Which of these statements are true about culture? a. Culture remains consistent. b. Individuals identify with one culture during their lifetime. c. Culture is complex. d. Culture excludes religion. Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes. There is a complex nature to culture, which has been defined and studied across many disciplines. 2. A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. “I don’t blame you. I don’t like lime Jell-O either.” b. “Tell me about your cultural beliefs to best help you.” c. “Why don’t you want to eat the lime Jell-O?” d. “It is important for you to eat so that you will heal.” The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that “we don’t want to offend anyone.” The challenge with this thinking is that if nurses do not ask about people’s differences, then the only option is to make assumptions. 3. Cultural diversity refers to the: a. variety of cultural or ethnic groups within a society. b. belief that one’s own culture is similar to another’s culture. c. realization that all people in a particular culture have the same beliefs. d. view that individuals living in a country should speak the native language. Cultural diversity is defined by the Oxford Dictionary (“Cultural diversity,” 2016) as “The existence of a variety of cultural or ethnic groups within a society.” 4. Which of these is the fastest growing minority group in the United States? a. Asians b. Caucasians c. Blacks d. Hispanics The U.S. Census Bureau (2014) estimates that minorities (anyone who is not a single-race non-Hispanic White) will be the majority in America by 2044 as a result of both immigration and growth rate. The nation’s racial and ethnic minority groups, especially Hispanics, are growing more rapidly than the non- Hispanic White population, fueled by both immigration and births. 5. Which of the following ethnic populations has seen the fastest growth? a. African Americans b. Iranians c. Hispanics d. Vietnamese Results from the 2010 census show that racial and ethnic minorities accounted for 91.7% of the nation’s growth since 2000. Most of that increase, from 2000 to 2010 (56%), was due to Hispanics. 6. Equity is the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Which group formulated this definition? a. World Health Organization b. Affordable Care Act c. Centers for Disease Control d. Agency for Healthcare Research and Quality According to the World Health Organization (2016), “Equity is the absence of avoidable or remediable differences among groups of people, whether thos