RNSG 1363 Exam 1 Study Guide Graded A+ 2025

Module 12: Clinical Decision Making- Problem Solving, Decision Making, Critical Thinking, Delegation 1. Analyze the relationship of critical thinking to clinical judgment and the nursing process. a. Nursing Process & Critical Thinking i. Critical thinking involves Exploring, Analyzing, Prioritizing, Explaining, Deciding, & Evaluating. ii. During the Assessment portion of the nursing process you are “exploring” through criticalthinking. 1. Ex: What could be causing this alert pt. to become suddenly confused? iii. During diagnosis you are “analyzing” the situation. 1. Ex: What other information can I get to help me narrow down the causes of her confusion? iv. During the Planning of the NP, you are prioritizing & making decisions through critical thinking. 1. Ex: Is this change significantly? Do I need to call the MD to alert him of the change? v. During Implementation, you are deciding and explaining what to do. 1. Ex: Telling the MD the situation, your recommendation. vi. During the evaluation in the NP, you are also evaluating through critical thinking. 1. Ex: After reporting to MD, he orders the following. b. Definition of Critical thinking: An active, organized, cognitive process. A process for identifying underlying assumptions & variables to draw conclusions & make decisions. It is broader &considers wide range of alternatives to make the right decision in a situation. 1. Problem Solving and Nursing Process Page 1 of 25 lOMoARcPSD| Page 2 of 25 a. Assessment: ID the problem, gather information, ID people involved, ID cultural/environmental factors,encourage input from others b. Analysis/Diagnosis: Analyze the information gathers, clarify & prioritize the problems, determine the need for intervention. c. Planning: ID many different solutions, get participation from groups involved, review options & considersafety, costs, ethics, legality, and reopen-minded d. Implementing: Communicate the plan to all affected, make sure goals are clear, keep two-way communication w/staff, support & encourage compliance. The effective delegation, supervision, &communication are a must. e. Evaluation: Was the decision successful? What would have made it better? 2. Relationship between Decision Making & Problem Solving Problem Solving Decision Making ID the problem ID the problem Gather Info ID Alternatives Analyze Info Analyze Alternatives Develop Solutions Select Alternative Implement Solution Implement Alternative/Manage Risk Evaluate Solution Evaluate Alternative 3. Delegation a. When delegating nurse should understand the delegatee’s competencies, communicate, offer clearguidelines, monitor progress, and remain accountable for final outcomes of care. b. Responsible for follow-up & evaluation of the task c. Nurse must know the definition of delegation, items that cannot be delegated, lOMoARcPSD| Page 3 of 25 items that cannot be routinely delegated, guidelines for the RN about what can be delegated, description of professional nursing practice, description of LPN and unlicensed NA roles, degree of supervision required, and restrictthe use of the word “nurse” to licensed nurses only. d. Be familiar with the experience of the delegate, their scope of practice, agency policy e. Right task, right circumstance, right supervision, right direction, right personModule 14: Collaboration: Conflict Resolution 1. Examine the common causes of conflict. lOMoARcPSD| Page 4 of 25 a. Competition b/t groups, increased workload, multiple role demands, threats to safety/security, scarceresources, cultural differences, invasion of personal space, one person has information another personmay not have 2. Investigate the different methods for dealing with a possible conflict situations. a. SBAR: effectively transmits needed information to resolve conflict to provide safe pt- centered care. b. DESC Script: a structured, assertive communication approach for managing & resolving conflict. i. D: describe the specific situation E: express concerns about the situation S: suggest otheralternatives C: consequences should be stated c. LEEN: Listen, Empathize, Explain, Negotiate d. AEIOU: Assume the other team member means well, Express your feelings (“I” messages), Identify what you would like to happen (“I would like…”), Outcomes you expect are made clear (what are advantages, what is in it for the other person?), Understanding on a mutual basis is achieved. 3. Explain the use of the nursing process in conflict resolution. a. ID the conflict, generate possible solutions, evaluate & test solutions, decide on an acceptable solution,implement it, evaluate and repeat as needed. 4. Formulate coping strategies to handle difficult people. a. Stand your ground, use eye contact, be involved, listen, be patient, don’t make it personal, remain calm, non-critical, communicate often & at the right time, be open & effective. b. Apply conflict resolution techniques to the change process. c. Kurt Lewin’s Theory of Change: change should be gradual, planned, implemented for good reason, allaffected should be involved in the planning. i. Unfreezing: People need to understand why change is happening, see the lOMoARcPSD| Page 5 of 25 need for change & believe that improvement is possible through this change. Change agent must: Gather info about the problem, accurately assess the prob, decide if change is necessary, & make othersaware of the need for change. ii. Moving Stage: Implementing the change. Change agent defines goals & alternatives, plans the change, implements the change plan, includes everyone involved, have target dates, be availableto help, support, encourage others iii. Refreezing Stage: stabilizing the change, the new change now becomes the “norm”, if this is not accomplished people may drift toward old behaviors. Change agent should require compliance, enforce the change, support & encourage others until change is no longer viewed as something new & it is a part of the daily workflow. d. Types of Resistance to change: i. Passive: avoids change, cancels appts, misses meetings to discuss change, “too busy”, ignoresthe process ii. Active: direct attack or refusal to change 5. Stages of Team Building from Sullivan Article- informal or formal groups typically develop in these phases: a. Forming: assemble into a well-defined cluster, group members are hesitant but become familiar w/each other, tasks to be accomplished are clarified. Often depend on a leader to define purpose, tasks, roles. b. Storming: Competition & conflict come up as members of group determine roles, informal leadership often emerges here & leader needs to help the group acknowledge the conflict & solve it in a win-winmanner. lOMoARcPSD| Page 6 of 25 c. Norming: group defines its goals & behaviors, cohesiveness develops, cooperation. Group leader explains standards of performance & behavior, defines group’s structure & encourages relationshipbuilding. d. Performing: members agree on purposes & carry out the work. Task oriented. Cooperation improves, emotions subside, communicate effectively. Leader provides feedback on quality & quantity of work,praises achievement, critiques poor work, takes steps to improve work, reinforces interpersonal relationships w/in the group. lOMoARcPSD| Page 7 of 25 e. Adjourning/Reforming: the group either dissolves after meeting its objectives or the group stays together change takes place with the composition or goals & the group refocuses itself to go through the4 stages again. The leader either prepares group for closure or explains the new direction of the group. 6. Purpose of team building: reduce clinical errors, improve pt outcomes, improve pt satisfaction, increase staff satisfaction, provide evidence based care, promote cost effective change, reduce malpractice claims 7. Skills Needed to be a Good Team Leader: good written & oral communication skills, sensitivity to others & cultural values, awareness of other’s abilities, genuine interest in team members, open & objective communication style, planning & coordination skills, flexibility, involve others, acknowledges contributions &attributes of team members, operates well as team member & team leader. 8. Shared Governance: nursing shared governance is a managerial innovation that legitimizes nurses’ control over practice, while extending their influence into administrative areas previously only controlled by managers. a. Advantages: increase in job satisfaction, improved pt care, decreased turnover, improved efficiency b. Disadvantages: need time for meetings & group work, some employees will still want to make majordecisions, lack of participation, cost lOMoARcPSD| Page 8 of 25 Module 15: Managing Care: Prioritization 1. Explain the differences in effectiveness & efficiency. a. Efficiency: using the right combination of resources (energy, time, money) to accomplish a task b. Effectiveness: doing the right thing 2. Prioritization: deciding which needs or problems require immediate action & which lOMoARcPSD| Page 9 of 25 ones could be delayed untila later time b/c they aren’t urgent. a. ABC’s: A- airway B- breathing C- circulation (and neuro) D- disability b. Maslow’s Hierarchy of Needs: Physiological needs, Safety, Love & Belonging, Self Esteem, SelfActualization c. Nursing Process Steps: Assessment, Analyze, Diagnosis, Planning, Implement, Evaluate lOMoARcPSD| Page 10 of 25 3. Implement nursing strategies to provide cost effective care. a. Know the pt’s plan/purpose for care, the current clinical picture, possible outcomes to be able to plan. b. Know the legal role & competency of the nursing team members in order to assign & delegate pt care. c. Take into account the length of time a task may take; try to combine tasks when possible.