NR 446/NR446 Collaborative Healthcare Exam 2

What is Ventricular fibrillation (VF)? - And a chaotic rhythm characterized by a quivering of the ventricles, which results in total loss of cardiac output and pulse. VF is a life-threatening emergency, and the more immediate the treatment, the better the survival will be. VF produces a wavy baseline without a PQRST complex (Figure 7-45, p. 126). Because a loose lead or electrical interference can produce a waveform similar to VF, it is always important to immediately assess the patient for pulse and consciousness. What is Ventricular tachycardia (VT)? - And a rapid, life-threatening dysrhythmia originating from a single ectopic focus in the ventricles. It is characterized by at least three PVCs in a row. VT occurs at a rate greater than 100 beats per minute, but the rate is usually around 150 beats per minute and may be up to 250 beats per minute. Depolarization of the ventricles is abnormal and produces a widened QRS complex (Figure 7-43, p.126). The patient may or may not have a pulse. The wave of depolarization associated with ventricular tachycardia rarely reaches the atria. Therefore P waves are usually absent. If P waves are present, they have no association with the QRS complex. The sinus node may continue to depolarize at its normal rate, independent of the ventricular ectopic focus. P waves may appear to be randomly scattered throughout the rhythm, but the P waves are actually fired at a consistent rate from the sinus node. This is called AV dissociation, another clue that the rhythm is VT. Occasionally a P wave will "capture" the ventricle because of the timing of atrial depolarization, interrupting the VT with a single capture beat that appears normal and narrow. Then the VT reoccurs. Capture beats are a diagnostic clue to differentiating wide complex tachycardias. VTach rhythm analysis - Ans • Rate: The heart rate is 110 to 250 beats per minute. • Regularity: The rhythm is regular unless capture beats occur and momentarily interrupt the VT. • Interval measurements: There is no PR interval. The QRS complex is greater than 0.12 seconds and often wider than 0.16 seconds • Shape and sequence: QRS waves are consistent in shape but appear wide and bizarre. The polarity of the T wave is opposite to that seen in the QRS complex. • Patient response: If enough cardiac output is generated by the VT, a pulse and blood pressure are present. If cardiac output is impaired, the patient has signs and symptoms of low cardiac output; the patient may experience a cardiac arrest. VFib rhythm analysis - Ans • Rate: Heart rate is not discernible. • Regularity: Heart rhythm is not discernible. • Interval measurements: There are no waveforms. • Shape and sequence: The baseline is wavy and chaotic, with no PQRST complexes. • Patient response: The patient is in cardiac arrest. VTach causes - Ans Hypoxemia, acid-base imbalance, exacerbation of heart failure, ischemic heart disease, cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, genetic abnormalities, and QT prolongation are all possible causes of VT. VTach treatment - Ans Determine whether the patient has a pulse. 1. If no pulse is present, provide emergent basic and advanced life support interventions, including defibrillation. *2. If a pulse is present and the blood pressure is stable, the patient can be treated with intravenous amiodarone or lidocaine. *3. Cardioversion is used as an emergency measure in patients who become hemodynamically unstable but continue to have a pulse. VFib causes - Ans VF can be caused by ischemic and valvular heart disease, electrolyte and acid-base imbalances, and QT prolongation. VFib treatment - Ans Immediate BLS and ACLS interventions are required. * check pulse, CPR, shock(200J), shock(300J), epi(1mg q3-5minuutes), shock, amniodarone (300mg), shock, amniodarone (150mg), shock, lidocaine SVT treatment - Ans cardiovert, and give adenosine or vagal maneuver if stable elective cardioversion (stable) - Ans asymptomatic SVT, VTach: systolic >90, awake, no complaints emergent cardioversion (unstable) - Ans symptomatic SVT, VTach: altered LOC, systolic BP <90 defibrillation - Ans VTach (pulseless), VFib VTach & VFib (pulseless) - Ans defib (200J) defib (300J) defib (360J) epi (1mg q3-5 minutes) amniodarone (300mg) then (150mg) lidocaine Torsades de pointes ("twisting about the point") - Ans is a type of VT that is caused by a prolonged QT interval. Unlike VT, where the QRS complex waveforms have similar shapes, torsades de pointes are characterized by the presence of both positive and negative complexes that move above and below the isoelectric line. Torsades de pointes treatment - Ans This lethal dysrhythmia is treated as pulseless VTach (defib and CPR). magnesium levels are monitored and corrected with MgSO4 (Mg sulfate) Torsades de pointes causes - Ans Magnesium deficiency is often a cause of this dysrhythmia. Premature ventricular contractions (PVC) - Ans Premature ventricular contractions (PVCs) are a common ventricular dysrhythmia. PVCs are early beats that interrupt the underlying rhythm; they can arise from a single ectopic focus or from multiple foci within the ventricles. Premature ventricular contractions (PVC) causes - Ans Causes: Hypoxemia, ischemic heart disease, hypokalemia, hypomagnesemia, acid-base imbalances Premature ventricular contractions (PVC) treatment - Ans may occur in healthy individuals and usually do not require treatment. The nurse must determine if PVCs are increasing in number by evaluating the trend. If PVCs are increasing, the nurse should evaluate for potential causes such as electrolyte imbalances, myocardial ischemia or injury, and hypoxemia. *Runs of nonsustained ventricular tachycardia (3 in a row)=ventricular tachycardia. types of precautions - Ans standard, contact, droplet, airborne standard precautions - Ans hand hygiene, wear glove when dealing with body fluids, sharps in sharp-container, biohazard bags for body fluid discard, no artificial nails due to risk for infection contact precautions - Ans private room, gloves and gown ex. VRE, MRSA, C. Diff, herpes simplex, scabies droplet precautions - Ans private room, surgical mask or respirator required ex. chemo pts., diphtheria, rubella, streptococcal pharyngitis, pneumonia/scarlet fever in infants, pertussis, mumps, pneumonic plague, mycoplasma or meningococcal pneumonia airborne precautions - Ans private room, negative pressure, N95 mask/respiratory protection device ex. pulmonary or laryngeal TB, measles, chickenpox (varicella) *pt should wear mask out of the room if transferring/transporting types of insulin - Ans rapid-acting, short-acting, intermediate-acting and long-acting, combination therapy (premixed) rapid-acting insulin - Ans lispro (Humalog), aspart (NovoLog), glulisine (Apidra) *onset 10-30 min *peak 30min-1hr duration 3-5hr short-acting insulin - Ans regular (Humulin R or Novolin R) *onset 30min-1hr *peak 2-5 hr *duration 5-8hr intermediate-acting insulin - Ans NPH (Humulin N or Novolin N) *onset 1.5-4hr *peak 4-12hr *duration 12-18hr long-acting insulin - Ans glargine (Lantus), detemir (Levemir) *onset 0.8-4hr *no pronounced peak *duration 24+hrs forecasting - Ans involves trying to estimate how a condition will be in the future; this mode of planning takes advantage of input from others, gives sequence in activity, and protects an organization against undesirable changes reactive planning mode - Ans occurs after a problem exists. efforts are directed at returning the organization from a state of crisis to a previous, more comfortable state, so problems are dealt with separately w/o integration with the whole organization; can lead to hasty decisions and mistakes. preactive planning mode - Ans future- oriented and utilizes technology to accelerate change. unsatisfied with the past or present, they do not value experience and believe that the future is always preferable to the present. proactive/interactive planning mode - And past, present and future planning (anticipates change); they try to plan the future of their organization rather than react to it. is dynamic and adaptation is considered a key requirement since the environment changes so frequently. In anticipation of changing needs or to promote growth within the org, it is required of all leader-managers that personal as well as organizational needs and objectives are met. inactivism planning mode - Ans seeking the status quo by spending their time and energy preventing change and maintaining conformity; when changes do occur they happen slowly and incrementally. strategic planning - And examines an organization's purpose, mission, philosophy, and goals in the context of its external environment. Strategic goals and objectives are identified, stakeholders are identified and strategies to achieve the goals will be developed. strategic plans - Ans Strategic plans are based on and goals are aligned with the mission of the organization. Usually long term (3-10 years) and are considered historical patterns long range planning - And any planning that is at least 6 months in the future may be considered SWOT analysis - Ans S-Strengths: are those internal attributes that help an organization to achieve its objectives W- Weaknesses: are those internal attributes that challenge an organization in achieving its objectives O-Opportunities: are external conditions that promote achievement of organizational objectives T- Threats: are external conditions that challenge or threaten the achievement of organizational objectives steps in SWOT or TOWS analysis - Ans 1. define the desired end state or objective/goal (be simple/short, specific and subjective) 2. After desired objectives are defined, SWOT's are discovered and listed 3. decision makers must then decide if the objective can be achieved in view of the SWOT's 4. If the decision is no, a different objective is selected and the process repeats. This process allows strategic planners to identify those issues most likely to impact a particular organization or situation in the future and then to develop an appropriate plan for action. Balanced scorecard - Ans 1. Develop metrics (performance measurement indicators) 2. Collect data 3. Analyze that data from four organizational perspectives: Financial, Customers, internal Business processes (or simple processes) and Learning & growth *allow organizations to align their strategic activities with the strategic plan. Who developed the balanced scorecard? - And Robert Kaplan in 1990 strategic planning as a management process - And although SWOT and balanced scorecards are different, they can help organizations assess what they do well and what they need to do to continue to be effective and financially sound Organizational planning - Ans or the planning hierarchy pyramid. plans at the top are more general and influence all of the plans that follow (that are less specific). The planning hierarchy pyramid components - Ans mission, philosophy, goals, objectives, policies, procedures, rules mission/vision statement - And usually a brief statement (no more than 4 sentences) that identifies the reason the organization exists; used to describe future goals or aims of the org philosophy - And a set of values or beliefs that guide all actions of the organization; flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of the org; basic foundation that directs all further planning toward that mission goals - And the desired result toward which effort is directed; it is the aim of the philosophy objectives - And motivate people to a specific end are explicit, measurable, observable or retrievable and obtainable; how and when the goal will specifically be achieved (includes time frame and is measurable) policies - And plans reduced to statements or instructions that direct organizations in their decision making; they are intended to direct individual behavior toward the org's mission and define broad limits and desired outcomes; identifies issues, scope of org activities, list of evidence and review dates (ex. Why do I need to do this?) procedures - And plans that establish customary or acceptable ways to accomplish a specific task and delineate a step-by-step process of required action (ex. How do I do this?) rules - And plans that specifically define acceptable choices of action or non-action; generally included in the policy and procedure statements so to only allow one choice of action Planned change - And in contrast to accidental change or by-drift, results from a well thought-out/deliberate application of knowledge and skills by a leader to bring about a change; organizational restructuring, quality improvement and employee retention change agent - Ans a person skilled in the theory and implementation of planned change internal change agent - And often influenced by a personal bias regarding how the organization functions external change agent - Ans tends to be more objective in their assessments Who developed the Change theory? - And Kurt Lewin in 1951 Change theory - And three phases through which the change agent must proceed before a planned changes becomes part of the system; unfreezing, movement and refreezing unfreezing - Ans occurs when the change agent convinces members of the group to change or when guilt, anxiety or concern can be elicited, thus people become discontent and aware of the need for change; for effective change to occur the change agents need to have made a through/accurate assessment of the extent of interest in change and the nature and depth of motivation, and the environment in which the change will occur movement - And the change agent identifies, plans and implements appropriate strategies, ensuring that driving forces exceed restraining forces; recognizing, addressing and overcoming resistance may be a lengthy process that requires a great deal of planning and intricate timing, and whenever possible change should be implemented gradually. refreezing - And the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. If refreezing is incomplete, the change will be ineffective and the pre-change behaviors will be resumed, so for it to be effected the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change; change needs 3-6 months before it will be accepted as part of the system Lewin's driving forces - Ans (facilitators) advance a system toward change; ex. a desire to please one's boss, to eliminate a problem that is undermining productivity, to get a pay raise, or to receive recognition Lewin's restraining forces - Ans (barriers) impede change; ex. conformity to norms, an unwillingness to take risks, and a fear of the unknown creating an equilibrium for change - And driving forces must be increased and restraining forces decreased to alter the present state of equilibrium, b/c there will be no change until that occurs; this is a task of the change agent Burrowes & Needs (2009) Stages of Change Model (SCM) - Ans -contemplation (no current intention to change), 2. contemplation (individual considers making a change), 3. preparation (there is intent to make a change in the near future), 4. action (individual modifies his or her behavior), 5. maintenance (change is maintained and relapse is avoided) Bennis, Benne & Chinn (1969) Classic change strategies - Ans 1. rational-empirical, 2. normative-reeducative, 3. power-coercive rational-empirical - And the change agent uses this set of strategies assumes that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change normative-reeducative - And use group norms and peer pressure to socialize and influence people so that change will occur; the change agent assumes that humans are social creatures, more easily influenced by others than by facts power-coercive - Ans 1. application of power by legitimate authority, economic sanctions, or political clout of the change agent; ex. include influencing the enactment of new laws and using group power for STRIKES or sit-ins 2. using authority inherent in an individual position to effect change; these strategies assume that people are often set in their ways and will change only when rewarded for the change or when they are forced by some other method example of change strategies altogether - And the change agent might present the person with the latest research on cancer and smoking (rational-empirical) and might also have friends and family encourage the person socially (normative-re educative); the change agent might also refuse to ride in the smoker's car if the person smokes while driving (power- coercive) resistance - Ans is a natural and expected response to change. Individuals affected by the change should be involved in the planning; the greatest factor contributing to the resistance encountered with change is lack of trust between the employee and manager or the employee and the organization. time management - And making optimal use of available time (3) basic steps for time management - Ans 1. requires that time be set aside for planning and establishing priorities. 2. entails completing the highest priority task whenever possible, and finish one task before beginning another 3. the person must re-prioritize what tasks will be accomplished based on new information received time wasters - Ans 1. technology (internet, gaming, e-mail and social media sites) 2. socializing 3. paperwork overload (should be handled that day it arrives by throwing it away, or filing by the date to be completed accordingly) 4. a poor filing system 5. interruptions time savers - Ans 1. taking time to plan care and taking priorities into consideration 2. Delegating activities to other staff when client care workload is beyond what can be handled by one nurse enlisting the aid of other staff 3. when a team approach is more efficient than an individual approach 4. Completing more difficult or strenuous tasks when energy level is high 5. avoiding interruptions and graciously but assertively saying "no" to unreasonable or poorly timed requests for help 6. Documenting nursing interventions as soon as possible after completion to facilitate accurate and thorough documentation 7. grouping activities that are to be performed on the same client or are in close physical proximity to prevent unnecessary walking 8. break large tasks into smaller to make more manageable fiscal planning - Ans Requires vision, creativity, and a thorough knowledge of the political, social, and economic forces that shape health care; Acquired skill that improves with use/practice; not intuitive budget methods - An incremental(flat-percentage increase budgeting), zero-based, flexible, new performance incremental budgeting - And multiplying current-year expenses by a certain figure, usually inflation rate or consumer price index, the budget for the coming year may be projected; simple & quick zero-based budgeting - And re-justify their program or needs every budget cycle; the use of a decision package to set funding priorities is a key feature. components of decision package: 1. list all current and proposed objectives/activities in the department 2. alternative plans for carrying out these activities 3. costs for each alternative 4. ADV and DADV of continuing or discontinuing activities flexible budgeting - And flex up and down over the year depending on volume performance budgeting - Ans emphasizes outcomes and results instead of activities or outputs; budget as needed to achieve specific & evaluate budgetary success accordingly critical pathways - Ans (clinical or care pathway) a strategy for assessing, implementing, and evaluating the cost-effectiveness of pt. care advantages of critical pathways - Ans Provides means of standardizing care predictions for patients with similar diagnoses or procedure disadvantages of critical pathways - And difficulties they pose in accounting for and accepting what are often justifiable differentiation between unique patients who have deviated from their pathway -intensive documentation. budgetary process - Ans • Assess- what needs to be covered in the budget • Diagnosis-goal/ what need to be accomplished to create a cost-effect budget to maximize available resources • Plan- a budgeting cycle (12 months)= fiscal year budget, or a perpetual budget on a continual basis so 12 months of future budget data are always available • Implementation-ongoing monitoring and analysis occur to avoid inadequate or access funds • Evaluation- must be reviewed periodically and modified as needed **selecting an optimal time frame is important b/c errors are likely if the budget is projected too far in advance budgets - And personnel-workforce, operating, and capital budgets personnel-workforce budget - Ans largest budget; often accounts for the majority of health-care organization's expenses b/c health care is labor intensive; monitor closely to prevent under and over staffing actual worked time (productive time or salary expense) and time that the organization pays the employee for not working (nonproductive or benefit time) ex. if the employee gets one 30 minute lunch and two 15 minute breaks in a 12.5hr shift, the employee had 11.5hrs of productive time and 1.0hrs of nonproductive time -salary, benefits, overtime operating budgets - And involves all managers; reflects expenses that flex up and down in a predetermined manner to reflect variation in volume of service provided; changes w/ volume ex. cost of electricity (utilities), repairs and maintenance, and medical and non-medical supplies capital budgets - And plan for the purchase of buildings or major equipment (ex. CT scanners), including equipment that has a long life (>5-7 years), and is usually over $1000, is not used in daily operations, or is more expensive than operating supplies. composed of long term planning, and short-term budgeting. ex. long term major acquisitions= acquisition of a positron emission tomography imager or renovation of a major wing of the hospital short term component= equipment purchases within the annual budget cycle, such as call-light systems, hospital beds and medication carts How do you calculate nursing care hours per patient-day? - Ans NCH/PPD= (nursing hours in 24 hours; including clerk hrs.) divided by (patient census) how do you determine the NCH - Ans can be calculated by multiplying the total # of staff on duty each shift by the hours each worked in their shift. Each shift total is then added together to get the total number of nursing hours worked in all shifts. ex. between all 3 shifts (11-7, 7-3 & 3-11 on 01/31), and employees (17) the NCH = 136 hrs. 8hrs each x 17 employees = 136hrs What is the next step in solving NCH/PPD? - And you divide the nursing hours by the pt. census ex. if the pt. census is 25, then 136/25= 5.44 expenses - Ans fixed, variable, controllable and non-controllable fixed expenses - Ans do not vary with volume; ex. a building's mortgage payment, or a manager's salary variable expenses - Ans vary with volume ex. payroll of hourly-wage employees and the cost of supplies controllable expenses - Ans CAN be varied by the manager ex. unit manager can control the # of personnel working on a certain shift and the staffing mix non-controllable expenses - Ans CANNOT be varied by the manager ex. *equipment depreciation, the number/type of supplies needed by patients, or overtime that occurs in response to an emergency Payment systems (p. 211) - And bundled payment, Diagnosis-related groups (DRGs), fee-for-service system (FFE), prospective payment system (PPS)/capitation, third party payment system, pay for performance, pay for value programs, value-based purchasing Max Weber bureaucracy - And it was an institutional methods for applying general rules to specific cases, thereby making the actions of management fair and predictable; There must be a clear division of labor, well-defined hierarchy of authority in which supervisors are separate from subordinates, impersonality of interpersonal relationships= bureaucrats are not free to act in any way they please, there must be a system of procedures for dealing w/ work situations, a system of rts. covering the rights and duties of each position, and selection for employment and promotion is based on technical competence components of organizational structure in the Health care system - Ans relationships and chain of command, span of control, managerial levels, centrality relationships and chain of command - Ans formal relationships, lines of communication, and authority are unbroken solid lines on the organizational chart line-staff relationships - Ans only line positions have authority for decisions. clinical specialists and in-service directors in staff positions often lack the authority that accompanies a line relationship. unity of command - Ans is indicated by the vertical solid line between positions on the chart. best described as each employee/boss have one manager to whom they report and to whom they are responsible [optimum] span of control - Ans the # of people directly reporting to any one manager; determines the # of interactions expected of him/her. there is a inverse relationship between span of control and # of levels in hierarchy in an organization centrality - Ans where a position falls on the organizational chart, where frequent and various types of communication occur and is determined by organizational distance analyze how position on the organization chart is r/t centrality - Ans ex. a middle manager has a large degree of centrality bc this manager receives info upward, downward and horizontally dotted or broken lines - Ans represent staff positions b/c their positions are advisory, a staff member provides information and assistance to the manager but has limited organizational authority solid horizontal or vertical lines - Ans line positions solid vertical lines between positions - Ans represents the official chain of command (the formal paths of communication and authority) solid horizontal lines - Ans represent communication between people with similar spheres of responsibility and power but different functions what does the level of position on the chart signify? - Ans status and power what does the lines located at the bottom of the chart mean? - Ans least decision making authority what does the lines located at the top of the chart mean? - Ans people having the greatest decision-making authority scalar chains on the organization chart - Ans decision-making hierarchy or pyramid Fayol's informal structure - Ans focus is on camaraderie of employees, their relationships and informal power that is inherent within those relationships; **this structure includes employee interpersonal relationships, the formation of primary and secondary groups and the identification of group leaders w/out formal authority; unplanned and often hidden b/c have own communication network= grapevine (convos in hall, breakroom, during carpool and in between work) Fayol's formal structure - Ans organization charts only show formal relationships; emphasis is on organizational positions & formal power that provides a framework for defining managerial authority, responsibility and accountability; highly planned and visible Managerial levels - Ans first, middle and top level first level management - Ans concerned with specific units workflow, daily operation's, organizational needs and personal needs of employees ex. primary care nurses, team leaders, case managers, and charge nurses and every RN is considered a first-level manager (some organizations) middle level management - Ans carry out day-to day operations but are still involved in some long-term planning and in establishing unit policies. ex. nursing supervisors, nurse-managers, head nurses, and unit managers leader-managers at the first and middle level of management - Ans generally have the greatest influence on the organizing phase of the management process at the unit or department level; It is here that leader- managers organize how work is to be done, shape the organizational climate, and determine how patient care delivery is organized. top level management - Ans look at the organization as a whole, coordinating internal & external influences, & make decisions w/few guidelines or structures; are most likely to influence the philosophy and resources necessary for any selected care delivery system to be effective, since without a supporting philosophy and adequate resources, the most well-intentioned delivery system will fail. ex. organization's chief operating officer (CEO) and highest level nursing administrator of nursing or pt. care services, director of nursing or chief nurse officer (CNO) centralized decision making - Ans a few managers at the top of the hierarchy make the decisions and the emphasis is on top-down control; the vision or thinking of one or few individuals guides the organization's goals and how those goals are accomplished decentralized decision making - Ans diffuses decision-making throughout the organization and allows problems to be solved by the lowest practical managerial level; so problems can often be solved where they occur participatory decision making - Ans lays the foundation for shared governance; implies that others are allowed to participate in decision-making over which someone has control shared governance - Ans collaborative decision-making; empowers decision-makers and is directed at increasing nurses authority and control over their nursing practice by being an accountability-based governance system for professional workers. shared among board members, nurses, physicians and management components of shared governance model - Ans to integrate core values and beliefs that professional practice embraces, as a means of achieving quality care. emphasize empowerment of staff nurses and aim to improve nurses' work environment, satisfaction, and retention. magnet status - Ans a credential of organizational recognition of nursing excellence; awarded for 4 years, then must reapply. to achieve designation as a system, the system must not only retain the 14 forces of magnetism required for individual organizations, they must also demonstrate empirical modeling of the 5 key components: transformational leadership, structural empowerment, exemplary professional practice, new knowledge innovation and improvements, and empirical quality results 14 forces of magnetism - Ans 1. quality of nursing leadership, 2. organizational structure, 3. management style, 4. personal policies and programs, 5. professional models of care, 6. quality of care, 7. quality improvement, 8. consultation and resources, 9. autonomy. 10. community and the hospital, 11. nurses as teachers, 12. image of nursing, 13. interdisciplinary relationships, 14. professional development driving force to achieve magnet status - Ans the clear link between designation and improved outcomes legitimate power - Ans is position power. It is the power gained by a title or official position within an organization and has the ability to create feelings of obligation or responsibility; authority. reward power - Ans obtained by the ability to grant favors or reward others coercive power - Ans is based on fear of punishment if the manager's expectations are not met., e.g. delay a transfer. Punishment can be implied. expert power - Ans is gained through knowledge, expertise, skills or experience. Having critical knowledge allows a manager to gain power over others who need that knowledge, e.g. CNS has expert power referent power - Ans is power that a person has because others identify with that leader or with what that leader symbolizes. People who others accept as role models or leaders enjoy referent power e.g. physicians charismatic power - Ans a more personal type of power; personality informational power - Ans People have the need for information that others have in order to accomplish their goals. political power - Ans "The most important strategy is to learn to "read the environment" (e.g., understand relationships within the organization) through observation, listening, reading, detachment, and analysis." strategies to help the novice manager to negate the negative effects of organizational politics: - Ans 1. Become an expert handler of information and communication, 2. Be a proactive decision maker, 3. Expand personal resources, 4. Develop political alliances and coalitions, 5. Be sensitive to timing, 6. Promote subordinate identification, 7. View personal and unit goals in terms of the organization, 8. Leave your ego at home authority-power gap - Ans the right to command does not ensure that employees will follow orders. 1. The more power the subordinates perceive a manager to have, the smaller the gap between the right to expect certain things and the resulting fulfillment of those expectations by others. 2. Negative effect of a wide authority-power gap is that organizational chaos may develop Health Care Delivery Systems - Ans For-profit, Not-for- profit, managed care models For-profit organization - Ans org in which the providers of funds have ownership interest in the organization. these providers own stocks in the for-profit org and earn dividends based on what is left when the cost of goods and of carrying on the business is subtracted from the amount of money taken in Not-for-profit organization - Ans is financed by funds that come from several sources, but the providers of these funds do not have an ownership interest. Profits generated in the not-for-profit org are frequently funneled back into the organization for expansion or capital acquisition managed care models - Ans term used to describe a variety of health-care plans designed to contain the cost of health-care services delivered to members while maintaining the quality of care; HMO, POS, PPO, Medicare/Medicaid key principles of managed care - Ans the use of primary care providers as gatekeepers, a focus on prevention, a decreased emphasis on inpatient hospital care, the use of clinical practice guidelines for providers, selective contracting, capitation, utilization review, the use of formularies to manage pharmacy care, and continuous quality monitoring and improvement; driving forces for reserving the primary nurse role for RNs - Ans facilitators; advance a system toward change; total direct care to the pt. from admission to discharge and if not on duty associate nurses must follow the care plan established by the primary nurse to provide care restraining forces for reserving the primary nurse role for RNs - Ans barriers; impede change; an inadequately prepared or incompetent primary nurse (RN), may be incapable of coordinating a multidisciplinary team or identifying complex pt needs and condition changes population-based health-care management - Ans helps patients assess community resources, learn about their medication regimen, and treatment plan, and ensures that they have recommended tests and procedures for client with the same chronic illness desired outcomes for disease management programs - Ans p. 323 role of the case manager in achieving outcomes - Ans RN in the role of case managers will continue to experience new and expanded roles as key players in the development, coordination and evaluation of DM programs what effect does staff mix have on work design and pt. care organization? - Ans ratio of RN, LPN/LVN, and unlicensed workers (UAP). hospitals vary on their staffing mix polices traditional patient care delivery models (types of organizing pt. care) - Ans total pt. care, functional method, team nursing, modular nursing, primary nursing, case management total pt. care - Ans function: oldest method of pt. care total pt care ADV - Ans High autonomy and responsibility. Assigning patients is simple and direct and does not require the planning that other methods of patient care delivery require. Lines of responsibility and accountability are clear. Holistic and unfragmented care during the nurse's total pt. care DADV - Ans Required highly skilled personnel and thus may cost more than some other forms of patient-care. If nurses are inexperienced or there is poor supervision, it can result in unsafe care. functional method - Ans Function: task oriented functional nursing ADV - Ans Efficient. Tasks are completed quickly, with little confusion regarding responsibilities. Minimal amount of RNs needed. Can be used in a crisis. functional nursing DADV - Ans Not holistic, care is fragmented. Patient priority may be overlooked. Workers may feel unchallenged and understimulated. Job satisfaction may be low. modular nursing - Ans function: Uses a mini-team (two or three members with at least one member being an RN). Patient care units are typically divided into modules or districts and assignments are based on the geographical location of patients. modular nursing ADV - Ans A small team requires less communication, allowing members better use of their time for direct patient care activities. team nursing - Ans function:Most common in US Team of personnel provides care to a group of clients. The team leader's duties vary depending on the patient's needs and the workload. These duties may include assisting team members, giving direct personal care to patients, teaching, and coordinating patient activities. team nursing ADV - Ans Allows use of non-RN staff, under the direction of the RN. Allows members to contribute their own special expertise or skills. team nursing DADV - Ans Time management, role confusion and poor communication by the team leader. primary nursing - Ans function: Knowledge practice model - Relationship based nursing. Primary Nurse plans and designs care, set goals and evaluates client over 24 hours of care. Provides care when on duty, Associate nurse follows care established by primary nurse when primary nurse is off duty. primary nursing ADV - Ans Works well in Home health and hospice nursing environment. Holistic, quality patient care, high job satisfaction, calls for strong autonomy and responsibility. primary nursing DADV - Ans Requires excellent communication. Continuity of care and accountability may be challenged. case management - Ans function: Nurses address each patient individually, identifying the most cost-effective healthcare costs/providers, treatments, and care settings possible. Assist in helping patient's access community resources, learn about their medication regimen and treatment plan, and ensures that they have recommended tests and procedures. *Clinical outcomes should occur within a prescribed time frame *critical pathways were created as a result of case management system case management ADV - Ans Emphasis on managing interdisciplinary outcomes. case management DADV - Ans Role expectations and scope of knowledge required to be a case manager are extensive. Role ambiguity and role conflict. quality control - Ans activities that are used to evaluate, monitor, or regulate services rendered to consumers. steps to measure quality control - Ans 1. establishment of control criteria or standards 2. identifying information relevant to the criteria (what info is needed to measure the criteria?) 3. determining ways to collect information 4. auditing quality control is collecting and analyzing information 5. reevaluation standard - Ans predetermined baseline condition or level of excellence that constitutes a model to be followed or practiced. All based on evidence-based practice controlling - Ans last stage of the management process; implemented through all phases of management. Ex.: periodic evaluation of unit philosophy, mission, and goals; measurement of individual or group performance against pre-established objectives criteria or standards for measuring quality - Ans how it is defined and measured differs between providers and patients. quality does not exist unless desired health outcomes are attained; care must be consistent w/current professional knowledge and is a collection of both qualitative and quantitative data as well as a specific and systematic process outcome - Ans end results of care outcome audits - Ans determine what results, if any, occurred as a result of specific nursing interventions for the pts; they assume that the outcome accurately demonstrates the quality of care that was provided process audits - Ans measure the process of care or how the care was carried out and assume that a relationship exists between the process used and the quality of care provided; task oriented and focus on whether practice standards are being fulfilled structure audits - Ans assumes that a relationship exists between quality of care and appropriate structure such as resource inputs like environment in which the health care is delivered concurrent audits - Ans are performed while the patient is receiving the service retrospective audits - Ans performed after the pt receives the service prospective audits - Ans attempt to identify how future performance will be affected by current interventions root-cause analysis - Ans helps to identify not only what and how an event happened but also why it happened and with the end goal being to ensure that a preventable negative outcome does not reoccur. (ex. Sentinel event- unexpected but major event, need to determine why it happened and how to prevent it) quality gap - Ans difference in performance between top-performing health-care organizations and the national average quality assurance - Ans seeks to ensure that quality currently exists quality improvement - Ans models assume that the process is ongoing and that quality can always be improved upon. benchmarking - Ans the process of measuring products, practices and services against best-performing organizations- as a tool for identifying desired standards of organizational performance role of Joint Commission (JC)- p. 557 - Ans an independent, not-for profit org that accredits more than 20,000 health-care organizations and programs. first to mandate all hospitals have a QA program for quality control in acute-care hospitals. maintains nation's most comprehensive databases for sentinel events and core measures program in ORYX in order to standardize its valid, reliable and EB data sets. role of Centers for Medicare and Medicaid services (CMs)- p. 559 - Ans plays active role in setting standards for and measuring quality in health care. created the hospital quality initiative (HQI)- easy-to understand data on healthcare quality from nursing homes, home health agencies hospitals and dialysis facilities to all consumers. the intent was to encourage consumers and their physicians to discuss and maker better-informed decisions on how to get the best hospital care, how to improved care and support public accountability also created the payment for performance/quality-based purchasing (P4P) role of American Nurses Association (ANA)-p. 79 - Ans adopted the first professional code of ethics function as a guide to the highest standards of ethical practice for nurses; it is not legally binding. also created the scope and standards of practice for nursing administration practice role of National Committee for Quality Assurance (NCQA)- p.561 - Ans private nonprofit org that accredits managed care organizations. created health plan employer data and info set (HEDIS) to compare quality of care in managed care organizations. however NCQA accreditation is voluntary so only have of the orgs participate organizational structures - Ans bureaucratic/line structures, Ad hoc, matrix, service-line, flat organizational culture - Ans an organization's values, language, traditions, customs and sacred cows (few things not open to change); it is a system of symbols and interactions unique to each organization and it is the way of thinking, behaving and believing that members of a unit have in common ex. hospital logo that was designed by original board trustees is an item not considered for updating or change organizational climate - Ans how employee's perceive the organization ex. fair, friendly, and informal or as formal and very structured bureaucratic - Ans It is commonly referred to as a line organization B) It is typically found in large health-care organizations C) They resemble Weber's original design of organization D) Its authority is represented by its staff organizational chart; authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships Ad hoc - Ans use a project team or task approach and are usually disbanded after a project is completed. a decrease in formal chain of command and decreased employee loyalty to parent organization is a disadvantage matrix - Ans designed to focus on both product and function; has a formal vertical and horizontal chain of command function - Ans all tasks required to produce the product ex. staff education and adequate staffing may be functions necessary to produce the outcome product - Ans the end result of the function ex. good pt outcomes service-line organizations - Ans or care centered organizations, overall goal is determined by the large organization, but the process used to achieve the goals is determined internally flat designs - Ans an effort to remove hierarchical layers by flattening the chain of command and decentralizing the organization; there continues to be a line authority but b/c the org structure is flattened more authority and decision-making can occur where the work is being carried out. decision making styles - Ans decisive, flexible, hierarchical, integrative Decisive decision making - Ans The team uses a minimum amount of data and generates one option. flexible decision making - Ans The team uses a limited amount of data and generates several options. hierarchical decision making - Ans The team uses a large amount of data and generates one option integrative decision making - Ans The team uses a large amount of data and generates several options.