N9 Final Review from previous class

Final test review N9

Chapter 17
1.) What is the difference between teams and groups? Look at the concepts.(342,349)
Groups: Are a number of individuals assembled together or having some unifying relationship.
Teams: A number of persons associated together in specific work or activity.
*Not every group is a team, and not every team is effective.
*Teams are groups that have defined objectives, ongoing positive relationships and a supportive environment and that are focused on accomplishing a specific task.
* Key concepts of teams. 1. Conflict resolution, 2. Singleness of mission, 3. Willingness to cooperate, and 4. Commitment.
1. Conflict resolution; Identify the triggering event, discover the historical context for each person; assess how interdependent they are on each other; identify the issues, goals, and resources involved in the situations, and uncover any previously considered solutions.
Must be able to trust that they will receive what they need while being able to count on one another to complete tasks related to team functioning and outcome.
Team needs to work together to resolve conflicts among themselves and to do so in ways that enhance rather than inhibit their working together.
To communicate effectively, people must be willing to confront issues and to express openly their ideas and feelings- to use interactive skills to accomplish tasks.
2. Singleness of mission; A team must have a purpose, a plan, aim.
The most successful team have a mission some special work or service to which the team is 100% committed.
3. Willingness to cooperate; Effective team members are required to work together in a respectful, civil manner. (350)
4. Commitment; A state of being emotionally impelled and is demonstrated when there is a sense of passion and dedication to a project or event – a mission.
Commitment drives the success of the mission. (350)

2.) Communication patterns – understand about open communication and clear communication.(347 / table 17-3).
Attribution of blame; Sender blames receiver.
Placation; Sender placates receiver (Example; Sender demonstrates low self worth, puts himself / herself down). Constrained cool headedness; Sender is correct and very reasonable without felling or emotion. (Example; Fellings of vulnerability covered by cool analytical thinking).
Irrelevant; Sender is avoiding the issue, ignoring own feelings and feelings of the receiver (Example; Sender changes the subject).
Congruence; Senders words and actions are congruent, inner feelings match the message (Example; Any tension is decrease and selfworth is at a high level).




3.) What are the pitfalls of communication? (348-349, box 17-1).
Pitfalls in communication comprise action, behaviors and words that create distrust, are dishonoring, and decrease the feelings of self-worth in the receiver.
Box 17-1 Pitfalls
Giving advice, just listen.
Making others wrong, don’t gossip. Take the problem to the person.
Defensiveness. response as if attacked when there was no attack.
Judging the other person.
Patronizing, speaking to others as though they are less than human.
Giving false reassurance, Nurses are tempted to “fix” things and end up reassuring inappropriately.
Asking why questions, tend to create defensive response. Instead ask “ What makes you think…”
Blaming others, Instead say, “ I cant discuss this with you now. I would like to talk about this later when I am more calm”.

4.) What is active listening? Why is it so important? What can we do to show we are involved in a conversation?(357, box 17-6 and table 17-4).
Active listening means that you are completely focused and tuned in to the individual who is speaking. Listening without judgment. Listening to the essence of the conversation so that you can actually repeat to the speaker most of the speakers intended meaning. Being 100% present in the communication.
It is important because it helps gather information from the speaker.
To show we are more involved in the conversation we can;
Slow down your internal process and seek data. Do not interrupt the speaker.
Convey interest in what the other person is saying, example “ I see, I get it”
Encourage the individual to expand further on his/her thinking.
Help the individual to clarify the problem in his/her thinking.
Pull out key ideas from a long statement or discussion.
Respond to a persons feelings more than to his/her words.
Summarize specific points of agreement and disagreement as a basis for further discussion.
Express a consensus of group feeling.

Chapter 22
5.) What are the differences between group, interpersonal and intrapersonal conflict? (462)
Intrapersonal conflict; occurs within a person. Conflict over priorities, ethical standards, and different ways to act.
Interpersonal conflict; conflicts between and among patients, nurses, care team, etc…

6.) What is the organizational conflict? (461, 462, 607).
Conflict that occurs when a person confronts an organization’s policies and procedures for patient care and personnel and its accepted norms of behavior and communication.
As staff nurses assume more autonomy and accountability for identifying areas for quality improvement in patient care.
At the same time, managers role become blurred.

7.) What are the stages of conflict and how can you apply these concepts to a conflict in the workplace? (463, 464)
Frustration; Occurs when people or groups perceive that their goals may be blocked. This frustration comes from what people believe to be true, even though there may not be a real conflict at all. An example, a nurse may perceive that a patient is uncooperative when in reality the patient is afraid or has had a different set of priorities at the start from those of the nurse.
Conceptualization; Based on interpretation, most often interpretations are different, which is based on personal values, beliefs and culture. An example, within the same conflict situation, some individuals may see the conflict as insubordination, become angry and the threat to his/her role, and fall back upon rigid reliance on policy and procedure.
Action; Intentions, strategies, plans and behavior “flow” out of the conceptualization. As actions are taken to resolve the conflict, the way that some or all parties conceptualize the conflict may change. The important point is that people are always taking some action regarding conflict, even if the action is avoiding it or deciding to do nothing.
Outcomes; Tangible and intangible consequences, or “outcomes”, results from the actions taken. The conflict may be resolved with a new plan that incorporates the goals of two or more people to ensure that no one loses.

Chapter 23
8.) What is delegation?(483,484).
You have to have a delagator and a delagatee, and some kind of transfer of authority and responsibility to perform the work that is required. No definition suggests it is an abdication of accountability for the overall outcomes or performance or the abdication of the need to be involved. This is an important point because remaining in touch with others who are completing work on behalf of a manager is sometimes difficult. Accountability remains fixed and that same portion of work is transferred along with the authority and responsibility for that delegated work. So a definition of delegation therefore, might be as follows, achieving performance of care outcomes for which you are accountable and responsible by sharing activities with other individuals who have the appropriate authority to accomplish the work.

9.) What are the legal parameters of delegation? ( defined by boards, job descriptions, ect…) (484)
Consistency in preparation and job descriptions for UNP’s is lacking. The NCSBN has expressed concern about preparation inconsistency and suggests that programs and UNP’s both need greater public accountability. RN’s need to be aware of individual qualifications. Authority is designated by law such as nursing practice act, or it may be designated by educational preparation/certification.2 most common errors associated with poor patient outcomes related to 1 giving improper directions 2 providing improper follow-through of agency protocol. An example of improper follow-through is when the delegation encourages the individual to perform functions beyond the stated position description for the delegate.

10.)What are the advantages of delegation? (489)
Delegation has direct patient and professional benefits. One of these is availability of the professional staff to patients to teach the basics of safe activities of daily living (ADL). In an effective team, delegation can be an effective time-conservation technique.

11.)What are the disadvantages of delegation? (493,494).
If the delegator intervenes, the delegatee loses confidence or becomes frustrated, and the delegator has lost the benefits of delegating. Delegation really is a matter of trust. Safety or ethical discrepancies may arise. Delegation can become more difficult when staff levels are too low, unpleasant or when delegates are inexperienced. In settings other than those of confined geography, such as hospitals, long-term care facilities, and clinics, one of the greatest challenges of delegation relates to supervision. In such situations, it is especially important to be very clear about what is expected of the delegatee.

12.)Accountability and responsibility, what are the differences? (485)
The terms accountability and responsibility refer to the legal expectation the state has vested in persons with the designations of RN. Accountability means that someone must be able to explain actions and results. Legaly the RN is accountable for nursing care. Responsibility refers to reliability, dependability, and obligation to accomplish work. It also refers to each persons obligation to perform at an acceptable level. Thus, assistants, whether UNP’s or LVN’s are obligated to perform that which they can at acceptable quality levels. Those individuals are also responsible for informing the delegator what limitations, if any, would prevent the accomplishment of expected outcomes. The RN is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistant with the RN’s obligation to provide optimum patient care. Organizational accountability is another aspect. Making soild decisions depends on how well the organization provides adequate resources, including appropriate staffing and mix. Organizations that function in positive ways, such as Magnet organizations, typically have supportive environments that help teams function effectively. The driving principle in decision-making is patient (public) safety.









Chapter 26
13.)How do you manage time? (543.544).
Time management is the appropriate use of tolls, techniques and principles to control time spent on low-priority needs and to ensure that time is invested in activities leading toward achieving desired, high-priority goals.
Learn to have fewer projects. Be realistic and limit major commitments then give each activity your full and undivided attention.
Complete one task before starting another.
Prioritize goals and activities each day is very helpful.

14.)Stress and time… what are the symptoms of stress? (538)
1.Physical signs of ill health; increase in flu, colds, accidents. Change in sleeping habits, fatigue.
2.Chronic signs of decreased ability to manage stress; Headaches, hypertension, backaches, gastrointestinal problems.
3.Use of unhealthy coping activities; Increase use of drugs and alcohol, increased weight, smoking, crying, yelling and blaming.
Mental signs of stress;
Dread going to work every day.
Rigid thinking and a desire to go by all the rules all cases, inability to tolerate any changes.
Forgetfulness and anxiety about work to be done, more frequent errors and incidents.
Returning home exhausted and unable to participate in enjoying activites.
Confusion about duties and roles.
Decrease in concentration.
Generalized anxiety.
Depression.
Anger, irritability, impatience.
Spiritual/Emotional stress
Sense of being a failure; disappointed in work performance.
Anger and resentment toward patients, colleagues, and managers, overall irritable attitude.
Lack of positive feelings towards others.
Cynicism towards patients, blaming them for their problems.
Excessive worry, insecurity, lowered self-esteem.
Increased family and friend conflict.

15.) Personal time management and steps for time management.(547,548)
The first steps in time management are Goat Setting and developing a plan to reach the goals. Set goals that are reasonable and achievable. 2.) Set priorities: Once goals are known, priorities are set. Knowing what your goals and priorities are helps shape the “to do” list. On a nursing unit or as you work in a community setting, you must know your personal goals and current priorities. 3.) Organization: Keeping a workspace neat or arranging things in an orderly fashion may be a powerful time-management tool. A few hints include: A.) Planning ahead where things should go (frequently used items should be more accessible), B.) Not using the top of your desk (table, computer station) for storage; C.) Creating a “to do” folder; D.) Creating a “to do file” folder; and E.) Having a regularly scheduled time to work your way through the folders. 4.) Time Tools: Use a time log to list work-related activities for several days. If you do not plan the day, you may find yourself responding to events rather than prioritized goals. 5.) Managing Information: The first step in managing information is to assess the source. Once you have identified the source of your data, you have a better idea of how to deal with the information. By developing information-receiving skills, you can quickly interpret the data and convert them to useful information discarding that which is not needed. You should reduce or eliminate that which is useless. Next, monitor the information flow and decide what to do with incoming data. Find and focus on the most important pieces and then quickly narrow down the specific details you need. Identify resources that are most helpful and have them readily available. Be able to build the “big picture” from the masses of data you receive. Finally, recognize when you have enough information.
Once you have mastered the receiving end of information, concentrate on information-sending skills. Remember, your information is simply another person’s data. The most important skill is to know when you have said enough.

16.) Internal and External stressors. Know strategies for stress management. (535,537, 542).
Internal stress-personal triggers are events on situations that have an effect on specific individuals. Example is death of a loved one, auto accident, losing a job, noisy environment, negative self-talk.
External stress-occupational stress such as workload, rotating shifts, high point acuity
One effective way to deal with stress is to determine and manage its source. Step back and look at the big picture. Look at table 26.2 on page 542.

Chapter 9

17.) How do we get power?(170,171)
Power: The ability to influence others in the effort to achieve goals. When the American Medical Association (AMA) in 1980 proposes a new category of healthcare worker (registered care technologist-RCT) to replace nurses during a time of nursing shortage, nurses and nursing organizations responded powerfully. So we get power from numbers, remember the “show of force”.
Involvement in the politics or nursing, in the workplace, in the profession at large, or in the area of public policy enhances power of the individual nurse and the profession as a collective whole.

18.) How do we see power advantageously?(172)
The ability to influence others in the effort to achieve goals, demonstrates the essential nature of power in nursing. Nurses regularly influence patient’s in an effort to improve their health status as an essential element of nursing practice. In teaching patient’s and their families needed information and to change behavior to promote optimal outcomes we see power advantageously.

19.) How can we demonstrate our power in numbers to affect change? (i.e. all nurses working together). (181,182)
Although an individual can often be effective at exercising power and creating change, creating certain changes within most organizations requires collective action. Coalation building is an effective political strategy for collective action. Coalitions are groups of individuals or organizations that join together temporarily around a common goal. The goal often focuses on an effort to effect change. The networking between organizations that results in coalition-building requires members of one group to reach out to members of other groups. This often occurs at the leadership level and may come through formal mechanisms, such as letters that identify an issue or problem-a shared interest- around which a coalition could be built. For example, a state nurses’ association may invite the leaders of organizations interested in child health (ex: organizations of pediatric nurses, public health nurses and physicians, elementary school teachers, day-care providers) and consumers (ex:parents) to discuss collaborative support for a legislative initiative to improve access to immunization programs in urban and rural areas. Such conditions of professionals and consumers are powerful in influencing public policy related to health care.

20.) Know the levels of political activism when looking at power (names)?(172)
Models of political activism:
Apathy: no membership in professional organizations: Little or no interest in legislative politics as they relate to nursing and healthcare.
Buy-in: Recognition of the importance of activism within professional organizations (without active participation) and legislative politics related to critical nursing issues.
Self-interest: Involvement in professional organizations to further one’s own career: the development and use of political expertise to further the profession’s self-interests.
Political sophistication: High level of professional organization activism (ex: holding office at the local and state level) moving beyond self-interests; recognition of the need for activism on behalf of the public.
Leading the way: Serving in elected or appointed positions in professional organizations at the state and national levels; Providing true leadership on broad healthcare interests within legislative politics, including seeking appointment to policymaking bodies and election to political positions.

21.) Kinds of power with definition. (Box on 173)

22.) Different behaviors or nurse managers and their own use of power? (175,177)
1. Self-Image: Thinking of oneself as powerful and effective.
2. Grooming and Dress: Ensuring that clothing, hair, and general appearance are neat, clean, and appropriate to the situation.
3. Good manners: Treating people with courtesy and respect.
4. Body language: Maintaining good posture, using gestures that avoid too much drama, maintaining good eye contact and being confident in your movement.
5. Speech: Using a firm, confident voice, good grammar and diction; An appropriate vocabulary and strong communication skills.
Use of networking is an important power strategy and political skill. A network is a deliberate outcome of identifying, valuing and maintaining relationships with a system of individuals who are sources of information, advice and support. Nurse managers use their own power in shaping policy.

23.) Why should we participate in community, etc. (to become politically empowered)?(186,180)

By exercising power in the workplace and other professional activities, you empower patients, families, and colleagues to accomplish their goals. Shaping policy is an extension of nursing practice, part of the nurse’s advocacy role. You want to be active to ensure that the voice of nursing is heard in the workplace and the legislature.

Chapter 27

24.) Have a plan for career goals and certifications. Why do we need them? (571,572,574)
In addition to increasing your knowledge base, continuing education provides professional networking opportunities, contributes to meeting certification and licensure requirements, and documents additional pursuits in maintaining or developing clinical expertise. Both types of formal professional development, graduate education and continuing education, are valuable to your professional development, and both can contribute to a specific area of career development-certification.
Certification: is an expectation in some employment settings for career advancement, in the field of advanced practice nursing, it is viewed as a requirement for practice and reimbursement. In many states, certification in advanced practice is the mechanism to achieve recognition as an advanced practice nurse from the board of nursing. Certification plays an important part in the advancement of a career and the profession. Knowing what is important to do to meet your professional goals can help you decide what level of involvement is desirable and acceptable.

25.)
Career styles-know them. (Box 27-1 on page 558)

26.) Resume and Cirriculum Vitae-know the difference and what goes into each and their purpose. (563)
A resume is a customized document developed to highlight your accomplishments and tailored to describe the way in which you can fulfill a role or meet the needs of a specific organization. Unlike the CV, the resume is detailed. A resume sells the individual for the specific position being sought and illustrates the fit of an individual for a specific position. For the steady-state nurse, a resume could be used to reflect increasing skills and abilities; for others, a resume can create specific messages about an individuals unique experiences, education and abilities in relation to a new opportunity.
Cirriculum Vitae: A CV is a listing of professional life activities. It is designed to be all-inclusive but not detailed. This document lists all your professional accomplishments without elaboration on the details of your career. It is an effective tool for listing all the facts of your professional life.

27.) What is a personal data file? What does it mean? (561,562)
It is a data bank that serves as your professional career memory. You need to list in chronological order your education, continuing education, your experience, community/institutional service, publications, Honors, research, speeches/presentations given, workshops/conferences presented and certifications. It is for your own personal use.

Chapter 28

28.) What is the purpose of professional association? Who do they serve? What are the disadvantages of joining? (578,583)
Professional association (organizations) have been defined as groups of people who share a set of professional values and who decide to join their colleagues to affect change. It serves its members and its patients. Some members enter into the organizational experience with unreal expectations and quickly become disenchanted and disappointed with the organization, which results in completely pulling away from the organization. To maximize your experience, your owe it to yourself to do your homework, research the organization, talk to the members, determine the sense of the group dynamics, and assess what you want to derive from the experience and how you can contribute to the organization. Look at your strengths and talents and see if there is a need or a fit within the organization. Finally, remember that the organization is composed of humans who are volunteering their time; therefore, you should not expect a “perfect” organization. Every organization has its struggles, but you can gain tremendous benefits, both personally and professionally, from your involvement.

29.) Shared governance, understand the concept. (146,377)
Shared governance is characterized by the following:
The creational of organizational structures that allow nursing staff more autonomy to govern their practice.
Recruitment and retention of nursing staff while meeting patient needs in an effective and efficient manner.

Shared governance is described as a democratic, egalitarian concept. It is a dynamic process resulting from shared decision-making and accountability. Shared governance demands participation in decision-making rather than provides for participation.