leadership: group process, care coordination/case management, referrals

describe therapeutic relationships

• client focused (well-being, growth, thoughts, feelings)

• time-limited

describe social relationships

• mutually focused (reciprocal satisfaction, equal self disclosure)

• unknown duration

describe the nurse-patient relationship

• therapeutic relationship

• nurse’s responsibility

name give examples of blurred boundaries

1. gifts

2. sexual issues

3. being friends

4. self disclosure

5. touch

what is motivational interviewing?

a counseling method to resolve ambivalent emotions/insecurities to find internal motivation to change behavior

how do you maintain a therapeutic milieu?

• create limits and boundaries

• avoid medical jargon

• help pt problem solve

why are group interventions a thing?

• we are social creatures

• dec isolation

• shared experiences

• learn from others

• practice new behaviors

• efficient use of staff time

• cost effective

what are the therapeutic factors of groups?

• universality

• instills hope

• socializing techniques

• interpersonal learning

• catharsis

• altruism

• imitate behaviors

• imparting informaiton

• group cohesiveness

• existential resolution

describe the characteristics of an autocratic leadership

• leader

• limited member participation

• high productivity

• low moral

describe the characteristics of an autocratic leadership

• has members

• unlimited participation

• high productivity

• high morale

describe the characteristics of an laissez-faire leadership

• undetermined

• inconsistent members

• low productivity

• low morale

describe the characteristics of an heterogeneous groups

large range of difference amongst members

describe the characteristics of an homogenous groups

members share central traits

describe the characteristics of an closed groups

restricted membership

describe the characteristics of an open groups

new members are added as others leave

describe the characteristics of a subgroup groups

they are isolated within a larger group for specific needs

what are the phases of group work?

1. planning

2. orientation

3. working

4. termination

5. evaluation and follow up

describe the task role within a group

• keeps group focused

• gets work done

describe the maintenance role within a group

keeps the group working together

describe the individual role within a group

specific personalities and agendas

what are the five theoretical frameworks for groups?

• humanism (self actualization, subjective experience)

• cognitive-behavioral (focus on maladaptive behaviors)

• psychodynamic (resolve intrapsychic conflict)

• educational (practical support)

• systems (social interaction)

what are the qualities of virtual groups?

• must comply to HIPPA

• helpful for online CBT groups

• potential negative effect on therapeutic relationship

• loss of control for clinicians

what are seven ethical issues for group therapy?

1. informed consent

2. confidentiality and expectations to it

3. rules for leaving, socializing outside of group

4. member removal

5. appropriate training/credentials

6. ANA’s scope of practice

7. EBP

what are four challenging member behaviors?

1. monopolizing member

2. complaining member who rejects help

3. demoralizing member

4. silent member

what is the group process?

• forming a common bond

• storming (controlling chaos)

• norming - create mutual goals

• performing - working together

• adjourning - disengage from tasks and group members

describe self servers

• rules do not apply to them

• shows up late

• little contribution

describe motor mouths

• talk just to hear themselves

• always interrupting

describe the mouse

• scared to voice opinion

• take no risk or responsibilities 

describe the critical conservative

• criticizes ideas that are not theirs

• obsessively negative

describe the traditional model of case management

• focus on discharge planning and if care plan throughout hospital stay is needed and appropriate so insurer pays

• review chart q3-7 days

• 16-28 patients/day

describe the full immersion model of case management

• conducts daily chart review

• communicates with physicians/nurses daily

• 12-14 patients on medical/neurology

• 16-18 patients on surgical/cardiology

describe the nurse navigator role of case management

reduces barriers to care for vulnerable patients copings with delays in access, diagnosis, treatment, or fragmented/uncoordinated care

what is disease management?

coordinated healthcare interventions/communication where patient self care is helpful. the goal is to support patients with chronic diseases who get different levels of care

what tools are used to support case management?

• clinical pathways (care maps)

• disease management tools

what are the elements to a clinical pathway?

• timeline that outlines when care was given

• category of care activities/interventions

• immediate/long term outcomes to be achieved

• variance record

what are disease management protocols?

• support physician/patient relationship and plan of care

• emphasize prevention, EBP, and empower patient

• eval clinical, humanistic, economic outcomes

name two excitatory neurotransmitters

dopamine and NE

name two inhibitory neurotransmitters

GABA, serotonin

acetylcholine function

PNS neurotransmitter for muscle coordination, voluntary muscle movement, and memory

GABA function

decreased neuronal activity

norepinephrine function

SNS neurotransmitter for wakefulness and arousal

dopamine function

pleasure, motivation, voluntary movement, hallucinations from inc level

serotonin 5HT function

decreases when anxious/cross, cognitive memory, emotional response, sleep/wake cycles

glutamate function

memory, cognition, precuror to GABA

what is the goldilocks principle

• to find just right

• if too little → difficult memory, exhaustion

which patient situations need case management?

• complicated health care needs

• receiving fare that is expensive and complicated

• pose discharge planning issues

• receive care from multiple providers

• likely to have significant physical or psychosocial problems