Nursing Capstone Exam 2

What is the first part of the change process?

identify areas of change focusing on best practice, increasing pt safety, and improving pt outcomes

What is the second step of the change process?

put change agent as the leader; need someone positive for this to be successful, research ensures this is good change

What is a change leader?

focuses on ensuring development of safe and effective care

What is a change agent?

prepares, implements, and sustains changes; responsibility of all nurses

What makes an effective change agent?

committed to best way of doing things, courageous, takes initiative, outside box thinker, motivated, caring, humble, sense of humor

What does successful change require?

persistence and must show advancement; all team members need to be focused and intention and early involvement and participation are critical to getting the focus of buying team members

What is strengths in SWOT analysis?

internal factors that give you an advantage or benefit (e.g., skills, knowledge, resources).

What is weakness in SWOT analysis?

internal factors that may hinder your progress or success (e.g., lack of experience, limited time)

What is opportunities in SWOT analysis?

external factors that could potentially benefit you (e.g., internships, networking events).

What is threats in SWOT analysis?

external factors that could potentially harm your chances of success (e.g., competition, economic conditions).

What do decision grids like the SWOT analysis help with?

visualize options to allow for comparison

What ares should you look at with SWOT analysis?

time, costs, ethical or legal considerations, equipment needed, training; advantages and disadvantages should be considered in each category

What is the SWOT analysis used for?

strategic planning but also for individuals and group decision making

What is important when making change?

involved participation of team early in the process

What is Lewin's change management model of unfreeze, change, refreeze?

one of the cornerstone models for understanding organization change developed in 1947 by Kurt Lewin to explain PLANNED change

What is apart of the "unfreezing" in Lewin's planned change management model?

change agents to assess and determine whether individual see the need to unfreeze by listening to all participants "Do they have a shared vision for the change?"; When you determine the need for change, the unfreezing process requires listening to staff to see if they perceive the problem in the same light

What is necessary for leaders to inspire change?

must understand what matters to the people they work with and must come to an understanding of the deficits in education and experience they have

What do leaders want to know?

why change is needed bc change is hard; leaders need to know what matters most to the people they oversee for successful unfreezing and moving

What is apart of the moving or change part of Lewin's planned change management model?

Interventions and strategies are executed; key stake holders are involved (who does this effect and who needs to know about this change- email them or meet with them one on one prior to the change and give education on why it is necessary; small steps)

What is apart of refreezing part of Lewin's planned change management model?

Work to reinforce the new, desired behaviors and processes, positive reinforcement, rewards and recognition, provide feedback (positive feedback great!), provide data that shows an increase in pt centered care if applicable, reassess and measure the impact of change

What are the two forces in the force field analysis?

facilitators who favor change and barriers that are a force against change

When does resistance to change occur?

most often when personal security is threatened; concern with how the person is affected in competence to job, affect is having to job security or financial security.

What is apart of facilitating change?

include key stakeholders, clearly describe changes and benefits, get support from formal and informal group leaders, encourage involvement, convey understanding of negative feelings, extra work, and extra resources, and show a need for everyone to create motivation an buy-in

When doing strategic planning what is important?

loop in key stakeholders

Once a change has been integrated how can you assess how staff are feeling about the change?

survey, questioner, audit

What is needed for effective change?

effective planning which includes aligning goals, assisting staff with critical thinking and improving decisions, and allowing everyone in the organization to manage his own work and see how it relates to the organizational goals

What is a note about roger's diffusion of innovation theory?

Appreciate the late majority and laggards, they bring value and insight that others may not think of

What are characteristics of a healthy work environment?

empowering, safe, satisfying, greater retention of employees

Social work in the form of positive work relationships can be important for what?

buffering effects of stressful work enviornment

What is important about personal time management?

work life balance, identify goals

What is a healthy workplace the cornerstone to?

pt safety, satisfaction, and thriving local community

What are impacts of an unhealthy work environment?

anxiety, depression, anger, fatigue, insomnia, emotional/behavioral changes

What can stress lead to and what is your responsibility as a manager?

emotional symptoms; watch staff for s/s and intervene

What is stress defined as?

gap between how we would like ourselves to be and how they actual area and as a consequence or response to an event or stimulus; it is not inherently bad and whether highs and low are seen as distress or eustress is dependent on each individuals interpretation

Stress events can....

have different effects of different individuals causing changes in the response to the same event, consequences can be positive or negative depending

What can negative thinking lead to?

emotional distress

What can cognitive reframing help with?

individuals gain a sense of control over the situation can change the "I can't" thinking to "I can"; helps people identify wats to replace negative thoughts and statements with ones more realistic and helpful

If you are concerned about an employee....

managers should meet with them privately to assist in identifying stress and positive solutions

What are two ways to assist with stress management?

social support and staff social events including everyone

What are interventions for stress management?

private conversation with staff member, putting together team activities that include everyone (potluck or retreat), honoring requests for vacation/time away

What is cognitive reframing?

reconstructive therapy that helps individuals discover their own irrational thoughts, helps identify negative thinking; "i never", "she always"

Even when shortages arise...

managers should still provide free time and vacation time because if there is not a time to decompress, stress arises and turnover increases

Is perfectionism a personal trigger?

No

What are personal triggers?

any major life event

What factors contribute to unhealthy work environment?

personal triggers, perfectionism, cultural/racial inequity, staffing shortages, workplace violence/incivility

What is key to providing quality safe care?

patient centered care with nurses who advocate for patients by providing interpreters and encouraging pt to ask questions

What is the cornerstone to quality improvement?

nursing research (keep eyes open for opportunities)

What are examples of quality improvement?

•Patient advisory board

•Time out procedures

•Breast feeding first attempt

•Blood draw from a placenta (decrease blood transfusions)

•Delayed cord clamping for < 34 weeks (decrease blood transfusions and hyperbilirubinemia)

•CPAP at delivery (decrease chronic lung disease)

•Donor breast milk (improve patient growth and decrease NEC)

•NICU follow up clinic

•Kangaroo care

•Changes in nursing program at another institution

What are IOM "future of nursing recommendations"?

remove barriers to scope of practice, expand opportunities for nurses to lead in improvement efforts, implement nurse residency programs, increase proportion of nurses with BSN to 80% by 2020, double number of nurses with doctorates by 2020, ensure nurses engage in lifelong learning, prepare and enable nurse to lead change, and build an infrastructure for the collection and analysis of interprofessional healthcare workforce data

What is the IOM 2010 emphasizing?

need for nurses to engage in lifelong learning and to use evidence based and best practices to inform practice and ensure safety

What goes hand in hand with quality management and why?

quality assurance bc it provides checks and balances important for pt safety and is a method to monitor healthcare and focus on clinical aspects, discovery of errors, inspection of charts/nursing activities

What does QI focus on?

prevention of errors/review of activities/professional development

What is the goal and philosophy of quality management?

improve the system not assign blame; healthcare culture should emphasize customer satisfaction, innovation, and employee improvement

What is QI an ongoing process of?

innovation improvements, prevention of error, development of staff, adoption of the QM philosophy

What are some nursing considerations with QI?

•Nurses are responsible for early warning monitoring as they evaluate changes and conditions of patients

•Specially certified and BSN nurses have been associated with better pt outcomes

•Rn's being prioritized to deliver total pt care in high acuity units has been associated with better outcomes.

•Inclusion of direct care nurses in decisions regarding/involving their practice

•Teamwork compromised if staffing is inadequate

•Leaders, managers, and followers need to be committed to QI

•QI and QM need to be viewed as an important part of nurses roles

How can you be successful at QI?

quality info must be gathered and analyzed in an unbiased light before implementation suggestions and recommendations are made.

What is the QI process?

1.Determine which actions are most important (identify needs)

2.Teams need to find worders involved with the problem and must be able to function as a team (assemble interprofessional team)

3.Team collects meaningful data ie flowcharts, graphs, fishbone diagrams (collect data)

4.Outcomes need to be established ex decreased pressure ulcers by X%, decreased falls/IV infiltrates (establish measurable outcomes and quality indicators)

5.Select a plan: do a literature review, identify strategies for success, include education (make and implement plan)

6.Evaluate: Continue to collect/gather data and evaluate that data

What should nurses encourage pt to do?

ask questions when there are doubts and concerns

What are quality measures important for?

pt safety, satisfaction, and reimbursement

What are considerations for nurses with QM?

-Nursing has primary responsibility for ensuring patient safety

-Nurses lead Quality Improvement and Risk Management

-Quality improvement projects are happening locally and nationally

-To help secure our jobs, our futures, and patient safety

Magnet hospitals are required to demonstrate what?

how they provide excellence in five areas: transformational leaders, structural empowerment, exemplary professional practice, new knowledge, innovations, and improvements, (emphasis on) empirical quality results

What are "never events"?

clearly identifiable and preventable incidents with serious consequence to pts: wrong surgical site, foreign body left in surgery, mismatched blood transfusion, major med errors, severe hospital- acquired pressure ulcer, post-op death

What are sentinel events?

serious and unexpected death or harm; falls, inpatient suicide, infant abduction, wrong surgical site

What are "always events"?

HH, pt identifiers

What is a near miss?

did not result in injury, illness, damage but had potential to

What is the just culture algorithm valuable for?

guiding supervisors response to performance issue because it determines causal factors and fair consequences, also provides info on how to improve the system and fix process problems; the judgments are made objectively to assure the employee they were treated fairly

What are key points from this scenario: RN comes on shift to find patient with low blood glucose and wrong IV fluid hanging (should be D10W but NS is running)?

The nurse did scan the medication, but did not follow the 6 rights.

D10W and NS were both on the MAR. The NS should have been DC'd when the D10W was ordered

The NS and D10W are right next to each other on the PAR level

What are considerations with with root cause analysis?

needs to be a safe environment, do not push blame, best change in practice come out of RCAs, not discoverable in court, all document shredded and non one talks about it, oftentimes associated with tears, stress, scary, and highly emotional

What provides first access to care?

primary care

Who is covered in medicare vs medicaid?

medicare- elderly/disable

medicaid-low income

What are not-for-profit organizations?

controlled by voluntary boards or trustees, provides care to paying and nonpaying, excess revenue over expenses redirected to organization for growth and maintenance, typically exempt from taxes

What are for-profit organizations?

operate with specific intent of earning a profit from those who can pay, still has to follow EMTALA, excess revenue returned to stockholders

What is a consideration with pay in for vs not-for profit organizations?

For profit hospitals tend to have a lower wage/salary than non for profit.

What is accreditation?

an authoritative body determines that an organization meets certain standards of performance. Generally higher standard than regulatory. (Joint Commission, ISO, DNV)

What is regulation?

Set standards required for operation - compliance with federal and state regulations - developed by governmental administrative agencies - investigate and complaints brought by consumers of the services and the public. (CMS, FDA, OSHA)

What is the aim of accountable care organizations?

to coordinate care and chronic disease management and improve the overall quality of care provided to Medicare patients

What do veteran hospitals provide?

range of services and are responsible to government and taxpayers

What are accountable care organizations?

groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve

What is does coordinated care ensure?

patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors

What happens when an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely?

it will share in the savings it achieves for the Medicare program

What are examples of nursing role and function changes?

increased leadership and management positions, awareness of need for healthy work environment, influence policy and politics

We need nurses to be involved in....

the political process and policy process. Current legislation occurs in Idaho at the capitol. There is a capitol day for Nurses every year.

What is cultural sensitivity?

capacity to feel, convey, and react to ideas, habits, customs, behaviors, belief, or traditions unique to a group of people and provide individualized care

What do prejudices/unconscious bias enable us to do?

predict behaviors and make sense of situations but constrain our understanding and development of new insights.

What is implicit bias?

always present and found everywhere in all situations. It exists in every individual to some capacity, no matter how strongly they feel impartial. This is an unconscious act or thought; however, it does show a familiar association.

What is explicit bias?

actions based on prejudice and stereotypes. In this type, people are very aware of their bias

What are the goals of education programs for healthcare professionals?

are to remain culturally competent, free of judgement or bias, and provide fair and equal care

What is culture determined by?

behaviors and beliefs; this can include populations, religion, work/social settings/etc.

What is multiculturalism?

maintaining several different cultures

What does multiculturalism reflect?

positive interaction among different cultures, can refer to work units or specific groups, etc

What is transculturalism?

bridging differences in cultural practices

What is cultural awareness?

reflection, self examination, and in depth exploration of ones own cultural and professional background including biases, prejudices, and assumptions

What are considerations with culture?

passes from one generation to another (including at work), develops overtime, and is difficult to change, all people view their cultural background as "normal", and we must respect the difference we have instead of trying to change them (unless harmful)

What is cultural diversity?

range of cultural differences among individuals or groups

What is cross culturalism?

mediating between or among cultures, comparisons between two or more cultures to develop ways to work together

What is acculturation?

adapting to the dominant culture in the environment where you live/work

What is ethnocentrism?

The belief that ones own ways are the best, most superior, or preferred ways to act, believe, or behave

What will pt centered care ensure?

that the patients individual values and needs will guide the best care for them

Healthcare workers need to be...

culturally aware and culturally competent to ensure trust

What can culturally competent care lead to?

many challenges and opportunities