Leadership Exam 2

Autonomy

Promotes self-determination/freedom of choice

• as a nurse we should provide all info necessary for an individual to make a choice

Beneficence

Actions on takes should be done in an effort to promote good

• doing good for the most amount of people

Nonmaleficence

The act of doing no harm.

If the actions one takes cannot do good, then they should take actions to do no harm

Ethics

A system of moral conduct and principles that guide a person’s actions in regard to right and wrong in regard to oneself and society at large.

• Knowing the difference between what you have a right to do and what is right to do

• Doing the right thing

ANA Code of Ethics

Set of principles established by a profession to guide the individual practitioner.

The first code of ethics for nurses was adopted by the ANA in 1950 and has been revised 6 times since

Ethical Dilemma

A problem in the decision-making process that involves conflict between two moral imperatives

• Cannot be solved by only a review of scientific data

• The answer will have a profound effect on the situation/client

Fidelity

Need to keep a promise, loyalty.

Do what you say you will do

Justice

Seeks fairness, treating equals as such and treating ‘unequals’ according to their differences.

Providing the care your individual patient needs

Utility

The good of MANY outweighs the wants/needs of the individual

Veracity

The obligation to tell the truth

Paternalism

One individual assumes the right to make decisions for another

• POA

• Parent

• Mentally disabled adult

Americans with Disabilities Act of 1990

Civil rights law that prohibits discrimination against individuals with disabilities in areas like employment, transportation, public accommodations, and access to state and local government services.

Duty of Care

A legal obligation to act with reasonable standard of care to avoid causing harm to others, and failure to do so can lead to a claim of negligence

Negligence

Failure to use reasonable care, resulting in damage or injury to another

• Carelessness

• Include actions taken and actions omitted

• Unintentional tort

Malpractice

Improper, illegal, or negligent professional activity or treatment, especially by medical professional, lawyer, or public official

• Include actions taken and actions omitted

• Unintentional tortt

Six Elements of Malpractice

1. Duty of care owed the patient

   1. Standards of care, established through employment

2. Breach of duty owed the patient

   1. Failure of standard of care

3. Foreseeability of harm

   1. Knowledge that harm could occur

4. Causation (2 and 3)

   1. Relationship must be provable (care correlates to harm)

5. Injury

   1. Physical harm occurs

6. Damages

   1. Financial harm

Assault

The threat or attempt to cause harm

Battery

Unlawful and intentional touching or physical contact with another person, causing harm or offensive contact without their consent

False imprisonment

Intentional and unlawful restraint of another person’s freedom of movement, without legal justification or consent, and can be both a crime and civil tort

• restraints

• preventing someone from leaving

Libel

A written defamatory statement. False statements

Slander

A spoken defamatory statement

Nurse Licensure Compact

Nursing licensure is a privilege not a right

RNs may be licensed in one state and practice in another state within the compact

The state where the patient or client resides is the state that regulates the nurse’s practice

Nurse Practice Act

The single most important piece of legislation for nurses

Set educational and examination requirements for RNs

Defines the categories of nursing

Established a state board of nursing, which now develops and implements rules and regulations

Informed Consent

Authorization by patient or patient’s legal representative to do something to the patient.

Based on legal capacity, voluntary action, and comprehension

Privacy

The patient’s right to protection against unreasonable interference with reputation or right to be left alone.

Good Samaritan Law

Protects people who voluntarily help someone in an emergency from being sued for any harm caused while providing reasonable aid, encouraging bystanders to assist without fear or erpercussions

Civil Tort Law

Protect the individual rights of people

• Unintentional: malpractice or negligence

  • Commission: action is taken that shouldn’t have

  • Omission: action not taken but should have been

• Intentional: assault, battery, false imprisonment

• Quasi-intentional: breach of confidentiality, defamation

Team Nursing (Modular Nursing)

Ancillary personnel collaborate to provide patient care under the direction of a professional nurse.

Extensive team communication and regular team planning conferences.

Allows members to contribute their own special expertise or skills

Disadvantage:

• Improper implementation rather than the actual model itself

Functional Nursing

Evolved as a result of WWII due to not having enough nurses

Uses relatively unskilled workers who have been trained to complete certain tasks

Care is assigned by task rather than patient

Advantage:

• Efficient- tasks are completed quickly, with little confusion regarding responsibilities

Disadvantage:

• Fragmented care

• Possibility of overlooking patient priority needs

Case Management Nursing

Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes

Coordinate care through an episode of illness

Focus is on individual clients, not populations

Case Management Nursing and MAPs

• Utilized to plan patient care in case management nursing.

• Decide what is going to happen within a certain time frame

• MAPs include the nursing care plan, all providers follow the care MAP to facilitate expected outcomes

• If a patient deviated from the plan, a variance is indicated.

  • Case management changes the MAP to fit the variance

Issues related to changing the care delivery model

• Will the reorganization alter autonomy and individual and group decision making?

  1. How are decisions made for the patient and unit?

• Will social interactions and interpersonal relationships change?

• Will employees view their unit of work differently?

• Will the change require a wider or more restricted range of skills and abilities on the part of the caregiver?

• Will the redesign change how employees receive feedback on their performance, either for self-evaluation or by others?

• Will communication patterns change?

Effective Health Care Delivery

Facilitate meeting the goals of the organization

Cost-effective

Satisfy the patient

Provide role satisfaction to nurses

Allow implementation of the nursing process

Provide adequate communication among health care providers

Skills of an effective team leader

• Create a motivating climate- value employees

• Manage conflict

• Facilitate collaboration

• Negotiation

• Complying with employment laws

• Establish organizational communication

  • engage employees

• Empower employees

Relationship between communication and team building

Communication and team building are intertwined

Improving communication enhances how workers interact with one another

Activities encourage trust, cooperation, and communication

Quality Improvement Process

1. QI: Continuous, focuses on the client/patient. Proactive. 

2. Steps:

   1. Identify important needs to consumer (patient safety goals)

   2. Assemble interprofessional team to review identified needs/services

      1. Who is affected? Who contributes?

   3. Collect data to measure

   4. Establish measurable indicators

   5. Select and implement plan to meet outcomes

   6. Collect data to evaluate achievement of outcomes

Incident reports

A formal follow-up to communicate risk

• Tool must be constructed to collect complete and accurate information

  • Do not include impressions, opinions, interpretations

  • Do not admit guilt

  • No bias, objective review, non-punitive

Root-cause Analysis

Retrospective analysis of the event to identify cause to ensure future risk is minimized.

Sentinel Events

A serious, unexpected occurrence involving death or injury

• suicide, infant abduction, or wrong-site injury

Must be reported to the joint commission and investigated immediately

“Never event”

• Sx on wrong part

• Foreign body left in pt during sx

• Mismatched blood transfusion

Near miss

A clinical situation that resulted in no injury but that highlights the need for action

Risk Management

Attempts to analyze problems and minimize losses before and after client care error occurs

• financial, extended length of stay, negative public relations, employee dissatisfaction

• High risks: falls, med errors, suicide attempts, poor equipment

Purpose of QI

Systematically and continuously identify and address issues to improve the quality of processes, systems, and outcomes, ultimately leading to better performance and outcomes for individuals and organizations.

National Patient Safety Goals

• Identify patients correctly

• Improve staff communication

• Use medicines safely

• Use alarms safely

• Prevent infection

• Identify patient safety risks

• Improve health care equity

• Prevent mistakes in surgery

Collective Bargaining

Activities that occur between organized labor and management that concern employee relations

• People that get together and ask to change to occur

Negotiation of formal labor agreements and day-to-day interactions between unions and management

Managers Four Perspectives of Collective Bargaining

• The organization

• The worker

• General historical/social

• Personal

Arbitration

• Terminal step in the grievance procedure where a third party reviews the grievance, completes fact finding, and reaches a decision. Always indicates the involvement of a third party

• May be voluntary on the part of management and labor or imposed by government in a compulsory arbitration.

Grievance

Perception on the part of a union member that management has failed in some way to meet the terms of the labor agreement.

Lockout

Closing a place of business by management in the course of a labor dispute for the purpose of forcing employees to accept management terms.

Strike

Concerted withholding of labor supply to bring about economic pressure on employers and cause them to grant employee demands.

Pros of joining a union

• Increase in individual power

• Increase input into organizational decision making

• Increased pay, benefits, and working conditions

• Decrease in required overtime

• Structured process for grievances and support from union

• Lower discriminatory practices

• Believe it will improve patient outcomes and quality of care

Cons of joinging a union

• Cost- initiation and monthly membership fees

• Less worker autonomy- have to follow union decision

• Identification with management’s POV

• Fear of employer reprisal

• Fear of co-worker dissent

• Fear of lost income associated w/ strike or walkout 

• Concern over patient care with strikes

Managers use of EI

1. Ability to use emotions effectively and is required by leaders/managers in order to enhance their success. 

2. EI is critical for building a cooperative and effective team

3. Five Components:

   1. Self-awareness

   2. Self-regulation

   3. Motivation

   4. Empathy

   5. Social skills

Lewin Change Theory

1. Unfreeze: ensures that employees are ready for change

   1. Identify shared vision, goals, restricting forces, and driving forces

      1. Restricting forces: forces that pull the system away from change

         1. People, finances, external influences

      2. Driving forces: forces that push the system toward change

         1. Support, location, better outcomes, satisfaction

2. Change: execute the intended change

   1. Implement change

   2. Time varies

3. Refreeze: ensures that the change becomes permanent

   1. Solidify change

   2. Time varies

   3. Evaluation and adjustment

   4. Realization that change may not work (requires flexibility)

4. Lewin’s rules for implementing change (1951):

   1. Change should only be implemented for good reason

   2. Change should always be gradual

   3. All change should be planned, and not sporadic or sudden

   4. All individuals who may be affected by the change should be involved in planning for the change

Workplace Violence

1. Bullying, incivility, and mobbing in the workplace = workplace violence

2. Impacts the physical, emotional, and socioeconomic health of employees and threatens patient safety. 

3. Violence against healthcare workers is a worldwide problem

   1. Health care leads in non-fatal workplace assaults

4. Consequences of WV:

   1. Nurses exposed are more likely to experience PTSD, anxiety, depression, and burnout

   2. Increase in employee health complaints

   3. Emotional/psychological consequences occur- lack of sleep, fatigue, depression, anxiety

   4. Quality of care provided often decreases 

QI Process

1. Identify important needs to consumer

2. Assemble interprofessional team to review/identify needs and services

3. Collect data to measure

4. Establish measurable indicators

5. Select and implement plan to meet outcomes

6. Collect data to evaluate achievement of outcomes