Clinic Nurse Leader 245 Questions with Verified Answers,100% CORRECT

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Clinic Nurse Leader 245 Questions with Verified Answers Gap Analysis - CORRECT ANSWER Compares ACTUAL performance with POTENTIAL/desired performance Evaluates the strengths and weaknesses of ... the team in relation to required outcomes A good tool for analysis to gain better understanding of the team's functioning 3 phases of knowledge transfer when using EBP - CORRECT ANSWER 1. Knowledge creation and distillation (research and recommendations for clinical practice) 2. Diffusion and Dissemination (distribute info to users, partner with organizations like professional nursing orgs) 3. Implementation and Institutionalization (end user adoption - health care systems adopt practices) Examples of restraining forces in Lewin's Change theory - CORRECT ANSWER work against the driving forces to inhibit change example: want to quit smoking but live with people who smoke so hard to quit in that living situation Examples of driving forces for Lewin's change theory - CORRECT ANSWER factors that support change or push patient towards necessary changes such as the drive to quit smoking to breathe easier Peplau's Theory of Interpersonal Relations - CORRECT ANSWER focuses on relationship between patient and nurse 4 phases: 1. Orientation - seeks help through appts, treatment, etc. for RN to determine patients need for assistance 2. Identification - help identify who can help, set goals of care 3. Exploitation - receives care from rN 4. Resolution - care is completed Total patient care. - CORRECT ANSWER One nurse is responsible for planning, organizing and delivery of care to a particular client or group of clients during the assigned shift Primary nursing - CORRECT ANSWER a method of care in which the same RN assigned to same patient over time; assumes 24 hour responsibility for planning, directing, and evaluating client care from the time of admission through discharge team nursing - CORRECT ANSWER a nursing care pattern; a team of nursing staff is led by an RN who decides the amount and kind of care each person needs - each member responsible for certain cares such as ADLs or meds Each team member is able to contribute their own special expertise or skills caring for the client Continuity of care may suffer if daily assignment of team varies and client is exposed to many different caregivers. relative risk - CORRECT ANSWER used when the study involves comparing the likelihood, or chance, of an event occurring between two groups ratio of the absolute risk of a disease among the exposed group to the absolute risk of the disease among the unexposed group in an epidemiologic study confidence interval - CORRECT ANSWER the range of values within which a population parameter is estimated to lie based on a random sample of the population. The most common interval is the 95% confidence interval. It represents the range that one can be 95% confident that the population parameter lies. confounding - CORRECT ANSWER distortion in the degree of association because researcher failed to control, or eliminate the confounding variable, damaging the internal validity of an experiment. occurs when two variables are associated in such a way that their effects on a response variable cannot be distinguished from each other internal validity - CORRECT ANSWER extent to which a piece of evidence supports a claim about cause and effect & degree to which the results of a study are not due to bias or confounding External validity - CORRECT ANSWER the degree to which the results of the original study are applicable to a population other than the one initially targeted = generalizability An oral glucose tolerance test (OGTT) measures - CORRECT ANSWER your blood sugar after you have gone at least eight hours without eating and two hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or prediabetes. Oral Glucose Tolerance Test (OGTT) result of 150 means what? A. Based on a value greater than 140 mg/dL, the patient should have 3-hour 100-g OGTT within 1 week. B. The results are within normal limits and do not meet the threshold for the diagnosis of gestational diabetes. C. A fasting blood sugar should be checked as soon as possible. D. Based on this abnormal value, the 3-hour OGTT is not required. - CORRECT ANSWER A. Based on a value greater than 140 mg/dL, the patient should have 3-hour 100-g OGTT within 1 week. Rationale: If your blood glucose is higher than 140 mg/dL, the next step is the oral 3-hour glucose tolerance test. This test will determine if you have gestational diabetes. After performing the literature review and developing a PICOT question, what should you do next before implementation? A. Form a team of stakeholders B. Develop a comparison group C. Talk to the manager D. Start the implementation process - CORRECT ANSWER A. Form a team of stakeholders Rationale: After performing the literature review and developing a PICOT question, you should create a team of stakeholders to ensure the intervention has the appropriate resources to make the study successful. Pt has a blood sugar of 58 with headache and blurry vision. Which of the following interventions is appropriate for the nurse to tell the CNL? A. The patient is experiencing hyperglycemia and should be given a protein snack. B. The patient is experiencing hyperglycemia and should be given insulin and 1 cup of milk. C. The patient is experiencing hypoglycemia and should be given insulin and 1 cup of orange juice. D. The patient is experiencing hypoglycemia and should be given 1 cup of skim milk. - CORRECT ANSWER D. The patient is experiencing hypoglycemia and should be given 1 cup of skim milk. Rationale: The patient's fasting blood sugar is below 60 mm/dL and is symptomatic. She must be treated for hypoglycemia by drinking 1 cup of skim milk, or 1⁄2 cup of juice, or 1⁄2 cup of soft drink. As a trial CNL, whose buy-in will be the most important in fully implementing the CNL role in the hospital? A. The chief nursing officer (CNO) B. The unit manager C. The members of the interdisciplinary team D. The staff affected by your outcomes - CORRECT ANSWER The chief nursing officer (CNO) CNO will have the most influence in your hospital Orem's self care deficit theory - CORRECT ANSWER The nurse's actions are directed toward assisting the patient to assume responsibility for self-care & based on the premise that all individuals are capable of self-care 1st step: identifying and prioritizing the client's unmet self-care needs (deficits). 2nd step: selecting methods of assisting the client to compensate for or overcome his self-care deficits. Leininger's Culture Care Theory - CORRECT ANSWER Theory of cultural care diversity and universality - Integrates patients' cultural traditions, values and beliefs into care plans Care fits with or have beneficial meaning and health outcomes for people of different or similar culture backgrounds. similar to transcultural nursing (CPOE) Computerized physician order entry - CORRECT ANSWER Feature of the EHR that assures standardized, legible communication of the medical plan of care to other members of the healthcare team Helps prevent errors (HIE) health information exchange - CORRECT ANSWER Allows for multiple health care organizations serving a client to share health information across electronic networks , allows for timely access to client information for providers Although have to be careful with protected health information/HIPAA perceived conflict (felt conflict) - CORRECT ANSWER perceive that their situation is characterized by incompatibility and interdependence mistrust, hostility, and fear; misunderstanding each other or jumping to conclusions based on limited information Negotiating Conflict Style - CORRECT ANSWER Resolve the conflict through assertive give and take concessions to deal or bargain with another - seeks agreement but not necessarily consensus; solution is rather permanent; revenue budget - CORRECT ANSWER A budget that lists forecasted and actual revenues of the organization A projection of expected income for a budget period based on volume and mix of patients, rates, and discounts. Zero-based budgeting (ZBB) - CORRECT ANSWER a method of budgeting in which managers thoroughly reevaluate organizational activities to determine their true level of importance ( all expenses must be justified for each new period) 5 rights of delegation - CORRECT ANSWER 1. Right task 2. Right circumstance 3. Right person 4. Right direction/communication 5. Right supervision accomodating conflict style - CORRECT ANSWER cooperating in that one side gives in to the other side compromising conflict style - CORRECT ANSWER each side gives something up and gains something; group members concede some goals in order to achieve other more important goals collaborating conflict style - CORRECT ANSWER seeks joint resolution w/ best solution for all - develop optimal outcomes but does take a lot of time - requires commitment Confronting - CORRECT ANSWER immediate and obvious movement to stop conflict at the very start Does not allow conflict to take root; very powerful. Conflict Management Strategies - CORRECT ANSWER Avoidance Accommodation Competing Compromise Collaboration Negotiating Confronting Organizational conflict - CORRECT ANSWER One person or a group vs an organization Example: competition for resources; Quality of patient care (nurse patient ratio) competing with COST interpersonal conflict - CORRECT ANSWER conflict that occurs between two or more individuals or team to team intrapersonal conflict - CORRECT ANSWER conflict that occurs within an individual ex. should I call in sick and attend my daughter's birthday party- I asked for the day off and didn't get it Overt behavior in conflict - CORRECT ANSWER Behavior that is directly observed - aggression, competition, debate, or problem solving. covert behavior during a conflict - CORRECT ANSWER a response that is internal or hidden from view - scapegoating, avoiding or apathy antecedent conflict conditions - CORRECT ANSWER increase in conflict, incompatible goals, role conflict, structural conflict, competition for resources, differences in values and beliefs. phenomenlogical research - CORRECT ANSWER inductive descriptive approach used to describe an experience as it is lived by an individual grounded theory research - CORRECT ANSWER discover the problems that exist in a social scene and the process that persons involved use to handle them - how people define reality and how their beliefs are related to actions Change agent strategies - CORRECT ANSWER Power-coercive: applies power from authority, economic sanctions, or political clout (e.g. don't text and drive or you'll get a ticket) Empirical-rational: assumes ppl are rational and will follow self-interest (e.g. don't text and drive or you will get hurt) Normative-reeducative: assumes ppl act in accordance with social norms and values (e.g. don't text and drive - "everyone's doing it') Justice - CORRECT ANSWER fairness Values - CORRECT ANSWER the ideas, beliefs, and attitudes about what is important that help guide the way you live Distributive Justice - CORRECT ANSWER perceived fairness of the amount and allocation of rewards/goods among individuals in a society Bureaucratic leadership/Hierarchical leadership - CORRECT ANSWER Hierarchy of authority - strictly follows set of rules/policies, assumes individuals are motivated by external factors Trusts neither followers or self to make decisions so relies on organizational policies and rules Clinical Decision Support (CDS) - CORRECT ANSWER A set of patient-centered tools embedded within EHR software that can be used to improve patient safety, ensure that care conforms to published protocol for specific conditions, and reduce duplicate or unnecessary care and its associated costs Such as pop up reminders or alerts for interacting drugs address deficits in documentation; consider potential outcomes to their decision making, or as reminders to order screening tests Allocation focus of a policy means - CORRECT ANSWER providing resources (income, services, goods) to ensure policy implementation Regulatory intent of policies focuses on - CORRECT ANSWER prescribing and controlling behavior of particular population autocratic leadership - CORRECT ANSWER leadership style that involves making managerial decisions without consulting others - leader makes all decisions and directs followers behavior authoritative control over group, assumes individuals are motivated by external forces, democratic leadership - CORRECT ANSWER A form of leadership in which the leader solicits input from subordinates - consider employees opinions, suggestions, and concerns, - involves the whole group in decision making laissez-faire leadership - CORRECT ANSWER allows the group to function more or less on its own, leaders are hand off Group members make own decisions - Lack of responsibility in leading Question: A staff nurse is curious about whether emptying the nasogastric (NG) suction canister is a task that can be delegated to a CNA. You, the CNL, guide her to what resource? A. The unit charge nurse B. Hospital policy/procedure manual C. The State Board of Nursing Scope of Practice D. The Joint Commission website - CORRECT ANSWER The State Board of Nursing Scope of Practice Rationale: The most reliable source for what tasks may be delegated is the individual state's scope of practice. What p-value indicates a significant statistical finding in research? - CORRECT ANSWER Less than 0.05 Transtheoretical Model of Change - CORRECT ANSWER Prochaska and Diclemente's model to conceptualize the process of intentional behavior change Patients may spiral in and out of stages, forward and back Question: During the policy formulation phase, all of the following are correct except: A. Possible solutions are offered. B. Political circumstances are considered. C. A problem is identified. D. Policy decisions are adjusted to accommodate changing circumstances or needs. - CORRECT ANSWER D. Policy decisions are adjusted to accommodate changing circumstances or needs. Rationale: Policy formulation is the development of effective and acceptable courses of action in order to address what has been placed on the policy agenda. This should include the following characteristics: (a) The problem is identified, (b) possible solutions are offered, (c) political circumstances are considered, and (d) policy makers, stakeholders, and legislative staff are involved. servant leadership - CORRECT ANSWER focuses on increased service to others rather than to oneself Leading originates from a desire to serve, leader emerges when others' needs take priority focus on whether the least advantaged in society benefit from the leader's service Question: You are a CNL on an oncology unit. Recently, there has been an increase in the number of catheter- associated urinary tract infections (CAUTIs) on your unit. After shadowing nurses and aides you observed a variety of practices, techniques, and expectations surrounding daily catheter care. Your hospital does not have a current policy or procedure regarding catheter care. As the CNL, what should you do next? A. Review current evidence for catheter care practice and disseminate evidence to the staff B. Form an interdisciplinary team meeting to evaluate current hospital catheter care policies C. Create a rubric for educating patients and staff on catheter care D. Discuss with the unit manager the clinical issue and create a set of evidence-based unit expectations and practices for the oncology unit. Evaluate the need to address this issue with a hospital-wide policy or procedure - CORRECT ANSWER Discuss with the unit manager the clinical issue and create a set of evidence-based unit expectations and practices for the oncology unit. Evaluate the need to address this issue with a hospital-wide policy or procedure Rationale: The CNL should act to solve the clinical issue in the short term, and evaluate the need for a larger policy to address gaps in practice hospital-wide. Hawthorne effect - CORRECT ANSWER A change in a subject's behavior caused simply by the awareness of being studied - people act as expected when being watched, the act of research effects the outcome. Neoclassical Theory - CORRECT ANSWER A modification of classical theory with human component believe in cooperation and participation, tapping into motivation of the individual Classical Organizational Theory - CORRECT ANSWER An early approach to the study of management that focused on the most efficient way of structuring organizations - efficiency through design What are different organizational theories? - CORRECT ANSWER 1. classical 2. neoclassical 3. systems theory 4. contingency theory 5. chaos theory Contigency Theory - CORRECT ANSWER Dependent on environment; performance can be enhanced by matching an organizational structure to its environment Optimal form of the organization is CONTIGENT upon the challenges and circumstances of the environment no one best way of leading, and that a leadership style that is effective in some situations may not be successful in others. Question: What organizational theory is used with rapid, unpredictable, and constant change? A. Systems theory B. Chaos theory C. Change theory D. Traditional theory - CORRECT ANSWER Chaos theory quasi-experiment - CORRECT ANSWER an experiment that estimates the causal impact of an intervention on target population WITHOUT random assignment Can be used to include pre and post measures/surveys Run chart - CORRECT ANSWER tool for tracking results over a period of time - Line graph of data plotted over time Shows trends/patterns Question: A CNL in the emergency department (ED) is auditing stroke patients' charts and the administration of tissue plasminogen activator (tPA) and notices that only 83% of patients who are eligible to receive tPA are receiving it. The CNL knows that the 83% administration rate is below the national benchmark. The CNL identifies that there is a time lag in MRI. The CNL creates a stroke team to develop a guideline implementation action plan to improve the process of timing of the MRI. What is the best tool utilized by the CNL in implementing change? A. Research study B. Meta-analysis C. Plan-Do-Study-Act (PDSA) D. Standardize-Do-Study-Act - CORRECT ANSWER Plan-Do-Study-Act (PDSA) Rationale: PDSA is a model for quickly and easily testing ideas that could lead to improvement, based on existing ideas, research, feedback, theory, reviews, audits, or evidence of what has worked elsewhere. Mesosystem - CORRECT ANSWER Multiple similar microsystems in a division of the hospital ethnographic research - CORRECT ANSWER the study of human behavior in its natural environment & promotes culturally sensitive care - obtain perspectives beyond own culture What are some examples of how you increase EBP into unit practice? - CORRECT ANSWER -Ensure policies/procedures are based on recent literature -Journal Clubs -Nursing grand Rounds Group think - CORRECT ANSWER the mode of thinking that occurs when the desire for harmony in a decision-making group overrides a realistic appraisal of alternatives Conflict resolution phenomenon when group members try to decrease conflict by reaching consensus too early without all ideas/consequences discussed Interferes with critical thinking Pareto Chart - CORRECT ANSWER a bar chart on which factors are plotted to help identify top rates and guide a focus of primary issues - bar height reflects frequency or impact of causes (descending bars) help identify the causes that are likely to have the greatest impact on the problem if addressed - guide the process of selecting key, high impact improvements Some causes have a much greater effect on problem we want to address than others: "80% of the effects come from 20% of the causes" Question: A professor is discussing the difference between quantitative and qualitative research. As a CNL student, you are aware that quantitative research is related to numeric data with statistical analysis, while qualitative research focuses on non-numeric forms of research. Which of the following is an example of a quantitative study? A. Personal interviews B. Randomized controlled trial (RCT) C. Ethnography D. Phenomenology - CORRECT ANSWER RCT Rationale: RCT is a quantitative research process that is a true experiment; it is the strongest design to support cause-and-effect relationships, in which subjects are randomly selected. Histogram Chart - CORRECT ANSWER graphical representation of data Lewin's Change Model - CORRECT ANSWER 1. Unfreezing 2. Changing 3. Refreezing Question: Quality improvement (QI), as a function of the CNL role, is related to which core role competency of the CNL? A. Client advocacy B. Clinician C. Risk anticipator D. Team manager - CORRECT ANSWER Risk anticipator Rationale: QI is a direct function of risk anticipation Flowchart - CORRECT ANSWER A diagram that shows step-by-step progression through a procedure or system Maps out and helps visualize problem Fishbone chart - CORRECT ANSWER used to aid in brainstorming and isolating the potential causes of a problem - Help identify root causes Cause and effect diagram Bounded Rationality Model - CORRECT ANSWER According to this decision making model, individuals knowingly limit their options to a manageable set and choose the first acceptable alternative without conducting an exhaustive search for alternatives emphasizes limitations of rationality of the decision maker Question: A group composed of unit-based council members was put on a task force to improve the discharge planning process because patients felt unprepared and rushed at discharge. A decision was made to create a discharge planning nurse position to educate patients the night before the discharge. Even though the new nurses did not like this solution, they deferred to the senior nurses of this group who were adamant about implementing this position. Which barrier to effective teamwork does this exemplify? A. Physical threats B. Groupthink C. Team dysfunction - CORRECT ANSWER B. Groupthink Rationale: Groupthink is a phenomenon that occurs when group members try to minimize conflict and reach consensus too early without fully vetting all ideas and consequences. Delphi Technique - CORRECT ANSWER A decision-making technique in which group members do not meet face-to-face but respond to questions posed by the group leader systematically - ex. Survey monkey Transtheoretical Model of Change parts - CORRECT ANSWER -Precontemplation -Contemplation -Preparation -Action -Maintenance Pender's Health Promotion Model - CORRECT ANSWER health promotion activities to increase levels of well in that each person has unique personal characteristics/experiences that affect their choices of actions they have 1. individual experiences/characteristics that effect choice of action, 2. behavior specific thoughts, and 3. different believed outcomes/perceived benefits of anticipated outcomes Chaos Theory/Model - CORRECT ANSWER Rapid changes, frequent The world is not orderly must adapt and change, be flexible Bioethical Decision Model - CORRECT ANSWER 10 step process in order to help with decisions in ethical dilemma Includes reviewing the situation, gathering information, identifying ethical issues, look at moral positions, identifying actions with outcomes, then deciding on action, and evaluating results Question: The CNL of the heart failure unit encourages the staff to earn advanced degrees, obtain certifications, and present and publish EBP projects. The CNL exhibits which type of leadership style? A. Relational leadership B. Transactional leadership C. Situational leadership D. Transformational leadership - CORRECT ANSWER Transformational Leadership Rationale: A transformational leader motivates others to higher performance. Relational (Connective) Leadership - CORRECT ANSWER A leadership style that values collaboration and teamwork; interpersonal skills are used to promote collegiality in achieving organizational goals Create positive relationships within the organization Situational Leadership Theory - CORRECT ANSWER a leadership contingency theory that focuses on followers' readiness; adjust style to fit developmental level of followers trying to influence Fidelity - CORRECT ANSWER principle of keeping one's promise or word veracity - CORRECT ANSWER obligation to tell the truth According to the Diffusion of Innovation theory what 2 groups should you focus on when you want to have successful support for a change? - CORRECT ANSWER Focus on the early and late majority adopters to support change for success as majority of the general population tends to fall in the middle categories Non-maleficence - CORRECT ANSWER doing no harm beneficence - CORRECT ANSWER to do good to others Steps of Diffusion of innovation theory - CORRECT ANSWER 1. Knowledge (exposure to innovation, they lack information) 2. Persuasion (interested in innovation and seeks information about it) 3. Decision (advantages vs disadvantages, accept or reject) 4. Implementation (usefulness of intervention) 5. Confirmation (either continue to use or not) Diffusion of Innovation Theory - CORRECT ANSWER Roger's theory - explain how a new idea or product gains acceptance and diffuses/spreads through a specific population or subset of an organization. Some people are more apt to adopt the innovation than others - initial rejection does not necessarily mean the change will never be adopted Includes: innovators, early adopters, early majority, late majority, laggards Looks like a bell curve in that majority of the general population tends to fall in the middle categories NDNQI (National Database of Nursing Quality Indicators) - CORRECT ANSWER Helps give benchmarks and hospital specific measurements of nursing indicators Falls (with and without injury) Pressure ulcers RN surveys/satisfaction, pain assessment Restraints Nurse turnover HAI (VAPs, CLABSIs, CAUTIs) MORAL model - CORRECT ANSWER helps make ethical decisions M: massage the dilemma - identify and define issues, consider opinions of others and their value system O: outline the options - examine all options fully, make a list of pros and cons R: resolve the dilemma, review issues/options, apply ethical principles to each option, decide best option A: act on chosen option, actual implementation L: look back and evaluate entire process Refreezing - CORRECT ANSWER 3rd step of lewin's change model establishing change as the new habit Moving - CORRECT ANSWER The second step in Lewin's change model, in which new attitudes, values, and behaviors are substituted for old ones Question: A small group has been formed on the medical-surgical unit to implement change. Team members also have struggles over decision making and clarity of purpose. What stage of the Tuckman and Jensen's model is represented by members communicating their feelings but still viewing themselves as individuals rather than part of the team? A. Performing B. Norming C. Forming D. Storming - CORRECT ANSWER Storming Rationale: The storming phase is where competition and conflict are at their highest. Leadership behavioral theory - CORRECT ANSWER Based upon belief that leaders can be made and can learn to be successful leaders through teaching and observation Leadership trait theory - CORRECT ANSWER Based on the assumption that leaders are born with certain traits and characteristics (inherited character traits suited to leadership) that make them ideal leaders Belief people are born leaders or not Horizontal leadership - CORRECT ANSWER Leadership focus on collaboration and equality within group, everyone involved in objectives and protocols Vertical Leadership - CORRECT ANSWER top down style leadership organizational objectives, protocols, etc. are crafted at highest leadership level and transmitted down without seeking others input in design Unfreezing - CORRECT ANSWER first step of Lewin's change model - finding a method to let go of old pattern that was counterproductive in some way Motivating others and encouraging buy in (time for assessing and motivating) Sentinel event - CORRECT ANSWER Unintended event that results in SIGNIFICANT harm, physical or psychological to patient 6 aims of quality care by the IOM - CORRECT ANSWER 1. safe, 2. timely, 3. patient centered, 4. effective, 5. efficient 6. and equitable 8 steps of Quality Improvement - CORRECT ANSWER 1. Establish clear aim/purpose 2. Review the literature 3. Examine resources 4. Map current processes 5. Analyze root cause 6. Appropriate tools selected for analysis 7. Measures and metrics selected to measure success of initiative 8. Rapid Cyclical Review of plan, data, interventions, and outcomes Question: Failure mode-effect analysis is best used as follows: A. In response to a critical or sentinel event B. Prior to a process implementation or change C. As part of a random audit process D. In response to malfunctioning tools or equipment - CORRECT ANSWER B. Prior to a process implementation or change Rationale: The purpose of a failure mode-effect analysis is to anticipate potential problems; by virtue, this is best conducted prior to a process implementation. What are the 5 Ps of microsystem assessment? - CORRECT ANSWER Patients (characteristics) Professionals (who delivers care) Purpose (mission of setting) Processes (for delivering care) Patterns Complexity theory - CORRECT ANSWER belief that system self regulates and all things are connected. Rapidly changing, & unpredictable health care environment = expect the unexpected Focus on continual improvement roots in Chaos Model and quantum physics AKA quantum leadership? Complexity theory has developed from the field of: A. Nursing B. Business C. Industry D. Quantum Physics - CORRECT ANSWER Quantum Physics - chaos theory Quantum leadership - CORRECT ANSWER States that leaders must work together with subordinates to identify common goals and empower staff to make decisions for organizational productivity to occur based off chaos theory - getting employees involved in decision making, is outcomes based, and appreciates that the world is fluid and constantly changing. Public Policy Formation Phases - CORRECT ANSWER 1. Issue identification and agenda setting 2. Policy formation 3. Policy adoption 4. Policy Implementation 5. Policy Evaluation 6. Policy revision/amendment Logos - CORRECT ANSWER logical arguments - Thorough analysis: EBP, ensuring attention to detail Pathos - CORRECT ANSWER psychological appeal - emotions, needs, values Life long learner - CORRECT ANSWER CNLs role to pursue knowledge/skills Member of profession role - CORRECT ANSWER CNLs role accountable for ongoing skills/knowledge of profession, network, learning activities each year, etc. Question: The diabetes liaison on an adult medical-surgical unit informed the team that the unit was only 45% compliant with checking blood sugars within 15 minutes after a hypoglycemic event. The team decided to implement a process change to ensure the blood sugar recheck is completed within 15 minutes. The change was implemented and there was an increase to 85% compliance of hypoglycemic rechecks. What is the next step for the team in the PDSA cycle? A. Plan B. Do C. Study D. Act - CORRECT ANSWER Act Rationale: After analysis of the results of the trial (also known as study), the team will then act by devising the next steps based on the analysis. Healthy People 2020 - CORRECT ANSWER A set of disease prevention and health promotion objectives to meet to improve health of all Americans published by the US department of Health and Human Services (USDHHS) - 10 year national objectives 3 key beliefs for a person to take a health related action when utilizing the Health Belief Model - CORRECT ANSWER 1. person feels that a negative health condition could be avoided by doing new action 2. Have a positive expectation that by following new action, they will avoid a negative health condition 3. Believe that they can successfully take that new health action Health Belief Model - CORRECT ANSWER model for explaining how beliefs may influence behaviors focused on perceived susceptibility, severity, benefits, barriers, cues to action/readiness, and self efficacy Helps for motivating people to take positive health actions for those that use the desire to avoid a negative health consequence as the primary motivation (such as exercising to avoid an MI or condoms to avoid HIV) Question: The CNL has been requested to assist with end-of-life care decision making for an elderly homeless patient who has no family; he was deemed incompetent and is now unresponsive. The best decision- making guide that the CNL could use in this situation is: A. Plan-Do-Study-Act (PDSA) B. Autonomy model C. Orem's self-care theory D. MORAL model - CORRECT ANSWER MORAL model Rationale: This is a model that addresses ethical issues and guides an objective, orderly, and systematic decision. Capital budget - CORRECT ANSWER a budget that highlights a firm's spending plans for major asset purchases that often require large sums of money/purchases planned, medical equipment (ex. MRI), building expansions, infrastructure improvements - long term investments Transactional Leadership - CORRECT ANSWER leadership that motivates subordinates by rewarding them for high performance and reprimanding/punishing them for low performance Often not as positive outcomes Task/action oriented Intervenes only when standards not met Focuses more on those doing well Less creativity and problem solving Traditional systems theory - CORRECT ANSWER cycle of designing a system, results not occurring as predicted and then redesigning the system leaders think can control evolution of complex systems if have intentions - productivity as a function of the interplay everything interrelated Closed vs open system closed system - CORRECT ANSWER where individual organizations aren't dependent on community - self contained Open Systems Theory - CORRECT ANSWER A theory stating that any human system, such as an organization, is constantly influenced by and is influencing its environment (interacts internally and with its environment.) organizations are dependent on each other First party payers - CORRECT ANSWER Individuals responsible for payment for services rendered. Question: You, the CNL, are working in the ICU with a high volume of patients with prolonged Foley catheter use. What analysis tool is appropriate for the CNL to use in prevention of CAUTIs? A. Root cause analysis (RCA) B. Fishbone diagram C. St. Thomas risk assessment tool D. Failure mode-effect analysis - CORRECT ANSWER FMEA Rationale: The failure mode-effect analysis tool is a proactive risk assessment of high-risk or high-vulnerability areas that identifies and improves steps in a process, with a focus on failure prevention, not detection. Operating budget - CORRECT ANSWER A budget that states how managers intend to use organizational resources on a DAY TO DAY basis revenue and expense allocations, volume included Third party payers - CORRECT ANSWER governmental (medicaid/Medicare) or private insurance (Blue Cross) entities who pay for services provided Incidence vs. Prevalence rates - CORRECT ANSWER Incidence: rate of NEW dx cases of the disease Prevalence: number of cases ALIVE with the disease during a period of time SWOT analysis - CORRECT ANSWER strengths, weaknesses, opportunities, threats used as an analysis for implementing an initiative into a microsystem Identify how aspects may + or - effect the project Question: A nurse prepares to administer a patient's morning dose of metformin. After scanning the patient and the medication, a clinical alert appears on the computer screen warning of a possible interaction between the metformin and the CT contrast dye the patient received the day before. Based on this warning, the nurse chooses to hold the metformin and alert the pharmacy that this medication should be scheduled as held for 72 hours after receiving the contrast. This is an example of a: A. Clinical decision support system B. Health information technology C. Clinical alert warning system D. Decision tree - CORRECT ANSWER A. Clinical decision support system Rationale: Automated warnings within the EHR are an example of a clinical decision support system. The EHR itself is health information technology. While this was a clinical alert it also aided in guiding the nurse to action. Staffing mix - CORRECT ANSWER The mix of licensed and unlicensed staff and type of license cash flow budget - CORRECT ANSWER a budget that shows projected cash inflows and outflows for a specified period (anticipated or actual cash income/expenses) Transformational Leader - CORRECT ANSWER A leader who motivates people through charisma, sparks member interests, and builds loyalty and trusting relationships Problems become seen as a challenge to be solved Leader considers individuals, inspires and stimulates followers Leadership often leads to financial success for outcomes Higher attachment to organization Larger vision Health care literacy - CORRECT ANSWER capacity to obtain, process and understand basic health information and services to make appropriate health decisions CNLs can use the National Action Plan to improve health literacy resources Tertiary prevention - CORRECT ANSWER actions taken to contain damage once a disease or disability has progressed beyond its early stages help to return to an optimal state of health example: OT/PT post stroke PDSA (Plan-Do-Study-Act) - CORRECT ANSWER A four part continuous and ongoing process used to implement and test changes and improvements in a RAPID cyclical fashion - based on existing ideas, research, feedback, reviews, audits, or evidence create an AIM then .. Plan - planning change Do - try the change and observe it, usually smaller scale Study - analyze the results Act - Choose next steps to implement based on analysis , based on what was learned - refine change for larger scale Question: The health care team determines that the discharge process is ineffective and must be changed. The team determines the stakeholders and utilizes a force field analysis to weigh the pros and cons of the change. This was then used to motivate other team members and encourage buy in. Utilizing Lewin's theory of change, what stage is the team in? A. Sustaining B. Moving C. Refreezing D. Unfreezing - CORRECT ANSWER Unfreezing Rationale: The first step of Lewin's theory of change is the unfreezing stage. In order to battle the resistance of change, the leader must assess readiness for change and motivate others to see the reason for change. Secondary prevention - CORRECT ANSWER Efforts to diagnose illness early in order to limit the effects of an injury or illness Example: Screenings for cardiovascular disease, cancer, diabetes Primary prevention - CORRECT ANSWER preventing illness before onset examples: education on healthy habits, exercise programs and nutrition programs Healthy People 2020 goals - CORRECT ANSWER 1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages. Team Manager role - CORRECT ANSWER CNLs role that delegates and manages resources and serves as a leader and parter in interdisciplinary team; properly delegates and utilizes resources Root cause analysis (RCA) - CORRECT ANSWER tool to analyze occurrence of serious adverse events Used AFTER adverse event happens to identify underlying problems in the system It is not individual based follows protocol post mistake to collect data on the event, interviews, sequence of events, and identify how/why event occurred systems analyst role/Risk anticipator - CORRECT ANSWER CNLs role to do system reviews to improve care, anticipate risks to safety, & prevent medical errors Question: How can a CNL help to identify the general discharge needs of patients on his or her unit? A. Coordinate outpatient care and follow-up appointments B. Assess protective and predictive factors of patient health C. Discuss with each team's doctors the anticipated discharge needs of their patients D. Approach staff nurses about their patients' discharge needs - CORRECT ANSWER Assess protective and predictive factors of patient health Rationale: Assessing protective and predictive factors of patient health is the best way a CNL can identify potential needs or issues with patient discharges. Information Manager role - CORRECT ANSWER CNLs role to be IS and technology proficient for health outcomes 3 dimensions of safety - CORRECT ANSWER 1. safety climate - compliance with rules and no fault error reporting 2. Teamwork climate - collaboration and communication 3. Positive perception - working conditions, opinions of management Educator role - CORRECT ANSWER CNLs role to teach, utilize current information and technologies to facilitate learning of clients, groups, and professionals Outcomes Manager role - CORRECT ANSWER CNLs role to synthesize data/info and knowledge to evaluate and achieve optimal client and environment outcomes Clinician role - CORRECT ANSWER CNLs role to be accountable for health care outcomes - coordinator/evaluator of care, risk reduction, and health promotion Goal is to help lead and guide staff nurses with patient situations 8 essential components of CNL role - CORRECT ANSWER 1. Clinician 2. Outcomes manager 3. Educator 4. Information manager 5. Systems analyst 6. Team manager 7. Member of a profession 8. Life long learner Goal of CNL - CORRECT ANSWER day to day management of clinical issues and decisions, focusing on patient outcomes How does a CNL protect their profession? - CORRECT ANSWER Advance nursing - competency, advocate for CNL role/value, adhere to standards of practice Participate in education/professional organizations, influence government policy to protect rights of nurses, legislation, etc. Steps of FMEA - CORRECT ANSWER 1. select process to analyze 2. select team 3. describe the process - clearly define steps 4. identify what could go wrong during each step of process 5. pick which problems to work on eliminating 6. design and implement changes to reduce to prevent problems 7. measure success of process changes FMEA - failure mode effect and analysis - CORRECT ANSWER proactive analysis tool to help anticipate problems Helps identify weak points in a process, prevent failures of a process, and reduce/prevent errors BEFORE these have the chance to occur Can occur with NEAR MISSES - key opportunity to conduct it in order to analyze components that allowed for potential errors CNLs role with social Justice - CORRECT ANSWER community advocacy, EBP to ensure improved health outcomes Lobbying, examining legal processes, engaging policy makers to influence health policy, talking with local/state/fed lawmakers to influence health disparities and improve outcomes for populations/communities/home health care Patient Autonomy - CORRECT ANSWER The right of a patient to make informed and own choices regarding his or her health care. Patient Self-Determination Act - CORRECT ANSWER A federal law that mandates that every individual has the right to make decisions regarding medical care, including the right to refuse treatment and the right-to-die Patients must be asked for documents and be given info about advanced directives, living will/POA and education about them, and informed consent is accessible in the organization Directive Leadership - CORRECT ANSWER a leadership style in which the leader lets employees know precisely what is expected of them, gives them specific guidelines for performing tasks, schedules work, sets standards of performance, and makes sure that people follow standard rules and regulations Often helpful when employees are unskilled/inexperienced Ethos - CORRECT ANSWER speaker credibility - Expert knowledge in microsystem and trustworthiness 3 components of critical listening - CORRECT ANSWER 1. Ethos 2. Logos 3. Pathos SBAR - CORRECT ANSWER communication that should be utilized situation, background, assessment, recommendation Cultural Awareness - CORRECT ANSWER Self reflection/in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people Deontological Ethics - CORRECT ANSWER The idea that actions are right and wrong in themselves independently of any consequences The motives of the actor determine the goodness or value of the act - intention Teoleological Ethics - CORRECT ANSWER Consequentialist - value is based on outcomes of action theory of morality that derives duty or moral obligation from what is good or desirable as an end to be achieved. Ethical Relativism - CORRECT ANSWER suggests that what is ethical in one culture is not necessarily the same as in another culture bottom-up leadership - CORRECT ANSWER relies on wisdom/inputs of those involved with the work, seek meaningful input for interventions, procedures, workflow Cultural Knowledge - CORRECT ANSWER Information of culture, staying unbiased and finding out info about other cultures Cultural Competency Features - CORRECT ANSWER Cultural Awareness Cultural Knowledge Cultural Skills Cultural Interaction Cultural Sensitivity Precontemplation stage - CORRECT ANSWER stage of transtheoretical model of change in which people are unwilling to change their behavior Resistance, lack of knowledge, overwhelm - not considering change in next 6 months Core measures - CORRECT ANSWER key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs National standards of care/best practices and treatment processes for common conditions (such as stroke or asthma) Question: You are precepting a CNL student. She discusses her capstone project with you. She needs help determining the design of her study. She states that she will be working with diabetes patients on a medical unit. She intends to collect basic data and do a pre- and postintervention questionnaire based on the diabetes survival skills. She wants to compare the pre- and postdata to determine if her educational intervention was effective. She will not use randomization. What option best describes her study design? A. Well-designed randomized controlled trial (RCT) B. Quasi-experimental C. Meta-analysis D. Quality study - CORRECT ANSWER Quasi-experiment Rationale: A quasi-experiment is not a true experiment. A quasi-experiment does not have randomly assigned groups, but would include pre- and postmeasures. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) - CORRECT ANSWER standardized tool to measure 1. patient perception, 2. experience and 3. core measures Value based initiative by CMS DO NOT MEASURE: clinical outcomes, patient mortality, or readmission rates! What method do you use to analyze why mistakes occurred AFTER an adverse event has taken place? - CORRECT ANSWER RCA - Root cause analysis Pay for Performance (p4p) - CORRECT ANSWER performance-oriented incentives for hospitals and physicians to improve the quality of patient healthcare and disincentives inadequate outcomes Utilize HCAHPs payment strategy to reimburse based on quality of care provided (get more money if measures exceed benchmarks or if improve year to year) national program - hospitals must report quality measures What method do you use to analyze risks PRIOR to the error occurring? - CORRECT ANSWER FMEA - failure mode effect and analysis Cultural Skills - CORRECT ANSWER demonstrate ability to communicate efficiently, & INCORPORATE customs of person under their care Cultural Interaction - CORRECT ANSWER expand understanding and become more at ease when working w/ people from various cultural backgrounds Cultural Sensitivity - CORRECT ANSWER accept and understand individual's values/beliefs - show support, tolerance and empathy Palliative care - CORRECT ANSWER helps improve symptoms for those suffering from serious illness offers support to patient and family throughout illness and after death Question: As a CNL on a high-risk oncology unit, you recognize the need for regular access to chaplaincy services among your client population. You work with your unit and chaplaincy department to bring these services to your unit regularly. This is primarily an example of: A. Advocacy B. CNL role integration C. Leadership D. Lateral integration - CORRECT ANSWER Lateral Integration Rationale: Accessing resources across disciplines to meet the needs of a client population in a patient-centered manner addresses specifically lateral integration. How can a CNL help lessen errors during level of care transitions? - CORRECT ANSWER Can help to provide a screening process to identify higher risk patients Ensure support services arranged and patient understands clinical signs to call about and follow up plans What is a time during care that has a large potential for miscommunication, errors, oversight, patient safety lapses & stress for caregivers? - CORRECT ANSWER Transitions of care/Discharge Contemplation stage - CORRECT ANSWER stage of transtheoretical model of change in which people are considering changing behavior in the next 6 months seriously thinking about change in next 6 months, however may stay in stage for years because ambivalence/uncertainty Nonmodifiable vs. Modifiable Risk Factors - CORRECT ANSWER Nonmodifiable = age, race/ethnicity, fam history/genetics Modifiable = weight/obesity, sedentary lifestyle, smoking, alcohol intake, etc. should develop interventions based on MODIFIABLE risk factors National Patient Safety Goals (NPSG) for 2015 - CORRECT ANSWER -Improve accuracy of patient identification (2 pt identifiers) -Improve effectiveness of communication among caregivers -Improve Safety of using meds (label meds, accurate pt med info) -Reduce risk of HCAIs (EBP, comply with CDC and WHO guidelines) -Identify safety risks in population -Preventing wrong site, wrong procedure, wrong person surgery Risk reduction and patient safety are two important components of what? - CORRECT ANSWER Quality improvement (QI) Question: Use of electronic health records (EHRs) can aid the CNL to conduct quality improvement (QI) efforts in which of the following ways? A. Allow rapid access to informatics data, provide a way of ongoing monitoring, organize data into meaningful groups, and aid in the dedication of errors B. Allow rapid access to informatics data, ensure all staff follow protocols and policies, add second checks to medication administration, and aid in the detection of errors C. Provide a way of ongoing monitoring, add second checks to medication administration, organize data into meaningful groups, and aid in detection of errors D. Provide a way of ongoing monitoring, ensure all staff follow protocols and policies, add second checks to medication administration, organize data into meaningful groups, and aid in the detection of errors - CORRECT ANSWER A. Allow rapid access to informatics data, provide a way of ongoing monitoring, organize data into meaningful groups, and aid in the dedication of errors Rationale: Many EHR products can achieve each of these functions; however, not all are a part of QI efforts. Also, an EHR cannot ensure people act within established policies and procedures. Additionally, while an EHR can provide additional safeguards to medication administration and may improve safety, it does not help the CNL conduct QI efforts. 4 Goals of Disease Management - CORRECT ANSWER 1. Prevent chronic disease 2. Reduce costs 3. Improve quality of life 4. Reduce rates of death and disability preparation stage - CORRECT ANSWER stage of transtheoretical model of change in which people are seriously planning/getting ready to make a change within the coming month have taken some steps towards action Coordination in Lateral Integration - CORRECT ANSWER Coordinates flow of communication and services Intentional planning and direction Having clear understanding of roles, delegation and coordinating transitions of patient care Organizing toward a common goal, Intentional planning and direction, fostering systems that encourage collaboration Collaboration of lateral integration - CORRECT ANSWER Utilizing all disciplines and their resources to meet the needs of client population Problem solving interdisciplinary process shared responsibility for decision making - working towards a common goal shared governance - CORRECT ANSWER a method that aims to distribute decision making among a group of people, teamwork to improve staff satisfaction, productivity, and patient outcomes. Collective ownership to develop and improve practice shared leadership - CORRECT ANSWER simultaneous, ongoing, mutual influence process in which people share responsibility for leading and achieving goals Action stage - CORRECT ANSWER Stage of transtheoretical model of change in which people are actively changing a negative behavior or adopting a new, healthy behavior modifying behavior Question: The CNL works in a medical intensive care unit (MICU) at a level one trauma center. The CNL conducts a comprehensive assessment of the microsystem. All of the following are vital aspects that the CNL would need to identify within the microsystem except: A. The rate of ventilator-associated pneumonia B. The organization's operating budget C. The top three diagnoses D. The average age of patients - CORRECT ANSWER The organization's operating budget Rationale: The assessment of the microsystem focuses on the small, frontline unit, which does not include the organization's operating budget. The rate of nosocomial infections, top diagnoses, Communication for lateral integration - CORRECT ANSWER Liaison, foster open rapport, share clear goals and plans, keep all involved informed Verbal vs non verbal awareness; active listening Maintenance stage - CORRECT ANSWER stage of change in which people maintain behavioral change for up to five years starts after 6 months of continuous successful behavior change CNLs should focus on education, prepare for struggles of potential relapse and offer strategies to promote success to prepare for this time 3 key parts of EBP - CORRECT ANSWER 1. Evidence use 2. Patient preferences/values 3. Clinical/professional judgement EBP is used when there are 1 or more best practices that can be applied to clinical practice 4 components of lateral integration - CORRECT ANSWER 1. Communication 2. Collaboration 3. Coordination 4. Evaluation Question: As the CNL on a medical floor, you recognize the importance of annual flu vaccinations, especially considering your geriatric population. How can you promote vaccination rates within your population? A. Organize a flu clinic for staff and visitors B. Ask a physician to order flu shots for all admitted patients, and organize a flu clinic for staff and visitors C. Within the hospital, develop a nurse-driven protocol that allows nurses to place an order for flu shots for your population D. Ask the physician to order flu shots for all admitted hospital patients - CORRECT ANSWER C. Within the hospital, develop a nurse-driven protocol that allows nurses to place an order for flu shots for your population Rationale: Nurse-driven protocols are an excellent way to ensure that the population receives vaccinations. Flu shots may not be appropriate for all hospitalized patients, based on personal beliefs or current treatment, and should not be mass ordered. Lateral Integration - CORRECT ANSWER integrating unified/holistic care provided by multiple interdependent disciplines across continuum of care, helps break down barriers and manage care proactively to meet needs of client population CNL is seen as lateral integrator of care - helps facilitate, coordinate and oversee care by health care team, decrease fragmentation of care, improve complex needs Evaluation for lateral integration - CORRECT ANSWER Evaluate the delivery system and processes - monitor outcomes, implementation, and progress, - what's working well? What is not? Look at relevance of information How to know if do EBP process or Research Process? - CORRECT ANSWER if there is best practices shown in literature then no gap in knowledge in literature, you can conduct an EB project If after looking in literature there is gap in knowledge in the research, then you need to design own research study What is Kotter's 8 step plan used for? - CORRECT ANSWER assessing microsystem's readiness to change Coaching vs. Mentoring - CORRECT ANSWER Coaching: evaluate team members with constructive feedback, ongoing 2 way process to share knowledge and experiences Mentoring: long term relationships focused on clinical advancement Research Process Steps - CORRECT ANSWER 1. Identify problem 2. Review literature 3. Design a study 4. Write proposal 5. Obtain IRB approval 6. Collect and analyze data 7. Present or publish findings Question: You are the CNL in an outpatient pediatric clinic. The most common diagnosis for your patient population is asthma, and your patients are frequently seen at local emergency departments (EDs) for asthma exacerbations. Which action most directly optimizes the level of function in daily life for these patients? A. Provide or reinforce previous education to patients and families on asthma and inhaler use B. Review discharge orders and ensure that all clients are prescribed a long- and short- acting inhaler C. Provide an in-service at local schools to educate teachers on managing asthma exacerbations in children D. Advocate for the development of a nurse phone triage to answer urgent patient and family asthma concerns - CORRECT ANSWER -Review discharge orders and ensure that all clients are prescribed a long- and short- acting inhaler Rationale: Many of these interventions can help promote knowledge on what to do in the event of an asthma exacerbation; however, ensuring that each patient has the proper inhalers best optimizes the daily level of function. Kotter's 8 steps Change Model - CORRECT ANSWER 1. Establish a sense of urgency 2. Create a guiding coalition 3. Developing a vision and strategy 4. Communicating the change vision 5. Empowering broad based action 6. Generating short term wins 7. Consolidating gains and producing more change 8. Anchoring new approaches in the culture PICOT question - CORRECT ANSWER P- patient population of interest I- intervention of interest C- comparison of interest O- outcome expected T- time Level of Evidence Hierachy - CORRECT ANSWER 1 - systematic review/meta analysis of RCTs and EBP guidelines 2 - one well designed RCT 3 - quasi experimental studies without randomization 4 - well designed case control or cohort study 5 - systematic reviews of descriptive/qualitative studies 6 - single descriptive or qualitative study 7 - expert opinion Cohort study - CORRECT ANSWER study where a group of exposed individuals and a group of non-exposed individuals are followed over time to determine the incidence of disease retrospective or prospective Retrospective: exposures are defined before looking at the existing outcome data to see whether exposure to a risk factor is associated with a statistically significant difference in the outcome development rate Prospective: follows participants for a defined period to assess the proportion that develop the outcome/disease of interest. Case control study - CORRECT ANSWER study design used to identify factors that may contribute to a medical condition by comparing a group of patients who have that condition with a group of patients who do not. retrospective - look back to assess whether there is a statistically significant difference in the rates of exposure to a defined risk factor between the groups Descriptive study - CORRECT ANSWER Observational studies which describe the patterns of disease occurrence in relation to variables such as person, place and time or used to describe characteristics of a population or phenomenon being studied no cause and effect What format should you use to help identify a clinical question? - CORRECT ANSWER PICOT Question HP2020 indicators - CORRECT ANSWER access to services preventative services environment injury/violence maternal/infant/child health mental health nutrition/obesity/physical activity Oral health Reproductive/sexual health Social determinants Substance abuse Tobacco Emergency assessment of level of responsiveness - CORRECT ANSWER AVPU: Alert Verbal stimuli response Painful stimuli response Unresponsive Rapid Primary Assessment - CORRECT ANSWER ABCs (airway/spine stabilization, breathing, circulation/bleeding) Then DE - Disability (neuro status) and E (exposure, unclothed complete assessment) Nursing Process - CORRECT ANSWER ADPIE Assessment Diagnosing/Analysis Planning - priority setting, goals, and outcomes Implementing Evaluation - assess outcomes and goal attainment, apply any modifications to plan PQRST - CORRECT ANSWER Provocative/palliative Quality Region/radiation Severity Timing CAGE assessment - CORRECT ANSWER used for substance use Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? TWEAK questionnaire - CORRECT ANSWER questionnaire for assessing alcoholism Tolerance (number of drinks to feel 'high') Worry (close friends/family worried about drinking in last year) Eye opener Amnesia (person told you things you don't remember saying/doing) Kut down (do you feel you need to cut down on your drinking) Tolerance and worry are 2 points each, others 1 pt→ Greater than 2 points is a drinking problem Secondary/indirect data - CORRECT ANSWER client data obtained from family members, support, health care team, dx tests, current research, etc. Functional Assessment - CORRECT ANSWER Assessment used to evaluate activities of daily living, self care abilities, self esteem, nutrition, interpersonal relationships/resources, environment, abuse, coping techniques SOAP Note format - CORRECT ANSWER Subjective data Objective data Assessment - interpretation, conclusions, problems, Plan - consults, rationales, tests EBP Process Steps - CORRECT ANSWER 1. Identify a clinical question 2. Gather relevant articles/literature/evidence 3. Critique evidence (evidence hierarchy 7 levels, quantitative? qualitative? etc.) 4. Synthesize evidence and patients views (strengths and limitations of research) 5. implement EB Change 6. Evaluate outcomes 7. Present/Publish findings 5 stages of group development - CORRECT ANSWER 1. Forming 2. Storming 3. Norming 4. Performing 5. Mourning/adjourning Storming - CORRECT ANSWER the second stage of development, characterized by conflict and disagreement/lack of unity, concerns voiced, disagree over what the team should do and how it should do it, must be able to grow together in order to move onto 3rd step Norming - CORRECT ANSWER 3rd stage of group development - group now established, ground rules and agendas set, everyone's on same page, working in safe environment, opinions shared openly and valued Forming - CORRECT ANSWER First stage of team development, coordinator sets mission, team members meet each other, seeing if goals meet, form relationships, some uncomfortable silence & seeking safe/trusting environment Direct costs - CORRECT ANSWER directly related to provision of a service identified to individual patient or activity (linen change, supplies for a dressing, food provided throughout day) Medicaid - CORRECT ANSWER sponsored by states and federal government for low income and or disabled individuals ICD-9-CM - CORRECT ANSWER International Classification of Diseases, 9th Revision, Clinical Modification used for documenting diagnoses and procedures, assigned a DRG and used to create patient charges Contingency Organizational Theory - CORRECT ANSWER Dependent on environment Performance can be enhanced by matching an organizational structure to its environment DRG (Diagnosis Related Group Classification) - CORRECT ANSWER used by Medicare and other payers to determine reimbursement to organizations and providers Case mix - CORRECT ANSWER Variety of categories of patients (type and volume) treated by a healthcare organization and representing the complexity of the organization's caseload the best way to create a budget. It looks at human and material costs and environmental resources. The nurse manager of a regional home health services company allows the employees to determine solutions for change, and always considers their opinions, suggestions, and concerns. What type of leadership style is the manager demonstrating? A. Autocratic B. Laissez-faire C. Consultative D. Democratic - CORRECT ANSWER Democratic Rationale: Democratic leadership involves the whole group in the decision-making process. indirect costs - CORRECT ANSWER costs of doing business not directly related to specific individuals (heat, electricity, water, etc.) - still charged to the patient Medicare - CORRECT ANSWER A national health insurance program that helps pay for health care for people over age 65 Delegation - CORRECT ANSWER The assignment of new or additional responsibilities to a subordinate Know team members' skills, experiences and competencies in order to assign tasks to team members perform with the necessary knowledge, skills and competency to comply with standard of practice. Adjourning/Mourning - CORRECT ANSWER achieved the mission/goals that were set, termination of group, can feel sense of loss Performing - CORRECT ANSWER 4th stage of group development - all are accountable and responsible for project; tasks are being completed, strengths and weaknesses already identified, collaboratively working to manage outcomes, implement measurable processes and outcomes [Show More]

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