Download - HESI Review for Leadership 2010

8/3/2019 HESI Review for Leadership 2010

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Leadership Review


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Skills of the Nurse Manager Communication

Organization

Delegation

Supervision

Critical thinking


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Characteristics of the Nurse

Manager Authority Accountability

Responsibility Leadership Commitment to Quality

* Questions often included examples ofnursing interventions which DO or DONOT demonstrate these skills andcharacteristics.


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Classic Leadership Styles Democratic: Assertive

Authoritarian: Aggressive

Laissez-Faire: passive


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Communication Skills

(Being Assertive) Clearly defined goals and expectations

Verbal/Non-verbal messages congruent

Critical to the directing phase ofmanagement

Assertive communication starts with Ineed rather than you must.


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Motivation The nurse manager can provide an

environment that will promote motivation:

Positive feedback Respect

Seeking input

* Motivation comes from within an individual.


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Organizational Skills People

Time

Supplies/resources


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Delegation State Nurses act gives authority to RNs

to delegate.

Process by which responsibility andauthority are transferred to another

individual


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Responsibility: the obligation to complete atask

Authority: the right to act or command theaction of others

Accountability: the ability and willingness toassume responsibility for actions and relatedconsequences


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The nurse transfers responsibility andauthority to others.but retains

Accountability.

Use the 5 rights to determine

delegation


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5 Rights of Delegation Right task

Right circumstance

Right person

Right direction/communication

Right supervision


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Supervision Skills Direction/Guidance:

Clear, concise directions

Expected outcome

Time Frame

Limitations

Verification of assignment


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Evaluation/Monitoring:

Check in frequently

Communication lines

Achievement of outcomes


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Follow-up:

Communication evaluation findings to the

LPN or UAP and other appropriatepersonnel

Determine if teaching/guidance is needed


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Critical Thinking Skills

(Use the Nursing Process) Assessment: What are the needs/issues?

Analysis: What is the highest priority?

Planning:

What outcomes/goals must be accomplished? What are the available resources? (staff, team

members, time, equipment, space etc.)


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Implementation:

Communicating expectations

Is documentation complete?

Evaluation:

Where the desired outcomes achieved?

Was safe, effective care provided?


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Any activity requiring nursing judgmentCANNOT be delegated

Delegating to the right person requires thatthe nurse be aware of the qualifications ofthe delegate. (training, skills, education anddemonstrated/documented competence)


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RN is Accountable for:

Direction, Evaluation and Follow-up for

LPNs

Graduate nurses

Inexperienced nurses

Student nurses UAPs


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Priorities

Assessed first

Significant change in condition

Most critically ill

Safety and infection control are highpriority when determining roomassignments


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LPNs

Implements basic nursing process afterthe RN has evaluated client and

determined plan of care


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LPNs

Inspect

Document

Administer what medications?

Obtain

Skills


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UAPs

Assist with ADLs

Document intake/output

Telling

Assisting

Ambulating Bed making


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Lewins Change Theory

Unfreezing: Initiation of change

Moving: Motivation/moving towardthe change

Refreezing: Implementation of achange


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Skills of Change Agents

Problem-solving

Decision making

Interpersonal

* Change causes anxiety. The changeagent must also show respect, valueopinions, and build trust.


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Collaborative HealthcareTeams

1. Shared goals, commitment andaccountability

2. Open and clear communication

3. Respect for the expertise of all teammembers


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Critical Pathways

Interdisciplinary plan of care

For diagnoses and care that can be

standardized

A guide to track client progress

Does NOT replace individualized care

Positive or negative variance


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Case Management

Coordination of care provided by aninterdisciplinary team

Manages resources effectively

Use critical pathways to organize care


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Quality Assurance

CQI: Continuous Quality Improvement

TQM: Total Quality Management

both are organized approaches to theimprovement of:

Outcome achievements

Quality of care provided


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Legal Aspects of Nursing

Nurse Practice Act: Governs thenurses responsibility in making

assignments. Educational preparation

Experience

Knowledge


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Negligence and Malpractice(Unintentional Tort)

Negligence: Performing an act that areasonable and responsible person would not

do. (Would a reasonable and professionalnurse under the same circumstance act in thesame manner?)

Malpractice: professional misconduct, orunreasonable lack of skill in carrying outprofessional duties.


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4 Elements are necessary toprove Negligence or Malpractice

1. Duty: Obligation to use due care.(What a reasonable and responsible

nurse would do). Failure to care foror protect others against reasonablerisks.

The nurse must anticipate risks


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2. Breach of Duty: Failure to performaccording to the standards of practice

3. Injury/Damages: causes actualdamage or injury to the client(physical or mental)

4. Causation: A connection existsbetween the conduct and the injury


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Hospital policies: provide a guide for nursingactions. They are NOT LAW, but courts

generally rule against nurses who do notfollow hospital guidelines.

Incident reports: alert administration topossible liability claims and the need forfurther investigation. They DO NOT protectagainst legal action.


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Assault: mental or physical threat, forcingwithout touching. (forcing a client to take

medication..sneaking medication into foodor drink. Forcing a client to take treatment.

Battery: Touching with or without the intentto harm. (hitting or touching a client). If acompetent adult refuses a treatment, and isforced, a battery has occurred.


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Invasion of Privacy

False Imprisonment: confinementwithout authorization

Exposure of a Person: Exposure ordiscussion of a clients case. After

death, the client has a right to beunobserved and protected.


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Invasion of Privacy

Defamation: Divulgence of privilegedinformation or communication (charts,

conversations, or observations)


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Fraud

Willful and purposefulmisrepresentation that could cause, or

has caused, loss or harm to a person orproperty. Presenting false credentials (nursing

school, licensure)

Describing no truths in treatments Telling a client that the procedure will hurt,

when indeed there is pain involved!


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NOT reporting suspected child abuse isconsidered a crime

It is he nurses legal responsibility to reportsuspected child abuse.


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Assisting or giving aid to a person in thecommission of a crime makes that person

equally as guilty of the crime.

Omitting an act where there is legal duty toperform is a crime.

Refusing to assist in the birth of a child if suchrefusal results in an injury to the child.


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Nursing Practice Act and theLaw

Civil Procedures: Methods used toprotect the rights of psychiatric clients.

Voluntary Admission: client admitshim/herself to an institution for

treatment and retains civil rights.


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Nursing Practice Act and theLaw

Involuntary Admission: Someone otherthan the client applies for admission into an

institution.

Emergency Admission: Any adultmayapply for emergency detention of another.

However, medical or judicial approval isneeded to keep them more than 24 hours.


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Legal and Civil Right ofPatients

Right to:

1. Wear their own clothes, keep personal

items, and a reasonable amount ofcash

2. Have individual storage space for their

own use3. See visitors daily


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Legal and Civil Right ofPatients

Right to:

4. Have reasonable access to phone and

opportunity to have privateconversations by telephone

5. Right to receive and send (unopened)mail

6. Right to refuse shock treatments orlobotomy


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Competency

Competency Hearing: Legal hearingthat is held to determine a persons

capability to make responsible decisionsabout self, dependents, or property.


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Competency

Persons declared incompetent have the legalrights status of a minor, they cannot:

Vote Make contracts or wills

Drive a car

Sue or be sued

Hold a professional license

A legal guardian is appointed by the court


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Insanity: a legal term meaning theaccused is not criminally responsible for

the unlawful act committed because ofmental illness


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Inability to stand trial: not mentallycapable of standing trial. He/She:

1.

Cannot understand the charge againsthim/her

2. Must be sent to a psychiatric unit untillegally determined competent for a trial

3. Once the individual is mentally fit, he/shemust stand trial and serve any sentence, isconvicted


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Patient Identification

Use at least 2 patient identifierswhenever taking blood samples, admin.

meds, or admin. blood products.

Patient room number MAY NOT be used

as a form of identification.


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Surgical Permit

Consent to operate, must be obtained priorto any surgical procedure, however minor itmight be.

Legally, the surgical permit must be:

1. Written

2. Obtained voluntarily3. Explained to the client (informed consent)

must be obtained


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Surgical Permit

Surgery Permits:

1. Must be witnessed by an authorized personsuch as a healthcare provider or a nurse.

2. Protect the client against unnecessarysurgery and protect the healthcare

provider/surgeon, hospital, and hospitalstaff against possible claims of unauthorizedoperations


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Surgical Permit

3. Adults and emancipated minors maysign their own operative permits if

they are mentally competent.4. Permission to operate on a minor child

or an incompetent adult or

unconscious adult must be obtainedfrom a responsible family member orlegal guardian.


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Surgical Permit

If HESI asks who should explain theprocedure:

The ans: The Provider

The nurses responsibility is to make

sure it is signed and on the chart beforethe procedure, it is NOT the nursesresponsibility to explain the procedure


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Consent

The law does notrequire written consent toperform medical procedures.

Client must be fully informed Can be treated with verbal consent

If informed consent can not be obtained,emergency laws can be applied (if treatmentmeans to save life or limb)

Ex: unconscious patient arrives in ED


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Verbal Consent

Describes in detail how and why verbalconsent was obtained

Placed in the clients record

Witnessed and signed by 2 persons


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Written or Verbal Consent

Alert, coherent, competent adults

Parent or legal guardian

Person having right to make decisionsfor the client


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Good Samaritan Act

Protects health practitioners againstmalpractice claims for care provided in

emergency situations

The nurse is required to perform in a

reasonable and prudent manner


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Prescriptions/Orders

Phone orders: read-back

Cannot alter orders in any way


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What if ???????

He/she (RN) believes order isWRONG????

Inform the healthcare provider/physician Record the physician was informed

Inform nursing supervisor

Refuse to carry out the prescription


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What if ????????

He/She (RN) believes the order is ofpoor judgment?

Record provider was notified andquestioned

Carry out the order (nursing judgmentcannot be substituted for medical

judgment)


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What If???????

The nurse is asked to perform a task ofwhich they have not been educationally

prepared for or that is out of theirscope of practice?

Inform the provider that he/she does not

have education or experience Refuse to carry out the prescription


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Restraints

Restraints of any kind can beconsidered false imprisonment without

an order

Freedom from restraints is a basic

human right and is protected by law


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Restraints

Can only be applied

In an emergency

For a limited time For the limited purpose of protecting the

client from injury

N i R ibiliti


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Nursing Responsibilities(Restraints)

Nurse must notify theprovider/physician immediately that the

client has been restrained Document the facts regarding the

rationale for restraining the client

Use restraints after exhausting allreasonable alternatives


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Restraints

Apply restraints properly

Check frequently to ensure no damage

or injury to the client Remove restraints as soon as possible


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HIPAA

Ensures patient privacy/confidentiality


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Which client(s) would be appropriate to assign a newlygraduated RN, who has recently completed orientation?(Choose all that apply)

An anxious chronic pain client who frequently uses the callbutton

A second day post-op who needs pain medication prior todressing changes

A client with HIV who reports a HA and abdominal andpleuritic chest pain

A client being discharged with a surgically implanted catheter


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You are caring for a patient with esophagealcancer. Which of the following can be

delegated to the nursing assistant?

a. Assist the patient with oral hygiene

b. Observe the patients response to feedings

c. Facilitate expression of grief or anxiety

d. Initiate daily weights


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In caring for a patient with oral cancer, which taskwould be appropriate to delegate to the LPN/LVN?(Select all that apply)

a. Assist the patient to brush and floss

b. Explain when flossing and brushing arecontraindicated

c. Give antacids and sucralfate suspension as orderedd. Recommend saliva substitutes


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You are the charge nurse. Which client is mostappropriate to assign to the step-down unit nursepulled to the intensive care unit?

a. A 68-year-old client with acute respiratory failureand respiratory acidosis

b. A 72-year-old client with COPD and normal ABGswho is ventilator dependent

c. A 56-year-old new admit with DKA on an insulindripd. A 39-year-old client on a ventilator with narcotic

overdose and respiratory alkalosis


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Which of the following cancer patients couldpotentially be placed together as roommates?

a. A patient with a neutrophil count of 1000/mm3b. A patient who underwent debulking of a tumor to

relieve pressure

c. A patient receiving high-dose chemotherapy after a

bone marrow harvestd. A patient who is post-op laminectomy for spinal

compression


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In caring for a patient with neutropenia, whattasks can be delegated to the CNA? (Choose allthat apply)

a. Take VS every 4 hoursb. Report temp > 100.4c. Assess for sore throat or coughd. Gather supplies to prepare the room for protective

isolatione. Report superinfections, such as candidiasisf. Practice good handwashing technique.


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The MD has written the following orders.The clients morning assessment revealsbounding peripheral pulses, a 2 lb weight

gain, pitting edema, and moist cracklesbilat. What would you do first?

a. Initiate daily weights

b. Maintain accurate intake and outputc. Restrict fluids to 1000-1500 per dayd. Adminster Furosemide 40mg


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You are the charge nurse for the coronary care step-downunit. Which patient is best to assign to an RN who hasfloated for the day from the general medical-surgical floor?

a. Patient requiring discharge teaching about a coronary arterystent.b. Patient receiving IV furosemide to treat acute left ventricle

failurec. Patient just transferred from the radiology dept. after a

coronary angioplasty

d. Patient just admitted with unstable angina and who hasorders for a heparin infusion and aspirin.


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You are ambulating a cardiac surgery patient whohas telemetry cardiac monitoring when anotherstaff member tells you that the patient has

developed superventricular tachycardia with a rateof 146 bpm. In which order will you take theseactions?

a. Call the patients physician

b. Have the patient sit down

c. Check the patients BP

d. Administer 02 via nasal cannula


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During the initial post-operative assessment of apatient who has just been transferred to the PACUafter repair of a AAA, you obtain all of the followingdata. Which has the most immediate implications

for the patients care?

a. The arterial line indicates a blood pressure of190/112

b. The monitor shows sinus rhythm with frequentPACs

c. The patient does not respond to verbal stimulid. The patients urine output is 100 mL of amber urine


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A new RN is preparing to administer PRBCs to a client whoseanemia was caused by blood loss after surgery. Which actionby the new RN requires that you, as the charge nurse,intervene immediately?

a. The new RN waits 20 minutes after obtaining the PRBCsbefore starting the infusion

b. The new RN starts an IV access for the transfusion using a 22-gauge catheter

c. The new RN primes the infusion set with Lactated Ringers

d. The new RN tells the client that the PRBCs can cause a seriousreaction.


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A group of clients is assigned to an RN-LPN/LVNteam. The LPN/LVN is most likely to be assignedto provide client care and administer meds to which

of these clients?a. A client in renal failure who needs epoetin (Procrit)

b. A client who needs Vancomycin with peaks andtroughs

c. A client who needs a last dose of chemotherapy

d. A client who needs a blood transfusion


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A client is admitted to the ER after a MVA. He does notremember the accident. He is awake and oriented to persononly. He is confused regarding time, month and the city helives in. Pupils are equal and reactive to direct light. He c/o ofa severe HA and is becoming restless. What is your priority at

this time?

a. Continue to stimulate the patient to keep him oriented

b. Restrain him to keep him safe from injury

c. Perform neuro checks every 15 minutes

a. Administer Demerol for pain and restlessness.


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Which assignment would be appropriate fora L&D nurse who will be working for oneshift on a Medical-Surgical floor?

a. A 3-year-old with croup

b. A 30-year-old with malignant hypertension

c. A 40-year-old with unstable angina

d. A 50-year-old with congestive heart failure


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After receiving shift report, which client would you assess first?

a. A 20-year-old with a possible acute myelogenous leukemiawho has arrived on the medical unit.

b. A 38-year-old with aplastic anemia who needs teaching aboutdecreasing risks for infection.

c. A 40-year-old with lymphedema who requests help putting oncompression stockings before getting OOB.

d. A 60-year-old with non-Hodgkins lymphoma who is refusingthe ordered chemotherapy.


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You are preparing to admit a patient with aseizure disorder. Which of the followingactions would you delegate to the LPN/LVN?

a. Document the admission assessment

b. Set up 02 and suction equipment

c. Place a padded tongue blade at the bedside

d. Check the room to make sure it is clean


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After a patient has a seizure, whataction can you delegate to the nursing

assistant?a. Document the seizure

b. Initiate neuro checks

c. Restrain the patientd. Take the patients VS


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A patient has been placed in fixed skeletal tractionwith a halo fixation device. When caring for thispatient the nurse will delegate which of the

following to the LPN/LVN? (Choose all that apply)

a. Check the patients skin for pressure from thedevice

b. Assess the patient neurological status

c. Observe the halo insertion sites for signs ofinfection

d. Clean the halo insertion sites with alcohol


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After receiving the am. shift report, which of these clients willyou see first?

a. A 23-year-old with a migraine who is complaining of severe

nausea associated with retching

b. A 45-year-old who is scheduled for a craniotomy in 30 min.and needs preoperative teaching

c. A 59-year-old with Parkinsons who needs a swallowing

assessment before breakfast

d. A 63-year-old with multiple sclerosis who has an oral temp of101.8 and flank pain

Download - HESI Review for Leadership 2010

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