Chapter 17: Organization of Patient Care My Nursing Test Banks

Chapter 17: Organization of Patient Care

MULTIPLE CHOICE

1. A nurse manager is engaged in a process designed to achieve goals in dynamic, competitive environments through allocation of resources. This process is called:

a.

process improvement.

c.

strategic planning.

b.

total quality improvement.

d.

market analysis.

ANS: C

Strategic planning is the process by which specific goals are met through an allocation of resources. It also involves clarifying the organizations philosophy, mission, and vision and analyzing the current environmental state.

PTS: 1 DIF: Application REF: UNIT STRATEGIC PLANNING

2. A student asks a nurse manager why they should use a SWOT analysis. The nurse manager explains that a SWOT analysis is:

a.

useful in strategic planning.

b.

an acronym for a type of quality improvement technique.

c.

a financial management term.

d.

a human resource process.

ANS: A

A SWOT analysis is an environmental analysis used in strategic planning to measure an organizations strengths (S), weaknesses (W), opportunities (O), and threats (T).

PTS: 1 DIF: Application

REF: ASSESSMENT OF EXTERNAL AND INTERNAL ENVIRONMENT

3. A nurse manager is composing a vision statement for the organization. The nurse should include which of the following of the four elements of a sound vision statement?

a.

It is written down.

b.

It is written in the present tense using action words.

c.

It covers a variety of activities and spans specific short-term time frames.

d.

It balances the needs of providers, patients, and the environment.

ANS: C

An effective vision statement will include a range of activities that can be accomplished within a specified time frame.

PTS: 1 DIF: Application REF: VISION STATEMENT

4. A nurse has just started to work for an organization that employs a shared governance organizational framework. The nurse understands that this type of framework is grounded in a philosophy of decentralized leadership; however, the nurse understands that which of the following may not necessarily be correct regarding shared governance?

a.

It implies the allocation of power and control.

b.

It fosters autonomous decision making.

c.

It consists of mutually interested or vested parties.

d.

It encourages professional liaisons among all hospital levels.

ANS: D

Shared governance is an organizational framework positioned in a framework of decentralized leadership, and it implies the allocation of control, power, or authority (shared) and fosters autonomous decision making and professional nursing practice among mutually (shared) interested parties such as management and clinicians (not all hospital levels).

PTS: 1 DIF: Application REF: BENNERS NOVICE TO EXPERT

5. The nurse is informed that the clinic employs all four principles of the whole-systems shared governance. The nurse knows that which of the following is NOT one of these four principles?

a.

Partnership

c.

Accountability

b.

Collaboration

d.

Ownership

ANS: B

The principles of whole-systems shared governance are partnership (implies horizontal linkages between nursing and other staff roles), equity (staff roles are based upon relationships, not titles), accountability (individuals are accountable for their actions), and ownership (individuals own the work they perform).

PTS: 1 DIF: Comprehension REF: SHARED GOVERNANCE

6. A nurse works for an organization using a shared governance model, and she understands that, under such a model, structures are generally divided into multiple councils. Which council would the nurse join in order to participate in establishing practice standards for a workgroup?

a.

Education council

c.

Clinical practice council

b.

Quality council

d.

Management council

ANS: C

The purpose of a clinical practice council is to provide the practice standards for that workgroup. An education council assesses the learning needs of the unit staff and designs and develops programs to meet those needs. A quality council credentials staff and oversees quality management initiatives. A management council ensures that the standards of practice and governance are agreed upon and upheld and that there are adequate resources to deliver safe patient care.

PTS: 1 DIF: Analysis REF: CLINICAL PRACTICE COUNCIL

7. A nurse manager is a strong proponent of the concept of learning organizations as a means to promote professional practice through the encouragement of personal mastery and awareness of ones mental models. This concept was developed by:

a.

W. Edwards Deming.

c.

Florence Nightingale.

b.

Peter Senge.

d.

Philip B. Crosby.

ANS: B

Peter Senges (1990) seminal work, The Fifth Discipline, discussed the concept that learning organizations promote professional practice through the encouragement of personal mastery (beyond our competence and skills to an ongoing expansion of our current knowledge), awareness of our mental models (mental models influence how we take action and consist of deeply ingrained assumptions, generalizations, and biases), and team learning (a workgroups ability to align and develop their talents to attain a shared goal or vision). W. Edwards Deming and Philip B. Crosby are best known for their contributions to the continuous quality movement. Florence Nightingale was one of the pioneers of nursing practice, and she promoted the link between unsanitary conditions and adverse patient outcomes.

PTS: 1 DIF: Comprehension REF: EDUCATION COUNCIL

8. The nurse manager is aware that situational leadership maintains there is no one best leadership style, but rather effective leadership lies in matching the appropriate leadership style to the individuals or groups level of task-relevant readiness. The nurse manager wishes to help promote and develop the managers staff and followers. Under the situational leadership model, which of the following is not necessarily correct to achieve this outcome?

a.

Coaching

c.

Collaborating

b.

Supporting

d.

Delegating

ANS: C

Hersey and Blanchards (1993) situational leadership framework is based upon four stages of behavior through which leaders can move back and forth as they determine which style they need to use to promote staff development. These stages are directing, coaching, supporting, and delegating (not collaborating).

PTS: 1 DIF: Application REF: SITUATIONAL LEADERSHIP

9. A nurse manager is trying to develop a means to facilitate professional staff development by building upon the skills, abilities, and experience of each practitioner. This method is otherwise known as:

a.

career enhancement.

c.

the novice to expert model.

b.

clinical ladder.

d.

situational leadership model.

ANS: B

The use of a clinical ladder is a means of ensuring staff competence, and it acknowledges that staff members have varying skill sets and abilities based upon their education and experiences. The clinical ladder helps to evaluate these abilities and rewards each staff member differently according to his placement in the designed (ladder) clinical structure.

PTS: 1 DIF: Comprehension

REF: ENSURING COMPETENCE AND PROFESSIONAL DEVELOPMENT

10. A nurse manager is attempting to devise a statement that reflects the purpose of a health care agency. This statement is referred to as which of the following?

a.

Core values

c.

Vision

b.

Philosophy

d.

Mission

ANS: D

An organizations mission statement reveals its purpose, direction, and reason for existence. A philosophy is a statement of beliefs based upon core values (inner forces that give it purpose). A vision statement reflects the organizations vision (foresight) of what it wants to be.

PTS: 1 DIF: Comprehension REF: MISSION STATEMENT

11. A nurse manager is using Benners (1984) novice to expert model for clinical and career promotion ladders in order to provide a framework for facilitating professional staff development. Which of the following is not necessarily one of the five stages of Benners novice to expert model?

a.

Novice

c.

Competent

b.

Beginner

d.

Expert

ANS: B

Benners novice to expert model consists of five stages of experience: novice, advanced beginner (not just beginner), competent, proficient, and expert.

PTS: 1 DIF: Comprehension

REF: TABLE 17-1 BENNERS MODEL OF NOVICE TO EXPERT

12. The nurse manager decides to use the Bassett Healthcare Professional Nursing Pathway model because it builds upon the original work by Benner regarding clinical ladder stages. The nurse manager knows that which of the following is not necessarily a stage in this model?

a.

Novice

c.

Preceptor

b.

Competent

d.

Expert

ANS: C

The four stages of the Bassett Healthcare Professional Nursing Pathway model are Stage I, novice; Stage II, competent; Stage III, proficient; and Stage IV, expert. While being a preceptor for either clinical or managerial tasks can be an example of a proficient or expert individual who has been selected to train others, it is not one of the stages of this particular model.

PTS: 1 DIF: Comprehension

REF: FIGURE 17-5 PROFESSIONAL NURSING PATHWAY

13. A nursing instructor wants to determine whether the students understand accountability-based care delivery systems. During the class, the instructor explains that the system emphasizes that accountability is based upon several elements. When questioned about the elements, which response by the students would indicate that further teaching is needed?

a.

Processes, not outcomes

c.

Individually defined

b.

Inherent in the role

d.

Foundation for evaluation

ANS: A

Accountability-based care delivery systems focus upon roles, their relationship to the work being done, and the goals or outcomes they are to achieve. Elements of this type of system are that accountability is about outcomes, notprocesses, is individually defined, is inherent in the role, is not delegated, and is the foundation for evaluation.

PTS: 1 DIF: Analysis REF: ACCOUNTABILITY-BASED CARE DELIVERY

14. A nurse manager is developing a comprehensive unit-based performance quality improvement program that includes outcomes tracked from four domains. Which of the following would the nurse manager least likely choose as one of the domains?

a.

Process

c.

Cost

b.

Service

d.

Clinical quality

ANS: A

Unit-based quality improvement programs need to track certain aspects of care that reflect the units goals in order to ensure their compliance with regulatory and quality initiatives. These outcomes should come from four domains: access, service, cost, and clinical quality. Process is not included, but various processes will be used in the tracking and monitoring procedures.

PTS: 1 DIF: Analysis

REF: UNIT-BASED PERFORMANCE IMPROVEMENT

15. A student nurse asks a nurse educator what the Bassett Healthcare Quality Compass is used for. The nurse educator responds that it is used for:

a.

staff evaluation and promotion.

c.

quality assurance.

b.

accountability-based care delivery.

d.

unit-based performance improvement.

ANS: D

The Bassett Healthcare Quality Compass can be used to display the outcomes of unit-based performance improvement programs such as patient satisfaction, cost, and utilization.

PTS: 1 DIF: Application

REF: UNIT-BASED PERFORMANCE IMPROVEMENT

16. A nurse manager is employing the Bassett Healthcare Quality Compass and is aware of its four domains, which are:

a.

functional status, patient satisfaction, clinical outcomes, and cost/utilization.

b.

patient satisfaction, clinical improvement, resources, and utilization.

c.

clinical outcomes, cost, resources, and patient satisfaction.

d.

utilization, functional status, cost, and clinical improvement.

ANS: A

The Bassett Healthcare Quality Compass is comprised of four unit quality improvement outcome domains. These domains are functional status, patient satisfaction, clinical outcomes, and cost/utilization.

PTS: 1 DIF: Application

REF: UNIT-BASED PERFORMANCE IMPROVEMENT

17. A nurse asks the nurse manager how accountability in health care-related professions can be evaluated. The nurse manager explains that staff accountability can be evaluated by:

a.

their actions and the ability to state when they have been wrong.

b.

the ability to support their actions and justify the results.

c.

the ability to report, justify, or explain actions.

d.

processes and experiences.

ANS: C

Individuals who are deemed accountable are able to report, explain, or justify their actions. For example, a nurse who assigned a NAP to bathe a patient and discovers that this has not been done although it is nearing the end of the shift takes responsibility for this task and might talk with the NAP to see why this was left undone, complete the task with the NAP, complete the task themselves, or report this undone task to the next shift or unit manager.

PTS: 1 DIF: Application REF: INTRODUCTION

18. A nurse manager is developing a mission statement for an organization and must consider several questions. Which of the following questions is not necessarily part of developing a mission statement for the organization?

a.

What do we stand for?

b.

What principles are we willing to defend?

c.

Who are we here to help?

d.

Where are we going?

ANS: D

Organizational mission statements state the purpose of the organization. Questions that need to be asked when developing this statement are What do we stand for?, What principles are we willing to defend?, and Who are we here to help? The question of where we are going pertains to more long-range goals, which are reflected in the vision statement of an organization.

PTS: 1 DIF: Application REF: MISSION STATEMENT

19. A student nurse has frequently heard the name Senge, and he asks a nurse educator who Senge was. The nurse educator explains that Senge was:

a.

a pioneer in quality management.

b.

an insightful leader who advocated intuitive thinking for nursing process.

c.

an advocate for nursing education and improved clinical conditions and experiences.

d.

a leader in how individuals learn in organizations.

ANS: D

Peter Senge is best known for his pioneer work on learning organizations. His own definition of learning organizations is organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together (Senge, 1990, p. 3).

PTS: 1 DIF: Application REF: EDUCATION COUNCIL

20. A nurse manager is deciding on a specific target that the unit desires to attain within the timespan of 1 year. This target would be a(n):

a.

goal.

c.

objective.

b.

initiative.

d.

project

ANS: A

Goals and objectives are used in the strategic planning process. A goal is a specific aim or target that the unit wishes to achieve within the timespan of 1 year. An objective is a measurable step to be taken to reach the goal (outcome). Performance measures include these goals and objectives in their process improvement plans.

PTS: 1 DIF: Comprehension

REF: GOALS AND OBJECTIVES

21. The Director of Nursing (DON) has issued a policy that allows the nursing staff to self-schedule. In addition, the DON actively seeks input from the nursing staff when making decisions that will affect them. The DONs actions are consistent with which of the following?

a.

Shared governance

c.

Laissez-faire leadership

b.

Autocratic leadership

d.

Critical thinking

ANS: A

By allowing nurses to participate in self-scheduling and encouraging their participation in decision making, the DON is facilitating shared governance. Shared governance is an organizational framework grounded in a philosophy of decentralized leadership that fosters autonomous decision making and professional nursing practice.

PTS: 1 DIF: Application REF: SHARED GOVERNANCE

22. You have a BSN and 2 years of nursing experience. You provide accountable and competent practice. You are able to work independently and to coordinate a team using appropriate delegation and supervision. According to Benner, you would be considered to be in which stage of nursing?

a.

Novice

c.

Proficient

b.

Competent

d.

Expert

ANS: B

According to Benners Professional Nursing Pathway, you would be considered a competent nurse. Competent nurses are also qualified to serve as preceptors.

PTS: 1 DIF: Analysis

REF: FIGURE 17-5 PROFESSIONAL NURSING PATHWAY

23. You would like to advance in your career and have submitted your portfolio for review. The supervisor has identified a group of peer reviewers. According to the Bassett Healthcare Professional Pathway Algorithm, the purpose of the peer reviewers would include which of the following?

a.

Finding fault in your nursing practice

b.

Identifying areas of strength as well as areas for professional/practice development

c.

Discussing your portfolio with nurses outside your organization

d.

Assisting the organization in controlling costs which might result from excessive promotions

ANS: B

According to the Bassett Healthcare Professional Pathway Algorithm, the purpose of the peer reviewers would include identifying areas of strength as well as areas for professional/practice development. After the peer review and discussion, the peer group would make their decision concerning your promotion recommendation.

PTS: 1 DIF: Application

REF: FIGURE 17-6 THE BASSETT HEALTHCARE PROFESSIONAL PATHWAY ALGORITHM

24. As the nurse manager of your unit, there are times when you must be autocratic; however, in most situations, you encourage the participation and involvement of all your staff. Today, in a meeting with a group of APNs, you did not take the lead. Based on all of your approaches, your leadership style is most likely which of the following?

a.

Transactional

c.

Democratic

b.

Transformational

d.

Situational

ANS: D

Situational leadership maintains that there is no one best leadership style, but rather that effective leadership lies in matching the appropriate leadership style to the individuals or

groups level of task-relevant readiness.

PTS: 1 DIF: Analysis REF: SITUATIONAL LEADERSHIP

25. The nurse manager is revising the unit-based performance improvement plan and considers such issues as service, cost, access, and clinical quality. These components are tracked through which of the following?

a.

Outcomes

c.

Clinical practice area

b.

Staff education

d.

Nurse-patient ratios

ANS: A

The unit-based performance improvement plan must consider outcomes. Outcomes should be tracked from the four domains of access, service, cost, and clinical quality

PTS: 1 DIF: Application

REF: UNIT-BASED PERFORMANCE IMPROVEMENT

MULTIPLE RESPONSE

1. The nurses on your unit are developing a vision statement that will be consistent with the vision statement of the organization. The unit vision statement would include which of the following elements? Select all that apply.

a.

It is written down.

b.

It is written in present tense, using action words, as though it were already accomplished.

c.

It includes the units policies related to patient care and staff behavior.

d.

It covers a variety of activities and spans broad time frames.

e.

It balances the needs of providers, patients, and the environment. This balance anchors the vision to reality.

f.

It states the procedures to be used when providing safe, effective care.

ANS: A, B, D, E

The units vision statement would include the following elements: It is written down, It is written in present tense, using action words, as though it were already accomplished, It covers a variety of activities and spans broad time frames, and It balances the needs of providers, patients, and the environment. This balance anchors the vision to reality. The vision statement does not include policies or procedures; they would most likely be found in the policy and procedure manual.

PTS: 1 DIF: Application REF: VISION STATEMENT

2. A nurse complains to the supervisor that horizontal violence (bullying) is occurring on the unit. The nurse most likely indicates to the supervisor that which of the following was occurring on the unit? Select all that apply.

a.

Intimidation

d.

Faultfinding

b.

Verbal abuse

e.

Support

c.

Camaraderie

f.

Elitist attitude

ANS: A, B, D, F

Horizontal violence (HV), also known as bullying, is described as aggressive behavior towards individuals or group members by others (Hastie, 2002). It is a little-known phenomenon that recent evidence demonstrates is prevalent in the workplace of practicing Registered Nurses. Horizontal violence contributes to nursing turnover and undermines a culture of professional nursing practice. Examples of HV include acts of unkindness, dishonesty, and divisiveness such as gossip, verbal abuse, intimidation, sarcasm, elitist attitudes and faultfinding. It is often said that nurses eat their young.

PTS: 1 DIF: Application REF: EVIDENCE FROM THE LITERATURE

3. Which of the following are major components of Relationship-Based Care that support patients and families? Select all that apply.

a.

Leadership

d.

Elitism

b.

Teamwork

e.

Outcomes measurement

c.

Resource-driven practice

f.

Professional nursing practice

ANS: A, B, C, E, F

The six major components of Relationship-Based Care that support patients and families include leadership, teamwork, resource-driven practice, outcomes measurement, professional nursing practice, and patient care delivery. Elitism is not a component of Relationship-Based Care.

PTS: 1 DIF: Comprehension

REF: COORDINATING COUNCIL

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