Final Spr 10 Student Syllabus

8/13/2019 Final Spr 10 Student Syllabus

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N 138 Sections 1 & 3

N 138Leadership andManagement

Student Course Syllabus

Spring 2010

Spring 2010 page 1 of 61


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Table of Contents

San Jos State University Greensheet N 138, Leadership and Management Section 1-3,Spring 2010 .............................................................................................................................. 3

N 138 Course Schedule........................................................................................................ 10

Detailed Course Calendar N 138 ........................................................................................... 11

N 138 Class Evaluation Form ................................................................................................ 17

N 138 Group Presentations .................................................................................................... 18

Rubric for N138 Graded Student Activity (30 points)...........................................................21

CRITIQUE OF GROUP MEMBERS ON GRADED STUDENT ACTIVITY .................... 22

WORKSHEET: Leadership Characteristics In class activity ~ Optional .......................... 23

Emotional Intelligence Work Sheet (20 Points) N138...........................................................24

Mentor Paper (5 Points) .........................................................................................................25

Patient Advocacy Exercises ................................................................................................... 38

Legalities, Errors and Breakdowns ........................................................................................ 41

Medicare lists 10 medical errors it won't pay for...................................................................47

Ethics Worksheet ................................................................................................................... 50

Quality Quiz...........................................................................................................................52

Classic Principles of Change..................................................................................................55



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San Jos State University Greensheet N 138, Leadership and Management Section 1-3,

Spring 2010

Instructor: Lori Rodriguez

Office Location: HB 403

Telephone: (408) (924-4136)

Email: [email protected]

Office Hours: TBA

Class Days/Time: Wed 1500-1700

Classroom: IRC 302

Instructor: Mojgan Harirfar

Office Location:

Telephone: 408-296-3934


Office Hours: After class by appointment


Classroom: HB 408

Instructor: Susan McNiesh

Office Location: HB 413

Telephone: 408-924-3151


Office Hours: By appointment


Classroom: IRC 302/308



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Facul ty Web Page and MYSJSU Messaging (Optional)

Copies of the course materials such as the syllabus, major assignment handouts, etc. may befound on Blackboard. You are responsible for regularly checking with the messaging systemthrough MySJSU (or other communication system as indicated by the instructor).

Course Descrip tion and Goals

Applies the nursing process using the systems approach to nursing management recognizingthe influences of human diversity and cost containment. Encompasses models and theoriesof management and leadership, quality improvement, ethics, safety and focuses on the roleof the professional nurse.

Student Learning Objectives1. Evaluate the nursing management role in current and future health care

environments, including change, communication, decision making, conflictresolution, quality management and empowerment

2. Apply systems theory to the nursing management role in health care settings, usingconcepts which promote flexibility in adapting to health care environment changes.

3. Analyze management skills and leadership styles and leadership styles of effectivenurse managers.

4. Analyze decision-making models using problem solving, ethical decision-making

and quality improvement frameworks regarding the management of patient/clientcare.

5. Select concepts from leadership and management theories to plan ways to recruit,motivate, evaluate, and retain diverse staff.

6. Explain economic principles as they relate to cost containment and budgeting.

7. Discuss methods of interacting/communicating with staff from a variety ofethnic/cultural perspectives especially when working in groups.

8. Devise strategies to address common nursing management problems includingdelegation and supervision.

9. Analyze ethical, legal and cultural issues encountered in the nursing managementrole.

10. Plan strategies for developing the professional role of the nurse.

11. Compare the use of information systems in a variety of agencies and the effect on patient care

12. Evaluate the role of the nurse in case management and outcomes evaluations



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13. Describe the role of networking of the nurse leader to promote improved client care.

14. Analyze the function of the Board of Registered Nursing in granting licensure andcontrolling standards of practice.

15. Compare the standard of practice in a variety of specialty nursing groups

Required Texts/Readings

Textbook

American Psychological Association. (2001). Publication manual of the American

Psychological Association (5 th ed.). Washington, DC: Author.

Sullivan, E. (2003). Becoming influential: A guide for nurses. New Jersey:

Prentice-Hall.

Kelly, P. (2007). Nursing leadership and management . New York:Del-Mar Learning.

Nursing practice act with rules and regulations (most recent). Sacramento, CA:

California Board of Registered Nursing. Can be purchased fromwww.lexisnexis.com/bookstore for $16.00 Contains ALL regulations and related statutessuch as Title 16, Education Code, and relevant parts of the business and professional code.

Other readings (or recommended readings)Can be found on WebCT/Blackboard

Library Liaison (Optional)

The Library Liaison is Valeria XXX provides expert service to all nursing students who seekassistance on research and finding references. She can be emailed at XXX.

Classroom Protocol

All students are required to attend class or view the webcast (ONLY IF YOU ARE SIGNEDUP FOR THE WEBCAST). If you are viewing the webcast the activities in class are to beturned in to the instructor within 4 days of the webcast, including an evaluation of the class.Because the class is more effective with group participation, you are encouraged to attendclass. Class will begin promptly at 3:00 pm and last until 5:00 pm and include breaks. Cell

phones should be off or placed on vibrate. If you are attending class in the IRC food isdiscouraged.

http://www.lexisnexis.com/bookstorehttp://www.lexisnexis.com/bookstore


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Dropping and Adding

You are responsible for understanding the policies and procedures about add/drops,academic renewal, etc. found at http://www.sjsu.edu/registrar/. You should be aware of thenew deadlines and penalties for adding and dropping classes.

Assignments and Grading Policy

1. Evaluation is a continuous process and is the responsibility of both the instructor andthe student.

2. Late assignments are not accepted unless there has been an agreement previously between the faculty member and the student. If you are turning in an assignment late,attach an email confirmation between us that states that both of us were aware of theassignment being late.

3. Students are expected to complete all assignments and grades for individualassignments will be posted on WebCT/Blackboard.

4. While it is possible to get an A in this class, students should not expect an automaticA as has been given in other process classes. The subject of leadership is essential tothe success of the baccalaureate nurse and should not be taken lightly

5. No handwritten assignments will be accepted.

Assignment Maximum Points Percentage of grade

Emotional Intelligence 20 10%

Mentoring 5 2.5%

Class Participation 10 5%

Graded Student Activities 30 15%

ATI 10 5%

Midterm #1 50 25%

Midterm #2 50 25%

Final 25 12.5%

University Policies

Academic integrityStudents are expected to be familiar with the Universitys Academic Integrity Policy. Yourown commitment to learning, as evidenced by your enrollment at San Jos State University,and the Universitys Academic Integrity Policy requires you to be honest in all youracademic course work. Faculty members are required to report all infractions to the Office



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of Student Conduct and Ethical Development. The policy on academic integrity and otherresources related to student conduct can be found at http://sa.sjsu.edu/student_conduct .

All SJSU Policies in the Catalog, Schedule of Classes, and Academic Senate apply to thiscourse (see http://info.sjsu.edu/static/catalog/policies.htm )

Please note, policies related to Academic Integrity, S02-04 and S03-7, can be found athttp://sa.sjsu.edu/download/judicial/Academic_Dishonesty_Policy.pdf andhttp://www2.sjsu.edu/senate/S04-12.htm .

With the increased use of the internet, frequently students unknowingly violate the plagiarism policy. At SJSU, plagiarism is the act of representing the work as ones ownwithout giving appropriate credit. It includes incorporating the ideas, words, sentences,

paragraphs, or parts thereof, without giving appropriate credit.

Prior to completing assignments for this course please go to:http://www2.sjsu.edu/leap/plagiar.htm and read the complete description of plagiarism. Youshould also see the SJSU Library Tutorial on Avoiding Plagiarism athttp://tutorials.sjlibrary.org/plagiarism/index.htm . If you have any questions regardingAcademic Integrity, please ask the faculty for clarification.

http://sa.sjsu.edu/student_conducthttp://sa.sjsu.edu/student_conduct


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Campus Policy in Compliance with the American Disabilities ActIf you need course adaptations or accommodations because of a disability, or if you need tomake special arrangements in case the building must be evacuated, please make anappointment with me as soon as possible, or see me during office hours. PresidentialDirective 97-03 requires that students with disabilities requesting accommodations must

register with the DRC (Disability Resource Center) to establish a record of their disability.Special accommodations for exams require ample notice to the testing office and must besubmitted to the instructor well in advance of the exam date.

Student Technology Resources (Optional)

Computer labs for student use are available in the new Academic Success Center located onthe 1 st floor of Clark Hall and on the 2 nd floor of the Student Union. Additional labs areavailable in the NLRC. Computers are also available in the Martin Luther King Library.

A wide variety of audio-visual equipment is available for student checkout from MediaServices located in IRC 112. These items include digital and VHS camcorders, VHS andBeta video players, 16 mm, slide, overhead, DVD, CD, and audiotape players, soundsystems, wireless microphones, screens and monitors.

Learning Assis tance Resource Center (Optional)

The Learning Assistance Resource Center is designed to assist students in the developmentof their full academic potential and to motivate them to become self-directed learners. The

center provides support services, such as skills assessment, individual or group tutorials,subject advising, learning assistance, summer academic preparation and basic skillsdevelopment. The Learning Assistance Resource Center is located in Room 600 in theStudent Services Center.

SJSU Writing Center (Optional)

The SJSU Writing Center is staffed by professional instructors and upper-division orgraduate-level writing specialists from each of the seven SJSU colleges . Our writingspecialists have met a rigorous GPA requirement, and they are well trained to assist all

students at all levels within all disciplines to become better writers.

Web-cast vi ewing

Students who elect to watch class via the web-cast must complete and submit the exercisedesigned for the web cast viewing within 4 days of class. Failure to do so will result in the

http://www.sjsu.edu/writingcenter/about/faculty/http://www.sjsu.edu/about_sjsu/facts_and_figures/colleges/http://www.sjsu.edu/about_sjsu/facts_and_figures/colleges/http://www.sjsu.edu/writingcenter/about/faculty/


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N 138 Course Schedule(Note: This is an abbreviated course calendar to give you an overview of where we aregoing. Refer to the Course Calendar on Blackboard of Assignments and Readings.

Major assignments with points connected are in BOLD

Week Date Topics, Readings, Assignments, Deadlines

1 1/27 Introductions

2 2/3 ATI

3 2/10 Essential characteristics of leaders, Leadership and ManagementPrinciples ESSENTIAL IN CLASS ACTIVITY THIS DAY(Puzzle)

4 2/17 Organizational Culture and Leadership and Management

5 2/24 Prioritization, Delegation, and Supervision Due : Emotional

Intelligence Activity 6 3/3 Time and Resource Management

Supervising and coaching performance

7 3/10 Midterm #1

8 3/17 Legalities

9 3/24 Ethical theories and Patient Advocacy

3/31 NO CLASS

11 4/7 Errors, Breakdowns, the IOM

12 4/14 Quality Improvement and Managing Outcomes

13 4/21 Midterm #2

14 4/28 Occupational Opportunities and Interviewing ~ Part 1

15 5/5 Change Theory

16 5/12 ATI Exam

Final Exam


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Detailed Course Calendar N 138

Date Topics Activities Assignments Group Presentat

1/27 Introductions Introductions

Sign up for group presentations

Orientation to thecourse reader,greensheet, coursecalendar requirementsand Change Paperdirections

2/3 ATI EXAM 1

2/10 Essentialcharacteristics of

Leaders andLeadership Styles

THIS CLASSMAY NOT BEVIEWED BYWEBCAST

Puzzle Activity

After completing theassigned readings forthis class, brieflyanswer or discuss thefollowing questions and

be prepared to shareyour ideas in class:

What leadershipstyles do youfrequently see?

What kind of a

leader would youlike to be? How does

leadership styleaffect participant

productivity?

Read: Kelly:Chapter 1: NursingLeadership and Management

Read Sullivan (2003) Chapter 1 & 2Becoming Influential: A guide for nurses

Optional Module: If you would like to brush up on your presentation skills, thensee the module/reference: PresentationSkills for SJSU Nursing Students (Can befound on WebCT/Blackboard). It is areview and can be used as a reference later.

Graded student Leadership Styl

Meet with the ininstructions.

Addititonally: Ecommon leadersand give two ex

be effective andeffective. Providmanager and a lHow do we kno

Each member oof the following

(1) Trait theorie

(2) behavioral thfaire

(3) Situational th


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(4) transactiona

(5) transformati

2/17 Organizational

Culture andLeadership andManagement

If you are viewing by webcast, Completethe in class activitiesand write an evaluationof the group

presentation. Submit via

blackboard email to theinstructor no later thanSunday

Why work at a magnethospital? What are theforces of magnetism?

Discussion: Identify arole model: Describeyour nursing role modeland explain why youhave selected this nurse.How did this role modelinfluence your nursing

practice? What, if any,impact did this rolemodel have on you.Discuss how aspects ofthe ideal leader are also

present in the practiceof your role model.

Read Kelly, Chapter 2 & 3 OrganizationalBehavior and Magnet HospitalsRead: Sullivan: Ch 1-2

Graded student (you may write how the unit thato answer the fohospitals should1. What categoris the difference

2. Who (categorcharge of the da

3. What supportunit?

4. Is there a manit?

5. Who does the

6. Is shared gov

7. What are the

8. Give a brief dfacility.

2/24 Prioritization,Delegation and

Supervision

If you are viewing by webcast, Completethe worksheets that areon blackboard and turnthem in and write anevaluation of the group

Prioritization andDelegation Exercises(print out fromBlackboard)

PowerPoint presentation onPrioritization andDelegation (slides can

be found onBlackboard)

Complete the Emotional IntelligenceActivity (Available on Blackboard) andturn in 2/24

Read: Kelly (2007) Chapters 16, 17, 18

The California Nurse Practice Act(Excerpts on Blackboard)

Group presentatdiscuss and presChapter 18 to thInclude in discu

ABC of prioritizMaslow's hieraradvantages and (6) The triangle


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3/3 Time andResource

Management

Supervising andCoaching others

performance




Read Kelly, Chapter 18 on TimeManagement and PrioritizationandChapter 29 focusing on "The Nurse asa First time Manager of a Small PatientGroup" p. 628-634.

3/10

Midterm (1 hour)

. Midterm (1 hour)

3/17 Legalities PowerPoint presentation Read: Kelly, P. (2007). Chapter 23: Legal

aspects of health care

Graded student of the Outline choose 4 differe


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If you are viewing by webcast, Completethe in class activities(errors and breakdownworksheet and write anevaluation of the group



on Chapter 23

Read: ATI section on Legalities p. 19-24.

In the introduction to chapter 23, there is asmall case study. Please read, answer and

be prepared to discuss in class.

being broken inor all from the nsections. Presendiscuss how youThen you willscenarios on the

3/24 Ethical theoriesand

responsibilities

And patient

advocacy




Bring Ethics Worksheetto class (found onBlackboard)

Question for groupdiscussion: Why shoulda nurse behaveethically? (There areseveral possible reasonsdiscussed in the text.)Make a powerfulargument for ethical

behavior. If you are notin class answer this in a

paragraph and get it toyour instructor no laterthan 4 days after class.

Print out the worksheet

on Patient Advocacy inBlackboard and answerthe questions. Be

prepared to discuss youranswers

Read: Kelly, P. (2007). Chapter 24:Ethical aspects of Healthcare

Read over ATI section on Ethics: Chapter2 p. 10.

Read chapter one of Ethics and Conflict

on BlackboardComplete the Ethics Worksheet onBlackboard and bring to class prepared todiscuss the answers.

READ: On WebCT/Blackboard: Priest,C.(2005). Held liable. Reflections on

Nursing LEADERSHIP. 20-22, 36.

READ: Kelly, P. (2007). NursingLeadership and Management. DelmarPublishing p. 213-214; 507-508

READ: Page 1-2 of ATI Leadership book

Graded student debate describedissue and debate


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3/31 No Class

4/7 Errors,Breakdowns, the

IOM


presentation.Submit via blackboardemail to the instructorno later than Sunday

Discussion of error and breakdown worksheet.

Power Point slides onthe IOM and discussion

Compete error and breakdown worksheetand be prepared to discuss in class.

Read: Baker. (1997). Rules outside therules for administration of medication.Image: Journal of Nursing Scholarship,29:2 155-158.

Read : Henneman, E. (2007) UnreportedErrors in the Intensive Care Unit: A CaseStudy of the Way We Work. Critical Care

Nurse 27(5) p. 27-34.

Graded student information on treport? How to are important. M

groups through breakdowns wo

The presenting sarticle "unreport

both Mr. L and Mwithout naminginto four groupserrors. The preswas not mentionerrors: communMethod for impdiscussed in cla

4/14 QualityImprovement and

ManagingOutcomes

If you are viewing by webcast, Completethe in class activitiesand write an evaluation

of the group presentation. Submit via


Quality WorksheetRead Kelly (2007) Chapter 20 onManaging Outcomes

Ask your preceptor or the manager of theunit you are working on what qualityindicators they are working on in yourunit. Bring this information to class fordiscussion.

Complete quality worksheet onBlackboard

4/21


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4/21 Midterm

4/28

Occupational

Opportunities andInterviewing

. *Read Kelly Chapter 27

Panel Discus

5/5 Change Theory

If you are viewing by webcast, Completethe in class activities

and write an evaluationof the group presentation.

Submit via blackboard email to theinstructor no later thanSunday

Discuss: In changetheory What is a drivingforce? What is arestraining force?

What strategies forchange have you seenthat work?

Read: Kelly (2007) Chapter 13Change, Innovation, and ConflictManagement

Read: Outline: 6 Stages of Change onWebCT/Blackboard.

Print a copy of Classical Principles ofChange from Blackboard and bring toclass

Mentor Assignment due

Graded student situation to chanwork through alshould meet witover the steps of

Examples of topthis list or you c

1. Problem: Usimaintaining pati

2. Problem: HigIntroducing a neto decrease patie

3. Problem: Uphto leather or was

The rest of the dsheet on Blackb

5/12 ATI

FINAL


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N 138 Class Evaluation Form

To be used if missing a class: This form must be submitted to your instructorelectronically by the Saturday at midnite after the class in order to received credit for

attending the class.

1. The class that I missed was on _______(date) and the topic was_________________

2. What I learned from viewing the webcast was(List 3 major points)

3. This will increase my ability to

4. This will increase patient safety by(optional)

5. I need further information on.

6. Overall, I felt that the content of the class was

Excellent Good Average Poor

7. I think this class could be improved by

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N 138 Group Presentations

This grid is set up for a 30 student class. If less students remove 1 from sharedgovernance, job seeking, or the change activity.

Week

2/10

The Puzzle Activity and Leadership Styles

6 Students: Meet with the instructor 1 week prior toclass to get your instructions.

Part 2: Each member of this group is then to present adescription of the following leadership theories or concepts.(1) Trait theories (2) behavioral theories: autocratic,

democratic, and laissez faire (3) Situational theory; ( 4)transactional leader; (5) transformational leadership

2/17

Organizational CultureEach student is to provide a chart (you may write on the board) or

bring a prepared chart of how the unit that you are assigned to isorganized. Be able to answer the following questions. (At least twodifferent hospitals should be represented)1. What categories of staff nurses are on the unit, and what is the

difference between them?2. Who (category not the name of the person) is in charge of thedaily activities on the unit?

3. What support personnel are assigned and present on the unit?

4. Is there a management structure for the unit and what is it?

5. Who does the manager report to?

6. Is shared governance in place?

7. What are the councils and do they work?

8. Give a brief description of upper management of your facility.

2/24Prioritization, Delegation and Supervision

4 Students: Members of this group are to discuss and present thetime management tools in Chapter 18 to the rest of the class, usingexamples. Include in discussion: (1) the Pareto Principle (2) ABC of

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prioritizing include review of table 18-2; (3) Maslow's hierarchy; (4)Review end of shift reports advantages and disadvantages; (5) Shiftaction plan; (6) The triangle hierarchy in Ch. 18

Members of this group are then to lead small groupdiscussions on prioritize in various nursing situations.

Situations will be provided by the instructor

3/3 NO STUDENT ACTIVITY

3/17

Law Activity

4 students: Using the Legal part of the Outline for Errors andBreakdowns worksheet, choose 4 different laws that you have

observed or heard of being broken in the clinical setting. You maychoose any or all from the negligence, malpractice, and breech of

duty sections. Present the details of what you have seen and discusshow you as a manager would address these issues. Then you willlead small groups through the first 4 scenarios on the worksheet

3/24

Ethics Debate

4 students using the format for debate described on p. 526 of Kellywill choose an ethical issue and debate it in front of the class. You

will then lead small groups through the Patient Advocacy worksheet.

4/7

Error and Breakdowns Activity

4 students will present information on the IOM reports: What iscontained in each report, how to get this information; and why thereports are important. Then you will lead small groups through the

remaining scenarios on the Errors and breakdowns worksheet.

The presenting students will provide a summary of the article"Unreported Errors in the Intensive Care Unit" for both Mr. L and

Mr. C outlining the sequence of evnts witout naming the errors.Then they will divide the class into four groups and each group findand name 1-2 errors. The presenting group will point out the errors

that were not mentioned by the class as well as the category oferrors: communication, and failure of collaboration.

4/14 NO STUDENT ACTIVITY

MIDTERM #2

4/22OCCUPATIONAL OPPORTUNITES AND INTERVIEWING

NO STUDENT ACTIVITY

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5/6

The Change Activity

4 students are to present a situation to change from the list below.They are then to work through all aspects of managing the change.Students should meet with the instructor in advance in order to go

over the steps of managing the change.

Steps for presenting changeA. State the specific problem requiring changeB. Describe the clinical situation that this change will

addressC. Describe how you will validate that change is

needed (environmental survey, benchmarking,interviews and the pros and cons of each

C. Identify individual/s and/or committee/s involvedD. Make a statement of desired changeE. Assign the role of change agent and target/s for

changeF. Identify 3 driving forces (factors that promote thechange) and 3 restraining forces (factors or co-existing problems that will discourage the desiredchange).

G. Identify a plan to make the change that illustratesthe use of at least 5 change principles (Shouldhave at least 5 steps and 5 principles).

H. How will you measure if the change is effective?

EXAMPLES of topic for presentation are on this list-You areencouraged to choose your own.

1. Problem: Using same stethoscope for multiple patients maintaining patient safety/prevention of infection

2. Problem: High stress prior to a special procedure. Introducing anew intervention: Use of essence of lavender to decrease patient

stress prior to special procedures

3. Problem: Upholstered chairs in patient areas changing to leatheror washable surface

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Rubric for N138 Graded Student Activity (30 points)

Criteria Excellent 6 pts* Fair 3 pts Poor 0 pts

Prework

points)

Presenters provide ahandout or outline,slides (if being used) arecompleted and turned inand ready to be used Alist of group participantsis given to the instructor

One or more are missing None of the prework is provided.

Content

pts)

Accurate, current,complete, supported by

professional literature,on topic.

Accurate, current,supported by

professional literature

Either inaccurate or notcurrent.

No support from professional literature.

Content presentation)

Organized, creative andinteresting, speakersspeak loudly andclearly.

Organized, speakerstalked too fast or tooquietly

No clear attempt toengage audience,unpolished,unprofessional.

Professional andappropriate references

Four references provided, referred to,and on topic.

Less than 4 references provided and there is noreferral to the references

No references providedor references are offtopic

Evaluation of teammembers

)

A thoughtful, reflectivecritique of teammembers contribution isturned in. (only given 5

pts*

Ratings do notcorrespond with thequality, thoroughness,and organization of the

presentation. (0 pts)

Total=30 points Total=30 points

C:\Lori Data File\2010 SJSU Spring\Nursing 138\Evaluations\Rubric forN 138 graded studentactivities.doc

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CRITIQUE OF GROUP MEMBERS ON GRADED STUDENT ACTIVITY

Please list the names of the members of your group and indicate how much they

participated, were they encouraging and positive, did they assume any leadership role,were they contributing followers and would you work with them again.

1.

2.

3.

4.

5.

6.

How do you think you did with this activity and would you recommend any changes inthe future?

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WORKSHEET: Leadership Characteris tics In class activity ~Optional

Clinical nursing leaders possess certain characteristics. Think of a great clinical leaderyou have observed or been lucky to work with. What makes them different? Why doyou think they are a leader? The following is a list of characteristics that a clinicalleader may have. Not all leaders have all characteristics.

PART ONE of this exercise is to add in the blank spaces on the left side, anycharacteristics that you have observed that are not on this list.

Extensive cumulative knowledge gainedfrom experience and the sciences

Skillful comportment

Authoritative clinical wisdom andknowledge

Conviction to act as a moral agent

Ability to listen

Ability to enhance others strengths

Teaching, coaching and mentoring skills

Courage

Relentless preparation

Powerful speaking skills

A strong belief system, strong views

Optimism

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Emotional Intelligence Work Sheet (20 Points) N138

Research the concept of Emotional Intelligence (E. I.) and answer these questions:

1. Who first developed this theory?

2. Share the 5 main components of E. I.

3. Explain what it is and why it is an important characteristic of an effective leader.

4. Do a self assessment of your emotional intelligence and provide some objectives onhow to strengthen your areas for improvement.

5. How will you evaluate whether you are improving?

6. Explain how this approach can benefit you in the clinical setting.

7. Explain how you might use this approach in your nursing career

Taken from Kelly p. 644 E MOTIONAL H EALTH ASSESSMENT YES NO

1. I dont often get angry.

2. When I do get angry, I keep my anger under control

3. I laugh every day

4. My friends make me laugh

5. I reward myself for something every day6. I am aware of my emotions and am confident in my decisionmaking.

7. I can handle my emotions appropriately

8. I am motivated to constantly improve

9. I am empathetic to others

10. I can handle social situations

TAKE A MINUTE TO ASSESS YOUR EMOTIONAL HEALTH . THIS TOOL IS DESIGNED TO ASSESSTRENDS ONLY

. T

HE FIRST STEP TOWARD EMOTIONAL HEALTH IS ACKNOWLEDGMENT OFFEELINGS .

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Mentor Paper (5 Points )

Directions: In this 1-2 page double spaced paper, you are to write about the experiencethat you had mentoring another student. Please list the name of the student, and contactinformation, then discuss what kinds of help and support that you offered the student anddiscuss what you learned from the experience.

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Patient Advocacy Exercises

Directions: Read page 1 & 2 of your ATI Leadership Book

Note the model on page two. According to ATI five skills are required for advocacy.

They are:

Skills Values

Risk taking Caring

Vision Autonomy

Self confidence Empowerment

Articulate Communication Respect

Assertiveness

Read the following student situations and answer the questions that follow

1. A student requests to a physical therapist that a patient not be exercised vigorously onthis day, because the patient has been having diarrhea for the last 24 hours and the

student feels that the patient is weak.Is this advocacy?What should the next action of the student be?What skills or values does the student exhibit (if any)?

2. The student notes that the insulin order on a patient has been incorrectly written andthe patient has been receiving the wrong medicine for 24-36 hours. The student talksto her preceptor who says it wont hurt the patient. The student insists that the doctor

be called to clarify the order.

Who is the patient advocate?What is the risk that is taken?What is (are) the most prominent skills that the nurse or student is displaying?

3. A post op patient assigned to our student is going home later today. There is an orderfrom his physician that he must ambulate 3 times in the hall before he may go home.In the morning the student gets him up, but the patient states he only can walk as faras the chair and then needs to rest. He continues to not want to ambulate during therest of the shift and the student lets him rest in bed.

Is this advocacy?What skills do you see the student exhibiting?How would you handle this?

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4. An attempt was made to wean the patient off of the ventilator today and at the end ofthe 12 hour shift the student talks it over with her preceptor and suggests that the

patient is exhausted, and wonders if the weaning process could be postponed until thenext day. The preceptor assesses the patient and agrees and notifies the MD.

Was this advocacy?What do you think of this preceptor?What skills are most prominent in the students actions?

5. A student notes on the admitting note that the resident has written that the patient thatshe has just admitted to labor and delivery is a drug and alcohol abuser. The studentquestions the patient and the patient denies that this is so. Previous medical historycorroborates the students findings. The student vigorously tracks down the resident(who was about to leave the hospital.)

Is this advocacy?Labor and delivery students: What are the ramifications for the patient if this

information is left in the patients history?

What skills are most prominent in the students actions?6. The student was assigned a 26 year old male trauma patient who suffered from amotorcycle accident. He has surgical incision down the mid abdomen and wassuffering from DVT on the left lower extremity. One of the orders was to ambulatethe patient today with an assist from physical therapy. The physical therapist came inand tried to walk the patient down the hall but the patient became tachycardic anddiaphorectic. They sat him down and monitored his BP. The PT said that the patientwas suffering from orthostatic hypotension. The physical therapist felt it was betterto let him rest.

Is this advocacy?Who's job is it to assess and diagnose the patient?What else could the student have done?Are these symptoms of orthostatic hypotension? How could you differentiate?

7. A patient who was identified in report as a problem patient continues to not eat thefood delivered on her breakfast tray, specifically bacon and eggs. The patient isPunjabi and is a vegetarian. The student orders a new breakfast and documents this in

patient preferences and gets the diet order rewritten by the physician.

What can happen when you are told that someone is a problem patient?What did the student do that no one else had done up to that point?Is this a case of advocacy?What skills are most prominent in the students actions?

8. A student is caring for a labor and delivery couple. The wife speaks another languageand the husband is doing the translating. The anesthesiologist and resident enter theroom to give the patient a requested epidural. The resident makes three unsuccessfulattempts at getting the epidural in. The husband requests after the third time that nomore attempts be made, the student passes this request on to the resident andattending, (they ignore the request). At this point the patient is screaming and crying.As the resident sets up for his fourth attempt, the student intentionally contaminatesthe site so that the procedure was halted. By the time they get the supplies for anotherattempt, the patient is ready to deliver (too late for an epidural!)

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Is the student a patient advocate?What risk did she take?Can you think of another way to accomplish the same goal or alternative solutions

to this problem?What do you think happened to this student?

C:\Lori Data File\2008 SJSU Fall\138\Class 7\Patient advocacy exercise.doc

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Legalities, Errors and Breakdowns

Class Activity

Directions : Form groups of 3. Read each of the scenarios in the case study area andanswer the questions that follow using the error and breakdown clarification sheet as a format. For a full description of the terminology and definitions refer to your text Kelly(2007). Chapters 23 & 24.

Clarification of problem1. Legal issues

1. Civil2. Criminal3. TortThe denial of a persons legal rightThe failure to comply with a public dutyThe failure to perform a private duty that results in harm to another.

1. Negligence and Malpractice: If harm occurs to the patient1. Must have proof of the following four elements: A duty or obligation created by law, contract, or standard of practice

that is owed to the complainant by the professional A breach of this duty, either by omission or commission Harm, which can be physical, emotional, or financial, to the

complainant Proof that the breach of duty cased the complainant harm.

2. Duty breach1. Failure to attend to2. Failure to monitor3. Failure to document4. Failure to advocate (lack of agency or fiduciary concern)5. Inappropriate judgment6. Failure to intervene7. Failure to communicate8. Medication errors9. Failure to prevent10. Failure to communicate11. Failure to rescue

4. Federal administrative: Laws that protect the rights of citizens (HIPAA)(OSHA)(Civil rights)

5. Contract Law

2. Ethical issues (from Kelly (2007) p. 5231. Defined: a conflict between 2 or more principles. There is no correct answer.2. Is it right

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3. Is it fair?4. Who gets hurt?5. Would you be comfortable if the details of your decision were reported on the

front page of your local newspaper or through your hospitals email system?6. Would you tell your child or young relative to do it?

7. How does it smell? This question is based on a persons intuition and commonsense.

3. Performance problem1. Individual

1. Skill/Knowledge deficit2. Attitude (motivation deficit)

2. Organizational1. Resource deficit2. Participation deficit

Scenarios1. An experienced nurse disables the medication delivery system in order to speed up

the delivery of medication. She feels justified in doing this because her unit is alwaysshort staffed and there are no consequences.

Is this a legal problem? What aspect under the employment contract is this nurseviolating? If she makes an error will the organization legal representation? Whyor why not?

Is this an ethical problem?

Is this a performance problem?

Is it a system problem?

2. An elderly patient was admitted after injuring his head in a fall at home. After afew days the man developed a skin infection at the spot where an IV was insertedin his arm. This probably would in itself have gone unnoted. But, the nurse didnot report to the physician when the patient developed chills and circumoralcyanosis hours before he died.

Is this a legal problem? What breach (breaches) of duty occurred?




3. A was patient admitted to the hospital with diabetes and gangrene on the rightfoot. On the patients admission not the RN mistakenly typed no code. Nursingstaff did not notify the doctor when the patients blood pressure dropped and he

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became non-responsive. A nurse told the family that he was drawing his last breath and was a no code.

Is this a legal problem?




(A patient was admitted June 8 after breaking her hip in a fall at her nursing home. The patient had complained of constipation on June 13 and was given a laxative at thattime the nurse noted that she complained of a tender abdomen. The patient waslater discharged June 13 and returned to the hospital June 14 with a bowelobstruction. Following surgery for the obstruction she died June 16 of kidneyfailure

Is this a legal problem?Is this an ethical problem?



5. The patient arrived Nov. 28 with dizziness. Labwork showed critically low Hband Hct. Which the lab reported to an emergency room clerk at 11:27. Clerk didnot pass this on to a nurse or doctor. Doctor read the faxed lab report at 12:12 a.m.and ordered red blood cells infused. Lab notified emergency room the blood wasready at 12:25. Lab called back at 1 .m. to say no one had picked up the blood.Patient was transferred to ICU and transfusion started at 4:05 a.m. But the patientdied at 5 a.m.





6. A 41 year old woman was admitted Dec. 28 for a tubal ligation reversal surgery,which was successful. At 4:05 a.m. a nurse came to check her vital signs but

couldnt rouse her, so decided to let her slip. At 4:45 a.m. the nurse still couldntrouse the patient but found her pulse racing. The nurse did not call the doctor. The

patient was found dead by a lab tech who came to draw blood at 6:15. Is this a legal problem?



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7. A 73 year old man underwent triple bypass surgery Jan. 24. Three days later, hehad nausea, dizziness, and hypotension. His blood pressure fluctuated through theafternoon. The nurse reported the changes to the doctor but failed to mention thatthe staff had elevated the patients legs in an apparent effort to raise the blood

pressure. The doctor ordered a transfer to ICU at 7 p.m., but the patient stopped breathing and died.





8. A two year old girl was brought to the emergency room on Apr. 10 after being runover by a car. CT images showed chest and abdominal injuries. Surgeons andfacilities were available, but the child was transferred to another hospital, whereshe arrived two hours and fifteen minutes later and ultimately died.





9. The patient was admitted on April 26 with chronic breathing problems. On May13 his heart rate suddenly slowed, prompting a monitor alarm, which was ignored by the charge nurse and a unit clerk sitting at the nurses station. An alarm wentoff at 4:29 pm and the monitor showed the patients heart stopped at 4:39 p.m. butno one checked on him until two other nurses arrived at 5:05 p.m.




Is it a system problem?10. A 12 year old girl died after a nurse gave her a double dose of epinephrine. Is this a legal problem?



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11. A 64 year old man died Dec. 24 after being given an overdose of TPA. A nursehad sset an IV pump to shut off when the correct dose was finished, but went on a

break. Two other nurses saw there was additional medication in the pump andunwittingly administered the overdose.





12. A 77 year old man with respiratory difficulties died of choking Nov. 1 after eatinglunch served by an aide who didnt know a doctor had ordered that the patientshould not be fed by mouth. Investigator said the death resulted from this error. Anurse wrote a report but an assistant unit manager waited five days to forward tothe hospital risk management office





13. A woman was admitted Sept. 1 for treatment of urosepsis and pneumonia; she

also had severe dementia and was being fed by a gastrostomy tube. Two dayslater, a doctor and a relative decided to disconnect the feeding tube and let herdie.The relative was not designated with power of attorney to make medicaldecisions.





14. A 21 ear old cancer patient died Aug. 29 after a doctor injected him with thewrong chemotherapy medication. The investigator said this led to his death.




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The hospital pharmacist delivered the wrong medication. The hospital failed to follow policy requiring two staff to check the label before administering. The hospital retrainedthe staff on requirements for double checking medications adopted new policy requiringnurses to pick up and sign for chemotherapy drugs from pharmacy.

15. A 78 year old patient went into cardiac arrest on Dec. 16. His heart monitors had been turned off for 2 hours, when an aide found him unresponsive and partlyoff the bed. He was in a vest restraint that was not fastened properly. He died afterlife support was discontinued.




Is it a system problem?Staff did not follow correct procedures for cardiac monitoring and for using restraints tokeep patients from injuring themselves. Hospital did not report the incident to the statefor 7 days. The hospital said it did not report immediately because the incident was stillunder investigation. ICU monitors have been reconfigured so they cant be turned off.Staff was retrained in using monitors and restraints.

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Nurses have been trained to provide more information during shift changes about whether patients are prone to falls. High-risk medications like heparin are nowmarked with pink labels to ward against mix-ups.

http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/10/01/MNRP1393PK.DTL

This article appeared on page A - 7 of the San Francisco Chronicle

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Ethics Worksheet

Be prepared to discuss in class. If you do not attend class answer all questions andturn in to your instructor.

1. Which of the following questions does ethics attempt to answer?

a) How can I help this patient? b) What are the legal implications of this action?c) What does this patient need or want?d) What should I do?

2. Who is responsible for developing the best possible way to solve bio-ethicaldilemmas?

a) Clergy b) Ethicianc) Everyoned) Philosophers

3. To which of the following fields of ethics does bioethics belong

a) Aesthetics b) Applied ethicsc) Utilitarianismd) Meta-ethics

4. Which of the following precepts is of primary importance in both the Hippocraticoath and the principle of nonmaleficence?

a) Do no harm b) Do unto others as you would have them do to youc) Do what promotes the greatest good for the most peopled) Let the patient decide what should be done

5. Which of the following methods of ethical inquiry would advocate a balance betweenthe evil effect that is tolerated and the good effect that is desired?

a) Existentialism b) Formalismc) Proportionalismd) Situationalism

6. Which of the following methods of ethical inquiry is based on the notion that eachmoral decision is never exactly the same as any other moral choice we have?

a) Existentialism

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b) Formalismc) Proportionalismd) Situationalism

7. If a nurse posed the question, Which action would do the patient the most good?

she/he would be most likely be reasoning from which of the following ethical perspectives?

a) Beneficence b) Egoisticc) Justiced) Rights-basede) Utililtarianism

8. If a nurse admits a mistake promptly and offers to do whatever is necessary to correctit, she/he would be most likely reasoning from which of the following ethical

principles?

a) Beneficence b) Veracityc) Non-maleficenced) Autonomye) Respect for others

9. If another nurse asks a nurse to co-sign for a medication that she/he did not witness being drawn up and the second nurse says no, she/he is most likely reasoning fromwhich of the following ethical principles.

a) Beneficence b) Veracityc) Justiced) Autonomye) Respect for others

10. The nurses on your unit where you are being precepted often take short-cuts from thefacility protocol. What ethical principle are they violating?

a) Beneficence b) Non-maleficence

c) Justiced) Autonomye) Respect for others

Question for group discussion: Why should a nurse behave ethically? (There are several possible reasons discussed in the text.) Make a powerful argument for ethical behavior. Ifyou are not in class answer this in a paragraph and get it to your instructor no later than 4days after class.

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Quality Quiz

1. In patient-centered care the key focus is best described as:

a. Patients describing how they feel about past treatment and expectations

b. The nurse completing a nursing assessment in a timely manner

c. The hospital asking patients if they have an advanced directive

d. Patients being told in the ER that they must contact their insurer

2. Which of the following is the best description of evidence-based practice?

a. Use of research results when approved by a professional body

b. Integrating best research results, clinical expertise, and patient values

c. Applying research results by healthcare practitioner

d. Documenting rationales for treatment decisions by using research results

3. Which of the following would not be considered an important strategy for reducingdisparity in health care?

a. Offer universal healthcare coverage

b. Focus more on insurance coverage rather than access and efficiency

c. Increase representation of minorities in the health professions

d. Increase the amount of content and learning experiences about disparity for staff

4. Who are the some of the stakeholders in the quality initiative?

a. Patient

b. Employers

c. Nurse

d. All of the above

5. Which of these factors has had a particular impact on the quality of health care?a. Cost of care

b. Increase in chronic illnesses

c. Number of healthcare providers

d. Efficiency within the system

6. You are a hospital nurse on the quality team. The team is developing a list of focusareas for the annual review of quality. The team is using the national priority areas

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of care as its guide. Which of the following would not belong on the list?

a. Care coordination

b. Diabetes

c. GI problems

d. Nosocomial infections

7. A nurse is preparing medications and puts the wrong medication on the tray for apatient. Before she enters the room she looks at the medication and realizes it is thewrong color and returns to check the medication bottle. She reports this to nursemanager as a near miss. What is the most appropriate explanation of theimportance of a near miss?

a. Near misses are common in healthcare delivery.

b. Identifying near misses can reduce healthcare costs.

c. Willingness to identify near misses indicates safety is valued, part of the culture.

d. Increased education can decrease near misses.

8. A patient is admitted for surgery and while in the hospital develops a urinaryinfection while a urinary catheter is inserted, which increases his hospital stay by 3days. What type of error is this?

a. Active b. Latentc. Error of planningd. Iatrogenic

9. You are a nurse working in a community clinic and need information that can guidetreatment for patients with asthma. Where would you quickly find clinicalguidelines about asthma?

a. Foundation for Accountability website b. National Center for Nursing Quality websitec. Agency for Healthcare Research and Quality websited. Medicare website

10. One of the most recent efforts to improve care and practice, which has had animpact on how care is viewed and evaluated, is:

a. The Magnet Hospital Recognition Program b. JCAHO accreditation processc. NLN accreditation of schools of nursingd. The Leapfrog Group

11. The nursing staff on a unit are discussing a recent error which resulted in thepatient going to ICU and being intubated for 2 weeks. They need to analyze whatoccurred. What is the best description of the type of error?

a. Near miss b. Latent error

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c. Sentinel eventd. Diagnostic

12. JCAHO accreditation requires hospitals to meet specific standards in a specificmanner.

a. True b. False

13. The best approach to assessing quality of care is to include as many diseases andtheir treatment as possible to reach the best view of the status of healthcare delivery.

a. True b. False

14. An error in a surgical procedure is which type of error?

a. Preventive b. Diagnosticc. Generald. Treatment

15. Safe care is quality care

a. True b. False

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Classic Principles of Change

Modified from Harper, C.L. (1993). Exploring social change (2nd ed.). Englewood Cliffs, NJ: Prentice Hall. Taken from: Menix, K.D. (2003). Leading Change a chapter in Yoder Wise, P. Leading and Managing in Nursing (3 rd ed.). Mosby.

Change agents within healthcare organizations use personal, professional, and

managerial knowledge and skills to lead change.

The recipients of change believe they own the change.

Administrators and other key personnel support the proposed change

The recipients of change anticipate benefit from the change

The recipients of change participate in identifying the problem warranting a change

The change holds interest for the change recipients and other participants

Agreement exists within the work group about the benefit of change

The change agent and recipients of change perceive a compatibility of values

Trust and empathy exist among the participants of the change process

Revision of the change goal and process is negotiable

The change process is designed to provide regular feedback to its participants .

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N 138 Evaluation Form

To be used if missing a class: This form must be submitted to your instructorelectronically by the Saturday following the class at midnite order to received credit for

attending the class.

1. The class that I missed was on _______(date) and the topic was_________________

2. What I learned from viewing the webcast was(List 3 major points)

3. This will increase my ability to

4. This will increase patient safety by(optional)

5. I need further information on.

6. Overall, I felt that the content of the class was

Excellent Good Average Poor

7. I think this class could be improved by

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San Jose State University

School of Nursing

Nursing N 138

Group Evaluation Form

Circle the answer which best matches your response to each statement as follows

Strongly Agree (SA) Agree (A) Undecided (U) Disagree (D) Strongly Disagree (SD)

1. The group was well prepared SA A U D SD

2. The choice of topic was interesting and engaging SA A U D SD

3. The group employed effective teaching strategies SA A U D SD

4. Participation increased my knowledge SA A U D SD

5. Audiovisuals were appropriate SA A U D SD

6. Handouts helped to stress major points SA A U D SD

7. The entire presentation was organized and well thought out SA A U D SD

Feedback to participants:

Final Spr 10 Student Syllabus

Documents