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Information

  1. CONCEPTS OF MANAGEMENT
    1. Definitions
      1. Case management—process that involves comprehensive coordination of activities and services provided to the client throughout the continuum of care or episode. Activities include: case finding, screening, intake, assessment, problem identification, prioritization of client's problems and needs, planning, reassessment, evaluation, documentation, designing and monitoring clinical pathways, and identification of variances.
      2. Continuous quality improvement—process used to make improvements in client care; indicators of excellence are identified and process involves actively including input from and collaboration with the client (whose needs are at the center of the process), the family, and all health-care team members.
      3. Incidents/variance reports—part of quality improvement, where occurrences take place in a health-care agency that are not typical according to medical orders, may be an accident, or may be a violation of policy and procedures (e.g., wrong medication dose, a client or visitor falls, needle stick by nurse). These are considered unexpected incidents, exceptions that happen during client care.
      4. Quality assurance—activities that evaluate the quality of care provided to clients to ensure that it meets predetermined standards of excellence.
      5. Resource management—providing appropriate number and type of resources needed by clients to achieve desired outcomes.
      6. Supervision—process of guiding, encouraging, and assessing the work of others to whom tasks were delegated.
      7. Delegate responsibility and direct nursing care provided by others—based on particular client/family needs and on job description, roles, functions, and skills of other nursing personnel: client's condition (stable or medically fragile), complexity of required care, potential risks for harm to client, degree of needed problem-solving expertise, predictability of outcome, type and level of client interaction required. Important: The person who delegated the task has the responsibility and final accountability for effective completion of the task.
    2. Management theories
      1. Microlevel theories: clarify and predict behavior (e.g., motivation) of the individual, with input on the group/organization (e.g., group dynamics).
      2. Macrolevel theories: focus on best ways to make changes within an organization, organizing projects, obtaining resources, attaining goals.
      3. Intrapersonal/interpersonal theories:
        1. Cognitive: belief—a person's motivation is based on expectations about what will happen as a result of own behavior; involves goal setting, with regular feedback to increase motivation to achieve.
        2. Scientific management: belief—repetition of task will result in expertise.
        3. Neoclassical management: based on Maslow (i.e., person continuously strives to meet higher level needs); ERG (Existence, Relatedness, Growth); job redesign (i.e., ensures that task has validity, significance, autonomy, and feedback).
        4. Social/reinforcement: belief—motivation comes from learning from those with whom a person identifies; conditioned by reinforcement.
    3. Management behaviors
      1. Decision maker
        1. Initiator of new projects.
        2. Crisis handler (e.g., interpersonal conflicts among staff).
        3. Resource allocator (people, physical, financial).
        4. Negotiator.
      2. Communicator
        1. Monitor of data collection and processing.
        2. Dissemination of collected information.
        3. Speaker on behalf of agency.
      3. Representative
        1. Institutional figurehead.
        2. Group leader.
        3. Liaison between agency and community.
  2. ESTABLISHING PRIORITIES
    1. When managing a number of clients at the same time, the nurse needs to set priorities by assessing types of care needed:
      1. Decide on the most important nursing activity (giving a medication? performing a treatment? taking vital signs? providing nutrition? measuring I&O? etc.).
      2. Identify the first action the nurse needs to take.
      3. Select the best nursing action.
      4. Determine which client needs immediate care.
    2. Determine priorities with the guidance of:
    1. Maslow's hierarchy of needs (see Figure 10-1. Maslow's Hierarchy of Needs, Psychosocial Integrity)
      1. Choose physiological needs (survival) as the highest level of priority.
      2. Followed by safety needs.
      3. Then psychological needs (care and belonging).
      4. Lastly, self-actualization needs.
    2. Steps of the Nursing Process (A2DPIE)
      1. First is assessment (data collection).
      2. Next, analyze the data (nursing diagnoses).
      3. Then, plan (goals).
      4. Followed by implementation (actions).
      5. Finally, evaluation (outcome).
    3. ABCS
      1. Airway (e.g., patent airway)
      2. Breathing
      3. Circulation
      4. Safety
    4. RACE (e.g., in event of fire)
      1. Remove the client.
      2. Then sound the alarm.
      3. Call the fire department.
      4. Extinguish the fire.