A medical-surgical unit has implemented a policy change.
The nurse manager notices that one of the nurses, who has a history of being resistant to change, is not delivering care according to the new policy.
What action should the nurse manager take?
Explain the importance and rationale of implementing the new policy to the nurse.
Encourage the nurse to verbalize the reasons for resistance to the change.
Indicate that there will be disciplinary consequences if the nurse does not implement the new policy.
Ignore the resistance and allow peer pressure to facilitate a change in the nurse’s behavior.
The Correct Answer is B
Choice A rationale:
While explaining the importance and rationale of the new policy may be helpful in some cases, it may not be sufficient for nurses who are resistant to change. This approach assumes that the nurse's resistance is due to a lack of understanding, which may not be the case. It's possible that the nurse understands the rationale but has other concerns or objections.
Focusing solely on explaining the rationale can make the nurse feel they are not being listened to or that their concerns are not being valued. This can further contribute to resistance.
Choice B rationale:
Encouraging the nurse to verbalize their reasons for resistance allows the nurse manager to understand the root cause of the resistance. This could include:
Concerns about the effectiveness of the new policy
Belief that the new policy will create more work or make their job more difficult
Feeling that they were not adequately consulted or involved in the decision-making process Personal factors such as fear of change or a preference for established routines
Once the nurse manager understands the nurse's concerns, they can work together to address them and find ways to facilitate acceptance of the new policy. This approach fosters open communication, collaboration, and shared decision-making, which are essential for successful change management.
Choice C rationale:
Indicating disciplinary consequences may be necessary in some cases, but it should be a last resort. It can create a negative and hostile work environment, further alienate the nurse, and potentially lead to resentment and decreased morale among other staff members.
It's important to prioritize understanding and addressing the underlying reasons for resistance before resorting to disciplinary measures.
Choice D rationale:
Ignoring the resistance and relying on peer pressure is a passive and ineffective approach. It does not address the nurse's concerns and may even exacerbate the situation. This can lead to conflict among staff members, create a divide between those who support the change and those who resist it, and potentially compromise patient care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale for Choice A:
Ineffective airway clearance is the most immediate and life-threatening concern in the postoperative period following a radical neck dissection. This procedure involves extensive removal of lymph nodes and tissues in the neck, which can significantly disrupt normal respiratory function and airway patency. Here's a detailed explanation of the factors contributing to this risk:
Altered Respiratory Anatomy: The surgical resection of tissues and lymph nodes can directly impact the structure and function of the airway. This includes potential narrowing of the trachea, vocal cord dysfunction, and impaired laryngeal movement, all of which can hinder effective airflow.
Thick, Copious Secretions: The surgical trauma and manipulation of tissues often lead to increased production of thick, tenacious secretions in the respiratory tract. These secretions can obstruct the airway, making it difficult for the patient to clear them effectively.
Impaired Cough Reflex: The surgical dissection may disrupt the nerves involved in the cough reflex, which is a crucial mechanism for clearing secretions from the airway. This further impedes the patient's ability to maintain a patent airway.
Risk of Aspiration: Accumulation of secretions in the airway elevates the risk of aspiration, which can lead to pneumonia and other serious complications.
Potential for Edema: Postoperative swelling in the neck tissues can further compress the airway, exacerbating the risk of obstruction.
Nursing Interventions for Ineffective Airway Clearance:
Prompt recognition and management of ineffective airway clearance are essential to prevent respiratory compromise and ensure patient safety. Here are key nursing interventions that should be prioritized:
Frequent Assessment: Continuously monitor respiratory rate, effort, breath sounds, oxygen saturation, and level of consciousness for any signs of respiratory distress.
Positioning: Elevate the head of the bed to 30-45 degrees to promote lung expansion and facilitate drainage of secretions. Suctioning: Regularly suction the airway to remove secretions, using aseptic technique and proper suctioning pressure.
Deep Breathing and Coughing Exercises: Encourage and assist the patient with deep breathing and coughing exercises to mobilize secretions.
Humidification: Provide humidified oxygen or use a nebulizer to help thin secretions and make them easier to expectorate.
Chest Physiotherapy: Perform chest physiotherapy techniques, such as percussion and vibration, to loosen secretions and promote their removal.
Monitoring Fluid Balance: Maintain adequate hydration to help thin secretions, while closely monitoring fluid intake and output to prevent fluid overload.
Addressing Other Choices:
While the other choices may also be relevant concerns in the postoperative period, they do not pose the same immediate threat to life as ineffective airway clearance.
Correct Answer is B
Explanation
Choice A rationale:
Incorrect. Patients have a legal right to access their medical records under the Health Information Portability and Accountability Act (HIPAA). Denying access is a violation of patient rights and could lead to legal consequences.
Undermines patient autonomy and trust. Patients have a right to know what information is in their medical records and to participate in their own healthcare decisions. Denying access can erode trust in the healthcare system.
Potential for errors and misunderstandings. If patients cannot review their records, they may not be able to identify errors or misunderstandings that could impact their care.
Choice B rationale:
Correct. This response upholds patient rights while ensuring that the request for access is documented and handled appropriately.
Protects patient privacy and confidentiality. The written request process helps to ensure that only the patient or their authorized representative has access to the records.
Provides a mechanism for tracking and auditing access requests. This can help to prevent unauthorized access and ensure compliance with HIPAA regulations.
Choice C rationale:
Incorrect. Patients have a right to access their records at any time, not just when they are being discharged.
Delays access to information. Patients may need to review their records to make informed decisions about their care, even if they are not being discharged.
Potential for records to be lost or misplaced. There is a risk that records could be lost or misplaced if they are not provided to the patient until discharge.
Choice D rationale:
Incorrect. Patients do not need to provide a reason for wanting to access their medical records.
Intrusive and unnecessary. Patients may feel uncomfortable or embarrassed about having to explain their reasons for wanting to access their records.
Potential for discrimination. Patients may be less likely to request access to their records if they feel that they will be judged or questioned about their reasons for doing so.
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