NUTR EXAM 2

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NUTR EXAM 2
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2011-02-26 11:43:07
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Questions for exam 2
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  1. JCAHO (AKA Joint Commisions)
    • - Most powerful influence on health care quality
    • - independent, non-profit voluntary accrediting agency
    • - Develops standards for a variety of health care institutions
  2. JCAHO accreditations
    Accreditation is for a 3 year period --> if don't pass have 1 year to come up with standards
  3. JACHO Compliance is rated from 1-5
    1=1 substantial compliance --> going above and beyond (want 1 or 2)

    5 = 5 noncompliance --> not following the standard at all
  4. Medicare for ______
    age 65+
  5. Medicaid for ________
    below perverty level
  6. DRG (Diagnosis related groups )
    diagnosis determines how long the patient can stay in hospital

    codiagnosis can allow person to stay longer

    ex. malnutrition
  7. Policies and procedures
    Direct and assist employees to the work necessary to achieve the organization’s goals

    • Policies:
    • - Framework for future decisions
    • - Guides employees toward best action in a given situation

    • Procedures:
    • - Determines step by step how an activity is done
    • - Expresses standards of time, quality, etc.
  8. Characteristics of policies
    Flexible and adaptable to a variety of situations

    Broad enough to allow supervisors to use some judgment and decision making
  9. Sources of info for writing policies
    Past experience

    Similar organizations

    Attitudes of top level managers as well as other managers

    Day to day experiences
  10. Characteristices of procedures
    Must be specific

    Should be guides for action, not thinking
  11. Benefits of procedures:
    Training employees

    • Has supervisor carefully analyze the job
    • Leads to uniform performance

    Help in decision making
  12. Key parts of a procedure:
    • Who is responsible for the job?
    • What?
    • When?
    • Under what circumstances?
  13. Policy and procedure manual
    Policies and Procedures must be updated regularly

    Several copies should be available

    Policies and Procedures must be shared with employees
  14. Example food service -- polices and procedures should be developed for:
    Purpose of the food service department

    • Organizational design
    • General and therapeutic menus

    Ordering, receiving and storing food
  15. Food prepartion
    Meal and nourishment service

    Cost control, budget and records

    Housekeeping, sanitation and safety

    Personnel: hiring, orientation, discipline, firing, staff development and training.
  16. Rules
    Statements of what can be done and not done

    Do not allow for freedom or flexibility

    Do not have any time sequence and set of steps

    Can be part of a procedure or stand alone
  17. Prior to intoducing a new policy
    Check for potential conflicts with present job requirements

    Be sure there is available staff time for implementation
  18. internal recruitment
    Ex. Transfer from other departments
  19. External Recruitment
    Ex. Employment agencies

    Hotlines: Monster. Com

    Job banks -> NH dietetic association has one

    Head hunters -> look for people to fill managerial positions
  20. Civil rights act of 1964
    - Regulates employment practices

    - The Equal Employment Opportunity Act is part of this act

    -It is illegal for employers to discriminate based on race, color , religion, sex, or national origin in hiring, firing, promoting, compensating or in terms , conditions or privileges of employment
  21. Age discrimination in employment act of 1967
    Protects people 40 years and older from age discrimination

    Prohibits employers from replacing older employees with younger workers regardless of whether the purpose is to save money or to give the company a more youthful image
  22. Vocational rehabilitation act of 1973
    Affects all companies that hold federal contracts

    They must seek out, hire and advance reasonably well qualified individuals whose groups have been discriminated in the past

    • Also protects individuals with physical and mental challenges
    • Usually called affirmative action
  23. Vietnam veterans readjustment assistance act
    Prohibits discrimination against disabled veterans but specifically Vietnam Vets
  24. Pregnancy discrimination act of 1978
    Added amendment to the 1964 Civil Rights Act

    Prohibits discrimination against workers on the basis of pregnancy, recent childbirth or related medical conditions
  25. Under title VII of civil rights act
    Employers must maintain a workplace free from sexual harassment and intimidation

    Sexual harassment is defined as subjecting a person to unwelcome sexual advances, requests for sexual favors and any verbal or physical conduct of a sexual nature
  26. 1993 tge definition of harassment was broadened to include
    • Any verbal or physical conduct that denigrates or shows hostility or aversion towards an individual because of race, color, religion, gender, national origin, age, disability or to their friends and relatives
    • Examples: racial slurs, ethnic jokes etc
  27. Civil rights act of 1974
    Amendment to the Civil Right Act of 1964

    Prohibited quotas and allowed for collection of damages if a person is found to have been discriminated against

    The term “glass ceiling” came out of this legislation

    glass ceiling - barriers that prevents women and minorities from achieving managerial positions

    It is an invisible barrier which often prevents women and minorities from achieving management positions
  28. Executive order of 1965
    Changed the word creed to religion when considering types of discrimination and rather than say gender discrimination changed it to sex discrimination
  29. Privacy act of 1974
    Employees of the US Government have the privacy of their personal files as well as lockers , background investigations and other matters

    Personnel can copy and correct info in their files and can appeal over disputed material in their files
  30. mericans with disabilities act 1990 (clearly and strongly enforced)
    Prohibits discrimination against disabled individuals

    Employers are required to make reasonable accommodations or modifications that help impaired individuals to function in their jobs

    example: having computer technology and brail for blind

    You cannot ask when interviewing for a job whether a person has a disability but you can ask if a person can perform the job with or wit
  31. Professional and non-professional venues to advertise
    advertisements in ADA Journal, Today's dietician, the news paper
  32. Items which cannot be asked in some states, but can ask after the person is hired for insurance resons :
  33. Maiden name • Height and Weight
    • • Birth place • Marital Status
    • • Date of birth • Citizenship -> can ask isf is a citizen or has green card just not from where
    • - Religion
    • - Nationality
    • - Race
    • - Inquiry on arrests -> can ask if convicted for anything
    • - Photograph
    • - Clubs, societies etc
  34. Pre-employment tests
    • - Intelligence Tests
    • - Aptitude Tests -> to tell what best suits a person
    • - Achievement Tests --> can person achieve what job entails
    • - Personality Tests
    • - Civil Service Tests
  35. Job analysis
    • Detailed study of the job
    • Answer the following

    What is the job?

    What kind of tasks are involved?

    • What employee behavior is required:
    • How can it help in the selection process?
  36. Ways to obtain info from job analysis
    Interview person doing the job

    Record a daily diary

    • Complete a checklist
    • Hire a consultant

    Visit a facility that has the job
  37. Job analysis can be used for a variety of purposes (11):
    To plan work activities during non-peak periods

    To determine work simplification

    • To determine work methods and procedures
    • For training purposes
    • To determine performance standards
    • To aid in better supervision
    • To provide facts for union negotiations and job classifications

    To discover related and overlapping jobs that can be combined

    To determine workload when new equipment or new work methods are introduced

    To provide safety precautions

    To provide data on time constraints
  38. Job specification
    Minimum requirements that must be met by the applicant

    Based on the job analysis
  39. Infor on a job specification (10)
    • - Experience
    • - Education
    • - Special training
    • - Personal requirements --> must be able to lift 50lbs
    • - Working conditions
    • - Hours of work
    • - Job classification
    • - Promotional opportunities
    • - Tests required
    • - Need for license or certification
  40. Job description --> employee gets a copy of it
    Organized list of routine duties and responsibilities

    Compiled from job analysis

    Avoid occasional tasks

    • Be precise but flexible
    • One needed for each position on the organizational chart
  41. Job description is used to
    • - Match applicants to the job
    • - Establish orientation and training programs
    • - Establish performance appraisal forms
    • - Establish job classification and pay
    • - Determine limits of responsibility and authority
    • - Clarify chain of command
  42. Personal interview
    Helps determine the fitness of the applicant for the job

    Provides information to help applicant determine interest in the job
  43. Interview: Facrots to consider (4)
    Goal of the interview --> hire the best person use either job analysis or job description

    Review job description and specification

    Contact references if necessary

    Prepare questions or not
  44. What to do during interview? (9)
    • - Be neutral to answers given
    • - Use open ended questions when possible
    • - Ask follow up questions for clarification
    • - Ask simple questions first
    • - Explore ability first
    • - Do only approximately 20% of the talking (they do 80%)
    • - Maintain control
    • - Take only brief notes
    • - Treat everyone equally
  45. What not to do in an interview? (3)
    • - avoid making snap judgement
    • - avoid yes and no questions
    • - don't ask leading questions
  46. Information about benefits
    -Holiday Pay-> 5-10 days determined by employer

    -Personal Days

    -Vacation Days ->Often lumped w/ personal days and called paid time off

    Sick Leave

    Bereavement Leave or Jury Duty --> suppose to get paid

    -bereavement for immediate family
  47. Interviewing and hiring problems (6)
    • - Selecting someone completely opposite from the former employee or vice versa
    • - Selecting someone who has similar characteristics to the interviewer
    • - Being influenced by candidate order (judging the last persons interview on the 1st persons)
    • - Allowing one absolutely glowing recommendation to influence decision
    • - Need to hire quickly
    • - Basing decision on feelings and emotions
  48. Questions to ask references? (5)
    • - How long employee worked for them
    • - Type of employee the applicant was
    • - How applicant got along with others
    • - Was applicant promoted or demoted
    • - Would you rehire this applicant
  49. What do you evaluate in an interview? (6)
    • - Personal qualities
    • - Intellectual qualifications
    • - Work capacity
    • - Interpersonal relationships
    • - Physical qualities
    • -like a person with a good clear voice to answer phones
    • - Experience
  50. After the interview (4)
    • - Inform applicant when the final decision will be made
    • - Reflect on all information available
    • - Compare with application information
    • - Make selection and notify applicants of decision
  51. General orientation done by HR (3)
    Philosophies and goals of the organization

    Provides an understanding of the organization

    Provide a handbook to keep for future reference
  52. Specific orentation done by department (6)
    • - When to report to work
    • - How to keep track of hours
    • - Meals, uniforms an other benefits
    • - Payroll procedures
    • - Disciplinary procedures
    • - How to do the job
  53. Why is orientation important? (5)
    • - Introduces new worker to the job
    • - Assists in the adjustment period
    • - Prevents learning policies through rumor mill
    • - Reduces dissatisfaction and turnover (people stay at job longer)
    • - Eliminates fears of the unknown
  54. What does orientation do for the employee? (4)
    • - Creates a favorable attitude
    • - Establishes a sense of belonging
    • - Breaks down barriers
    • - Promotes self confidence
  55. What does orientation for for the institution? (4)
    • - Upgrades workforce
    • - Promotes job competence
    • - Reduces future grievances
    • - Reduces employee turnover
  56. Types of workers: Profesionals - dietitians and managers (5)
    • - Have extensive academic training
    • - Commitment to public service - willing to provide services in facility and community
    • - Ability to make independent judgments
    • - May be generalists or specialists
    • - Often prefer participative management
  57. Types of workers: Supervisory- shift supervisors (3)
    - Oversees the work of one or more individuals

    - Are accountable for their work as well as the work of others

    - Possess authority and responsibility for what happens in the workplace
  58. Types of workers: skilled- have indepth knowledge in a particular area (2)
    • - Require special technical training
    • Know the “how to” but not always “why”
    • - Do not require close supervision
    • - Examples: cooks, secretaries, exterminators, equipment repairman
  59. Types of workers: Unskilled (3)
    • - Bring no marketable skills to the job
    • - Usually are trained on the job
    • - Commonly earn minimum wage

    Examples: receptionists, cashiers and foodservice workers
  60. Full time employment (FTE)
    • - Usually 37½ to 40 hours – total 2,080 hours/year
    • - Typical shift is 8 hours/day – 5 days a week
    • - Some hospitals do 12 hr shifts 3 days/ week
  61. Part time employment
    • - Number of hours less than full time
    • - Typical is 20-24 hours a week
    • - May or may not get benefits
  62. Short hour
    • - Less than half time (<20hrs/wk)
    • Do not have any benefits
    • - May receive a higher pay scale in lieu of benefits
  63. Per diem employee
    • - Also called casual or on call employee
    • - Not guaranteed any number of hours
    • Scheduled as needed
    • - Usually fills in for other workers on leave
  64. Job sharing - must be good at communication to prevent duplicate work
    • - Two individuals sharing one position
    • - Can lead to decreased productivity if not managed properly
    • - Can result in duplication of effort or in omission of essential elements
  65. Probationary employees
    Newly hired – lasts a period of 60-90 days

    Employee can be dismissed without cause
  66. Temporary worker - not on payroll, you pay temp agency and they pay worker
    • - Hired to work on a special project or
    • May cover an absence or Hired to cover increased need

    -Often may not be on the payroll of the organization but hired through an employment agency

    - Usually hired for several weeks/months.Often has a skill that another employee in the organization cannot fill

    • - A temp receives no benefits
    • - Can be expensive (wages+fees) but may be worth it to maintain quality and standards
  67. Contract employee- sometimes in nursing home
    • - Hired to do a job that is finite in nature
    • - Can be paid hourly, monthly or by the project
    • - Receives no benefits
    • - Usually provides special services
    • - Usually called a consultant
    • great for people that want to have a family make $50-100 per hour
  68. Terms for types of pay
    • - base
    • - holiday (time and 1/2)
    • - overtime - (time and 1/2)
    • - double time
    • - shift differential (more for working nights and evenings)
    • - hazard pay
    • - split hsift
    • - doubleback - more money made in 2nd shift when 2 shifts back to back
  69. salaried workers
    • - Paid for doing a job no matter how many hours it takes to get the job done
    • - Usually a minimum of 40 hours but may fluctuate from week to week
    • - Burnout can occur due to stress, fatigue and dissatisfaction if not managed properly
  70. Compensatory time
    • - When salaried workers work more than 40 hours, some institutions allow those hours as time off. --> comp day
    • - Usually must be used within 60 days
    • - Can also be redeemed for wages
    • - Must be clear policies to prevent abuse
  71. Diversity in workplace
    • -Ethnicity
    • - Race
    • - Gender
    • - Xenophobia (Fear of strangers/foreigners)
  72. Changing demographics
    Women managers in the workforce

    Older Americans working longer

    • Multiculturalism
    • Disabilities
  73. Benefits of diverity
    • -Broader variety of viewpoints
    • -Extends the marketplace
    • - Ability to satisfy the needs of a diverse community
  74. Drawbacks of diversity
    • - Xenophobia (fear of strangers or cultures)
    • - Takes time and money to help
    • workers overcome biases
  75. Rule of staffing
    If all groups of workers can do the task with similar or acceptable level of proficiency, the task should be given to the least skilled
  76. Professional staffing
    • - Based on work activity
    • -Criteria – to meet the needs of 100% of patients on modified diets and 25% of other patients at risk (ex. cancer patients eat normal diet)
  77. Work is divided into 5 categories
    Service time

    Instruction Time

    Routine Support Service Time

    Nutritional Assessment Time

    Available Staff Time
  78. Work categories: Service time
    • - Reviewing the medical record
    • - Obtaining the diet history from the patient
    • - Communicating with team members (put likes and dislikes so patient doesn't get food they won't eat)
    • - Preparing materials for diet instruction
    • - Developing the care plan
    • - Recording in the chart
  79. Work Categories: Instruction time- average amount of time you should spend teaching a client a particular diet- formed by ada
    This can be computed from the Client Learning Study
  80. Work categories: Routine support service time
    Time spent on activities that are performed for ALL patient
  81. Work categories: Nutritional assessment
    • - Anthropometric measurements
    • - Parenteral and enteral nutrition
  82. Work categories: available staff time
    Hours each professional is available

    1 FTE has 33.75 hrs available (taking out breaks, lunch and vacation time)

    when benefits are calculated in
  83. Usually the staffing is about 1/3 to 1/2 the calculated need- how to make up for this problem? (2)
    • - out patient group classes make up for less 1 on 1 dietitian client interaction
    • - videos are also used to teach diets
  84. Criteria for staffing requirements (10)
    • - Goals and objectives of the organization
    • - Standards of performance
    • - Efficiency of the workforce
    • - Type of establishment
    • - Menu – number and types of diets
    • - Kitchen layout and design
    • - Location of kitchen
    • - Sanitation requirements
    • - Responsibility for distribution of trays - Hours of operation
  85. Scheduling
    • - Considers hours of work per day
    • - Time the worker is to be scheduled
    • - Number of days per week to be scheduled
  86. Compressed work week
    employee scheduled for 40 hr/wk in less than 5 days
  87. Flextime scheduling
    • - Permits flexibility
    • - Working less than 8 hours some days and more than 8 on other days
  88. Problems with flextime scheduling in dietetics (5)
    • - Record keeping
    • - Extra supervisory staff
    • - Difficult to meet needs of foodservice - Delays interdependent tasks
    • - Many jobs cannot be delayed to the next day
  89. Types of work schedules:
    • master schedule - all shifts
    • shift schedule - staggered
    • production schedule
  90. Guidelines that are typically used in making schedules
    No more than 7 consecutive days and no less than 2 consecutive days off

    Most institutions have formulas for scheduling weekends
  91. Try not to have shifts vary form day to day
    • - Try to honor employee preferences if possible
    • - Do not use scheduling to reward or punish. This will undermine your
    • credibility
  92. In most states (working age laws)
    • - Teens must be 14 to work in food service
    • - Teens 16 and under cannot work more than 8 hrs/day and 40 hrs/wk
    • - When school is in session, they cannot work before 7 a.m. or after 9 p.m.
    • - Teens under 18 cannot repair or maintain equipment; cook or bake; load or unload trucks; use a food slicer
  93. Scheduling holidays
    Don’t use seniority as a factor

    Do ask for volunteers --> can help by doing small tasks or visiting people

    Develop a holiday cycle
  94. Scheduling time off
    • - Have a policy for asking for time off
    • - Have employees responsible for finding a replacement if it is short notice
  95. Cyclical schedule
    Eliminates having to start from scratch every time – saves time

    • Two week cycles are the most common
    • Provides consistency, more equitable, easier to develop
  96. Writing the work schedule (10)
    • 1. Know how many (total) Workers are needed each day
    • 2. Know which positions are cross-trained
    • 3. Use a grid – names along the side, dates at the top
    • 4. Use a legend to indicate positions when people are crossed-trained
    • 5. Enter all days off; regularly scheduled, holidays, vacation, special requests, extended sick leave
    • 6. Write in work days assuring the guaranteed number of hours for each worker
    • 7. Look for gaps and fill in with part-time employees
    • 8. Use per diem employees if needed
    • 9. Check and cross check to be sure hours are accurate – overtime COSTS! 10. Also check for cost effectiveness
  97. Training facts:
    • - Each employee has different needs, desires, prejudices, IQ’s, beliefs and skills
    • - Everyone learns at a different rate
    • - Training must be tailored to the individual
    • determined by amount employee needs and how fast employee learns
  98. Training adults in different from training/teachign children
    • - Adults do not learn just for the sake of learning
    • - Adults learn in order to perform and solve some immediate problems
    • - Adults want learning that is relevant
  99. Training adults in different from training/teachign children
    • - Adults do not learn just for the sake of learning
    • - Adults learn in order to perform and solve some immediate problems
    • - Adults want learning that is relevant
  100. Malcolm S. Knowles on "Adult learning"
    • - Adults resist situations where they are treated with disrespect
    • - Adults like to help plan and conduct their own learning experiences
    • - Adults require practical results from learning --> like seeing a finished product
    • - Adults perceive learning experiences that are organized around life problems
  101. Determining training needs (5)
    • - Determine Performance deficiency
    • - Determine desired performance and steps to get there
    • - Determine ideal end results
    • - Determine the skills that must be taught
    • - Determine the feasibility of training
  102. Training session
    • Put the employee at ease
    • Explain the operation

    TELL - SHOW - ILLUSTRATE
  103. 4 Things to be aware of when training employees
    Not all training runs smoothly

    Learning is faster at first then slows down

    Learners get discouraged and may regress (plateaus discourage learners)

    Learning plateaus often occur
  104. Training methods for professional staff: job rotation (excellent)
    • - Gives the employee the opportunity to acquire a broad perspective and diversified skills
    • - Helps the employee see the BIG PICTURE
    • - Each rotation could be 2-3 months
    • more proficient workforce
  105. Training methods for professional staff: Lecture
  106. - Oldest technique
    • - Purpose is to inform
    • - Saves time, inexpensive
    • - Passive – can be boring
    • - Must be supplemented by AV’s
  107. Training methods for professional staff: workshops and skill trainings
    • - Allow for the exchange of ideas, discussion of problems, finding solutions to issues
    • - Opportunity to express views and opinions
    • - Great for networking with others, learning teamwork
  108. Training methods for professional staff: Role playing
    • - Acting out situations
    • - Used to train for interviewing, counseling, managing
    • - Gain insight from their own performance and comments from observers
  109. Training methods for professional staff: Committee assignments
    • - Widens perspective
    • - Experience situations involving resolution of different ideas
    • - Learn to adjust to other people’s viewpoint
    • - Gives opportunity to assume a position of leadership
  110. Training methods for professional staff: Case studies
    • - Solve problems under simulated conditions
    • - Requires active involvement in problem solving
    • - Use pertinent situations with immediate application

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