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AJN, American Journal of Nursing:
doi: 10.1097/
Feature Articles

CE Test 2.5 Hours: Exploring the Concept and Use of Positive Deviance in Nursing

Contrada, Emily

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Continued Education
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To provide information about the Walker and Avant method of concept analysis and to explore and identify the essence of the term positive deviance in the nursing practice environment.

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After reading this article and taking this test, you will be able to

* recognize the key features of the concept of positive deviance.

* identify the various terms and uses associated with this concept.

* apply the concept of positive deviance to nursing practice.

1. According to Huber, decision making involves multiple conditions of certainty, uncertainty, and

a. risk.

b. choice.

c. emotion.

d. experience.

2. The process of concept analysis involves examining the attributes or characteristics of a concept, resulting in an operational definition that is

a. creative.

b. workable.

c. precise.

d. conditional.

3. Pascale and colleagues describe positive deviance as a term that is

a. legitimate.

b. oxymoronic.

c. misleading.

d. innovative.

4. Spreitzer and Sonenshein described a normative approach that defines positive deviance as intentional behaviors that depart from the norms of a referent group in

a. uncommon ways.

b. beneficial ways.

c. radical ways.

d. honorable ways.

5. Bloch used which of the following terms to describe positive deviants?

a. trailblazers

b. groundbreakers

c. high achievers

d. diamonds in the rough

6. Some researchers view positive deviance as a process, one based on the belief that every organization has people who have access to the same resources as their colleagues but whose different work practices

a. are unique.

b. are questionable.

c. upset the status quo.

d. produce better outcomes.

7. Clancy advised managers of complex health care environments to find the positive deviants in their organizations and do which of the following?

a. Reward them in tangible ways.

b. Tap into their creative minds.

c. Make them administrative liaisons.

d. Ask them to share strategies with peers.

8. In a study of hospitalbased nurses, Hutchinson used which of the following terms to describe the behavior of nurses who bend the rules for the sake of their patients?

a. creative individualism

b. strategic risk taking

c. responsible subversion

d. productive nonconformism

9. Bloch stated that positive deviants

a. are anarchists.

b. want organizational success.

c. challenge authority figures.

d. serve intrinsic goals.

10. Which term describes how some nurses use imagination and creativity in examining a given practice and considering ways to accomplish or improve it?

a. active intelligence

b. inspired innovation

c. resourceful acumen

d. enlightened exploration

11. Most nurses realize that when they step outside the boundaries of hospital rules and protocols, they

a. have a higher goal in mind.

b. put their careers at risk.

c. lack peer support.

d. attract followers.

12. A common antecedent of positive deviance is

a. implementation of work-arounds.

b. respect for organizational norms.

c. individual prosocial behavior.

d. a certain level of clinical expertise.

13. The most practical consequence of positive deviance in nursing seems to be

a. attunement to the patient.

b. the sense of conflict.

c. experiential learning.

d. the deviance itself.

14. According to Dehler and Welsh, the “polar opposite” of positive deviance is

a. chaos.

b. defiance.

c. conformity.

d. accountability.

15. Walker and Avant used which of the following terms to describe categories of actual phenomena that by their existence demonstrate the occurrence of a concept?

a. empirical referents

b. corroborative indicators

c. constructive deviations

d. demonstrative phenomena

16. Berner and colleagues found that 92% of surveyed critical care nurses were aware of legal limits when they made patient care decisions. They also found that what percentage of the surveyed nurses reported having made decisions that went beyond those limits?

a. 50%

b. 60%

c. 70%

d. 80%

17. Complexity science suggests that complex systems require an approach that is

a. holistic.

b. individual.

c. simple.

d. flexible.

18. Dowding and Thompson stated that because of the impact of nurses’ decisions on patient outcomes and experiences, knowing which of the following is “of prime importance”?

a. how to adapt innovation for a particular system

b. how to measure the accuracy of nurses’ decisions

c. when to diverge from organizational norms

d. when to report nontraditional nursing practices

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