Health Systems Management
Midterm Exam
Course Introduction
Health Systems Management provides an overview of the organization, operation, and regulation of health care systems and services. The course explores the structure and dynamics of health systems, focusing on topics such as policy-making processes, quality improvement, healthcare financing, and delivery models. Students will analyze the roles of public and private sectors, leadership and strategic management in healthcare organizations, and the impact of social, economic, and technological factors on system performance. Through case studies and practical assignments, learners will gain skills necessary for effectively managing health services and contributing to improvements in health system efficiency, accessibility, and quality.
Recommended Textbook
Leading and Managing in Nursing 6th Edition by Yoder Wise
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30 Chapters
763 Verified Questions
763 Flashcards
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Chapter 1: Leading,Managing,and Following
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26 Verified Questions
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Source URL: https://quizplus.com/quiz/12928
Sample Questions
Q1) A dispute arises between an RN staff member and an LPN over a patient issue.The tension between the two begins to affect other staff members,who are drawn into the conflict; eventually,the team becomes polarized toward either the RN or the LPN.This situation might have been prevented through:
A)Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves.
B)Asking other staff members what the real issues were in the dispute between the RN and the LPN.
C)Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves.
D)Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute.
Answer: A
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3
Chapter 2: Safe Care The Core of Leading and Managing
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Sample Questions
Q1) To achieve nurse-sensitive care standards developed by the NQF,you advocate for which of the following in your health facility?
A)Evidence-based practice to reduce the prevalence of pressure sores
B)Implementation of informatics at the bedside
C)Staff-manager conferences to review reporting of adverse medical events
D)Patient councils to review food, recreation, and nurse-patient relations
Answer: A
Q2) As a manager in a new nursing home,where might you consult for guidance and evidence to support the development of safe patient practices?
A)Hospitals
B)Business
C)Industry
D)Outpatient clinics
Answer: A
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Chapter 3: Developing the Role of Leader
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Sample Questions
Q1) While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students,Natalie,a nursing unit manager,emphasizes that:
A)Most nurses are not expected to assume leadership roles.
B)The role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards.
C)Only individuals in formal leadership roles are expected to be leaders.
D)The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.
Answer: D
Q2) The adage "leaders are born and not made" reflects which of the following ideas around leadership?
A)Management can be taught; leadership depends on abilities.
B)Mentorship is important in developing innate skills of leaders.
C)Leadership is a natural skill that cannot be refined or developed.
D)Succession planning and formal education related to leadership are ineffective.
Answer: A
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Chapter 4: Developing the Role of Manager
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Sample Questions
Q1) A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage.During a called staff meeting,the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices.In doing this,the nurse manager is using the concept of collaboration to:
A)Demonstrate interdependence.
B)Depict flexibility and broadmindedness.
C)Focus all energies of staff members on a best possible strategy.
D)Defuse the possibility that staff members will escalate their discontent when staffing the unit on weekends.
Q2) Budgeting and protection of revenues is a function of:
A)Leadership.
B)Management.
C)Team leadership.
D)Followers.
Q3) The successful integration of informatics into healthcare settings is key to:
A)Quality decision making related to management of resources and patient care.
B)Accessing current information about business practices.
C)Meeting the modern-day expectations of staff regarding technology use.
D)Speeding up calculations and decisions in budget development.
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Page 6
Chapter 5: Legal and Ethical Issues
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Sample Questions
Q1) A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family,who died on the weekend,had requested analgesics from the RNs on duty.An RN came with the analgesic nearly 45 minutes later,just after the patient had died.The manager is aware that the unit was especially busy that weekend because many patients were seriously ill,staff had called in ill,and the staffing manager was unable to completely replace staff who were absent.The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done.This manager is experiencing:
A)Compromised agency.
B)Moral distress.
C)Moral sensitivity.
D)Moral dilemma.
Q2) An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic.The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers:
A)Make reasonable accommodations for persons who are disabled.
B)Allow modified job expectations for persons recovering from alcoholism.
C)Hire disabled individuals before hiring other qualified, non-disabled persons.
D)Treat, for purposes of employment, homosexuals and bisexuals as disabled.
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Page 7
Chapter 6: Making Decisions and Solving Problems
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Sample Questions
Q1) Justin is a nurse manager in a rehabilitation unit in a small urban center.There is a high turnover rate among rehab-assistants because of the heavy work assignments.Despite his need for staff,Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team.Which of the following decision-making solutions should Justin consider to have a more efficient department
A)Replace staff only with qualified applicants.
B)Determine what the problem or problems are before hiring new staff.
C)Consult with the human resources department and develop a plan for hiring new staff.
D)Consider all the options listed.
Q2) High-quality decisions are most likely to be made in nursing situations when:
A)Team leaders make the crucial decisions.
B)Individuals are advised of the problems.
C)Group size is neither too small nor too large.
D)Members are passively involved.
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Page 8
Chapter 7: Healthcare Organizations
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Sample Questions
Q1) To prepare for the orientation of newly hired nurses,the nurse manager plans a presentation outlining the concept of healthcare networks.Healthcare networks are:
A)Units that provide only primary care services.
B)Owned by the institutions.
C)A feature of all public institutions.
D)Units that serve large populations.
Q2) Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days).This facility would likely be considered:
A)Primary care, specialized.
B)Tertiary care, long-term.
C)Acute care, specialized.
D)Public care, specialized.
Q3) Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid.Tracy's responsibilities most likely would include:
A)Managing physician-led research.
B)Monitoring physician documentation of the need for medical care.
C)Determining which services are designated fee-for-service.
D)Identifying errors in physician diagnoses.
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Chapter 8: Understanding and Designing Organizational
Structures
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Sample Questions
Q1) In opening a new dialysis unit,the nurse manager has to develop a philosophy for the unit.This philosophy needs to:
A)Reflect the culture of the unit and its values.
B)Be developed by the nursing manager on the unit.
C)Identify the clients that will be served on the unit.
D)Replicate the organization's philosophy.
Q2) The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment,this partnership will:
A)Promote professional medical authority, autonomy, and responsibility.
B)Need a degree of flexibility to engender success.
C)Be essential for self-governance.
D)Provide for the establishment of medical committees.
Q3) A hospital is working toward becoming a Magnet hospital.The chief nursing officer is aware that professional nursing departments of the future will:
A)Not be directed by nurses.
B)Be virtual organizations.
C)Be designed to maintain nursing standards of practice.
D)Be entitled to have client care departments.
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Chapter 9: Cultural Diversity in Health Care
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Sample Questions
Q1) At Health Center XYZ,staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake.Over time,the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings.New staff members are quickly made to realize that silence is expected.The situation described is an example of:
A)Ethnicity.
B)Work environment.
C)Work culture.
D)Marginalization.
Q2) According to Leininger,"cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values,beliefs,and practices on patients of other cultures.The discussion topic most likely to be without cultural imposition would be: A)Abortion.
B)Wound management.
C)Blood transfusion.
D)Advance directives.
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Chapter 10: Power,Politics,and Influence
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Sample Questions
Q1) The institution where you are a nurse manager has resisted the adoption of a new document management software,citing cost as a concern.You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software.This is an example of:
A)Collaboration.
B)A coalition.
C)Networking.
D)Policy building.
Q2) During a unit meeting,you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group.You are surprised because Vivian has often confided that she does not like Mary.Vivian's behavior is best described as:
A)Insincere.
B)Networking.
C)Politically sophisticated.
D)Collegial.
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Chapter 11: Caring, Communicating, and Managing with Technology
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Sample Questions
Q1) A rural-urban health consortium enables physicians in a rural remote setting to consult with specialists in care through electronic conferencing,which includes consultation using intranet radiology images.This system may be in which phase of electronic medical technology adoption,according to the Healthcare Information and Management Systems Society (HIMSS)?
A)0
B)1
C)3
D)6
Q2) The chief nursing officer understands that to be able to compare data across client populations and sites,it is important that nurses use:
A)Similar settings.
B)Information systems.
C)Knowledge systems.
D)Structured nursing languages.
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Page 13
Chapter 12: Managing Costs and Budgets
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Sample Questions
Q1) During the budgeting process,nurse managers are typically responsible for which of the following? (Select all that apply.)
A)Determining inflationary rates for the upcoming year
B)Developing unit operation objectives
C)Justifying capital equipment requests
D)Predicting cash flow
E)Negotiating budget with other managers and administration
Q2) Within a healthcare environment,where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services,it is critical for nurse managers to:
A)Maintain a clear vision of how to trim healthcare costs.
B)Balance value-added services against costs and revenues.
C)Consistently delete programs that are of high cost.
D)Implement programs that bring in additional revenues.
Q3) Which of the following factors is not implicated in rising healthcare costs?
A)Rising expectations of consumers for cure and care
B)Marketing of drugs to consumers
C)Large administrative staffs to process medical billings
D)Rising Medicare costs
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Page 14
Chapter 13: Care Delivery Strategies
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Sample Questions
Q1) You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes.To achieve maximum reimbursement for a client who is recovering from a hip replacement,the nursing staff most likely will follow the nursing care guidelines presented in the:
A)Nursing care plan.
B)Physician's orders.
C)Critical pathway.
D)Clinical practice guidelines.
Q2) The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift.In making this decision,the charge nurse has overlooked this nurse's:
A)Clinical expertise.
B)Leadership ability.
C)Communication style.
D)Conflict-resolution skills.
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Page 15
Chapter 14: Staffing and Scheduling
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Sample Questions
Q1) Your healthcare organization has a decentralized system for scheduling.As part of this process,after you have developed a draft schedule,you may need to:
A)Seek budgetary approval.
B)Balance personal schedules against institutional needs.
C)Negotiate the schedule with unit staff.
D)Submit the schedule to a centralized staffing office for review.
Q2) The number of adverse events such as falls and pressure ulcers on your unit is increasing.An ideal staffing plan to address this issue would include which of the following? Increasing the:
A)Total number of staff on the unit.
B)Staff and RN hours per patient.
C)Total number of staff, and implementing 12-hour shifts.
D)Number of RNs and number of RNs with experience on the unit.
Q3) A busy neurologic ICU and step-down unit most likely would use which patient classification system?
A)Factor evaluation
B)Prototype evaluation
C)Hybrid system
D)AHRQ system
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Page 16
Chapter 15: Selecting, Developing, and Evaluating Staff
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Sample Questions
Q1) The validity of comments and ratings related to performance is enhanced by:
A)Maintenance of anecdotal notes over the entire evaluation period.
B)Quantity of information gathered for appraisal purposes.
C)Agreement of the employee with the ratings and comments.
D)Whether or not other individuals have contributed to the observations.
Q2) Sue,a nurse manager,discusses her concerns about the hospital's employee appraisal system with her work group,noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills.Sue's concerns reflect which best practices associated with performance appraisal?
A)Rating scales are too generalized to be considered valid or reliable.
B)The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills.
C)BARS is considered superior to simple rating scales in terms of performance appraisal.
D)Rating scales need to be designed by users to be well accepted.
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Chapter 16: Strategic Planning, Goal-Setting, and Marketing
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Sample Questions
Q1) After an extensive campaign to ensure that the community surrounding Pacific Hospital has been exposed to the emphasis of excellence in clinical care that occurs through the use of evidence,the marketing team finds that the public perception has changed little.This determination is made possible through:
A)Marketing surveys.
B)Focus groups.
C)Informal feedback.
D)Comparison of data against benchmarks.
Q2) To meet the social and human needs of a target market,it is critical to:
A)Assess the needs and priorities of the target market.
B)Revise the organization's mission statement to reflect external needs.
C)Assess the internal culture and needs.
D)Develop highly sophisticated media.
Q3) Assessment of the needs of the consumer or client (in developing a strategic marketing plan)focuses on:
A)Present needs only.
B)Present and future needs.
C)The development of surveys.
D)Secondary analysis of existing data.
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Page 18
Chapter 17: Leading Change
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Sample Questions
Q1) Elizabeth is an example of a(n):
A)Early adopter.
B)Late majority.
C)Laggard.
D)Resister.
Q2) The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems.The best approach to address this need for change,yet to have the best outcomes for clients,staff nurses,and the organization,is to:
A)Select one of the change models.
B)Use Lewin's model and principles of change.
C)Apply both planned and complexity theory approaches.
D)Form a task force of nursing staff and wound care specialists.
Q3) The wound care nurse decided to involve those to be affected by change early in the change management process.This can positively result in:
A)Coordination.
B)Resistance.
C)Anticipation.
D)Participation.
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Chapter 18: Building Teams Through Communication and Partnerships
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Sample Questions
Q1) Team Member A and Team Member B engage in heated disagreements on a frequent basis in team meetings.Their behavior is characterized by insistence on their points of view and refusal to back down or to negotiate alternative solutions once their ideas have been expressed.This behavior is characteristic of:
A)Autocratic leadership.
B)Constructive conflict.
C)Dualism.
D)Creativity.
Q2) The SBAR system of communications is one of the most used communication systems in health care because:
A)It deals with all aspects of communications in patient care except communication with the physician.
B)The nurse is on the same communication level as administration.
C)It honors a familiar, structured transfer of information among health professionals.
D)It honors an unstructured transfer of information.
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Page 20
Chapter 19: Workforce Engagement and Collective Action
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Sample Questions
Q1) Nursing labor management partnerships:
A)Engage nurses at all levels in problem solving for better patient care.
B)Require unions and management to negotiate in good faith regarding hours of work and wages.
C)Have been shown to have negligible effects on nurse turnover and patient outcomes.
D)Have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.
Q2) Awareness and use of power have been challenging for nurses in general because of:
A)Incidences of punishment by authority figures.
B)Too little time in the workplace to collectively develop power strategies.
C)Lack of cohesiveness and unity among nurses.
D)A tradition of obedience to authority.
Q3) Collective action is effective in:
A)Ensuring that needs of nurses are placed ahead of other disciplines.
B)Defining nursing as a profession.
C)Advising patients of the needs of nurses.
D)Amplifying the influence of individuals.
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Chapter 20: Managing Quality and Risk
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Sample Questions
Q1) Patient perceptions are useful in:
A)Determining disciplinary actions in QI.
B)Establishing the competitive advantage of QI decisions.
C)Providing one source of data for QI initiatives.
D)Establishing blame for poor-quality care.
Q2) With the rise of violence in the psychiatric department,the nurse manager decides that she should work with the risk manager in violence prevention.The nurse manager should:
A)Request all staff to accept new risk management practices.
B)Hold staff accountable for safe practices.
C)Document inappropriate behavior.
D)Hire more police security.
Q3) A method commonly used in Quality Assurance to monitor adherence to established standards is:
A)A Pareto chart.
B)Brainstorming.
C)Patient interviews.
D)Chart audit.
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22
Chapter 21: Translating Research into Practice
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Sample Questions
Q1) The chief nursing officer at a local hospital seeking Magnet status creates staff development classes concerning translation of research into practice (TRIP).What best describes TRIP?
A)Conducting an integrative review of the literature
B)Searching the literature for a systematic review
C)Providing the results of research studies to practitioners
D)Applying strategies that aid in adoption of research in practice
Q2) Which of the following is an effective approach in the appraisal of research studies?
A)Accept only studies that use a RCT design.
B)When ranking research studies, choose RCTs over qualitative studies.
C)Select only studies with a large sample size.
D)Evaluate the quality of the research against the standards for that type of research.
Q3) To help staff nurses adjust to using research in practice,what strategy would the nurse manager use?
A)Attendance at a regional research conference
B)Formal classes in electronic search techniques
C)Establishing a journal club
D)Issuing reports on the adverse consequences of outdated practices
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23
Chapter 22: Consumer Relationships
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Sample Questions
Q1) During review of a patient's progress,the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient.The patient is unable to pay.As the head nurse,you persist in ensuring that this patient receives the treatment.You are:
A)Empowering the patient.
B)Avoiding litigation.
C)Advocating for the patient.
D)Supporting the clinical pathway.
Q2) Based on data from the patient satisfaction survey,the nurse manager decides that a change should be made in communication with family members.What would be important for a nurse manager to consider when instituting a change to improve customer service?
A)Assess the perceptions of the nursing staff regarding the particular service problem.
B)Include community representatives on a planning committee to address the change.
C)Involve physicians, other healthcare professionals, and ancillary staff.
D)Review all patient complaints with the nursing staff.
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24
Chapter 23: Conflict The Cutting Edge of Change
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Sample Questions
Q1) Two staff nurses are arguing about whose turn it is to work on the upcoming holiday.In trying to resolve this conflict,the nurse manager understands that interpersonal conflict arises when:
A)Risk taking seems to be unavoidable.
B)People see events differently.
C)Personal and professional priorities do not match.
D)The ways in which people should act do not match the ways in which they do act.
Q2) The nurse manager decides to use a mediator to help resolve the staff's conflict.A basic strategy for truly addressing this conflict is to:
A)Identify the conflicting facts.
B)Be determined to resolve the conflict.
C)Schedule a meeting time for resolution.
D)Have a clear understanding of the differences between the parties in conflict.
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Chapter 24: Managing Personal/Personnel Problems
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Q1) All of the following are grounds for immediate dismissal except:
A)Failing to pursue further medical help for a patient; patient dies.
B)Selling narcotics obtained from the unit supply of narcotics.
C)Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member.
D)Grabbing the unit manager and threatening further physical harm after a poor performance appraisal.
Q2) The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:
A)Using replacement personnel with new ideas may be beneficial.
B)Salary costs are lower because personnel are fewer, and outcome is favorable.
C)Absence on the part of the rest of the staff is decreased.
D)Unacceptable patient care may result.
Q3) In keeping with guidelines of the organization,the nurse manager documents staff problems.Documentation of disciplinary problems should:
A)Include a plan to correct them and to prevent future occurrences.
B)State a detailed history of past problems that are related to the current one.
C)Be written at the convenience of the manager.
D)Not be discussed until the formal performance evaluation.
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Page 26
Chapter 25: Workplace Violence and Incivility
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Sample Questions
Q1) At 3 AM,a man walks into your emergency department.He paces back and forth in the waiting area before he approaches staff to ask if he can see his wife,who is a patient on another floor.He speaks rapidly,his face is flushed,he glances around often,and he keeps his hand in his jacket pocket.A best initial response would be to:
A)Assess your situation and your surroundings.
B)Ask two or three staff to assist in confronting the individual.
C)Ask what floor his wife is on and remind him that visiting hours are closed.
D)Remain calm as there is no potential for violence here.
Q2) In designing a new healthcare facility,it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings? (Select all that apply.)
A)Emergency
B)Psychiatry
C)Gerontology
D)Maternal-child
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Chapter 26: Delegation An Art of Professional Nursing Practice
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Sample Questions
Q1) In delegating to a UNP in a home health setting,which of the following represents the most appropriate delegation communication?
A)"You will be taking care of Mrs. S., who needs assistance with her bath."
B)"You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in."
C)"I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care."
D)"Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."
Q2) With delegation,responsibility and accountability remain with the:
A)Physician.
B)Professional who delegates.
C)Individual who receives the delegation.
D)Individual who previously performed the task.
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Page 28
Chapter 27: Role Transition
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Sample Questions
Q1) Sarah is a nursing graduate of 5 years who is very confident in her clinical skills.She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus.She is excited about being able to use her knowledge and interest by being hired as a nurse manager.Before beginning her new position,Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage.Sarah's actions are important in avoiding role:
A)Ambiguity.
B)Transition.
C)Development.
D)Negotiation.
Q2) A nurse is interviewing for a manager's position.Which of the following actions is considered a role preview?
A)Formal commitment of the employment contract
B)Improving role performance
C)Touring the unit
D)Disillusionment about the expectations of the job
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Chapter 28: Self-Management Stress and Time
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Sample Questions
Q1) A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS.She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings.One reasonable stress management strategy would be to:
A)Start taking yoga lessons.
B)Make an appointment to meet with a psychiatrist.
C)Start jogging 5 to 6 miles every day.
D)Plan to go out for a drink with fellow nurses after work every day.
Q2) Which one of the following statements has been proven to be true?
A)Recent research has found that women do not have a unique physiologic response to stress.
B)Both men and women interpret the same stressor in the same manner without regard to past experiences.
C)Stress influences the immune system in one complex manner.
D)Stressors that are identical do not necessarily have similar effects on each individual.
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Chapter 29: Managing Your Career
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Sample Questions
Q1) An experienced staff nurse applies for a distinct position of patient advocate at a new clinic.Based on the various tools available to her,which of the following should she bring to her interview to best present her skills?
A)Résumé
B)Annual evaluations
C)Portfolio
D)Patient advocacy project
Q2) You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project.Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path?
A)You are pressured to do so by your supervisor.
B)The organization has no other suitable candidate for the position.
C)You have limited knowledge of information technology and no real interest, but this will increase your knowledge.
D)Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.
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Chapter 30: Thriving for the Future
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Sample Questions
Q1) A business condition that may assist forecasting but add to the complexity of change is:
A)Consulting with professional groups about change.
B)Researching about trends on futuristic sites.
C)Asking patients to examine options for change.
D)Building profit projects and sustainability into planning.
Q2) A necessary leadership strength for nurses of the future is:
A)Inspiring others to work their best to create the future.
B)Understanding the nuances of fundraising to make up funding shortfall.
C)Guarding the tendency of other professions to encroach on nursing roles.
D)Adapting work life to an aging nursing workforce.
Q3) Which aspect of our tradition and history in nursing may impede our movement towards future-oriented thinking?
A)Lack of confidence
B)Focus on the discipline of nursing
C)Focus on details in the everyday practice
D)Mistrust of trends and new evidence
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