article notes


english writingnotes
1) be yourself but carefully
2) Data science and art of persuasion.
3) evolution and future
4) find the coaching in criticism
5) five messages leader must manage
6) from purpose to impact
7) Good communication that blocks learning
8) how to become an authentic speaker
9) how to give a killer presentation
10) how to pitch a brilliant idea.
11) Making Business Personal
12) making dumb groups smarter
13) Manage Your Energy, Not Your Time
14) moments of greatness
15) overloaded circuits
16) The Authenticity Paradox
17) the five messages leader must manage
18) the four truths of storyteller
19) When to Cooperate with Colleagues and When to Compete
i have attached a good article not as a reference.

Be Yourself, but Carefully
How to be authentic without oversharing
by Lisa Rosh and Lynn Offermann

Don't use plagiarized sources. Get Your Custom Essay on
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Just from $13/Page
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h flj uthenticity” is the new buzzword
\ among leaders today. We’re told to

‘ %bring our fijU selves to the office,
to engage in frank conversations, and to
tell personal stories as a way of gaining our
colleagues’ trust and improving group per-
formance. The rise in collaborative work-
places and dynamic teams over recent
years has only heightened the demand
for “instant intimacy,” and m2magers are
supposed to set an example.

But the honest sharing of thoughts,
feelings, and experiences at work is a
double-edged sword: Despite its potential
benefits, self-disclosure can backfire if

it’s hastily conceived, poorly timed, or
inconsistent with cultural or organiza-
tional normshurting your reputation,
alienating employees, fostering distrust,
and hindering teamwork. Getting it right
takes a deft touch, for leaders at any stage
of their careers.

Consider Mitch, the director of a
newly established department at a major
U.S. university, who was responsible for
negotiating and maintaining links with
other educational and research institu-
tions. Attempting to break the ice in his
first meeting with the dean of a promi-
nent college, he mentioned how excited

October aoi3 Harvard Business Review 135


he was to be at the dean’s school, because
he’d wanted to attend it but had been
rejected. He got a cold stare in response,
and the meeting ended without an
agreement. Mitch thought his comment
was friendly and self-deprecating; now
he realizes that it probably lowered his
standing with the dean, who may have
thought he was either challenging the
admissions process or seeking pity. Mitch
learned that such revelations must be
skillfully deployed.

In our years of studying and consult-
ing on leadership development, team
building, and communication skills, we’ve
come across hundreds of cases like this.
Drawing on them and on more than four
decades’ worth of research in social and
organizational psychology, we now have
some lessons to share. Here we look at the
common mistakes executives make when
they’re trying to be authentic and offer
a five-step plan for moving toward more-
efFective self-disclosure.

Where Leaders Slip
Authenticity begins with self-awareness:
knowing who you areyour values,
emotions, and competenciesand how
you’re perceived by others. Only then
can you know what to reveal and when.
Good communication skills are also key to
effective self-disclosure; your stories are
worthwhile only if you can express them
well. We typically encounter three types of
executives whose lack of self-knowledge
causes their revelations to fall flatoblivi-
ous leaders, bumblers, and open books
and two types who fail because they are
poor communicators: inscrutable leaders
and social engineers. (However, people
often fit into more thcin one category at
least some ofthe time.)

Oblivious leaders don’t have a realis-
tic view of themselves and thus reveal
information and opinions in a manner that
appears clueless or phony. Take Lori, the
director of sales and business develop-
ment for a global software company. She
sees herself as an inclusive, participatory,
and team-oriented manager and likes to

136 Harvard Business Review October 2013

tell Stories about her time as a junior staff
member and how much she valued having
a voice in decisions. But her subordinates
consider her to be highly directive and
thus find her anecdotes disingenuous. As
one employee puts it, “I don’t care if you
make every decision, but don’t pretend to
care about my opinion.”

Bumblers have a better understanding
of who they are but not of how they come
across to others. Unable to read colleagues’
social cues, including body language and
facial expressions, they make ill-timed, in-
appropriate disclosures or opt out of rela-
tionship building altogether. This behavior
is particularly prevalent in cross-cultural
situations when people aren’t attuned to
differing social norms. A case in point in-
volves Roger, a partner in a multinational
consulting firm who was assigned to help
boost meirket share for the firm’s newly
formed Asia-Pacific office. Asked to coach
a team that had recently lost an impor-
tant account, he decided to share a story
about losing his first client. In the United

States, anecdotes about his own mistakes
had always made his subordinates feel
better. But Roger’s Asian colleagues were
dismayed that their new leader would risk
his honor, reputation, and influence by
admitting weakness.

You don’t need to leave your country to
bumble. Take Anne, the general manager
of a cafeteria for an international technol-
ogy company. An extrovert who knows
herself well, she shares her experiences
and perceptions freely. This can be effec-
tive when she’s talking to her staff, but it’s
less so with outsiders. For example, when
an HR manager recently complimented
her on the catering she’d coordinated
for an in-house awards ceremony, Anne
thanked him and went on to disclose that
she’d been concerned because the com-
pany had come close to outsourcing its
food service. Instead of seizing an oppor-
tunity to secure more internal business for
her beleaguered cafeteria, she diminished
her status and worried team members
who overheard the exchange.

Unable to read
social cues,
including body
language and
facial expressions,
make ill-timed,


Open books talk endlessly about them-
selves, about others, about everything;
they’re too comfortable communicating.
So although colleagues may seek them out
as sources of information, they ultimately
don’t trust them. Consider Jeremy, an
outgoing senior manager with a sharp
mind but a string of failed management
consulting engagements. When people
first meet him, his warmth, intelligence,
and ability to draw them into conversa-
tion make them feel as if he were an old
friend. But his aggressive familiarity soon
wears thin (“I know more about his wife
than I know about my own,” one former
colleague says), and his bosses question
whether he’s discreet enough for client
work. Indeed, Jeremy was asked to leave
his most recent job after he used a key
meeting with a prospective client to detail
work he’d done for several others, not only
outlining their problems but identifying
them by name.

Inscrutable leaders are at the other
end ofthe spectmm: They have difficulty
sharing anything about themselves in the
workplace, so they come off as remote ind
inaccessible and can’t create long-term
office relationships. Aviva is a registered
dietician who expanded her private prac-
tice into a full-service nutritional guidance,
exercise training, and health products
company. Although she’s talented and
passionate, she has difficulty retaining
employees, because she fails to communi-
cate her enthusiasm and long-term vision.
Recently featured on a panel of female
entrepreneurs, she opted to present a
basic annual report and outline her sales
strategy rather than to captivate the
audience with a personal story, as others
had done. Afterward, the other panelists
were flooded with rsums and business
cards; Aviva had lost out on the significant
benefits that can come from appropriate

Finally, social engineers aie similar to
inscmtable leaders in that they don’t in-
stinctively share, and to bumblers in that
they often have difficulty reading social
cues, but their chief shortcoming is the

way they encourage self-disclosure within
their work groups. Instead of modeling
desired behaviors, they sponsor external
activities such as off-site team buuding.
Andrew, for example, is a unit head at a
financial services firm with an ultracom-
petitive corporate culture. Every year, he
sends his team on a mandatory retreat run
by an outside consultant who demands
personal revelations in artificial settings.
Yet Andrew never models or encourages
self-disclosure in the officeand he looks
the other way if employees exploit col-
leagues’ self-revealed weaknesses to get
ahead. When we asked one of Andrew’s
direct reports about the most recent group
getaway, she said, “I learned that I hate my
colleaguesand my managereven more
than I thought.”

Executives who make any or all of
these mistakes may appear to be simply
incompetent. But their cautionary tales
are much more common than you might
think, and we can all learn from them. In
our work we’ve seen even the most self-
aware, talented communicators err in how,
when, or to whom they reveal a personal
story. Everyone should understand best
practices in self-disclosure.

A Five-Step Path
Let’s retum to Mitch, who blimdered
with the college dean. Chastened by
that experience, he vowed to get better
at revelation. Since then his disclosures
have proved far more effective, allowing
him to establish many enduring partner-
ships. What makes him so successful now?
First, he’s self-aware: He knows who he
is, where he came from, where he’s going,
and what he believes in. He encourages
colleagues to give him feedback, and he’s
enrolled in several developmental training
programs. Second, he communicates
cautiously, letting the task at hand, along
vwth environmental cues, dictate what
to reveal when. For instance, he was all
business at one meeting with a potential
partner until she voiced a concem about
whether her students could assimilate at
his university. Sensing a critical moment

in the negotiation, he decided to tell her
about the challenges he’d faced in an
exchange program during collegetry-
ing to learn another language, make
friends, and adjust to the curriculum. The
story was personal and heartfelt but also
demonstrated an understanding of his
counterpart’s concem and a commitment
to addressing it. He deepened the relation-
ship and sealed the deal.

Mitch arrived at effective, authentic
self-disclosure by following five steps:

Build a foundation of self-
knowledge. You can leam
about yourself in many ways,
but the best approach is to so-
licit honest feedbackideally

a 360-degree reviewfrom coworkers and
follow it up with coaching. In Why Should
Anyone Be Led by You? (Harvard Busi-
ness School Press, 2006), Rob Goffee and
Gareth Jones suggest exploring biography.
You might consider your upbringing, your
work experiences, and new situations,
such as volunteer opportunities, that test
your comfort zone and force you to reflect
on your values. You might also consider
your personal management philosophy
and the events and people who shaped it.
We start our executive coaching engage-
ments with a detailed interview that
essentially walks clients through their
personal and professional histories, their
successes and failures, and the lessons
they’ve drawn as a result. These exercises
can help you choose which stories are
most appropriate to share with others.

Consider relevance to the
task. Skillful self-disclosers
choose the substance, process,
and timing of revelations to
further the task at hand, not

to promote themselves or create purely
personal relationships. In fact, we found
in our earlier work that team develop-
ment efforts often fail because they try
too hard to foster intimacy rather than
focusing on task-relevant disclosure and
social cohesion. Be clear that your gocd in

October 2013 Harvard Business Review 137


Whenand When Notto Share
This checklist can help you decide when
self-disclosure is advisable.

revealing yourself at work is to buud trust
and engender better collaboration and
teamwork, not to make friendsthough
that may happen. So before you share per-
sonal information, ask yourself whether
it will help you do your job. Is it germane
to the situation? Will your staff get a bet-
ter understanding of your thinking and
rationale? If not, you might want to save
the story for a coffee date with friends.
If your goal is simply to develop rapport
with employees, you can find safer ways
to accomplish thatsuch as bonding over
a beloved sports team, a new movie, or a
favorite restaurant.

Keep revelations genuine.
This should be a no-brainer,
but we’re amazed at how often
we hear about managers who
fabricate tales. Take Allan, who

recently stepped down from his position
as the associate director of marketing and
communications for a regional hotel chain.
In both presentations and small group
discussions, he would cite examples of
how he had successfully used social media,
video on demand, and search engine opti-
mization in his prior position at a premier
boutique hotel. The problem was that he
held that job in the early 1980s, before
those technologies were widespread. Allan
did have extensive social media marketing
experience, but it had come through his
volunteer church work; he fudged the de-
tails in an effort to bond with his younger
colleagues. Eventually they found out,
and Allan lost credibility, which ultimately
led to his departure from the company.
Making up stories or exaggerating parts of
a narrative to fit the situation may seem
like a good idea, but it is easily discovered
and can do a lot of harm. Instead try to
find real if less-than-perfect disclosures
that still capture the emotions of the situ-
ation and convey empathy. If, for example,
Mitch had never been part of an exchange
program, he might have told his potential
partner that he was a father and therefore
recognized the importance of assuaging
young people’s fears in new situations.

For an interactive
version of this
tool, with tailored
advice, go to

How much self-reection
have you done?
A I don’t engage in self-reflection.

B I’ve taken many self-assessment tests but rarely get feed-
back from others.

C I’ve completed numerous self-assessments, and my scores
are usually similar to those my colleagues give me in
360-degree reviews.

What is your goal in
A I want to demonstrate knowledge, competence, or empathy.

B I want to connect with my colleagues in order to improve the
atmosphere at work.

C I want to gain the trust of my colleagues in order to make
our performance more effective.

What kinds of information
do you disclose?
A I fabricate a story to fit the situation.

B I tell a true story that may or may not fit the situation.

C I tell a true story that fits the emotion of the situation
and conveys empathy.

What personal information do
your colleagues share with you?
A No one shares personal information in my workplace.

B I know a lot about the personal lives of a few friends at work
but not much about my other colleagues.

C My colleagues share personal information, especially when it
is pertinent to the task.

How long have you known
your colleagues?
A We just met.

B We’ve had one or two formal meetings.

C We’ve had at least a week of formal and informal discussions
and have completed one significant task.

If your answers were mostly As, you might want to be quiet.

If they were mostly Bs, you should proceed cautiously.

If they were mostly Cs, speak up.

October 2013 Harvard Business Review 138


Understand the organiza-
tional and cultural con-
text. Considerable research
has shown that people from
individualistic societies, such

as the United States and India, are more
likely to disclose information about them-
selves and expect others to do the same
than people from coUectivist societies,
such as China and Japan. Thus Roger’s
Asian teammates might have been put off
by his readiness to share a personal story.

care agency. Exhausted after a sleep-
less night with her sick baby, she shared
that experience in her introduction, to
the discomfort of her audience. “They
wanted to know about my education and
industry background, and instead I spoke
graphically about baby throw-up,” she re-
calls. “It took me a few months after that
to reestablish credibility.” This doesn’t
mean you have to wait years before telling
colleagues anything about your personal
life. You just need to have spent enough

Skillful self-disclosers choose the
substance, process, and timing of
revelations to further the task at
hand, not to promote themselves.

regardless of its content. Make an effort
to investigate national and orgjinizational
norms about sharing so that you’ll know
when it’s best to keep quiet. In any con-
text, but especially one new to you that
involves teammates from other countries,
companies, or functions, you should talk
to respected insiders about how people
operate and what level of candor is ex-
pected. HR personnel and group leaders
may be able to provide this information,
but you can also test the waters with task-
relevant self-disclosure to see how people
respond. And you can look for cues such
as eye contact and others’ attempts to
share or solicit stories.

Delay or avoid very personal
disclosures. Intimate stories
strengthen relationships; they
don’t establish them. Sharing
too much personal information

too quickly breaks all sociocultural norms
of behavior, making one appear awk-
ward, needy, or even unstable. That was
Helen’s mistake when she was asked to
introduce herself at the cross-site launch
of a training program at her home health

time with them to develop a foundation
of trust and to learn organizational norms.
First develop common objectives, delin-
eate goals and roles, and demonstrate
credibility and trustworthiness through
your work. Take careful note of how open
others are before offering significant dis-
closures of your own. In some workplaces
you will eventually find it safe and helpful
to share; in others you’ll realize it’s ex-
tremely unwise to do so.

These five steps should help you
avoid some of the pitfalls we’ve outlined
and become a more effective leader.
Remember to think carefully about your
motives and likelihood of success. (See
the exhibit “Whenand When Notto
Share.”) Self-disclosure is a valuable
mcinagerial tool, but it must be used
judiciously. What stories do you have to
tell, and who needs to hear them? 0

HBR Reprint R1310J

Lisa Rosh is an assistant professor of
management at the Sy Syms School of

Business at Yeshiva University. Lynn Offermann
is a professor of organizational sciences and
communication at the George Washington

^’v 9 m m m ^ “^




HKUST’s open-enrollment and

custom programs w\\ advance

your global business knowledge

and help you become a promising

business leader in Asia

for the world

t a M

Copyright 2013 Harvard Business Publishing. All Rights Reserved. Additional restrictions
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institution. For more information and teaching resources from Harvard Business Publishing
including Harvard Business School Cases, eLearning products, and business simulations
please visit 126 Harvard Business Review
JanuaryFebruary 2019

Scott Berinato
HBR senior editor


Illustrations by KRISTEN MEYER

& the Art of

Organizations struggle to communicate the insights in all the
information theyve amassed. Heres why, and how to fix it.


Harvard Business Review
JanuaryFebruary 2019 127

Idea in Brief


Companies responded
to the analytics boom
by hiring the best data
scientists they could
findbut many of them
havent gotten the value
they expected from their
data science initiatives.


For an analytics project
to create value, the
team must first ask
smart questions,
wrangle the relevant
data, and uncover
insights. Second, it
must figure outand
those insights mean for
the business. The ability
to do both is extremely
rareand most data
scientists are trained
to do the first, not
the second.


A good data science
team needs six talents:
project management,
data wrangling, data
analysis, subject
expertise, design, and
storytelling. The right
mix will deliver on the
promise of a companys


Data science is growing up fast. Over the past five
years companies have invested billions to get the most-
talented data scientists to set up shop, amass zettabytes
of material, and run it through their deduction machines
to find signals in the unfathomable volume of noise.
Its workingto a point. Data has begun to change our
relationship to fields as varied as language translation,
retail, health care, and basketball.

128 Harvard Business Review
JanuaryFebruary 2019

But despite the success stories, many companies arent
getting the value they could from data science. Even well-run
operations that generate strong analysis fail to capitalize on
their insights. Efforts fall short in the last mile, when it comes
time to explain the stuff to decision makers.

In a question on Kaggles 2017 survey of data scientists,
to which more than 7,000 people responded, four of the
top seven barriers faced at work were related to last-mile
issues, not technical ones: lack of management/financial
support, lack of clear questions to answer, results not
used by decision makers, and explaining data science to
others. Those results are consistent with what the data sci-
entist Hugo Bowne-Anderson found interviewing 35 data sci-
entists for his podcast; as he wrote in a 2018 article,
The vast majority of my guests tell [me] that the key skills
for data scientists are.the abilities to learn on the fly and
to communicate well in order to answer business questions,
explaining complex results to nontechnical stakeholders.

In my work lecturing and consulting with large orga-
nizations on data visualization (dataviz) and persuasive
presentations, I hear both data scientists and executives vent
their frustration. Data teams know theyre sitting on valuable
insights but cant sell them. They say decision makers mis-
understand or oversimplify their analysis and expect them to
do magic, to provide the right answers to all their questions.
Executives, meanwhile, complain about how much money
they invest in data science operations that dont provide
the guidance they hoped for. They dont see tangible results
because the results arent communicated in their language.

Gaps between business and technology types arent
new, but this divide runs deeper. Consider that 105 years
ago, before coding and computers, Willard Brinton began
his landmark book Graphic Methods for Presenting Facts by
describing the last-mile problem: Time after time it happens
that some ignorant or presumptuous member of a committee
or a board of directors will upset the carefully-thought-out
plan of a man who knows the facts, simply because the man
with the facts cannot pre sent his facts readily enough to
overcome the opposition.As the cathedral is to its founda-
tion so is an effective presentation of facts to the data.

How could this song remain the same for more than a
century? Like anything else this deeply rooted, the last-
mile problems origins are multiple. For one, the tools used

to do the science include visualization functionality. This
encourages the notion that its the responsibility of the data
person to be the communicator. The default output of these
tools cant match well-conceived, fully designed dataviz;
their visualization often isnt as well developed as their data
manipulation, and the people using the tools often dont
want to do the communicating. Many data scientists have
told me theyre wary of visualization because it can dumb
down their work and spur executives to draw conclusions
that belie the nuance and uncertainty inherent in any
scientific analysis. But in the rush to grab in-demand data
scientists, organizations have been hiring the most techni-
cally oriented people they can find, ignoring their ability or
desire (or lack thereof) to communicate with a lay audience.

That would be fine if those organizations also hired other
people to close the gapbut they dont. They still expect
data scientists to wrangle data, analyze it in the context of
knowing the business and its strategy, make charts, and
present them to a lay audience. Thats unreasonable. Thats
unicorn stuff.

To begin solving the last-mile problem, companies must
stop looking for unicorns and rethink what kind of talent
makes up a data science operation. This article proposes a
way for those that arent getting the most out of their opera-
tions to free data scientists from unreasonable expectations
and introduce new types of workers to the mix. It relies on
cross-disciplinary teams composed of members with varying
talents who work in close proximity. Empathy, developed
through exposure to others work, facilitates collaboration
among the types of talent. Work is no longer passed between
groups; its shared among them.

A team approachhardly new, but newly appliedcan
get data science operations over the last mile, delivering the
value theyve created for the organization.

Why Are Things Like This?
In the early 20th century, pioneers of modern management
ran sophisticated operations for turning data into decisions
through visual communication, and they did it with teams.
It was a cross-disciplinary effort that included gang punch
operators, card sorters, managers, and draftsmen (they
were nearly always men). Examples of the results of this

Executives complain about how much money they invest in data science operations
that dont provide the guidance they hoped for. They dont see tangible results
because the results arent communicated in their language.

Harvard Business Review
JanuaryFebruary 2019 129

How Communication Fails
Ive learned in my work
that most leaders recognize
the value data science
can deliver, and few are
satisfied with how its
being delivered. Some data
scientists complain that
bosses dont understand
what they do and underutilize
them. Some managers
complain that the scientists
cant make their work
intelligible to a lay audience.

In general, the stories I hear
follow one of these scenarios.
See if you recognize any of them.

The Statisticians Curse
A data scientist with
vanguard algorithms and
great data develops a suite
of insights and presents
them to decision makers
in great detail. She believes
that her analysis is objective
and unassailable. Her
charts are click and viz
with some text added to the
slidesin her view, design
isnt something that serious
statisticians spend time on.
The language she uses in her
presentation is unfamiliar to
her listeners, who become
confused and frustrated.
Her analysis is dead-on,
but her recommendation
is not adopted.

The Factory and the Foreman
A business stakeholder wants
to push through a pet proj ect
but has no data to back up
his hypothesis. He asks the

data science team to produce
the analysis and charts for
his presentation. The team
knows that his hypothesis
is ill formed, and it offers
helpful ideas about a better
way to approach the analysis,
but he wants only charts
and speaking notes. One of
two things will happen: His
meeting will be upended
when someone asks about
the data analysis and he
cant provide answers, or his
proj ect will go through and
then fail because the analysis
was unsound.

The Convenient Truth
A top-notch information
designer is inspired by
some analysis from company
data scientists and offers
to help them create a
beautiful presentation for
the board, with on-brand
colors and typography and
engaging, easily accessible
stories. But the scientists
get nervous when the
executives start to extract
wrong ideas from the
analysis. The clear, simple
charts make certain
relationships look like direct
cause and effect when theyre
not, and they remove any
uncertainty thats inherent
in the analysis. The scientists
are in a quandary: Finally, top
decision makers are excited
about their work, but what
theyre excited about isnt a
good representation of it.

collaboration are legion in Brintons book. Railroad compa-
nies and large manufacturers were especially adept, learning
the most efficient routes to send materials through factories,
achieving targets for regional sales performances, and even
optimizing vacation schedules.

The team approach persisted through most of the cen-
tury. In her 1969 book Practical Charting Techniques, Mary
Eleanor Spear details the ideal teama communicator, a
graphic analyst, and a draftsman (still mostly men)and
its responsibilities. It is advisable, Spear writes, that
[all three] collaborate.

In the 1970s things started to split. Scientists flocked
to new technology that allowed them to visualize data in
the same space (a computer program) where they manipu-
lated it. Visuals were crude but available fast and required
no help from anyone else. A crack opened in the dataviz
world between computer-driven visualization and the
more classic design-driven visualization produced by
drafts people (finally).

Chart Wizard, Microsofts innovation in Excel, intro-
duced click and viz for the rest of us, fully cleaving the
two worlds. Suddenly anyone could instantly create a chart
along with overwrought variations on it that made bars
three-dimensional or turned a pie into a doughnut. The
profoundness of this shift cant be overstated. It helped
make charts a lingua franca for business. It fueled the use of
data in operations and eventually allowed data science to
exist, because it overcame the low limit on how much data
human designers can process into visual communication.
Most crucially, it changed the structure of work. Designers
draftspeoplewere devalued and eventually fell out of data
analysis. Visualization became the job of those who managed
data, most of whom were neither trained to visualize nor
inclined to learn. The speed and convenience of pasting
a Chart Wizard graphic into a presentation prevailed over
slower, more resource-intensive, design-driven visuals, even
if the latter were demonstrably more effective.

With the advent of data science, the expectations put on
data scientists have remained the samedo the work and
communicate iteven as the requisite skills have broadened
to include coding, statistics, and algorithmic modeling.
Indeed, in HBRs landmark 2012 article on data scientist as
the sexiest job of the 21st century, the role is described in


130 Harvard Business Review
JanuaryFebruary 2019


explicitly unicornish terms: What abilities make a data
scientist successful? Think of him or her as a hybrid of data
hacker, analyst, communicator, and trusted adviser. The
combination is extremely powerfuland rare.

A rare combination of skills for the most sought-after jobs
means that many organizations will be unable to recruit the
talent they need. They will have to look for another way to
succeed. The best way is to change the skill set they expect
data scientists to have and rebuild teams with a combination
of talents.

Building a Better Data Science Operation
An effective data operation based on teamwork can borrow
from Brinton and Spear but will account for the modern
context, including the volume of data being processed, the
automation of systems, and advances in visualization tech-
niques. It will also account for a wide range of proj ect types,
from the reasonably simple reporting of standard analytics
data (say, financial results) to the most sophisticated big data
efforts that use cutting-edge machine learning algorithms.

Here are four steps to creating one:

Define talents, not team members. It might seem
natural that the first step toward dismantling


COPD Exacerbation Case Study

Please provide complete, thorough, and detailed answers to all questions in the case study. Multiple-choice answers should include the correct choice and rationale for that choice and/or rationale why other choices are incorrect.
Please see attached file.

Case Study
COPD Exacerbation

Difficulty: Advanced

Setting: Hospital

Index Words: chronic obstructive pulmonary disease (COPD), medications, nutrition, patient education, assessment, coping

Giddens Concepts: Clinical Judgment, Collaboration, Gas Exchange, Nutrition, Oxygenation, Safety

HESI Concepts: Assessment, Clinical Decision MakingClinical Judgment, Collaboration/Managing Care, Gas Exchange, Nursing Interventions, Nutrition, Oxygenation, Safety

D.Z., a 68-year-old man, is admitted at 1600 to a medical floor with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD). His other past medical history includes hypertension and type 2 diabetes. He has had pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. His current medications include enalapril (Vasotec), hydrochlorothiazide (HCTZ), metformin (Glucophage), and fluticasone/salmeterol (Advair). He appears a cachectic man who is experiencing dif- ficulty breathing at rest. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately he feels tired most of the time. He reports cough productive of thick yellow-green sputum. You aus- cultate decreased breath sounds, expiratory wheezes, and coarse crackles in both lower lobes anteriorly and posteriorly. His vital signs (VS) are 162/84, 124, 36, 102 F (38.9 C), and Spo2 88%.


Physician’s Orders

Diet as tolerated
Out of bed with assistance
IV of D5W at 50 mL/hr ECG monitoring
Oxygen (O ) to maintain Spo of 90%
Arterial blood gases (ABGs) in am
CBC with differential now
Basic metabolic panel (BMP) now Chest x-ray (CXR) daily
Sputum culture
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT

Chart View

1. Are D.Z.’s VS and Spo2 acceptable? If not, explain why.

2. Describe a plan for implementing these physician’s orders.

3. What is the primary nursing goal at this time?

4. Based on this priority, identify three independent nursing actions you would implement.

5. Identify three expected outcomes for D.Z. as a result of your interventions.

Chart View

Medication Administration Record

Methylprednisolone (Solu-Medrol) 125 mg IVP every 8 hours
Azithromycin (Zithromax) 500 mg IVPB q24h 2 days then 500 mg PO 7 days Fluticasone/salmeterol (Advair) 100/50 mcg 2 puffs twice daily
Heparin 4000 units subcut every 12 hours Enalapril (Vasotec) 10 mg PO daily
Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment every 6 hours Metformin (Glucophage) 500 mg PO twice daily

6. Indicate the expected outcome for D.Z. that is associated with each medication he is receiving.


7. Because D.Z. is on azithromycin (Zithromax), what interventions need to be included in his plan of care? Select all that apply.
a. Monitor intravenous (IV) site for inflammation or extravasation.
b. Assess liver function study results and bilirubin levels.
c. Request a hearing test before initiating therapy.
d. Carefully dilute the medication in the proper amount of solution.
e. Place D.Z. on intake and output.
f. Administer the medication over 30 minutes.

8. D.Z is ordered heparin 4000 units subcutaneous q12h. The following vial is available. How many milliliters will D.Z. receive? Shade in the dose on the tuberculin syringe.

9. What are two common side effects of bronchodilators that you need to assess for?

10. You deliver D.Z.’s dietary tray, and he comments on how hungry he is. As you leave the room, he is rapidly consuming the mashed potatoes. When you pick up the tray, you notice that he has not touched anything else. When you question him, he states, I don’t understand it. I can be so hungry, but when I start to eat, I have trouble breathing and I have to stop. One theory for the increased work of breathing is based on carbohydrate (CHO) loading. Explain this phenomenon.

11. Identify four interventions that might improve his caloric intake.

12. You notice a box of dark chocolate on D.Z.’s overbed table. He tells you that his wife brought him those because he always wakes at night and eats four or five pieces. What is thought to be the basis for this craving for chocolate?

13. After speaking with D.Z. about his diet and reviewing his medications, you are now concerned about his glycemic control. Hospital policy allows you to obtain as-needed blood glucose levels for diabetic patients, so you direct the nursing assistive personnel (NAP) to obtain D.Z.’s blood glucose level at 2100. What is your responsibility in delegating this task to the NAP?

14. The NAP reports that D.Z.’s blood glucose level is 366 mg/dL. What action do you need to take and why?

2 Respiratory Disorders

15. What other health care professional would probably be involved in D.Z.’s treatments and how?

Case Study Progress
The next morning, D.Z. is sitting in the bedside chair and appears to be experiencing less difficulty breathing. He states his cough remains productive of yellow-green sputum, although it is easier to cough up than it was the previous day. You auscultate decreased breath sounds and a few coarse crackles in both lower lobes posteriorly. His VS are 150/78, 94, 24, 99.7 F (37.6 C). His Spo2 is 92% with oxygen on at 2 L per nasal cannula.

Arterial Blood Gases (ABGs)

58 mm Hg
32 mmol/L
65 mm Hg

Chart View

16. Interpret D.Z.’s ABG values.

17. Has D.Z.’s status improved or not? Defend your response.

18. What interventions would you include in your plan of care for D.Z. today?

Case Study Progress
D.Z.’s wife approaches you in the hallway and says, I don’t know what to do. My husband used to be so active before he retired 6 months ago. Since then he’s lost 35 pounds. He is afraid to take a bath, and it takes him hours to dressthat’s if he gets dressed at all. He has gone downhill so fast that it scares me. He’s afraid to do anything for himself. He wants me in the room with him all the time, but if I try to talk with him, he snarls and does things to irritate me. I have to keep working. His medical bills are draining all of our savings, and I have to be able to support myself when he’s gone. Sometimes I go to work just to get away from the house and his constant demands. He calls me several times a day asking me to come home, but I can’t go home. You may not think I’m much of a wife, but quite honestly, I don’t want to come home anymore. I just don’t know what to do.”

19. How would you respond to her statement?





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