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Foundations of Nursi
Foundations of Nursing - Basic Nursing - Chapt 3 & 4
| Question | Answer |
|---|---|
| What changes in the Health Care Delivery System in 1960's | Physician practice were authority, preogative autonomy, free choice, solo practice, fee for service (FFS) |
| What was the Health Care Delivery System made up of primarily in the 1960s | Independent, not for profit hospitals.Small private practices of office based physicians.Neighborhood & medical supply stores |
| Utilization Review (UR) | State regulation of hospitals construction - State must say if a hospital needs more room. |
| Diagnosis Related Groups (DRG) | Medicare to limit hospital length of stay - Daily records of what to do, must be discharged when told. |
| What changed the in Health Care Delivery System in 1989? | Hospitals were having decreased profits & decreased hospital length of stay.Acutely ill utilized home care & ambulatory.Cost sky rocketed.Ill were sent home |
| Were changes in the Health Care Delivery System in 1990s | 95% of all insured were enrolled in some from of managed care, including fee for service (FFS), prefered provider organizations (PPO), Health maintenance organizaitions (HMO).RN's & LPN's being replaced by unlicensed assistive personnel (UAP's) |
| PPO | Preferred Provider Organizations |
| HMO | Helth Maintenance Organizations |
| What are managed Care Plans | Critical PathwaysCare MapsClinical PathwayStandard Nursing Care PlansState desired outcomes (goals) within timelines. They must be followed to receive the maximum cost reimbursement for service- Do not fit every - What we want to happen. |
| Holistic Healthcare | Comprehensive & total care of a personEmphasized wellness - Sbsence of disease, meet basic needs, avoidance of hazardous situations, ability to cope with stress.Old trend being revisited. |
| Herbalist | Use herbs & botanicals |
| Acupuncture & Acupressure | Based on Qi (chee)Pain #1 reason for use |
| Therapeutic Relaxation | Deep breathing can lower blood pressure |
| Therepeutic Touch | Do not actually touch - restores electromagnetic field |
| Client | No longer known as a PatientCustomer is buying a service. |
| Hospitals - Acute Care Facilities (ACF) | Ambulatory - Dietary - Emergency Care - ICU - Chemo - Surgical - Home Health - Hospice |
| Hospitals - Specialized | Developmental or Mental Disable - VA - Burn - Rehab Centers - Psychiatric - Pediatric |
| ACF | Acute Care Facilities |
| Community Health Services | Outpatient Services - Walk-In Care - School - Industry - Telehealth |
| Outpatient Services | PT, OT, Wound Care, Chemo, etc. |
| Walk-In Care | Minor Med |
| Industry | Workman Comp - Prevention - Education |
| Extended Care Facility (ECF) | Nursing Home, Rehab Centers, Mental Health Center |
| ECF | Extended Care Facility |
| Skilled Nursing Facilities (SNF) | Certified for a certain number of beds (RN doing care) |
| SNF | Skilled Nursing Facilites |
| Intermediate Care Facilities (ICF) | 24 Hour services of nursing assistans under supervision of an LPN, with a RN on staff. |
| ICF | Intermediate Care Facilities |
| Components of Quality Care | Focus on deliver of careOutcome based careNursing AccountabilityConsumer needs |
| Client Resresentatives | Patient representativeAdvocateLiaisonOmbudsmanSocial services |
| Hospital Administration has a | Chain of Command |
| Hospital Ownership - Profit oriented - Proprietary | IndividualPartnershipCorporation |
| Hospital Ownership - Nonprofit - Voluntary | Church associated - Baptist, MethodistPrivate school - VanderbiltFoundation associated - Shriner's |
| Hospital Ownership - Nonprofit - Governmental | Federal - VAState - UniversityCountyCity - The Med |
| Proprietary, inverstor owned, or for profit hospital | Very few, many nursing homes |
| Not for profit Hospital | Majority of all hospital |
| Standars of Quality | Established by individual health care facilities to guide the nurses in client care - Do not overrule Board of Nursing (BON) |
| BON | Board of Nursing |
| Hospital Accrediation Organization | Joint Commission for Accrediation of Healthcare Organizations, (JCAHO) |
| Joint Commission for Accrediation of Healthcare Organization (JCAHO) | Can not close hospital but can stop funding. |
| JCAHO | Joint Commission for Accrediations of Healthcare Organizations |
| Methods of Payment | Fee for Service (FFS)Third-party payment-Private-Group-HMO-PPO-Medicare-Medicaid |
| Private Insurance | High CostCompany often refuses to insure anyone who is considered a health risk |
| Group (family) or individual insurance | Cost is highDon't usually insure people with health risks |
| Group Insurance | Company insurancePremium is fairly lowPeople usually insured without physicals |
| Health Maintenance Organization (HMO) | Fixed monthly chargeGroup practice (several MD’s & specialist)Person pays a certain amount per month to stay well (Capitation fee)Pay a small added cost when see MD (Co-pay)Prevention–main goaldisorders & diseases are treated as they occur |
| PPO’s (Preferred Provider Organizations) | “Managed” systemGroups of Healthcare practitioners who contract to provide servicesServices within groupOutside of group is higher |
| POS (Point of Service Plans) | Contacts with physicians and healthcare providers“Managed” by a primary care doctor with groupCan see outside of group but has to pay higher premiums |
| Social security System | Federal system to provide health, old age, survivor, and disability insuranceEnacted by RooseveltFederal |
| Medicare | Promoted by the government to aid people 65 or olderDivision of the department of health & human services Organized to set up programs to aid handicapped & disabled individualsAvailable to recipients of Social Security Disability Insurance (SSDI) |
| (SSDI) | Social Security Disability Insurance |
| Medicaid | Joint effort between Federal and State governmentsDiffer from state to statePeople over the age of 65BlindDisabledReceiving Aid to Families with Dependent ChildrenMust qualify - Not all get |
| PPS – Prospective Payment System | RUG’s (Resource Utilization Group)DRG’s (Diagnosis Related Groups) |
| RUG’s (Resource Utilization Group) | Used in nursing homes for payment |
| PPS | – Prospective Payment System |
| RUG’s | (Resource Utilization Group) |
| Ethics | Conduct appropriate for all members of a group |
| Ethical Problems | Organ TransplantClinical DeathQuality of LifeTreatment IssuesEuthanasia - Legal in Oregan |
| Morality | Behavior in accordance with customs or tradition; usually reflects personal or religious beliefs |
| Laws | Nurses are governed by civil and criminal law in roles as providers of services, employees of institutions, and private citizensProfessional nurses are held responsible (liable) for harm resulting from their negligent acts, or omissions to act |
| Felony | Offenses as falsification of medical records, insurance fraud, theft of narcotics or practicing without a license |
| Tort | Injury that occurred because of another person’s intentional or unintentional actions or failure to act |
| Nonmaleficence | Do no harm - No evil |
| Beneficence | Doing good - Remove harm - Paternalism is an undesirable outcome of beneficence, where health care provider decides what is best for the client & attemps to encourage the client to act against his/her own choice. |
| Justice | Providing fair and equitable treatment to all clients |
| Veracity | The obligation to tell the truth |
| Fidelity | The duty to do what one has promised |
| Ethical Codes | Not legally binding-Most Boards of Nursing (BON) has authority to reprimand nurses for unprofessional conduct |
| Advocate | A person who speaks up for or acts on the behalf of the client, protects the client’s right to make own decisions, and upholds the principle of fidelity |
| Nurse Practice Act | Defines what nursing is, is not, & under what circumstancesAll nurses are responsible for knowing provisions of the act for the state No MD, RN, or agency can give the licensed practical/vocational nurse the right to do more than can be performed |
| Tennessee Nurse Practice Act | Rules and regulations of individual stateAdministered by Board of NursingThe board’s mission is to safeguard the health, safety and welfare of Tennesseans (the public) |
| Standards of Care | Guidelines by which the nurse should practiceGuidelines for determining whether nurses performed duties in an appropriate mannerBased on what an ordinary prudent nurse with similar education and experience would do in similar circumstances |
| Employee Guidelines | Respondent SuperiorEmployer will be held liable for any negligent acts of an employee if the alleged negligent act occurred during the employment relationship and was within the scope of the employee’s responsibilities |
| Hospital Staffing | Nurses should not walk out when staffing is inadequate because charges of abandonment can be madeNurses in short staffing situations are obligated to notify the nursing supervisor |
| Floating | Nurses who float should inform the supervisor of any lack of experience in caring for the type of clients on the new nursing unit |
| Disciplinary Action | Boards of nursing may deny, revoke, or suspend any license to practice as a practical/vocational nurse in accordance with their statutory authority |
| Causes for Disciplinary Action | Knowingly delegating nursing care to unlicensed personnel that places the client at risk for injury |
| Negligence And Malpractice | If a nurse gives care that does not meet appropriate standardsMalpractice is determined if the nurse owed a duty to the client & did not carry out the duty & the client was injured because the nurse failed to perform the duty |
| AMA | Against Medical Advice |
| Experimentation | Stringent regulations govern research on humansNuremberg laws |
| Professional Liability Insurance | Nurses need their own liability insurance for protection against malpractice lawsuits |
| Good Samaritan Laws | Immunity from suit applies only when all of the conditions of the state law are met, such as the caregiver receives no compensation for the care provided and the care given is not intentionally negligent |
| Assault | Occurs when a person puts another person in fear of a harmful or an offensive contactThe victim fears and believes harm will result as a result of the threat |
| Battery | An intentional touching of another's body without the other’s consent |
| Invasion of Privacy | Includes violating confidentiality, intruding on private client or family matters, and sharing client information with unauthorized persons |
| False Imprisonment | Occurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the clientOccurs when restraining devices are used without an appropriate clinical needA client can sign an Against Medical Advice form |
| Defamation | Occurs when information is communicated to a third party that causes damage to someone’s reputation, either in writing (libel) or verbally (slander) |
| Fraud | Results from a deliberate deception intended to produce unlawful gains |
| Patient’s Bill Of Rights | Key elements of a client's rights with which nurses should be familiar include informed consent and confidentiality |
| Confidentiality | A special relationship exists between two people in which information discussed will not be shared with a third party who is not directly involved in the client’s careInformation release may be mandatory when ordered by a court |
| Informed Consent | Consent must be obtained by the physician, surgeon, or other medical practitioner performing the treatment or procedureMinors who are married or emancipated from parents & those seeking treatment for STD can sign an informed consent form |
| Libel | Written statement or photograph that is false or damaging. |
| Slander | Term given to malicious verbal statements that are false or injurious |
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