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NURS 201
Exam 2
| Question | Answer |
|---|---|
| access | depends on the ability to pay and the availability of services |
| quality | the degree to which health service for people and populations increase the likelihood of desired health outcomes and are consistent with professional outcome -- simply the right care for the right person at the right time |
| out of pocket | American pay for health care with cash payments |
| individual private insurance | members pay a monthly premium either by themselves or in combination with employer payments |
| example of third party payers | individual private insurance because the insurance company pays all or for most of the cost of care |
| employer based private insurance | receiving an offer coverage from their employer |
| what is the most common source of health care coverage in the US | employer based private insurance |
| government financing | federally funded healthcare programs |
| medicare | amendments to the social security act established national and state health insurance programs for citizens over 65 years of age under title 18 (XVIII) |
| medicaid | a federally funded public assistance program for people of any age who have low incomes; for blind, older adult, and disabled people covered by supplemental security benefits; and for beneficiaries of Aid to Families with Department children |
| children's health insurance program | $20 billion over to 10 years to help states insure low - income children who are ineligible for medicaid but cannot afford private insurance |
| veterans health administration | home to the US' largest integrated health care system, consisting of 152 medical centers, nearly 1,400 community - based outpatient clinics, community living centers, veterans' centers and domiciliaries |
| pay for performance | strategy using financial incentives to reward providers for the achievement of a range of payer objectives, including delivery efficiencies, submission of data and measures to the payers and improved quality and patient safety |
| fee for service | arrangement in which everything a provider "does" for a patient leads to a bill generated and a fee paid, financial incentives reward doing more care, not necessarily better care - usually seen in hospitals |
| role of nurse in hospitals | nurses are direct care providers, other roles include manager of other members of the health care team providing patient care, administrator, nurse practitioner, clinical nurse specialist, patient educator, in service educator and researcher |
| outpatient facilities | those who are not hospitalized overnight but who require diagnosis or treatment |
| role of nurse in primary care centers | working in a health care provider's office makes health assessments, performs technical procedures, assists the health care provider, and provides health education and counseling |
| role of nurse in ambulatory care centers and clinics | provide technical services (administering medications) determine the priority of care needs, and provide teaching about all aspects of care |
| role of nurse in home health care | care in the home makes assessments and provide physical care, administer medications, teach & support family members. they also collaborate with other health care providers |
| role of nurse ins extended care services | provide medical and non medical care for people with chronic illness or disabilities |
| specialized care centers include | daycare centers, mental health/ behavioral centers, rural health centers, schools, industry and rehabilitation centers |
| role of nurse in daycare centers | nurse who works in a daycare center administer medication and treatments, conduct health screening, teach and counsel |
| role of nurse in mental health/ behavioral centers | must have a strong communication and counseling skills and must be thoroughly familiar with community resources specific to the needs of the patients being served in order to make appropriate referrals |
| role of nurse in schools | provide many different services, including maintaining immunization records, providing emergency care for physical & mental illnesses, administering prescribed medications, conducting routine health screenings and providing health information & education |
| role of nurse in rural health centers | many rural health centers are run by APRNs who serve as the patient's primary health provider for the care of minor acute illnesses as well as chronic illnesses |
| role of nurse in rehabilitation centers | direct care, teaching and counseling. The practice of rehabilitation nursing is based on a philosophy of encouraging independent self care within the patient's capabilities |
| respite care | a type of care provided for caregivers of homebound ill, disabled or older adults |
| main purpose of respite care | give the primary caregiver some time away from the responsibilities of day to day care |
| hospice | a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying people, their families and other loved ones |
| palliative care | an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses |
| physician | responsible for the diagnosis of illness and the medical or surgical treatment of that illness. They are granted to admit patients to a heath care facility and to practice care such as prescribing meds, interpreting results of labs and tests, and surgrey |
| physician assistant | providing support to the physician; usually depend on the supervising physician and might include conducting physical examinations and suturing lacerations |
| physical therapist | seeks to restore function or to prevent further disability in a patient after an illness or injury. The treat through massage, heat, cold, water, sonar waves, exercises & electrical stimulation |
| respiratory therapist | improve pulmonary function and oxygenation. Can administer a variety of tests that measure lung function & for education of patient about use of various devices & machines prescribed by health provider |
| occupational therapist | evaluate the patient's functional level and teaching activities to promote self- care in activities of daily living. They assess the home for safety and provide adaptive equipment as necessary |
| speech therapist | train patients who are deaf & hard of hearing speak more clearly, assist patients who have had a stroke to learn how to speak/ correct or modify a variety of speech. Diagnose & treat swallowing problems in pts who had head injury or stroke |
| dietitian | manage and plan for dietary needs based on knowledge about all aspects of nutrition. can adapt specialized diets for the individual needs of patients, counsel and educate patients, and supervise the dietary services of an entire facilit |
| pharmacist | responsible for keeping a file of all patient medications and for informing the health care provider when a potential or actual medication error in prescribing has occurred or when prescribed drugs may interact adversely |
| chaplain / spiritual care providers | respond to the spiritual needs of patients, families, and other members of the interdciplinary team |
| social worker | assist patients & families in dealing with social, emotional & environmental factors that affect their well being. Make referrals to appropriate community resources and provide assistance w/ securing equipment & supplies, as well as health care finances |
| unlicensed assistive personnel | help nurses provide direct care to patients such as CNAs and techs |
| discuss the role of the care coordinator (case manager) | the care coordinator is the care provider who is responsible for identifying a patient's health goals and coordinating services and providers to meet those goals |
| elements of discharge planning | discharge planning begins at admission, when information about the patient is collected and documented |
| guidelines for discharge planning | assessing and identifying health care needs, setting goals with the patient, teaching and evaluating discharge planning effectiveness |
| fragmented care | when the delivery of health care is spread across an excessively large number of poorly coordinated providers |
| causes of fragmented care | when different health care providers and / or health care organizations do not work well together |
| implications of fragmented care | now there is a higher risk of readmitted patients, medicare goes up |
| discuss the importance of continuity of care through communication | it helps improve the quality of care, which ultimately help improve the patients outcome |
| identify members of the collaborative health care team | when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care |
| discuss the role of a hospitalist | someone who cares for inpatients and help improve their health |
| 3 core elements of Tanner's clinical judgement model | 1. noticing/ interpreting 2. responding 3. reflecting |
| clinical thinking | considering the facts |
| clinical reasoning | thinking through your thoughts |
| clinical judgement | opinion or conclusion after analyzing information |
| NCBSN clinical judgement model for approach | trial/ error - not good for clinical approach EBP - we've done it before we know it works intuitive- knowledge the nursing process |
| NCBSN clinical judgement model for systematic | there has to be 1 thing that leads to another |
| NCBSN clinical judgement model for dynamic | can apply it to another situation |
| NCBSN clinical judgement model for interpersonal | patient is ALWAYS priority |
| NCBSN clinical judgement model for outcome oriented | did it work? |
| ADPIE | access, decide, plan a solution, implement the action, evaluate the outcome |
| access | systemically collect data to determine the need for care & recognize the cluster clues |
| decide | analyze to identify actual or potential problems and give it a name. prioritize. |
| plan | formulate the solution identifying outcomes and determine interventions |
| evaluate | did it work? were the goals attained? |
| initial (baseline) nursing assessment | getting all the baseline info to see where you're going |
| focused (specific form) nursing assessment | when you get specific information |
| emergent (emergency assessment) nursing assessment | when you make a decision quickly |
| triage (severity) nursing assessment | how bad is it? when or how fast do they need to get help? |
| patient centered assessment method (complexity) nursing assessment | total assessment on how everything related to each other |
| discuss methodology to cluster clues | they help with pattern recognition, grouping "like" data |
| apply basic principles of diagnostic reasoning to identify actual and potential problems | statements that describe a client's actual or potential HUMAN RESPONSE to health problem or life responses that the nurse is licensed and competent to treat |
| define the term nursing diagnosis, distinguishing it from a medical diagnoses | medical diagnosis identifies diseases, while nursing diagnosis focus on unhealthy response to health and illness |
| describe the purpose and benefits of outcome identification and planning | designed to prevent, reduce or eliminate a problem reasonable match to outcome put the interventions into action |
| identify guidelines for implementation | partnership with family, competence in skill and knowledge, caring approach, consistent with standards of care and policy |
| implement | implement the action |
| explain why reassessment after nursing intervention is important | its important to see what worked well and what didn't work |
| describe evaluation, its purpose, and relation to the other | measure how well outcomes were achieved, modify if indicated |
| identify qualities associated with a good leader | personal leadership skills and emotional intelligence |
| examples of personal leadership skills | commitment to excellence, problem solving skills, commitment and passion for your work, trusting, respectful, empathy |
| examples of emotional intelligence | self management, awareness, social awareness and relationship management |
| self management | able to control impulsive feelings and behaviors, manage your emotions in a healthy way |
| self awareness | recognize your own emotions and how they affect your thoughts and behavior, know your strengths and weakness |
| social awareness | you have empathy, you can understand the emotions, needs, and concerns of other people |
| relationship management | you know how to develop and maintain good relationships, communicate clearly, inspire and influence others |
| autocratic leadership | assumes control over decisions and activities, efficient, limited staff/ team involvement, emergency situations very traditional |
| democratic leadership | participative, equality among leader/ participants, develop skills & strengths within the group, lots of group involvement |
| laissez- faire | non-directive, staff/ team have the power, strengths of the team, independent practice, varied clinical maturity |
| servant leadership | enrich the lives of others, creates a more just and caring world, strong relationships ex: Florence nightengale |
| transactional leadership | task and reward, minimal creating thinking/ problem solving/ reform and promoting nursing excellence very black and white |
| transformational leadership | passion for their vision, inspiring and motivational, vulnerable, process as well as outcome, just culture this one is considered the best |
| just culture and apply it to professional nursing situations | indicates an organizational commitment to accountability. report errors without punitive response, discuss concerns with can improve opportunities |
| nurse manager | task oriented, staff advocate, communicate effectively, stakeholders (on the buisness side) |
| nurse leader | efficient delegation, empathetic communication, critical thinking skills, advanced clinical knowledge (directly involved with patient care) |
| conflict management | work through conflicts to minimize negative effects and promote positive consequences |
| conflict engagement | skills to perform well in the face of conflict instead of finding a work- around to avoid conflict PERLA: presence, empathy, acknowledgement, reflect, listen, ask quesitons |
| conflict resolution strategies: avoiding | ignore the conflict and/ or postpone resolution |
| conflict resolution strategies: collaborating | joint effort to resolve with win win solution (what we want to use in the clinical experience) |
| conflict resolution strategies: competing | win lose confrontation |
| conflict resolution strategies: compromising | relinquish of something of equal value |
| conflict resolution strategies: cooperating | conscious decision to concede |
| conflict resolution strategies: smoothing | focus on agreement at expense of actually resolving the conflict (talk, talk, talk but nothing happens) |
| 3 stages of change | unfreezing - need for change is recognized moving - change is initiated faster a careful process of planning refreezing - change becomes operational |
| planned change | a purposeful systematic effort to bring about change |
| steps of planned change | recognize change, identify a problem to be solved, determine solution, select a course of action, plan for making the change, implement the course of action, evaluate the effect of change, stabilize the change |
| resistance to change | threat to self, lack of understanding, limited tolerance for change, disagreements about the benefits of change, fear of increased responsibility |
| overcoming change | explain the proposed change to all affected, list advantages, relate the change to beliefs/ values, opportunities for feedback, introduce it gradually, incentive for commitment to change |
| five rights of delegation | right task right circumstance right person right direction/ communication right supervision/ evaluation |
| factors to consider before delegating | stability of the patient's condition, complexity of the activity to be delegated, potential for harm, predictability of the outcome, overall context of other patient needs |
| delegation to nurses | assessment, planning & evaluation, data interpretation, discharge planning, health education, care planning, triage, care of invasive lines, tubes, etc |
| delegation to assistive personnel | basic care activities, food/ drink, take vital signs, measure I/O, transfers/ ambulation, postmortem care, documentation, no invasive procedures |
| purpose of documentation | improves patient outcomes due to communication/ preventing errors/ planning care, provides legal documentation, identifies diagnostic and therapeutic orders, utilized for financial billing and reimbursement |
| documentation guidelines: content | sequential order, follow patterns, just the facts, precautions and notifications, quotes if stated, ONLY what you do |
| documentation guidelines: timing | NEVER before completed, as soon as possible |
| documentation guidelines: format | name, date and time, ink and no blank spaces, mistaken entry |
| electronic health records | quick access to patient records for more coordinated, efficient care. helping providers more effectively diagnose patients, reduce medical errors and provide safer care. enable better documentation and file organization |
| flow charts | show you trends |
| problem oriented | used for a specific issue - usually for a speciality unit |
| narrative charting | don't see as much, but used when you need to tell more information |
| nursing assessment | used to record the initial database obtained from the nursing history and physical assessment - accurate documentation of these data is important to provide a baseline for later comparisons as the patient's condition changes |
| nursing care plan | patient records must communicate the patient's problems or diagnoses ; related goals, outcomes, and interventions and progress or resolution of the problem |
| progress notes | inform caregivers of the progress a patient is making toward achieving expected outcomes |
| flow sheets | documentation tools used to efficiently record routine aspects of nursing care |
| discharge summary | should be written that concisely summarized the reason of treatment, significant findings, the procedures performed and the treatment rendered, the patient's condition or discharge and any specific pertinent instructions given to patient/ family |
| patient records and patient rights | see and copy health record, update health record, get a list of disclosures, request a restriction on certain uses or disclosures, choose how to receive health information |
| nursing informatics: patient portals use and benefits | better health outcomes, chronic condition management, timely access to care, patient retention, patient- centered medical home recognition |
| nursing informatics: tele health and mobile technologies | the use of electronic information and telecommunications technologies to support and promote long distance clinical health care, patient and professional health- related education, public health and health administration |
Created by:
sammy.e7
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