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85 Cards in this Set
- Front
- Back
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What is PROFESSIONAL STANDARDS REVIEW ORGANIZATION (PSROs)
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-federal gov't (biggest consumer of health care, pays for medicaid, medicare) created PSROs to review the quality, quantity and cost of hospital care
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UTILIZATION REVIEW (UR) COMMITTEES:
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-medicare-qualified hospitals had physician-supervised UR committees to review the admissions, diagnostic testing & tx provided by physicians who cared for clients receiving Medicare
-Intent of URs was to identify & eliminate overuse of diagnostic & tx services -hospitals added nursing case managers to meet guidelines established by Medicare, medicaid & other payers |
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Define PROSPECTIVE PAYMENT SYSTEM (PPS)?
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-eliminated cost-based reimbursement
-medicare benefits were no longer able to charge whatever the clients care cost -PPS grouped inpatient hospital services for medicare clients into DRG's |
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Define DIAGNOSIS-RELATED GROUP (DRGs):
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-fixed reimbursement amt w/ adjustment based on case severity,rural/urban/regionl costs
-hospitals receive set dollar amt for each client based on the assigned DRG regardless of the cients length of stay or use of services in the hospital |
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CAPITATION:
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-the providers received a fixed amt per client or enrollee of a health care plan
-Aim is to build a paymen plan for select diagnoses or surgical procedures tatconsists of the best standards of care, including essential dx and tx procedures at the lowest cost |
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Define RESOURCE UTILIZATION GROUPS (RUGs)
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-used in long-term care to manage cost
-similair to DRGs |
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Define MANAGED CARE:
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-Describes health care systems in which there is administrative control ove primary healthcare services for a defined client population
-assumes financial risk plus provides client care -focuses on containing or reducing costs, increasing client satisfaction, & improving the health & functional status of the individual |
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What is the Health Services Pyramid?
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-serves as a model for improving the health care of US citizens
-shows that population-based health care services provide the basis for preventive services -services include Primary, Secondary & Tertiary Health Care -achievements in lower tiers of pyramid contribute to the improvement of health care delivered by the higher tiers |
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MANAGED CARE ORGANIZATION (MCO):
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-provides comprehensive preventive & tx services to a specfic group of voluntarily enrolled persons
-focus on health health maintenance, primary care -care provided by a Primary care physician -referral needed for specialist & hospitalization |
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PREFERRED PROVIDER ORGANIZATION (PPO):
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-limits an enrollee's choice to a list of "preferred" hospitals, MD
-pays more out-of-pocket expenses for using a provider not on the list -focus on health maintenance |
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EXCLUSIVE PROVIDER ORGANIZATION (EPO):
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-limits an enrollee's choice to providers belongin to 1 organization
-limits access to specialist |
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MEDICARE:
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-federally funded
-65 and older -payment deducted from SS check -pays for Nurse Practitioners -Part A-D (page 18) |
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MEDICAID:
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-federally funded
-low income families -low income w/ LTC (long term care) disabilities -supplemental coverage and LTC assistance to older adults in Nursing homes -individual states determine eligibiliy requirements -finances large portion of maternal & child care for the poor -reimburses for Nurse Midwifery, other advanced nursing practices, nursing home funding |
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Private Insurance:
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-fee for service plan
-fee computed after client receives services on basis of # of services used -most policies have deductibles -expensive |
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Long-term Care Insurance:
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-supplemental insuran. for coverage of long-term care services & is in addition to Medicare
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*PREVENTIVE CARE:
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-health care focuses on educating an equipping the client to REDUCE & CONTROL RISK FACTORS of disease
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*Examples of PREVENTIVE CARE:
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-immunization programs
-stress management classes -advocating seat belt use -b/p & cancer screenings -poison control info -mental health counseling & crisis prevention -seat belts, air bags, bike helmets -PAP smear -breast exam -flu shot |
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*Health Promotion:
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activities that develop human attitudes and behaviors to maintain or enhance well-being
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PRIMARY HEALTH CARE:
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-routine care w/ periodic screenings designed to detect disease at its earliest stage
-Ex. office or clinic visits, scheduled school or work-centered screenings (vision, hearing, obesity) |
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Primary Health Care:
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-combo of primary and public health care that is accessible to individuals & families in a community & provided at an affordable cost
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Primary Prevention:
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-health-promoting behaviors or activities that reduce the occurrence of an illness
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Public health:
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-community & interdisciplinary care aimed at preventing disease & promoting health
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*Secondary Care/Prevention:
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-early dx & tx of illness (emergency or acute illness)
ie. screening for hypertension |
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*Examples of Secondary Prevention:
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-emergency care
-acute medical-surgical care -radiological procedures -intensive care services |
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*Tertiary Prevention:
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-prevents further progression o disease
-provision of specialized highly technical care fo clients |
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*Examples of Tertiary Care
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-intensive care
-subacute care -oncology center -burn centers -psychiatric facilities |
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What is the Difference b/w Primary care & Primary HEALTH care?
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-Primary care focuses on health services provided on an individual basis
-Primary Health Care- focuses on improved health outcome for an entire population |
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*Examples of where people receive Primary Care:
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-schools
-physician offices -occupational health clinics -nursing centers |
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List Settings for Secondary & Tertiary Care:
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-hospitals
-psychiatrc facilities -rural hospitals -ICUs -urgent cares -CCU -inpatient med-surg units |
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What are examples of Primary Health Care?
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-includes primary care plus
-prenatal care -well-baby care -nutrition counseling -family planning -exercise classes -control of diseases -health education -school based screenings (ATI book) |
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*Preventive Care:
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-disease oriented & focused on reducing & controlling risk factors for disease
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*Restorative Care:
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-serves clients recovering from acute or chronic illness/disability
-helps individuals regain maximal function & enhance quality of life -promotes pt independence & self-care abilites -requires multidisciplinary approach |
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*Ex of Restorative Care?
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-cardiovascular & pulmonry rehab
-sports med -spinal cord injury programs -home care |
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*Continuing Care:
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-addresses long-term or chronic health care needs
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*Ex of Continuing Care?
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-assisted living
-psychiatric & older adult day care -hospice -in-home respite care |
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Secondary & tertiary Care is also called?
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-ACUTE CARE
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Define WORK REDESIGN
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-because of work redesign, more services are available on nursing units, thus minimizing the need to transfer and transport clients across multiple diagnostic & tx areas
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Roles of a CASE MANAGER:
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-coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care
-focuses on d/c planning - advises nursing staff on specific nursing issues, coordinates the referral of clients to services , ensures staff implements client edu & monitors the clients progress through d/c -continues caring for clients after d/c from acute facilities |
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Define DISCHARGE PLANNING?
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-begins the moment a client is admitted to a health care facility
-centralized, coordinated, multidisciplinary process that ensures client has a plan for continuing care after leaving health care agency |
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How do nurses achieve Continuity of care?
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-use critical thinking skills and apply the nursing process
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Define CRITICAL PATHWAY;
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-tx plan that outlines the treatments or interventions clients need to have while in the hospital for a specific condition or illness
-helps ensure collaboration amoung diff member of health care team, which enables the client to be d/c in an appropriate length of time |
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Rural Primary Care Hospital (RPCH) provides:
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-24 hour emergency care w/ no more than 6 inpatient beds for providing temorary care for 72 hrs or less to clients needing stabilization before transfer to a larger hospital
-provides inpatient care to acutely ill or injured persons before transferring them to better-equiped facilities -basic radiological & lab services are available -nurses often function independently in the absence of a physician |
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What are some example of skills that clients may receive at home or in rehab setting w/ Restorative Care?
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-intravenous fluids
-enteral nutrition -pain control |
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Define HOME CARE:
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-Involves coordination of services & equipment for health maintenance, edu, illness prevention, dx and tx or disease, palliative care and rehabilitation
-focuses on client & family independence |
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DME:
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-durable medical equipment= medical products adapted for home use
-home care services coordinates to & delivery of DMEs |
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*List 9 Home Care Services:
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1. wound care: sterile dressing changes, debridement, irrigations, packing
2. Respiratory: O2, ventilator, suctioning, care of tracheostomies 3. V/S 4. Elimination: ostomy care, insertion of urinary caths, home dialysis, skin care 5. Nutrition: admin of tube & enteral feedings, 6. Rehabilitation: ambulate training, use of assistive device, ROM, transfer tech. 7. Meds: 8. IV therapy: admin of blood products, analgesic, chemotherapeutic agents, long-term dehyration 9. Lab Studies: bld glucose monitoring, drawing bld for lab test |
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Define REHABILITATION:
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-attempts to restore a person to the fullest physical, mental, social, vocational and economic potential
-services include physical, occupational & speech therapy, -helps to maximize the client's functioning & level of independence -occurs in many Health care settings |
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EXTENDED CARE FACILITY:
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-provided intermediate medical, nursing or custodial care for clients recovering from acute illness or clients w/ chronic illnesses or disabilities
-includes intermediate care and skilled nursing facilities ie. mva pt w/ brain injury is transfered to an extended care facility for rehab or supportive care until d/c to home is a safe option |
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Define SKILLED NURSING FACILITY:
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-an Extended care facilities
-aka: intermediate care -provides care for clients recovering from acute illness or disabilities -provides around the clock nursing coverage -skilled care includes: admin of IV fluids, wound care, long-term ventilator management & physical rehab -provides extensive supportive care to clients -nurses need skills similar to nurses working in an acute care setting & background in Gerontological nursing principles |
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Define CONTINUING CARE:
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-for people who are disabled, functionally dependent or suffering a terminal disease
-available w/in institutional settings (nursing homes, group homes, retirement communties), communities( adult day care, senior centers)or in the home (home delivered meals, HOSPICE) |
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NURSING CENTERS OR FACILITIES:
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-provides 24 hour intermediate & custodial care
-ie. nursing, rehab, dietary, recreational, social & regilious services -resident's temporary or permanent home -another term for nursing home -Regulated by standards= Omnibus Budget Reconciliation Act of 1987 |
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What are the major regulatory requirements defined by Omnibus Budget Reconciliation Act of 1987:
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(the term Nursing Facility become the term for nursing homes & other long-term care facilities)
-residents rights -admin, transfer, d/c rights -res. behavior & facility practices -quality of life -res assessment -quality of care -nursing, dietary, physician, dental, pharmacy services -infection control -specialized rehab services -physical environment |
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Define MINIMUM DATA SHEETS:
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-forms used in nursing centers/facilities to assess residents to determine the best type of intervention to support the health care needs
Sheets include: -residents background, -cognitive , communcation (hearing/vision) -physical functioning -mood, behavior, activity patterns -psychosocial well being -health conditions -disease dx -skin cond -med use -special tx and procedures ie. delirium falls, pressure ulcers, psychotropic drug use |
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Define ASSISTED LIVING:
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-offers long-term care setting w/ a homier environment & greater resident autonomy
-provides services such as laundry, assistance w/ meals, personal care, housekeeping & 24 hr oversight -allows residents to live in their own unit |
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Examples of Holistic interventions:
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-prayer
-establishing presence -reading scripture |
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Define RESPITE CARE:
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-service provides short term relief or time off for persons providing home care to an ill, disabled or frail older adult
-trained volunteers allow family caregivers to leave home for errands or social time |
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ADULT DAY CARE CENTERS:
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-usually associated w/ hospital or nursing home or operate independently
-offer services to clients in need of daily physical rehab, counseling for emotional, drug, alchohol addiction -nurses ensure clients take their meds,admin specific tx |
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Pallative Care;
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-not curative treatment
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HOSPICE:
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-allows clients to live and remain at home w/ comfort, independence & dignity while easing the pains of terminal illness
-provides client & family support during terminal phase & time of death -focus is symptom management & clients comfort |
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The focus of Hospice is _______ care?
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-Pallative
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21 Competencies:
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-emphasizes the importance of public service, caring for the health of communities & developing ethically responsible behaviors
**pg 27 Box 2-9 (READ) |
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Evidence-Based Practice:
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-problem solving approach to clinical practice that involves the concientious use of current best evidence, along w/ clinical expertise & client preferences & values in making decisions about client care
-helps nurses in resolving problems that occur in clinical settings and helps provide innovative health care that exceeds quality standards |
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What is the Difference b/w Evidence-based practice and research-based practice?
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-research refers to the use of knowledge based on results of research studies
-Evidence, adds a nurse's clinical experience, practice trends & client preferences |
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Define Quality Improvement (QI):
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-focuses on improving the performance of all providers
-a continuous process, not a one time statistic reported in isolation -provides outcome feedback and make corrections accordingly |
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Quality Health Care
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-p 27
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Define NURSING-SENSITIVE OUTCOMES:
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-are clients outcomes that are directly related to nursing care.
-have major effect on client safety & quality of care -nurses assume accountability and responsiblity for the consequences of the outcomes Ie. of Nursing sensitive outcomes: incidence of hospital acquired pneumonia, DVT, UTIs, pressure ulcers, falls, failure to rescue and 30-day mortality |
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NOC:
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-nursing outcome classification
-helps nurse better define & measure the impact of their interventions. -emphasizes outcomes that nursing interventions most affect |
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Define CLIENT-CENTERED CARE
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-dimensions that most affect clients experiences w/ health care
-includes 7 dimensions which include most of the scope of nursing **pg 28 (box 2-10) -nursing staff is responsible for identifying unique issues that influence client satisfaction |
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Technology in Health Care
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-read pg 28
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Combines the best computer science and information science w/ nursing science?
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-NURSING INFORMATICS
-supports nursing practice and the delivery of nursing care by providing nurses w/ a way to manage and process nursing data, info and knowledge |
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Individually distinct pieces of reality?
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-DATA
-ie client's B/P or measurement of clients wound |
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Nurses use or gain _______ when they orgainize, structure or interpret data
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-INFORMATION
-nurses use information when looking at trends in b/p readings over the past 24 hours |
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Develops when nurses combine and identify relationships b/w different pieces of information?
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-KNOWLEDGE
-nurses use knowledge to teach |
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What is the focus of Nursing Informatics?
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-focus is on the organization, analysis and dissemination of information Not on the technology or computer
-improves the way nurses provide health care and enhances client outcomes |
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EHR?
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-Electronic health Record,
-replacing the traditional printed med records -provides a comprehensive electronic record of a client's medical problems, tx, dx procedures and nursing care -provides info for research & quality improvement activities |
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As a result of ________, physicians and health care providers have to make their services more accessible
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-GLOBALIZATION p 29
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Who would be considered as a VULNERABLE POPULATIONS?
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-Children
-women -older adults -All most threatened by urbanization |
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SARS?
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-severe acute respiratory infection
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The Future of Health Care:
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-change opens up opportunties for improvement
-health care delivery systems need to address the needs of the uninsured and underservved -health care organizations are striving to become better prepared to deal w/ these and other challenges in health care p30 |
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The purpose of a utilization review committee is to:
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Review admissions, diagnostic tests, and treatments ordered by physicians
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The nurse is giving discharge instructions to a client with newly diagnosed diabetes. The nurse discusses with the client what the dietary intake should be. This is an example of which health care service?
A. Tertiary care |
-health promotion
-Health promotion includes dietary counseling. Blood glucose monitoring at the pharmacy is an example of illness prevention. Restorative care is care of a client who, for instance, is recovering from complications of diabetes. Any diagnostic procedure or tests completed in the hospital would be examples of such care. |
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A nurse volunteers to take blood pressure measurements after church services. This is an example of which level of health care service?
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-illness prevention
-Taking blood pressure measurements is illness prevention. Health promotion includes activities like exercise classes. Secondary care is often known as traditional care. It would include rehabilitation after a stroke in an individual with a history of elevated blood pressure. |
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A client discharged after suffering a stroke is transferred from a tertiary care facility to another facility for additional care to help the client recover and continue to regain function. This type of care facility is known as:
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-Restorative care
-Restorative care assists an individual in regaining the maximum possible level of functioning. Home care includes professional and paraprofessional services that are rendered in the home setting. Extended care is intermediate medical or nursing care for individuals with an acute or chronic illness or disability. Assisted care is a setting in which the client is able to function at a higher level of autonomy within a homelike environment but in which care can be given when needed. |
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example of respite care?
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-Day care
-Day care is an example of respite care because it allows the family to maintain normalcy while the client is under their care. A nursing home client receives 24-hour care in the facility. Home care is an intermittent service in which only certain tasks are performed. Nurse extenders may be hired to perform a specific task, such as bathing. |
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Ie. who clients who should be cared for in an extended care facility with skilled nursing?
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- brain injured client on a ventilator who is receiving intravenous medications
- child who recently had a spinal cord injury and is living with quadriplegia and needs to learn a new way of life |
