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143 Cards in this Set

  • Front
  • Back
Healthcare net works are
units that provide a full spectrum of services
A health maintenance organization is
has a centralized admintration that directs and compensates physician practice
School health programs are
increasingly being seen as primary care sites for children
Community services of local health department
focus on the treatment of community wide problems rather than an individual health problems
Managed care
third party payers benefit packages that uses specific standards to approve a period of time for the use of impatient and community
A merger between a hospital and local home health agency creates
creating more jobs in the community for RN's
Because of Diagnosis related groups DRG's home health org are
impacted by changing lengths of stay in acute care facities
Primary care
first access to health care
Not for profit org's
have funds that are redirected to the organization for maintenance and growth
Reviewing the current delivery model the nurse is aware that demographics change that will have significant effects on the healthcare delivery systems
the increasing percentage of the population
Three core concepts in informatics are
data, information and knowledge
using data about client out comes post cardiac cath for the past 6 months so as to modify practice is an ex
evidence based practice
One of the advantages of an integrated information system is
Centralized database
EX compare data across time, operate a computer,
informatics competencies
in order to be able to compare data across client population and sities the nurse should use
structured nursing languages
a negative or unfavorable variance in a monthly expense report may result from
client acuity being higher than predicted
rising cost of health care is stimulated by
consumers attitudes
population demographics
medical treatment patters
during the budgeting process the nurse manger are typically responsible for
calculating workload
developing unit operation objectives
justifying capital equipment request
associate degree in nursing is unique in that
it is scientifically and systematically created
development of the famous henry street settlement
Wald
ANA paper published int 1965, two leaves of nursing practice should be implemented
technical and professional
Certification in advance learning would be obtain by
ANA
a complaint about quality of nursing care, first action would be to
form a committee of nurses from the unit to perform a nursing audit
behavioral system model
Dorothy Johnson
what type of laws regulate nursing practice
statutory law
passing medication for all of the patients on the unit is using what type of nursing plan
Functional nursing
1 RN per 7 patients with nurses aids, is what kid of nursing plan
primary caretakers
ethical decisions in health care is based on
the patient's requests
period of time that the microscope was invented
renaissance era
Three behaviorist model
to be considered a behavior it must be able to be observed, described and recorded
an unconscious mental mechanism stimulates and determines all behavior
individuals are the result of both the actions they take and they actions the environment reinforces them for doing
RN convicted of negligence related to an incident in a hospital what is the responsibility of the hospital
the hospital is also responsible
Joint commission for accreditation of hospital have representative in a variety of associations, name three
AMA, American College of physicians, American hospital association but NOT ANA
team approach draw back
nursing care is fragmented
the intention of the nurse training act of 1965 was to direct funds for
promoting and maintaining quality nursing education
laws can vary from state to state, in some cases an individual judges decision may be consider
civil law
the idea that patients maintain health by adaptation is a nursing theory 1st proposed by
sister callista roy
group that assure that patients are medically ready to be discharged
professional standards and review organization
can revoke your nursing license
state nurses association
national council of state boards of nursing primary purpose is
educational standards for entry into practice
if your ever prosecuted in court of law for a crime related to your performance as a nurse, your actions will be judged against what set of nursing standards
the nursing standards listed in the policy and procedure manuals of the institution where you are enployed
statistics used in health care was first used by
Florence nightengale
what is a state matter and what is federal-- administration of narcotics and mandatory reporting of suspected abuse
administration of narcotics is federal and mandatory reporting of suspected abuse is state
The nurses theorist who developed a theory about self-care deficits is
Dorothea Orem
Dorothea Orem
Hildegard Peplau is best known for her theory that describes
therapeutic communication skills
To work with a person to promote health, the nurse could use which of the following theories?
Pender's Health Promotion Model
When working with a patient who is undergoing a cardiac catheterization procedure, the nurse could reduce patient anxiety
by using
Johnson's self-regulation theory
An efficient delivery model in which care is delivered based on each provider doing a specific set of tasks
functional nursing
The delivery model that best emphasized the autonomous role of the nurse is
primary nursing
Differentiated practice means that
patient care is delivered based upon the education of the provider
Managed care as a delivery model developed in response to
cost-containment efforts
main purpose of a care map and a critical path is to
achieve safe patient outcomes at a reasonable cost
In managed care models, when a patient is unable to have a diagnostic test because the preliminary work required for the test
was not ordered or administered, it is a
provider variance
Who would be knowledgeable and prepared to coordinate the evaluation of the care maps and critical pathways for groups of
patients?
the clinical nurse specialist
A limitation of the managed care delivery model is that
it is not supported by research as better then other models
Which of the following is true of breakpoint change?
It most stressful of the individual and requires a great deal of time and effort to manage
A nurse who gives people new information about a change and provides opportunities for feedback about a change is part of
the
moving stage
The development of groups of nurses and other providers to review studies to support changes in practice is an example of
using ________ to support change.
research utilization
Nurses use the power of expert knowledge and experience to
influence the change process and advocate for patients and staff
Nurses as a group have a great deal of power because ANA
he(ANA) American Nurses Association has an active lobby group
The style of leadership that has been demonstrated through research satisfaction of staff nurses is
participatory
Managers are different from leaders because managers have
specific goals and tasks to accomplish
Which of the following is true of the laissez-faire leadership style?
it is unfocused
In the dual factor theory of leadership, leadership is viewed as
motivational in purpose and involves levels of satisfaction and dissatisfaction
Nursing management is best defined as
planning, organizing, and controlling resources to achieve patient outcomes
The NANDA system is used to
delineate potential or actual nursing problems that require treatment
a limitation of the NANDA system is that
the diagnoses are untested by research
Which of the following is true of the nursing intervention classification (NIC) system?
The system provides a method for categorizing common nursing interventions
The purpose of the ANA lobbyists is to?
influence federal and state officials to support matters important to nursing.
The National Institute for Nursing Research is?
A major source of federal grant funding for nurses and health scientists
A prepaid health plan in which primary care providers are viewed as gatekeepers to care is?
a Health Maintenance Organization
The Magnet hospitals project was important because it?
identified the key elements hospitals could use to improve care and nursing practice.
One of the main goals of the American Nurses Associations to?
support high nursing standards.
The unionization movement of workers in the USA during the 1940's and 1950's contributed to the development of?
A health-care setting that delivered fee-for-service care by insurers of workers
The honor society of the nursing profession is
Sigma Theta Tau International
Which of the following statements is true about the 1965 ANA position Paper?
The recommendations of the paper have not been implemented by the profession.
Evaluation of the work process in continuous quality improvement would include review of?
transfer procedures from unit to unit.
Which of the following is true about total quality management?
It is proactive and participative management style.
The organization that accredits hospitals to assure that standards are being met is the?
Joint Commission on Accreditation of Healthcare organizations.
Enforcement of the nurse practice acts is done by?
he state boards of nursing
Misdemeanors and felonies are a type of?
criminal law
failure to assess the functioning of an intravenous pump delivering medications to a patient would be
act of omission
The Comprehensive Drug Abuse Prevention and Control Act of 1970 served to
control handling of narcotics and other regulated medicines by providers
Invasion of privacy is which type of offense?
Intentional tort
The organization created by the federal government in response to the consumer health movement is the
agency for health-care policy and research
The document that guides the professional nurses' ethical practice is the
American nurses association’s Code For Nurses
The obligation that professionals have to be truthful is
veracity
The obligation that health-care professionals do not harm and do good for patients is
beneficence
A limitation of the utilitarian theory or ethical decision making is that
it may not be applicable to all health-care situations because of the definition of happiness
When ethical decisions are made based on the deontological theory, ________ are used to guide the decision-making process
moral rules and principles
A decision in which the obligations of nurses and physicians are in conflict would be an example of
a normative decision
Autonomy as an attribute of a profession refers to the
control members have over the practice
An example of an autonomous intervention is the nurse
educating patients about smoking cessation
To describe, explain, predict, or control nursing phenomena is the goal of
nursing theory
they are abstract ideas about phenomena’s in nursing
The type of theory that is testable through research is termed
midrange theory
When working with a patient who is angry and needs assistance coping, the nurse could use which of the following theories
Lazarus's Model
An organization for professional nurses in the USA. Focus is on standards of healthcare,
nurse professional development, economic and general welfare of nurses. The goal is to transform healthcare so as to optimize the
well being of the American people and the world.
American Academy of Nursing (AAN):
American Civil War 1861-1865:
At the beginning, there was no organized system for caring for the wounded or sick. Doctors began
developing a short training course for female volunteers. Members of existing religious orders began to volunteer and were assigned to
larger hospitals. Dorothea Dix was appointed “Secretary of War” to oversee the trained nursing volunteers.
American Nurses Association (ANA):
Established in 1897. It’s a federation of state associations. Voluntary professional nursing
organization. Serves as a spokesperson/agent for nurses and nursing. Publications: American Journal of Nursing (AJN), Nursing
Research, International Nursing Index. The American member of the International Council of Nurses (ICN). Membership in the ANA is
open to professional nurses with currently valid license.
Balanced Budget Act (BBA) Public Law 105-33 of 1997:
This removed the restrictions on Nurse-Practitioner billing. It means that
NP’s can be independent Medicare providers and can bill Medicare separately. This law requires a collaborative rather than
supervisory relationship between NP’s and doctors.
Elements of a valid contract:
1. Parties are competent to contract. 2. The contract must concern a legal subject matter. 3. There must be a consideration (without
it, the agreement is for a gift). 4. There is a mutuality of agreement.
Worked with Lillian Wald and Lavinia Dock to establish the Henry Street Settlement. Pioneer in community health
nursing.
Mary Brewster:
A process that is implemented in an integrated health care delivery system. The RN is assigned as the Case
Manager and is responsible for moving the patient through the continuum of care in the integrated system. The Case Manager secures
services that are desired and available. Social Workers used to be Case Managers but RN’s are better suited for the task.
Case Management:
The nurse who founded the American Assembly for Men in Nursing
Luther Christman:
Decision Making:
1. Immediate – there is no time for reflection. Action is automatic or immediately
responsive. 2. Intermediate – There is time for reflection before acting. 3. Deliberate - Information acquisition precedes thinking,
consulting and reflection with the objective of making a rational decision. Deliberate decision making is the most common
Delegation Process: Five Steps:
1. define the task. You can only delegate a task that you have authority over. You must define the
task in terms of performance requirements and must determine which of the five levels of delegation to use. 2. Determine to whom to
delegate – give the task to the lowest appropriate person. 3. Provide clear communication about expectations regarding the task. 4.
Reach a mutual agreement about the task. 5. You must monitor and evaluate the results and provide feedback to the individual
regarding the performance of the task.
Direct Liability: Three theories.
Corporate Negligence, Breach of Contract/Breach of Warranty and Intentional Misrepresentation or
Fraud.
Eight Ethical Principles:
Justice is the right to be treated equally. Beneficence is the obligation to do good and avoid harm.
Autonomy is the right to self determination, freedom and independence. Nonmaleficence is the obligation to not create or inflict harm
on others. Veracity is the obligation to be honest and not deceptive. Fidelity is the obligation to be faithful to the commitment.
Confidentiality is owed to the patient. It’s an obligation as well as a right. Ethics is the obligation that the nurses’ personal beliefs not
interfere with patient care.
Fabiola
A wealthy first century Christian convert who founded the first free hospital for the poor.
Four Elements That Comprise Malpractice (or Negligence):
Duty. Breach of Duty. Proximate Cause (causation). Damages
Louise de Gras - Sisters of Charity 1633:
This religious order was founded by St. Vincent de Paul. Louise de Gras was the first
superintendent. She established the first nursing education program.
Health Care Financing Administration (HCFA):
This agency determines the reimbursement for service to Medicare beneficiaries. It
administers the Medicare and Medicaid programs.
Health Maintenance Organization (HMO):
Several types. Most popular are the Staff model, the Network model, and the Independent
Practice Association model. HMO’s are the most common type of managed care plan with the highest number of people enrolled.
HMO’s provide services for enrollees with a fixed fee mostly through affiliated providers
Was the National Organization for Women (NOW) first president. Now was formed in 1966. She was a
nurse and a feminist.
Wilma Scott Heide 1966:
Virginia Henderson 1961:
She created the Developmental Model. She was influenced by Orem and Maslow. She based her
theory on the assumption that the patient is a person who needs help moving toward the goal of independence. She saw a nurses’ role
as an advocate where the nurse would act on the behalf of the patient for those things that the patient would be able to do for
themselves if they had the strength, knowledge and willingness to do so.
HMO Act of 1973:
This act sets forth the requirements for federally qualified health maintenance organizations
International Council of Nurses (ICN): Established in 1900.
1900. It’s a confederation of national associations of professional nurses. One
per country. It provides for the sharing of knowledge so that nursing practice throughout the world is strengthened and improved.
Publishes the International Nursing Review.
Mildred Montag 1959:
In 1951, her doctoral research changed nursing education more dramatically than ever before. In 1959, she
published the results of “Community College Education for Nursing”, a five year project that resulted in the establishment of the
Associate Degree in Nursing being established.
Betty Neuman 1972:
She developed the Systems Model based on line of defense. This says that each patient has a usual range of
responses to stress that maintain equilibrium. (“Normal Line of Defense”). In unusual situations, the patient uses flexible lines of
defense (“Lines of Resistance”) to stabilize the situation. The nurses’ role is to decrease the stress factors and adverse conditions that
threaten optimal functioning. The nurse identifies stress factors and helps the patient respond by strengthening their normal and
flexible lines of defense.
National League of Nursing (NLN):
Grew out of and absorbed several professional nursing groups. Officially existed in 1952.
Membership is open to nurses, consumers and friends. The mission is to advance quality nursing education that prepares for future
changes in the profession. Publishes Nursing and Health Care. It is the official accrediting agency for nursing schools.
National Council of State Boards of Nursing (NCSBN): Created in 1978.
Its members are State and Territorial Boards of Nursing.
It collaborates on common interest matters, issues affecting the public health, safety and welfare which includes the development of
licensing exams. Develops and refines the National Council Licensure Exams (NCLEX) for Registered and Practical nurses.
Betty Neuman 1972:
She developed the Systems Model based on line of defense. This says that each patient has a usual range of
responses to stress that maintain equilibrium. (“Normal Line of Defense”). In unusual situations, the patient uses flexible lines of
defense (“Lines of Resistance”) to stabilize the situation. The nurses’ role is to decrease the stress factors and adverse conditions that
threaten optimal functioning. The nurse identifies stress factors and helps the patient respond by strengthening their normal and
flexible lines of defense.
National League of Nursing (NLN):
Grew out of and absorbed several professional nursing groups. Officially existed in 1952.
Membership is open to nurses, consumers and friends. The mission is to advance quality nursing education that prepares for future
changes in the profession. Publishes Nursing and Health Care. It is the official accrediting agency for nursing schools.
Nursing for the Future; the Brown Report 1948:
Funded by the Carnegie Foundation for the Advancement of Teaching and the
Sage Foundation. The study was conducted by the National Nursing Council. The purpose of the study was to analyze the changing
needs of the nursing profession. The study recommended that schools of nursing be located in universities and colleges. It also
recommended that nursing education should be mainstream education and could be divided into professional as well as practical.
Dorothea Orem 1959:
She developed the Self Care Model. There are three related theories: Self Care, Self Care deficit and Nursing
systems. Orem believed that nursing should focus on the self care deficit because the nursing system is designed as supportive and it
should provide education as needed by the patient.
Ostensible (apparent) Agency:
This doctrine says that the HMO or other managed care system can be held vicariously liable for the
medical malpractice of a contract doctor when: (1) The patient looked to the institution (HMO) rather than the doctor for care and (2)
the HMO created a reasonable presumption to the patient that the doctor was its’ agent. Ostensible agency is applied almost
exclusively to group and IPA model HMO’s.
Partners in Practice Model” developed in 1989 by Marie Manthey:
This model intends to provide an efficient way of using the
skills of a mix o professional and nonprofessional staff with differing levels of expertise. The nurse and the assistant agree to be
partners with the nurse taking the lead and directing the efforts of the junior partner. The partners work together with the same patients
and on the same schedule. This model offers more continuity and accountability, less expense and is more professionally rewarding for
the partners.
Patient Classification Systems:
(1) North American Nursing Diagnosis (2) Nursing Intervention Classification (3) Nursing Outcomes
Classification (4) Home Health Care Classification nomenclatures.
Peer Review Organizations (PRO):
The government instituted PRO’s as a mandate from the 1983 Medicare legislation. It
established mechanisms for quality assurance by private entities in a competitive market. Consumers are members on government
mandated PRO’s. PRO’s review only Medicare services and payment is tied to the outcomes of the Peer Reviews. The Peer Review
is used for multiple purposes, TQM/CQI, internal and external employee evaluation and as a legal tool but peer review results are
generally not admissible in court.
Hildegard Peplau 1952:
She is known as the “Pioneer of Psychiatric Nursing”. She developed the Interpersonal Relations Model
(process-organized). She said that a person is an organism that lives in an unstable equilibrium and life is the process of striving in the
direction of stable equilibrium which is never reached except in death.
Pew Health Professions Commission; 21 Competencies 1995:
this was a continuation of an earlier 1990’s report. Tries to assist
policymakers and educational institutions to produce health care workers who meet the changing needs of the US health care system.
It made specific recommendations to all health professionals in general and specifically to disciplines including nursing.
Problem Solving (seven steps):
(1) Define the problem (2) Gather relative information (3) Analyze the information (4) Develop
solutions (5) Make a decision (6) Implement the decision (7) Evaluate the solution.
Res Ipsa Loquitur “The thing speaks for itself” (Corporate Negligence/Liability Theory):
This permits the jury to conclude
negligence without proving the facts. For example: The patient dies of peritonitis and the surgeon left an instrument inside during
surgery. The jury can rule against the surgeon because it seems obvious that the error of forgetting to remove the instrument caused
the complication which caused the death of the patient.
Respondeat Superior “Master-Servant Doctrine”:
An employer may be held vicariously liable for the negligent acts of an employee
when those acts are conducted in the course and scope of employment. Based on three factors: (1) the level of control exerted by the
employer over the employees’ work (2) the method of payment (3) the parties’ understanding regarding the relationship. HMO’s use
the defense of “corporate practice of medicine. They say they aren’t liable because the HMO doesn’t actually provide the care, the
employees do.
Melinda Ann (Linda) Richards:
She is considered America’s first trained nurse. She developed new nursing programs and improved
on existing ones. She was very active in founding national nursing organizations and was the first president of ASSTSN.
Isabel Hampton Robb:
She made radical changes to nursing education. She cut down the student’s workday to ten hours and
eliminated the free private duty services.
Martha Rogers (1970):
Developed “the science of unitary man” model. The person is a unified field which is continually interacting
and exchanging matter and energy with the environment. She concluded that well being is reflected in patterns and organization of this
energy field. She saw the nursing role as one to act to promote and facilitate symphonic interaction between man and environment.
Sister Callista Roy 1970:
She developed the Adaptation Model. The model is influenced by system, stress and adaptation theories.
This model assumes that the patient adapts their behavior to cope with stimuli from environmental stressors. Stressors disrupt the
patients’ state of equilibrium and illness results. The nurses’ role is to assess the adequacy of the patients’ coping and maybe change
the patients response potential by bringing the stimuli to the point where a positive response is possible.
Margaret Sanger:
With her sister, she opened the first birth control clinic in the United States in Brooklyn NY. She battled for decades
over the distribution of birth control information.
Statute:
An act by the state legislature what becomes law. Statutes are enacted to prescribe conduct, define crimes, create
government bodies, appropriate public monies and, in general, to promote the public good and welfare. At the local level, government
adopts “ordinances”. At the state or federal level, they are called “regulations”.
Torts (Corporate Negligence):
tort is a legal wrong. Several kinds relate to nursing. Assault: menacing a patient. Battery:
physically contacting a patient who does not give permission for the contact. False imprisonment: unlawfully restraining a patient.
Invasion of Privacy/Violation of Confidentiality: making information about the patient public knowledge. Abandonment: unilateral
severance of care. Fraud: intentional deception that results in injury to the patient. Also remember Slander and Libel.
Unproductive Conflict:
The type of conflict that usually benefits from intervention, either from a facilitator (or if that person is engaged
in conflict) someone educated in conflict management. The facilitator may look to raise the conflicted persons’ consciousness about
the issue causing conflict. There are three general techniques:
(1) Controlled Discussion (2) Role Reversal (3) Hidden Agenda Counseling - in this type, the person says what they want to say to an
empty chair.
Utilization Review:
The Gatekeeper, also known as the Utilization Review Coordinator, controls the allocation of capitol and human
resources. The external utilization review determines what is customary and reasonable as it relates to health care and the cost of
reimbursement. Traditional utilization reviews did not provide an opportunity for health care consumers to appeal an internal decision.
Jean Watson 1979:
She developed the Theory of Caring. This is based on three assumptions: (1) caring is a universal social
behavior (2) care for self is necessary before care for others (3) care and love are the cornerstones of humanness. The nurses’ role is
to emphasize the humanistic dimension of nursing that can only be practiced interpersonally.