Exam 2 - Ch 1, 2 Health Care Delivery Potter Perry Fundamentals Of Nursing

Front 1

What are the characteristics of a profession?

Back 1

Requires an extended education
Requires a body of knowledge
Provides a specific service
Has autonomy
Incorporates a code of ethics

Front 2

4 professional organizations for nurses

Back 2

American Nurses Association (ANA)
National Student Nurses Association (NSNA)
National League for Nursing (NLN)
Vermont State Nurses Association (VSNA)

Front 3

Professional Standards for nurses include

Back 3

Scope and Standards of Practice (ANA, 2004)
Six Standards of Practice (Fundamentals of Nursing p.7)
Standards of Professional Performance (Fundamentals of Nursing p.7)
Code of Ethics

Front 4

The role of the nurse is no longer just care giving, it also emphasizes:

Back 4

health promotion, illness prevention, and wellness

Front 5

Long-term care insurance

Back 5

Separate insurance specifically to cover long-term care. Many long-term care services are not covered under standard insurance medicare or medicaid

Front 6

The 7 levels of health care are:

Back 6

preventative, primary, secondary, tertiary, restorative, continuing, hospice

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Primary health care -

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Health promotion for a whole population - includes prenatal care, well-baby care, nutrition counseling, family planning, exercise classes (primary care focuses on individual wheras primary health care focuses on improved health outcomes for an entire population).

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Preventative health care -

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Targeted screening (BP, cancer, STDs, etc), Poison control resources, Mental Health counseling, Community legislation (seat belts, air bags, bike helmets)

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Secondary health care delivery-

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Emergency care, Acute med-surg care, radiological procedures

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Tertiary health care delivery-

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intensive care, subacute care

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Restorative health care delivery-

Back 11

Cardiovascular and pulmonary rehab, sports medicine, spinal cord injury programs, home care

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Continuing health care delivery -

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Assisted living, Psychiatric and older adult day care

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Hospice health care -

Back 13

End of life care for terminally ill

Front 14

Levels of Prevention

Back 14

Primary, Secondary, Tertiary

Front 15

Primary Prevention -

Back 15

Also called "True Prevention" Helps healthy people avoid the onset of a malady. Focuses on health promotion and specific protections against illness. Examples include: immunizations, family planning, nutrition counseling, poison control and accident prevention information.

Front 16

Secondary Prevention -

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Focuses on health maintenance and early detection of illness so that prompt intervention can prevent more serious complications. Targeted toward individuals most at risk. Examples include blood pressure screening, growth and development charting.

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Tertiary Prevention -

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Begins after the illness is diagnosed and treated - focus on rehabilitation and resoration to maximum level of functioning. Aims to prevent patient from being permanently stuck in unhealthy state - prevent worsening such as depression or social isolation related to cancer diagnosis. Examples include diabetic teaching, support groups for specific illnesses, cardiac rehab, etc.

Front 18

What is the objectives and history of the patient's bill of rights?

Back 18

Written in 1972 by George Annas for the American Hospital Association, the PBR:
Recognizes the importance of open, honest communication between patient and provider
Respects role of patient in decision making about treatment
Respects cultural, racial, religious, age, gender, and other differences

Front 19

Very generally, what are the patient's rights outlined in the Patient's Bill of Rights?

Back 19

Right to Respect
Right to Knowledge about all aspects of care in understandable language/context.
Right to Refuse or direct treatment, including through an Advanced Directive
Right to Privacy including HIPPA compliance

Front 20

Advanced practice nurse (APN)

Back 20

Is an umbrella term for an advanced clinical nurse that includes nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, nurse-midwives

Front 21

American Nurses Association (ANA)

Back 21

The ANA is involved in establishing standards of nursing practice, promoting the rights of nurses in the workplace, advancing the economic and general welfare of nurses.

The purpose of the ANA is to improve standards of health and the availability of health care, to folder high standards in nursing, and to promote the professional development and general and economic welfare of nurses.

Front 22

Caregiver

Back 22

One who helps the client regain health and a maximal level of independent function through the healing process.

Front 23

CNM

Back 23

Certified Nurse-Midwife - an RN who is also educated in midwifery and is certified by the American College of Nurse-Midwives

Front 24

Certified Registered nurse anesthetist (CRNA)

Back 24

Is an RN with an advanced education in a nurse anesthesia accredited program

Front 25

Client advocate

Back 25

Protect client's human and legal rights and provide assistance in asserting those right if the need arises.

Front 26

Clinical nurse specialist (CNS)

Back 26

is an APN who is an expert clinician in a specialized area of nursing practice. The

Front 27

Code of ethics

Back 27

The philisophical ideals of right and wrong that define the principles you will use to provide care for your clients

Front 28

Continuing education

Back 28

involves formal, organized educational programs offered by universities, hospitals, state nurses associations, nursing organizations, and educational and health care institutions.

Front 29

In-service education

Back 29

Instruction or training provided by a health care agency or institution.

Front 30

International Council of Nurses (ICN)

Back 30

The ANA is part of the International Council of Nurses (ICN). The objectives of the ICN parallel those of the ANA: promoting national associations of nurses, improving standards of nursing practice, seeking a higher status for nurses, and providing an international power base for nurses.

Front 31

National League for Nursing (NLN)

Back 31

In North America, the 2 major professional nursing organizations are the ANA and the National League for Nursing (NLN). The NLN advances excellence in nursing education to prepare nurses to meet the needs of a diverse population in a changing healthcare environment. The NLN sets standards for excellence and innovation in nursing education.

Front 32

Nurse administrator

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manages client care and delivery of specific nursing services within a health care agency.

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Nurse educator

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Works primarily in schools of nursing, staff development departments of healt care agencies, and client education departments.

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Nurse practitioner

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provides health care to a group of clients , usually in an outpatient, ambulatory care or community-based setting.

Front 35

Nurse researcher

Back 35

Investigates problems to improve nursing care and to further define and expand the scope of nursing practice. Often works in an academic setting, hospital, or independent professional or community service agency.

Front 36

Nursing

Back 36

The ANA defines nursing as - the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations.

Front 37

Professional organization

Back 37

deals with issues of concern to those practicing in the profession.

Front 38

Registered Nurse (RN)

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A person who has completed an approved associate or baccalaureate degree program and passed the NCLEX-RN exam.

Front 39

TJC

Back 39

The Joint Commission annually updates and publishes National Patient Safety Goals. Examples of threats to client safety include medication errors, improper client transfers, client falls, incorrect procedures

Front 40

Evidence-based practice

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is a problem solving approach to clinical practice that uses the best available evidence along with your expertise and client preferences and values in making decisions about care.

Front 41

Six standards of practice that describe a competent level of nursing care.

Back 41

Includes 5 aspecta of Nursing process ADPIE plus O - target/expected Outcomes are identified prior to planning care.

Front 42

American Association of Colleges of Nursing (AACN)

Back 42

published the essential knowledge, practice and values, attitudes, personal qualities, and professional behavior for the baccalaureate-prepared nurse. Guides faculty on the structure, and evaluation of the curricullum and performance of graduate.

Front 43

National League for Nursing Accredidation (NLNAC)

Back 43

Published document indetifying core competencies for the professional nurse.

Front 44

Acute care

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Includes all secondary and tertiary care - NOT prevention or early intvervention but once problem has escalated to emergency, med-surg, ICU, etc.

Front 45

Adult day care centers

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Provide a variety of health and social services to specific client populations who live alone or with family members who work, etc.

Front 46

Assisted living

Back 46

Offers an attractive long-term care setting with a homier environment and greater resident autonomy. Clients require some assistance with ADLs but remain relatively independent.

Front 47

capitation

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Most health care providers now receive capitated payments. Capitation means that providers receive a fixed per client or enrollee of a health care plan. The aim of capitation is to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care at the lowest cost.

Front 48

Case Management

Back 48

Because of the need to contain costs, many hospitals use Case Management. In this model, a case manager, who is usually a nurse or social worker, coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care.

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Client-centered care

Back 49

A focus on client satisfaction. Picker/Commonwealth Program has identified 7 areas that most affect client satisfaction levels. These are -
Respect of values, preferences, expressed needs
Coordination and integration of care
Information/Communication
Physical comfort
Emotional Support and relief of fear/anxiety
Involvement of family and friends
Transition and Continuity

Front 50

Critical pathways

Back 50

Tool used by nurses in acute care settings to coordinate treatment from many areas/providers. For example, there are critical pathways for clients with pneumonia, congestive heart failure, etc.

Front 51

Diagnosis-related groups

Back 51

Congress established the Prospective Payment System PPS for all Medicare reimbursements. Inpatient diagnoses were grouped into 468 Diagnosis-Related Groups (DRGs) and hospitals receive a fixed payment for each group (with some adjustments for severity, urban/rural, teaching costs).

Front 52

Discharge planning

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Discharge planning begins the moment a client is admitted to a health care facility. It is important to anticipate what client will need in order to be discharged (or moved to a "lower-level" facility) and ensure that all aspects are brought together efficiently for a smooth transition.

Front 53

extended care facility

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Provides care when client is too well to be kept in a hospital but not well enough to go home. Includes intermediate medical, nursing, or custodial care over an extended period.

Front 54

home care

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Home care services may include - wound care, respiratory care, vital signs, assistance with elimination (ostomy care, assistance with home dialysis), rehabilitation, medications, IV, Labwork (sample collection)

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hospice

Back 55

is a system of family-centered care that allows clients to live and remain at home with comfort independence and dignity while easing the pains of terminal illness.

Front 56

independent practice association (IPA)

Back 56

A type of MCO that contracts with independent practice physicians who usually are not members of troups and whose practices include fee-for-service and capitated clients.

Front 57

Integrated delivery networks (IDNs)

Back 57

Larger health care systems have developed IDNs that include a set of providers and services organized to deliver a continuum of care to a population of clients at a capitated cost in a particular setting. The goal of this is to provide a continuity of care without duplication in the most appropriate settings.

Front 58

Managed care

Back 58

Describes health care systems in which there is administrative control over primarey health care services for a defined client population. The provider or health care system receives a predetermined capitated payment for each client enrolled in the program.

Front 59

medicaid

Back 59

government-sponsored health insurance for low-income individuals/families

Front 60

medicare

Back 60

government-sponsored health insurance for the elderly

Front 61

mimimum data set (MDS)

Back 61

In nursing homes or other long-term care facilities, the government requires staff to comprehensively assess each resident. One of the forms staff must complete is the MDS. This form focuses on patient's general physical and psychosocial health (i.e. cognitive functioning, mood, continence, dental health, etc.)

Front 62

Nursing informatics

Back 62

combines the best of computer science and information science with nursing science. It supports nursing practice and the delivery of nursing care by providing nurses with a way to manace and process nursing data.

Front 63

Nursing-sensitive outcomes

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Are client outcomes that are directly related to nursing care. They have a major effect on client safety and quality of care.

Front 64

primary care

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Provision of integrated, accessible health care services by health care professionals who address a majority of personal health care needs develop partnerships with clients and care for families and communities

Front 65

professional standards review organizations (PSROs)

Back 65

The federal government (largest consumer of health care) created PSROs to review the quality, quantity, and cost of hospital care.

Front 66

Prospective payment system (PPS)

Back 66

One of the most significant factors that influenced payment for health care was the PPS. Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals could not charge whatever they wanted to - PPS grouped inpatient services for Medicare clients into 468 diagnosis-related groups (DRGs). Each group had a fixed reimbursement amount.

Front 67

rehabilitation

Back 67

Restores person to the fullest physical, mental, social, vocational, and economic potential possible

Front 68

Resource utilization groups (RUGs)

Back 68

Capitation and Prospective Payment have influenced the way health care providers deliver care in all types of settings. Many now use RUGs in long term care to examine how resources are used and make efforts to manage costs without compromising care.

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Respite care

Back 69

Provides short-term relief or time off for persons providing home care to an ill disabled or frail older adult

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Restorative care

Back 70

Includes rehabilitation as well as any other treatment designed to restore client to best possible condition - Ongoing wound care is one example.

Front 71

Skilled nursing facility

Back 71

A type of extended care - offers skilled care from a licensed nursing staff, often includes IV care, wound care, ventilator management, physical rehabilitation.

Front 72

Utilization review (UR) committees

Back 72

Medicare-qualified hospitals had physician-supervised UR committees to review the admissions, diagnostic testing, and treatments provided by physicians who cared for clients receiving Medicare. The intent of Urs was to identify and eliminate overuse of diagnostic and treatment services.

Front 73

Work redesign

Back 73

In an effort to increase efficiency (as a direct result of PPS/managed care), many hospitals have redesigned nursing units to include more resources so clients do not need to be moved around so much