Ambulatory Care Exam 1 question & answers, Exams of Nursing

Download Ambulatory Care Exam 1 question & answers and more Exams Nursing in PDF only on Docsity! Ambulatory Care Exam 1 question & answers Elements of CCTM - Correct Answers ✅-Assuming accountability -Providing patient support -Building relationships and agreements among providers that lead to shared expectations for communication and care -Developing connectivity via electronic or other information pathways that encourage timely and effective information flow between Care coordination - Correct Answers ✅Need high quality referral or transition Should be timely Safe: Referrals and transitions are planned and managed to prevent harm to patients from medical or administrative errors. Effective: referrals and transitions are based on scientific knowledge Patient centered efficient Equitable 6 principles of CCTM Nusing - Correct Answers ✅These six principles provide a basis for establishing an informed and collaborative care coordination process that includes all staff, key stakeholders, and nurse leaders across the continuum of care: -Know how care is coordinated in your setting Ambulatory Care Exam 1 question & answers -Know who is providing care -Establish relationships with multiple entities and individuals who can work together to improve care coordination and transition management systems -Know the value of technology, its impact on workflow, and the roles of care coordination team members -Engage the patient and family -Engage all team members in care coordination The logic model and CCTM - Correct Answers ✅The Logic Model depicts program outcomes, how the program is supposed to accomplish these outcomes and what is the basis (logic) for these expectations. Links program inputs (resources) and activities to the program products and outcomes while communicating the logic Components: Inputs: resources that go into the program Activities: actual events or actions that take place Products: direct tangible output of program activities Ambulatory Care Exam 1 question & answers -a misconception that care transitions originate with a hospitalization rather than recognizing the multiple care transitions occurring among diverse ambulatory care settings; -a misconception that a measure of care coordination and transition management is handing patients written instructions prior to discharge, a single intervention of a hand-off but not a measure of performance of care being coordinated or the transition being managed; -a misconception that care coordination and transition management are discrete points of communication rather than a continuous conversation with ongoing communication; -a misconception that individuals with complex health care needs are equipped with self-management skills and decision-making skills to know what to do when their condition worsens or they develop a complication -a misconception that individuals with complex health care needs seek care in traditional primary care settings, when diverse ambulatory settings are serving vulnerable populations including uninsured, Medicaid, and geographically and economically disadvantaged. 3 General contexts of ambulatory care nurses: - Correct Answers ✅-episodic/preventative care -chronic disease management -practice operations Ambulatory Care Exam 1 question & answers Episodic/preventative care - Correct Answers ✅-Teletriage -Medication recon -Promote adherence to treatment -HPI/patient health status - flag key findings for prioritization Chronic disease management - Correct Answers ✅- Telecommunication -Discharge strategies - better education -Early identification of sx Practice Operations - Correct Answers ✅-Guide teletriage -QI Data analysis practice leadership -Prioritizing patient appointment access and service coordination RN skills were viewed as vital to manage patient flow and capacity, enhance same day care needs, and accommodate after hours scheduling -Trained and supervised LPNs and MAs -Directed community based teams -Managed patient navigation centers -Providing continuity when PCPs were unavailable Ambulatory Care Exam 1 question & answers Position statement for ambulatory nurses - Correct Answers ✅•RNs enhance patient safety and the quality and effectiveness of care delivery and are thus essential and irreplaceable in the provision of patient care services in the ambulatory setting. •RNs are responsible for the design, administration, and evaluation of professional nursing services within an organization in accordance with the framework established by state nurse practice acts, nursing scope of practice, and organizational standards of care. •RNs provide the leadership necessary for collaboration and coordination of services, which includes defining the appropriate skill mix and delegation of tasks among licensed and unlicensed health care workers. •RNs are fully accountable in all ambulatory care settings for all nursing services and associated patient outcomes provided under their direction. Key elements of ambulatory care nursing: - Correct Answers ✅ Clients who are helped most by care coordination: - Correct Answers ✅-Chronically ill patients -Someone who doesnt have effective PCP - many ED visits Ambulatory Care Exam 1 question & answers 4. Clinical Information Systems: Organize patient and population data to facilitate efficient and effective care 5. Self-Management Support: Empower and prepare patients to manage their health and health care 6. The Community: Mobilize community resources to meet needs of patients -Community informs/activates the patient -Health systems is delivery - situational support, promote prepared proactive practice team -Activated patient has good interaction with the team and that leads to improved outcomes Understand the models that shape a provider's personal attitudes toward substance misuse. Recognize the impact of those underlying models as they apply to clinical practice. - Correct Answers ✅Moral model: Attribute addiction to personal weakness, lack of character or willpower, or an outright disregard for social norms Use of substances is often considered volitional, solely a matter of personal choice Behavioral model: Ambulatory Care Exam 1 question & answers Addictions are habits that have been overlearned through observation, interactions with the environment Behaviors can be examined, challenged, and changed 12 step model: Spiritual program of action Individual should seek his or her own conception of power greater than self Disease model: Disease of brain - outside voluntary control Prevailing medical model- based on medical model Bio-psycho-social-spiritual model: Most reflective of holistic perspective of nursing 12 step and disease models Intertwined with spiritual Apply principles of care coordination to specific client challenges. How would a care coordinator be able to help a particular complex client? - Correct Answers ✅Primary and acute communicating Ambulatory Care Exam 1 question & answers -More comprehensive EMR system to promote continuity of care -Referral to specialists and simplifying issues -Ensuring resources are available first -Transportation, telephone, healthy food, home, -Simplify complexity of system Transition coaches Bridge care after hospital discharge Care coordinator Promote self management, patient advocacy Correct assignment based on skillset Reimbursement from Medicare ***Know the elements of the NIH Clear and Simple Communications process and be able to apply them to a clinical example. - Correct Answers ✅5 Steps for Clear and Simple communication: 1. Determine/define target audience, assess learning style 2. Target audience research, assess rumors/myths and misinfo, determine feelings, fill in gaps in info Ambulatory Care Exam 1 question & answers ■ reading and understanding moderately dense, less commonplace prose texts as well as summarizing, making simple inferences, determining cause and effect, and recognizing the author's purpose ■ locating information in dense, complex documents and making simple inferences about the information ■ locating less familiar quantitative information and using it to solve problems when the arithmetic operation is not specified or easily inferred -OTC med interactions -Read a prescription label -Chart determined BMI -Age range vaccinations Proficient - Correct Answers ✅-reading lengthy, complex, abstract prose texts as well as synthesizing information and making complex inferences -integrating, synthesizing, and analyzing multiple pieces of information located in complex documents Ambulatory Care Exam 1 question & answers -locating more abstract quantitative information and using it to solve multi- step problems when the arithmetic operations are not easily inferred and the problems are more complex reading lengthy, complex, abstract prose texts as well as synthesizing information and making complex inferences ■ integrating, synthesizing, and analyzing multiple pieces of information located in complex documents ■ locating more abstract quantitative information and using it to solve multistep problems when the arithmetic operations are not easily inferred and the problems are more complex -Calculate health care costs via table with variation -Define medical term from a complex doc -Legal document applicable to health care situations Apply appropriate educational approaches and tools for each level of literacy: basic, intermediate, proficient. - Correct Answers ✅Below Basic: Demonstration, verbal, Ambulatory Care Exam 1 question & answers Simple instructions Intermediate: Prose literacy etc - Correct Answers ✅The knowledge and skills needed to perform prose tasks (i.e., to search, comprehend, and use information from continuous texts). Prose examples include editorials, news stories, brochures, and instructional materials. Prose texts can be further broken down as expository, narrative, procedural, or persuasive Document literacy. The knowledge and skills needed to perform document tasks (i.e., to search, comprehend, and use information from noncontinuous texts in various formats). Document examples include job applications, payroll forms, transportation schedules, maps, tables, and drug and food labels. Ambulatory Care Exam 1 question & answers when asked, than when being lectured or being told to change. 2. Eliciting/evoking change talk --What would you like to see different about your current situation?" • How can I help you get past some of the difficulties you are experiencing?" • "• "Suppose you don't change, what is the WORST thing that might happen?" "If you make changes, how would your life be different from what it is today?" 3. Exploring importance and confidence 4. Open ended questions 5. Reflective listening - 6. Normalizing - many people feel this way 7. Decisional balancing - To realize that (a) they get some benefits from their risky/problem behavior, and (b) there will be some costs if they decide to change their behavior. pros/cons 8. Columbo Approach: deploying discrepancies "On the one hand you're coughing and are out breath, and on the other hand you are saying Ambulatory Care Exam 1 question & answers cigarettes are not causing you any problems. What do you think is causing your breathing difficulties?" 9. Statements supporting self efficacy - affirmation 10. Readiness to change ruler 11. Advice/feedback - facts about outcomes "So you said you are concerned about gaining weight if you stop smoking. How much do you think the average person gains in the first year after quitting?" 12. Summary/mirroring 13. Therapeutic paradox - Paradoxical statements are used with clients in an effort to get them to argue for the importance of changing. "Bill, I know you have been coming to treatment for two months, but you are still drinking heavily, maybe now is not the right time to change?") Precontemplation- not ready - Correct Answers ✅People in the Precontemplation stage do not intend to take action in the foreseeable future, usually measured as the next six months. Being uninformed or under informed about the consequences of one's behavior may cause a person to be in the Precontemplation stage. Multiple unsuccessful attempts at change can lead to demoralization about the ability to Ambulatory Care Exam 1 question & answers change. Both the uninformed and under informed tend to avoid reading, talking, or thinking about their high-risk behaviors. They are often characterized in other theories as resistant, unmotivated, or unready for help. The fact is, traditional programs were not ready for such individuals and were not designed to meet their needs. No intention for action within 6 mos Contemplation - getting ready - Correct Answers ✅Contemplation is the stage in which people intend to change in the next six months. They are more aware of the pros of changing, but are also acutely aware of the cons. In a meta-analysis across 48 health risk behaviors, the pros and cons of changing were equal (Hall & Rossi, 2008). This weighting between the costs and benefits of changing can produce profound ambivalence that can cause people to remain in this stage for long periods of time. This phenomenon is often characterized as chronic contemplation or behavioral procrastination. Individuals in the Contemplation stage are not ready for traditional action-oriented programs that expect participants to act immediately. Intend to change in next 6 mos, aware of issue Preparation - ready - Correct Answers ✅Preparation is the stage in which people intend to take action in the immediate future, usually Ambulatory Care Exam 1 question & answers may be that this stage is an ideal goal for population health efforts. In other areas, like exercise, consistent condom use, and weight control, the realistic goal may be a lifetime of maintenance. Recall and apply the principles of mental health screening to the ambulatory care setting. Use the ppt and Strobe article (with highlights) for principles and application. - Correct Answers ✅-Screening for potential problems: who do you screen? -Consider risk factors for suicide: substance abuse, loss of spouse or significant other, mental health issues, possibly depression -Consider risk factors for depression: life-altering change, older age, mental health issues, environmental circumstances Recognition of warning signs Strobe article: Know the provider issues of lack of awareness, resource, and skills in addressing substance misuse. - Correct Answers ✅Awareness: Everyone has biases and prejudices, both conscious and unconscious. It is important as a provider to try to recognize the unconscious biases as Ambulatory Care Exam 1 question & answers much as possible so that they won't have an effect on the way clients are treated. Some unconscious biases have to do with someone's beliefs about the root causes of addiction and the best way to address it. Internal awareness: provider's personal attitudes/beliefs/bias External awareness: recognition of warning signs, the need for screening Resource: Limited time: pressure to see greater numbers of clients Payor impact: reimbursement for time spent Need for referral or information resources Skills: Assessment: screening tools, labs, conversation Diagnosis: substance use disorder (as opposed to addiction/dependence). Includes severity of the disorder. Plan: use of behavior change theories (Motivational Interviewing, Stages of Change). Based on the assessment of severity: minimal use, non-problematic, at-risk or heavy, repetitive and intense. Implementation: may include collaboration Evaluation: ongoing Ambulatory Care Exam 1 question & answers Apply the nursing process to a clinical example of substance misuse in the outpatient setting.. - Correct Answers ✅Assessment - subjective objective data, labs, conversation, Dx - based on DSM 5, substance use disorder, NPs can dx Organization/plan - based on behavioral change theory - like how ready they are to change, resources, Severity Implementation - interdisciplinary, Evaluation - ongoing Strobe - evaluation and having patience, Nurse client relationship for substance abuse - Correct Answers ✅- Recognize own beliefs to avoid counter transference -Normalizing -avoid judgment -Affirmations - AUDIT - Correct Answers ✅The Alcohol Use Disorders Identification Test (AUDIT) is an instrument adapted from the World Health Organization. Validation studies have been carried out in the United