Healthcare and Nursing Practices: A Comprehensive Overview, Exams of Nursing

Download Healthcare and Nursing Practices: A Comprehensive Overview and more Exams Nursing in PDF only on Docsity! ANCC Non-Clinical Questions with Answers 2024 Hippa Protected Information \ n ✔Written information in the medical record Conversations among health care providers Patient information on the computer Health information cannot be used/shared without written permission Patient Safety and Quality Improvement Act (PSQIA) \ n ✔Establishes a voluntary reporting system to enhance the data available to assess and resolve patient safety and health care quality issues. Patient safety work product includes information collected and created during the reporting and analysis of patient safety event. Confidentiality provisions should serve to improve patient safety outcomes by creating an environment where providers may report and examine patient safety events w/o fear of increased liability risk. Confidentiality v/s Duty to Warn \ n ✔Duty to warn supersedes the right to confidentiality if a patients condition may endanger others. The duty to protect a patient from harming him/herself supersedes the right to confidentiality. Invasion of Privacy \ n ✔If the information can be shown to have been accurate, given in good faith and the receiver had a valid reason for obtaining the information. ie. patient has HIV and is bleeding. You can tell the psych nurse who is going to be providing mental health care. Healthy People 2020 \ n ✔Access to health care and improved health care Continuance of 2000 Goals: increased the quality and years of healthy life/ eliminate health disparities among Americans Objectives r/t equal access, availability, cost, quality of care Report to the Police \ n ✔Criminal acts and injury from a dangerous weapon Report to Department of Health \ n ✔Gonorrhea Chlamydia Syphilis Glasgow Coma Scale HIV TB Report to animal control \ n ✔Animal bites Report to Police via Social Services \ n ✔Suspected or actual child or elder abuse Not legally Required to report \ n ✔Domestic Violence This is a relationship that is consensual. However dysfunctional it may be. Collaborative Practice \ n ✔True Partnership Share common goals Recognize/accept separate areas of responsibility and activity. Coding \ n ✔CPT codes are comprised of 5 numeric digits. The first 3 numbers are always the same "992"...followed by the number assigned to the type of visit (e.g. New patient in an office (0), Established patient in an office (1), initial Hospital visit (2), and subsequent hospital visit (3)...then the last number on the CPT code is the encounter levels 1-5 (I.e. 1 =lowest level (problem-focused Hx, problem-focused exam, straightforward Medical decision making) and 5= highest level (comprehensive Hx, comprehensive exam, High Medical Decision making (MDM))). Ex. 99201 = this is the code for a new patient in the office ("0") with a low level of encounter (problem-focused Hx, problem-focused exam, and straightforward MDM (1)). Ex. 99215 = this is an established patient (1) with comprehensive Hx, comprehensive exam, and high MDM (5) Third Party Payers \ n ✔Medicare Medicaid Commercial Indemnity Insurers Commercial management organizations (HMO) Businesses or schools wanting health services for employees or students. Medicare A \ n ✔Inpatient/hospitalization Skilled nursing faculty Home health care Hospice associated with inpatient care Benefits at 65 yrs of age and those with severe disability no matter income level, or those with ESRD Issues regarding Access to Care \ n ✔Home health - Nurse/Therapy/HHA/MSW in the home - Cheaper Model than Hospital Meta-Analysis \ n ✔Data from multiple studies resulting in higher statistical power and single concussion. Gold standard A subset of systematic reviews; a method for systematically combining pertinent qualitative and quantitative study data from several selected studies to develop a single conclusion that has greater statistical power. This conclusion is statistically stronger than the analysis of any single study, due to increased numbers of subjects, greater diversity among subjects, or accumulated effects and results Experiment \ n ✔Involves random subject selection, one placebo or control group, and one or more intervention groups. RCT is a type of experimental study. Randomised Controlled Trials (RCTs) \ n ✔Randomly assigned double blind design (hidden from the patient, clinician and/or researchers. Experimental studies Cohort Study \ n ✔Looks at a group - risk factors for a disease, death or any other condition. No intervention is done. Identify risk factors and associations. Can be from present to future (prospective study) Case Report \ n ✔Detailed report of one person with a disease or an unusual condition that includes demo. Editorials \ n ✔based or not based on solid evidence. Weakes form Selection Bias \ n ✔When a researcher places a person in one arm of the study because they believe, perhaps subconsciously, that the person will benefit the most from the new intervention and/or that they are likely to show the new intervention in its best light. Intimacy versus Isolation \ n ✔EArly adulthood May be married Friendships and relationships are enjoyed - social isolation and lack of emotional commitment = failure Generativity versus Stagnation \ n ✔Middle Age Hold a job May have a family May become involved with social causes - inability to hold down a job, self-centered and not contributing to society = failure Ego Integrity Versus Despair \ n ✔Ranging from older adult to frail elderly Satisfaction with life accomplishments Leave a legacy grandma sews a quilt for each grandchild - many regrets about life who are at high risk for depression = failure Allowed to share health information \ n ✔To ensure proper treatment To pay for healthcare services Persons identified by patient To ensure quality care given To protect the health of the public To make required reports to the police Persons that do not have to follow HIPPA \ n ✔life insurers employers workers comp schools Child protective services Law enforcement Municipal offices Pre-Contemplation \ n ✔No intent to change behavior in the near future (6 months) resistant unmotivated avoid information, discussion or thought Contemplation \ n ✔Intent to change in the next 6 months aware of benefits to change ambivalent to change procrastinator Relative Risk \ n ✔is the ratio of the probability of an event occurring (for example, developing a disease, being injured) in an exposed group to the probability of the event occurring in a comparison, non-exposed group Preparation \ n ✔intend to take steps to change within the next month transition rather than stable stage Action stage \ n ✔has made overt, perceptible lifestyle modifications for fewer than 6 months Maintenance \ n ✔working to prevent relapse highest levels of self-efficacy and re less frequently tempted to relapse Transitional Care MOdel \ n ✔Prevent health complications and rehospitalizations of chronically ill, elderly hospital patients by providing them with comprehensive discharge planning and home follow-up. Health Belief Model \ n ✔Look at the barriers, benefits, threats and self-efficacy. 6 constructs predict health behavior - risk susceptibility -risk severity -benefits to action -barriers to action -self-efficacy -cues to action Federal Health Insurance Program \ n ✔Medicare -Administered by the CMS -fee-for service program -monthly payment deduction from SSC Family System Theory \ n ✔-all parts are integrated and need each other -dysfunction affects the whole system -Others may overcompensate and take over -increase stress someone else absorbs it and may become depressed or anxious The father and a 14 yr old girl come in. During your assessment of the 14 yr old she tells you that her dad has been biting her head off more and stressed more. She reports that he is sleeping a lot more and she had to pick up more of the responsibilities around the home and help him to get up and moving in the mornings. She is angry and distress and feels overwhelmed. Transcultural Nursing - Leininger's Theory of Cultural Care \ n ✔Specific pattern of behavior that distinguishes any society from others gives meaning to human expression of care sunrise model - care is influenced by many cultural features that shape one's world view. African American \ n ✔This is a matriarchal (female is the head of household) and some patients may feel that their illness is caused by lack of faith or by sin. Religious persons are important sources of emotional and tangible support. Latinos/Hispanics \ n ✔Matriarchal element - may consult folk healers, Susto= fright / Mal ojo is the evil eye. It is caused by an adult who stares with envy at the child. The hex can be broken if the person staring at the child touches the child. Can also be broken by passing an egg over the child with prayers and then place the egg under the bed overnight. Public affection is noted and multigenerational households are common Belmont Report \ n ✔outlines the important ethical principles that should be followed when performing research involving human subjects Tuskegee Syphilis experiemnt \ n ✔Initiated informed consent - 600 AA that were positive for syphilis were not treated or informed. Emancipated Minor \ n ✔Legal court document Active Duty Legally binding marriage or divorce N \ n ✔Total size sample Significance level \ n ✔p 0.5 or 0.1 mean \ n ✔average median \ n ✔number in the middle when arranged from lowest ot highest Mode \ n ✔most common value Range \ n ✔between the largest and smalles Total number of subjects in a group \ n ✔n Incidence to billing \ n ✔Bill under physician Physician must be in the same building 100% Not allowed in the hospital setting Quality Assurance \ n ✔A process for evaluating the care of patients using established standards of care to ensure quality. Prospective Study \ n ✔Studies done in the present to the the future. Cross Sectional Study \ n ✔compares differences and similarities between two or more groups of people or phenomena and collects data at one point in time. Descriptive \ n ✔Describe situation, experiences and phenomeno Ex post Facto \ n ✔Examines relationship among variable Retrospective \ n ✔Studies done on events that have already occured Case Study \ n ✔Investigation of a single person, group or phenomena. Bell curve \ n ✔a normal curve Systematic Review \ n ✔A document often written by a panel that provides a comprehensive review of all relevant studies on a particular clinical or health-related topic/question. Is created after reviewing and combining all the information from both published and unpublished studies (focusing on clinical trials of similar treatments) and then summarizing the findings. Once this is done you would do meta-analysis Specificity \ n ✔Presence of nitrate by dipstick is very specific but not a sensitive test for bacteriuria. Negatives test negative - they do not have the disease Sensitivity \ n ✔Esterase detection by dipstick is very sensitive but not specific. Positives test Positive - they have the disease Active Immunity \ n ✔It is immunity to a disease developed either through vaccine or by infection Passive Immunity \ n ✔Refers to immunity to a disease after receiving antibodies from another host Horizontal transmission \ n ✔Transmission of an infecting agent from one individual to another. Vertical Transmission \ n ✔Transmission of an infecting agent from mother to infant. Epidemic \ n ✔Rapid increase of a disease in a population that involves a large number of people Pandemic \ n ✔epidemic that occurs over a very large area. It involves a larger population Morbidity \ n ✔To an illness or any departure from physical and/or mental health Mortality \ n ✔Death Infant Mortality \ n ✔Infant deaths for every 1,000 live births prior to the age of 1. Beneficence \ n ✔The obligation to help the patient- remove harm, prevent harm, promote good. Acting in the patient's best interest. Compassionate patient care. The core principle in patient advocacy. Nonmaleficence \ n ✔The obligation to avoid harm. Protecting a patient from harm. Beneficence \ n ✔Encourage a patient to stop drinking and enrol in AA program. Education on a new prescription about how to take the medication Nonmaleficence \ n ✔Your patient has asthma. She brown bags her medication on this visit and you notice a beta-blocker. You educate her that she is not a good candidate for these drugs Utilitarianism \ n ✔The obligation to act in a way that is useful to or benefits the majority. The outcome of the action is what matters. It also means to use a resource for the benefit of most. Justice \ n ✔To be Fair To act without bias To equally and fairly distribute resources Verasity \ n ✔To be truthful The role of the NP \ n ✔Developed in the early 1960s Started in Peds First NP program \ n ✔1964, University of Colorado, Dr. Loretta Ford and Dr. Henry Silver The role of the NP \ n ✔Clinician Consultant/collaborator Educator Researcher Fidelity \ n ✔The obligation to maintain trust in a relationship. To be loyal and dedicated to one's patients. Keeping one's promise Autonomy \ n ✔The obligation to ensure that mentally competent adult patients have the right to make their own health decisions and express treatment preferences. Consultive relationship \ n ✔involves an informal process between two or more providers who exchange information about a patient occasionally. Elements of a Case for claim \ n ✔A Duty is owed (legal duty exists), a duty was breached (not following standard of care), the breach caused an injury (proximate cause) and damage occured. Budget Reconciliation Act of 1989 \ n ✔The first law allowing NPs to be reimbursed directly by MCR. Balanced Budget Act 1997 \ n ✔Broaden medicare coverage of the NP, required NPI number for billing increased rate of reimbursement for NPS to 85%of the medicare physician fee schedule State Nurse Practice Act \ n ✔State legislature enacted Differs from State to State Education Responsibilities Leads by example Magnet designation establishes goals, provides direction then reward Rewards good / punishes bad Laissez-Faire Leader \ n ✔Engages in minimal supervision/direction. Hands off approach. Does not like to make decisions. Works well if workers are experienced, like autonomy and are self-directed. New staff may become anxious. Authoritarian Leadership \ n ✔Likes control. Gives directions. Many rules Makes decision with little to no input from staff. Motivated, independent and self directed. Democratic Leader \ n ✔Frequent meetings Values staff input Shares decision making Values relationships and staff opinion. Servant Leader \ n ✔Likes to work along with staff Assumes many roles Treats staff as individuals May not like to make decisions Treatment guidelines \ n ✔Systematic review of available clinical evidence. www.guideline.gov Sentinel Event (SE) \ n ✔Patient safety event that results in any of the following: death, permanent harm, severe temporary harm with interventions required to sustain life. Must perform RCA and improve. Root Cause Analysis (RCA) \ n ✔This needs to be done anytime there is a sentinel event (SE) as established by The Joint Commissions in 2017 )TJC). Identify contributing factors that result in the error. Utilization of the team approach. Find the cause, work to fix the problem. Statue of limitations \ n ✔A period of limitation for the bringing of certain kinds of legal action. Health Information Technology for Economic and Clinical Health Act, also known as HITECH, \ n ✔Protection of PHI enacted in 2009. PHI must be encrypted prior to sending. Patients must be informed if their PHI has been disclosed inappropriately even if the disclosure was accidental. Providers will be offered financial incentives for demonstrating meaningful use of EHR until 2015 then penalties. Independent variable \ n ✔changed or controlled in a scientific experiment Dependent Variable \ n ✔variable being tested and measured in a scientific experiment. Incidence \ n ✔measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time. Rate of new cases of the disease Prevalence \ n ✔measure of disease that allows us to determine a person's likelihood of having a disease, number of alive cases with the disease Computerized Physician Order Management (CPOM) or Computerized Physician Order Entry (CPOE) \ n ✔the process of providers entering and sending treatment instructions - including medication, laboratory, and radiology orders - via a computer application rather than paper, fax, or telephone. Electronic Health Record (EHRs) \ n ✔Digital version of patient chart real time patient centered Negligence \ n ✔Failure to exercise care that a responsible prudent person would do in the same situation. tort law = caused by carelessness, but not intended Malpractice \ n ✔Professional negligence Failure to provide standard of care set by governing body. causes harm to the patient. must have the 4 elements duty - had a duty or obligation breech - breached this duty causation - harm sufficient was because of the breach Damages - related to the harm caused - direct Modifiable risk factors \ n ✔Things that can be change: blood glucose weight b/p reading Non-modifiable risk factors \ n ✔Age Ethnicity Race Collaboration \ n ✔Two or more individuals work together towards a common goal of planning, implementing, or evaluating a specific aspect of an educational program for a student or group of students. Consultation \ n ✔Is an indirect process in which a human service professional assists a consultee w/ a work-related (or a caretaking-related) problem w/ a client system, with the goal of helping both the consultee and the client system in some specified way. National Provider Data Bank (NPDB) \ n ✔a web-based repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers Emergency Medical Treatment & Labor Act (EMTALA) \ n ✔This act is used to prevent inappropriate transfers and "patient dumping" for indigent patients. Affordable Care Act of 2010 \ n ✔Expands healthcare coverage Only US Citizens can purchase Expands Medicaid Tax penalties if you do not get coverage IOM 5 Core Competencies \ n ✔patient centered care Work in interprofessional teams Employ EBP Apply Quality improvement Utilize informatics Prescriptions for Controlled Substances \ n ✔Date of issue Patients' Name and Address Practitioners name, address & DEA number Drug name, dose, quantity, direction for use # of refils manual signature American Telemedicine Association Practice Guidelines \ n ✔Follow federal, state and local regulatory & licensure requirements. Patient is physically located in a jurisdiction in which the provider is duly licensed and credentialed. Practice within the scope of their licensure and shall observe all applicable laws. Swiss Cheese Model \ n ✔systems approach to understanding errors. Declares humans are fallible and errors are to be expected even in the best organization. The holes represent opportunities for the process to fail Quasi-experimental \ n ✔manipulation of variable but lacks comparison group or randomization Hierarchy Level 1 \ n ✔Meta-Analysis