N342 AMBULATORY CARE EXAM 2024 WITH 100% ACCURATE ANSWERS, Exams of Nursing

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N342 AMBULATORY CARE EXAM 2024 WITH 100% ACCURATE ANSWERS Key Roles/Responsibilities is Ambulatory Care RN (4) - correct answer✔✔ 1) enhance pt safety and quality/effectiveness of care delivery (irreplaceable) 2) responsible for design/administration/eval of professional nursing services within organization in accordance with nurse practice acts/scope of practice/org standards 3) provide leadership necessary for collab/coordination of services; includes defining appropriate skills mix + delegation of tasks to licensed and unlicensed workers 4) RN fully accountable in amb care for all nursing services and associated pt outcomes provided under their direction Role of RNs in Ambulatory Care (7) - correct answer✔✔ 1) TELEHEALTH NURSE - uses nursing process/tech to care for remote pts. 2) NURSE NAVIGATOR - helps nagivate health system 3) NURSE EDUCATOR - educate pts and educate other nurses 4) NURSE-RUN CLINICS - APRN clinics 5) RESEARCH NURSE - for enrolling pts in trials and providing care during trial 6) CARE COORDINATOR - similar to nurse navigator 7) PROCEDURAL - infusion center, cath lab, amb surgery Categories of Challenges to RNs in Ambulatory Setting (6) - correct answer✔✔ 1) Societal Changes 2) Healthcare environment 3) Integration of Health Records 4) Changing Reimbursement Models 5) Ambulatory Care Nursing Workforce 6) Nursing Education Amb RN Challenges: Societal Changes - correct answer✔✔ - pop w/ more old people and more diverse w/ complex behavioral needs - high quality/individalization w/ care tech (mobile devices/social media - societal violence: challenges of settings lacking infrastructure + resources of larger facility Amb RN Challenges: Healthcare Environment - correct answer✔✔ -fragmented care delivery; struggle to coordinate across specialties - amb care increasing regulatory control -- demand for high quality/safety --> impacts reimbursement/ability to compete for contracts - increase demand for care; shortage of primary care providers Amb RN Challenges: Integration of Health Records - correct answer✔✔ -lack of record integration -- system fragmentation - longitudinal health records not accessible across settings/providers/services - EHRs not patient-centered; not good for care coordination - APRN and RN-led clinics important to increases assess to care and for chronic disease mangement -RNs as clinical leaders Telehealth Competency Categories (7) - correct answer✔✔ 1) Required Knowledge 2) Attitudes 3) General Skills 4) Technological Skills 5) Clinical Skills 6) Communication 7) Implementation Skills Telehealth Competencies: Required Knowledge - correct answer✔✔ - Clinical Knowledge - Knowledge of procedure/ what to do in case of emergency - Knowledge of policies, procedures, & protocols of organization concerning deployment of telehealth tech - Knowledge of clinical limitations of telehealth - Knowledge of how telehealth can be deployed in existing pathways - Knowledge of how tech can be used in sharing info w/ colleagues - Knowledge of the laws and regulations concerning the protection and exchange of medical data (data protection, informed consent and confidentiality) - Knowledge of the potential benefits of telehealth - Knowledge how to collect health-related data for patient monitoring - Insight into which sources patients like to use to find info about their disease - Insight into the reliability of health info on the web - Knowledge of relevant protocols - Knowledge about what to do if tech does not work Telehealth Competencies: Attitudes - correct answer✔✔ - Attitude aimed to support self- management/empowerment, encourages pts to play active role in treatment - Uses ethically correct attitude during video conferencing (honesty, confidentiality, personal and professional integrity) - Is patient - Can convey empathy through videoconferencing, by facial expression and verbal communication - Is able to promote privacy and confidentiality in videoconferencing - Encourages use of electronic measurement devices for collection of detailed patient info - Promotes importance of a unified way of analyzing and sharing clinical information to improve quality of data and care - Has confidence that telehealth technology is not difficult to use - Is open-minded to innovations in ICT (taking into account confidentiality) - Motivational attitude - Remains calm, friendly and analytic towards patient when troubleshooting - Is able to enhance confidence of pt in deployed technology Telehealth Competencies: General Skills - correct answer✔✔ - Analytical skills - think creatively and problem solve - Coaching skills - Prioritization, can switch quickly between patients and different requests for help - Protects privacy of self and patient Telehealth Competencies: Technological Skills - correct answer✔✔ - Can train patient to use equipment - Basic ICT skills - internet and computer - Check for functionality - Tech skills in field of new technology - Electronic health records Telehealth Competencies: Clinical Skills - correct answer✔✔ - Combine clinical experience w/ telehealth technology in decision making - Observation skills - interpret verbal and non-verbal expressions - Uses health-related data effectively - presents data clearly to colleagues - Able to measure, compare and interpret data - Compose risk prevention plan to support patient safe independent living - Triage and clinical reasoning Telehealth Competencies: Communication - correct answer✔✔ - Able to listen and ask focused questions, paraphrasing, summarizing - Able to reveal patient's problem through specific questions - Empathy - Communicate clearly and can enhance contact - Put patients at ease - Create confidential environment and pleasant atmosphere - Communicate across different disciplines - Motivational techniques Telehealth Competencies: Implementation Skills - correct answer✔✔ - Assess whether telehealth is convenient for patient - Assess needs and preferences of patient in respect to telehealth - Communicate effectively benefits of telehealth - Provide advice about reliable health information on internet - resources Most Important Telehealth Competencies (7) - correct answer✔✔ 1) communication skills 2) coaching skills 3) ability to combine clinical 4) experience with telehealth 5) clinical knowledge 6) ethical awareness 7) supportive attitude Who came up with Telehealth Competencies? - correct answer✔✔ Expert panel of nurses and nursing faculty - Dismissing patient concerns/ideas about what is going on - Not offering solutions - No patient education - Failing to recognize urgent sxs - Using advanced medical terminology Telehealth Triage Pearls of Wisdome - correct answer✔✔ ○ Consider how the person sounds on the phone ○ Do not diagnose (as RN) ○ Use caution with patient's self-diagnosis ○ If there is a protocol disposition, do not downgrade (can upgrade) ○ When in doubt, have the client seen ○ Document! ○ Don't rely on the client to call back with update What to ask in Telehealth triage (ORDER!!!) (6) - correct answer✔✔ ○ Life-Threatening ( like do you need to call EMS right now) ○ Possible Emergent (Now-4 hours) ○ Non-Urgent, moderately sick (24 hours) ○ Persistent, low risk for complications (3 days) ○ Chronic or recurrent (see 1-2 weeks) ○ Mild symptoms (tx at home) Other Priority Setting Models - correct answer✔✔ Acute/Urgent/Unstable vs. Chronic/Non-Urgent/Stable Process of Telehealth Nursing in Different Populations - correct answer✔✔ Ethical awareness is KEY Protocols address adult, pediatric, geriatric, maternal/child concerns and home health Utilizes professional interpreters and language lines Accessible to patients in both rural and urban areas Limitation: nurse realized not knowing a person's ethnicity & culture had implications for dietary/lifestyle counselling. nurse said would have changed approach to assessment and health edu. focus -- it illuminates a significant limitation of Getting a Picture purely through mental imagery. How does care coordination affect health care costs? + Examples - correct answer✔✔ BAD OUTCOMES AND HIGHER COST OF CARE/USE OF RESOURCES!!!! More ER visits polypharmacy minimal preventative care missed immunizations low screenings Serious illnesses disability death More staff used more supplies wasted lower reimbursement for care Apply the use of care coordination to the clinical setting to improve safety and pt care. - correct answer✔✔ Typical needs may include transportation to appointments, a refrigerator to store meds, phone to communicate w/ care providers, nourishing food, and a home. Specialty care for diabetes, cancer, or asthma, methadone treatment, mental health treatment, and issues with food security and housing stability are not in and of themselves complex challenges; Complexity arises when the takses and linking of each intervention to the overall care plan fall into the lap of the individual alone w/o effective partnering or support GOAL: change behaviors and choices that are under control of patient --> we as service professionals must get to know each individual, establish a personal, trusting relationship, and connect to motivators that are important to person. Dimensions of CCMT Model (9) - correct answer✔✔ 1) Support for Self-Management 2) Advocacy 3) Education and Engagement of Patient and Family 4) Cross-Setting Communication and Transmission 5) Coaching and Counseling of Patients and Families 6) Nursing Process 7) Population Health Management 8) Teamwork and Collaboration 9) Patient-Centered Care Planning Self Management Support for CCMT - correct answer✔✔ "systematic provision of education and supportive interventions by healthcare staff to increase pts' skills & confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support. Assess pt's current level of knowledge + Health Literacy: Language, Best method of learning, Modality, Culture Tailor to education needs + Teach Back Set SMART Goals Self-Monitoring Tools (more useful than a pack of instructions at discharge) 8) Maintaining relationships 10 Core Components of Transitional Care Model - correct answer✔✔ 1) Transitional Care Nurse as primary coordinator of care for consistency of provider for whole care episode 2) in-hospital assessment and dev. of EBP plan of care 3) Home visits by TCN + ongoing telephone support (every day of week) for avg 2 months post-discharge 4) Continuity of med care between PCP and hospital facilitated by TCN 5) Comprehensive focus on pts needs including reason for primary hospitalization + coexisting health conditions/risks 6) Active engagement of pt and caregiver w/ focus on edu/support 7) Emphasis on early ID and response to health care risk/sx to achieve long-term positive outcomes and avoid adverse events contributing to hospital readmissions 8) Multidisciplinary approach w/ patient, caregivers, and providers as one team 9) Physician-nurse collaboration 10) Communication to/between/among pt + caregiver + providers Core Features of Care Coordination Interventions (6) - correct answer✔✔ 1) Comprehensive Assessment 2) Implementation of evidence-based plan of transitional care 3) Care initiation in a hospital and extends beyond discharge 4) Information sharing 5) Patient engagement 6) Coordinated services Effective Care Coordination Interventions (7) - correct answer✔✔ 1) Follow evidence-based guidelines to manage care 2) Collaboratively develop and implement a plan of care containing specific action plans and goals 3) Implement self-care coaching and support 4) Facilitate communication among the patient's & providers concerns regarding their health status 5) Monitor & evaluate a patient's symptoms, well-being, and adherence to the plan of care 6) Manage care setting transitions 7)Arrange and coordinate needed health-related and community based support services. Essential Elements of Care Coordination/Nurse Fx - correct answer✔✔ Care provider responsible for identifying an individual's health goals and coordinating services + providers to meet these goals Expertise in self-management and patient advocacy + will be adept at navigating complex systems and communication w/ a range of people from family members to doctors nurse should be care coordinator when there is medical frailty or complexity! Emory Examples of Care Coordination (6) - correct answer✔✔ EHN RN Care Coordinator - Vulnerable Complex High Risk patients attributed to the Emory Healthcare Network RN Advisor - Telephonic communication with patients whom have an identified healthcare need Winship Nurse Navigator - Oncology patients receive cancer treatments and educate their patients about their diagnosis Transplant Coordinator - Transplant patients navigate transplant centers and monitor disease/medication therapies Triage RN - Receive patient communications and readily respond to the patient's identified needs Transitional Care RN (EUHM, only) - High risk discharged patients from EUHM and follow-up for 30 days. Principles of Care Coordination Model (7) - correct answer✔✔ 1) Follow evidence-based guidelines to manage care 2) Collaboratively develop and implement a plan of care containing specific action plans and goals 3) Implement self-care coaching and support 4) Facilitate communication among the patient's & providers concerns regarding their health status 5) Monitor & evaluate a patient's symptoms, well-being, and adherence to the plan of care 6) Manage care setting transitions 7) Arrange and coordinate needed health-related and community based support services. 3 ANA Keys to Effective Collaborative Relationships - correct answer✔✔ 1) Effective Communication 2) Authentic Relationships PATIENT-CENTERED: Referrals and transitions are responsive to patient and family needs and preferences EFFICIENT: Referrals & transitions are limited to those that are likely to benefit patients and avoid unnecessary duplication of services EQUITABLE: availability & quality of referrals and transitions does not vary by the personal characteristics of patients. Essential Differences Between 2 Case Studies Presented in Care Coordination - correct answer✔✔ Mrs. G had fragmented care and poor medicine management leading to a complete stroke. Mrs. H (Mrs G's sister) received coordinated care from her provider, clinical director of mental health center, and psychiatrist that the clinical director referred her to. - By ensuring she make an appt before leaving her, providers office ensure she has a line to the next part in her care. - When she missed her appointment, her medical office was notified and a new appointment was rescheduled and attended. - The psychiatrist was able to identify high BP and other unwanted symptoms to link back to her provider. - Her provider was able to give her the immediate care she required. 5 Features of Medical Home (based on joint principles) - correct answer✔✔ 1) Patient-family centered 2) Comprehensive 3) Coordinated 4) Accessible 5) Committed to quality and safety Medical Home Features: Patient-Family Centered - correct answer✔✔ A partnership among practitioners, patients, and their families ensures that decisions respect patients' wants, needs, and preferences, and that patients have the education and support they need to make decisions and participate in their own care. Medical Home Features: Comprehensive - correct answer✔✔ A team of care providers is wholly accountable for a patient's physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Medical Home Features: Coordinated - correct answer✔✔ Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports. Medical Home Features: Accessible - correct answer✔✔ Patients are able to access services with shorter waiting times, "after hours" care, 24/7 electronic or telephone access, and strong communication through health IT innovations. Medical Home Features: Committed to Quality and Safety - correct answer✔✔ Clinicians and staff enhance quality improvement to ensure that patients and families make informed decisions about their health. Possible Team Members in PCMH Setting - correct answer✔✔ Physicians APPs Managers (clinical/operations) Front end operations Clinical support staff (RN, LPN, MA) Other members (behavioral, nutrition, social worker, referral coordinators, health coaches and health educators) How do PCMH team members contribute to holistic care of patient? - correct answer✔✔ It is the nursing's holistic view that has historically kept the patient, family, and community center stage in the hospital and community-based delivery systems, while championing quality and effective care coordination to facilitate the best patient outcomes. How does the RN interact with other team members in Care Coordination? - correct answer✔✔ Roles of the RN: clinical manager, charge/lead, nurse clinician, telehealth, RN care coordinator. Optimize the scope of practice of RNs in primary care can help address the access crisis. Can provide team-based patient centered care.... (look at ppt) Collaborate with provider for individual patient care plans Care management/coordination with complex high risk patient referrals Coordination/transition of care across specialties. Primary care RN: focused on the whole health of the patient! Challenges to Implementing PCMHs (4) - correct answer✔✔ 1) Fee for Service → Value Based care: shift in mindset on how to provide pt care (especially in fee for service world) 2) Role change - working at top of license/cert 3) Patient Access Changes 4) Added Responsibilities Challenges to Implementing PCMHs: Shift to Value-Based Care - correct answer✔✔ ■ Healthcare costs are reduced ■ Shared savings agreements with payers ■ Increased reimbursements to PCMH practices POSSIBLE SOLUTION: demonstrating the evidence that value-based care lower costs and workload while benefiting patients. 5) Self-management support 6) Coordination of care PCHM Domain: Performance reporting - correct answer✔✔ Reports to track/compare results for a point in time for all patients and for those with specified diseases; includes well patient and data on preventive services. Reports include patient clinical info for a majority of care services received at other sites Trend reports compare/manage performance results of their pt pop over time PCHM Domain: Individual Care Management - correct answer✔✔ trained on PCMH and chronic acre models + practice transformation concepts delivers coordinated care management; integrated multidisciplinary team of providers RN + 2 of the following: DM educator, nutritionist, resp therapy, pharmacists, MSW, asthma educator, counselor, mental health counselor, or NP/PA w. health ed experience EBP guidelines used by team 1 chronic condition as initial focus for measuring/data/group visits Med review/management at every visit Systematic approach to track/followup on appointments/referrals, talk about advanced care planning, survivorship plan after treatment; assess palliative needs and provide services PCHM Domain: Preventive Services - correct answer✔✔ prevention program to identify patient to take about risky health behaviors use preventative guidelines promote ongoing well care visits/screenings incorporate outside encounter into EMR (ex: vaccines) tobacco use assessment + provide cessation education standing orders for preventative services 2nd-ary prevention program to ID asymptomatic pt w/ preclinical disease for treatment (ex: metabolic syndrome) staff trained on health promotion/disease prevention planned visits for preventative services in context of maintenance exam; team prepared in advance. PCHM Domain: Linkages to Community Services - correct answer✔✔ do a community resource comprehensive review + develop database; update semiannual Collab w/ community-based orgs staff trained in community resources system to educate patients about resources/referrals in community tracke referrals in high risk patients for completion system for follow up on high risk pt referrals and any next steps PCHM Domain: Self-Management Support - correct answer✔✔ staff educated on support concepts: motivational interviewing, identifying health literacy barriers self-mngmt support/follow up for all pts w/ chronic conditions system for follow-up with self-management regular pt experience/satisfaction surveys work toward self-mngmt in all patients at least 1 team member trained through accredited self-mngmt support program and responsible for working w/ other team members PCHM Domain: Coordination of Care - correct answer✔✔ provider notified if pt w/ select condition admitted or discharged from hospital or other facility where provider has privileges care coordination tracked and sensitive issues flagged w/ pts w/ chronic conditions care coord. w/ payer case manager for pts with complex or catastrophic conditions staff trained on care coordination care coordination needed for all pts who need care coordination assistance Difference Between Annual Physical and Annual Wellness Visit - correct answer✔✔ RNCC performing AWV