Final Exam Review Flashcards
1
Q
What are Canadian provinces responsible for in health care?
A
- administration and delivery of health services
- Constitution Act 1867
- Provinces decide how much money to spend on health services, where to deliver these services, where to locate hospitals, and how many doctors are needed
2
Q
What is the federal government responsible for in health care?
A
responsible for health care in….
- Yukon, Nunavut, and the Northwest Territories
- Aboriginal people who live on reserve, members of the armed forces, veterans, Royal Canadian Mounted Police, and inmates of federal institutions
3
Q
What is the Canadian Health Act?
A
- Federal legislation passed in 1984
- Based on five principles:
1. Universality
2. comprehensiveness
3. Accessibility
4. Portability
5. Public Administration
4
Q
What is block funding?
A
Combination of cash payments and tax points
–> form and cost sharing between federal and provincial governments
5
Q
What are the two provisions to cost sharing in block funding?
A
- No extra billing for medical services by doctors
- No user fees charged for insured health services
6
Q
What are the 4 key approaches to Health Care in Canada?
A
- Population health
- Integrated health care delivery
- Primary health care
- Disease management
7
Q
What is population health?
A
- an approach to health care that focused on health determinants
- aims to reduce inequities amount different groups of populations (the vulnerable)
8
Q
What is the ultimate goal for population health?
A
improve the health of the entire population
9
Q
What is LHINs?
A
local health integrated network that works with the ministry of health and long term care
10
Q
What is the three recommendations that LHINs developed?
A
- use the home and community care charter for the planning, delivery, and evaluation of home care and community services
- submit an evidence-informed capacity for its region
- allowed discretion to direct funds to reflect the priorities within their region to meet client and family home care and community service needs
11
Q
What are the two main acts governing privacy issues and must be considered in the context of health care and delivery?
A
- Privacy act
- Personal information protection and electronic documents act
12
Q
What are the three studies of health care economics?
A
- Scarcity
- Choice
- Preference
13
Q
What is scarcity in health care economics?
A
Resources exist in finite quantities and consumption demand is greater than existing resources
-not enough resources but high demand
14
Q
What is choice in health care economics?
A
decisions are made about which resources to produce and consume among options
15
Q
What is preference in health care economics?
A
individual and societal values and preferences influence the decisions that are made
16
Q
What are the traditional perspectives on cost of health care?
A
based on altruism and ethics
- early nursing generally focused on altruistic services which evolved from early charitable institutions
17
Q
What is altruism in traditional perspectives on cost of health care?
A
unselfish concern for the welfare of others
18
Q
What is ethics in traditional perspectives on cost of health care?
A
doctrine that the general welfare of society is the proper goal of individual’s actions
19
Q
What are the three traditional perspectives functions based on cost of health care?
A
- financing
- funding
- delivery
20
Q
What is the importance of evidenced-based practice?
A
- does not guarantee good decisions but it is key to improving outcomes that affect health
- should be views as the highest standard of care(supported by critical thinking and sound clinical judgement)
21
Q
What is politics?
A
- variety of methods to achieve their goals
–> involves using power to influence, persuades, or change- it is the activity in which conflicting interests struggle for advantage or dominance in the making and execution of public policies
22
Q
Why do politics exist?
A
resources can be limited and some people control more resources than others
23
Q
What are stakeholders?
A
Control of health care resources is spread among a number of vested interest groups
- exert political pressure
on health policy makers in an effort to make the health care system work to their economic advantage (at the municipal, provincial, or federal level).
24
Q
What is The Canadian Association of Retired Persons (CARP)?
A
an influential advocacy for 50+.
25
What are the politics and demographic changes?
Seniors 65 and older are likely to be the most powerful consumer group through the next two decades (this group accounts for 13 percent of the population).
- Many seniors are joining consumer groups to have a greater political voice, to influence health policy decisions, and to ensure they receive the health care services they will need for years to come.
26
What are consumer demands in health care?
- Consumers want to be more than passive recipients of health care.
--> They expect organizations and providers to be consumer-friendly and service-oriented.
--> They want a say in how health care is delivered.
27
What is leadership?
- **influencing the thinking and actions of others with respect to achieving a goal**
--> Can occur without a formal management role
--> Refers to an individual’s ability to affect others,
often by inspiring, enlivening, and engaging them
to participate
--> Can occur between the leader and another individual; between the leader and a group; or between a leader and an organization, a community, or a society
28
What are the two types of leadership?
1. formal
2. informal
29
What is formal leadership?
a person in a **position of authority** or someone with a sanctioned, assigned role within an organization that **connotes influence**.
30
What is informal leadership?
an individual who demonstrates leadership outside the scope of
a formal leadership role or as a member of a group, rather than as the head or leader of
the group.
**member of a group instead of a head leader influencing leadership**
31
What are the five characteristics of leaders?
1. Intelligence
2. Self-confidence
3. Determination
4. Integrity
5. Sociability
31
What is emotional intelligence?
The ability both to recognize the meaning of emotions and their relationships and to reason and solve problems on the basis of emotions.
**able to read emotions**
32
What are the five basic social and emotional competencies of emotional intelligence?
1. Self-awareness
2. Self-regulation
3. Motivation
4. Empathy
5. Social skills
33
What are the three major leaderships theories?
1. Behavioural approach
2. Contingency approach
3. Contemporary approach
34
What is the behavioural approach of leadership?
this includes autocratic, democratic, and laissez-faire leadership
35
What is autocratic leadership?
centralized decision making, with the leader making decisions and using power to command and control others.
36
What is democratic leadership?
participatory; authority is delegated to others. The democratic leader uses expert power and the power base afforded by having close, personal relationships to be influential.
37
What is laissez-faire leadership?
passive and permissive; the leader defers decision making.
**group makes decisions**
38
What is the contemporary approaches?
Transformational leadership theory is based on the idea of **empowering others** to engage in pursuing a collective purpose by working together to achieve a vision of a preferred future.
38
What is the contemporary approaches?
Transformational leadership theory is based on the idea of empowering others to engage in pursuing a collective purpose by working together to achieve a vision of a preferred future.
39
What is management?
systematic process of planning, organizing, leading, and controlling actions and resources to achieve organizational goals
40
What is interprofessional team?
Composed of members with a variety of clinical expertise
*two or more teams**
41
What is a committee?
A work group with a specific task or goal to accomplish
*Types:*
--> Ad hoc (short-term goal)
--> Standing (may be mandated by organizational bylaws)
--> Advisory (reports back to a council or an executive)
42
What are the five stages of team process?
1. Forming
2. Storming
3. Norming
4. Performing
5. Adjourning
43
What are the three types of budgets?
1. operating
2. capital
3. construction
44
What is an operating budget?
account for income and expenses associated with day-to-day activity within a department or organization.
**daily budgeting**
45
What is a capital budget?
account for the purchase of major new or replacement equipment.
46
What are a construction budget?
are developed when renovation or new structures are planned.
47
What is budget preparation?
- Budgets are generally developed for a 12-month period, or yearly cycle.
- Fiscal year is determined by the organization.
- Shorter- or longer-term budgets also may be developed.
48
What is zero-based budgeting?
process used to drill down into expenses by detailing every supply item and quantity of items used.
**intense budgeting, EVERY item and quality of items are marked**
49
What is a strategic plan?
Defined as the sum total or outcome of the processes by which an organization engages in environmental analysis, goal formulation, and strategy development with the purpose of organizational growth and renewal
50
What is strategic planning?
Plans that apply to the entire organization, that establish the organization’s overall objectives, and that seek to position the organization in terms of its environment
51
What is reengineering?
- known as business process reengineering
- fundamental **rethinking and redesign of the process under review to bring about radical and dramatic improvements and increases in value**
- Strategic planning is a major component of business process reengineering.
52
What is an environmental assessment?
- A broad view of the organization’s current environment
- Uses a SWOT analysis
53
What does SWOT analysis mean?
S – Strengths
W – Weaknesses
O – Opportunities
T – Threats
54
What is a mission statement?
a formal expression of
the purpose or reason for existence of the organization
55
What is philosophy?
a value statement of the
principles and beliefs that direct the organization’s behaviour
56
What is a vision?
provides a clear picture of what the future will look like; defines the key results achieved and goals that are to be accomplished
57
What is a value?
may be formally stated and explicit, or may be implicit and part of the organizational culture
58
What is Benner's novice to expert model?
Acknowledges that practitioners can be expected to have acquired tasks, competencies, and outcomes that are based on five levels of experience:
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
59
What model do you use to recognizing moral distress?
The "4 A's"
Ask—is there unease or discomfort with a situation that may be causing moral distress?
Affirm—affirm distress and commit to self-care
Assess—assess the source and severity of
the moral distress (along with one’s readiness to act)
Act—work toward a positive sustainable change
60
What are ethical theories?
- Ethical theories are systematic approaches that help to decide right from wrong.
- Three examples include consequentialist, utilitarianism, and deontology
61
What is utilitarianism in ethical theories?
focuses on providing benefits to the greatest number
62
What is consequentialist in ethical theories?
focuses on duties or the means rather than focusing on the end to a goal
62
What is principles?
A framework for considering ethical issues that includes the following guiding principles:
- Respect for autonomy, Beneficence, Non-maleficence, and Justice
63
What are the four ethical issues that arise from nursing practice?
1. Consent and autonomy
2. Resource allocation
3. End-of-life care
4. Truth telling
64
What are nursing informatics?
Science and practice that integrates nursing, its information and knowledge, and their management with information and communication technologies to promote the health of people. families, and communities worldwide.
65
What is E-health?
intersection of medical informatics, public health, and business.
- prefers to health services and information delivered or enhanced through the internet and related technology
66
What does the acronym PLEASED stand for? What is it used for?
P – Purpose for which the site was created
L – Links and their accuracy and reliability
E – Editorial or site content: accuracy, bias, comprehensiveness, currency
A – Author: credentials, expertise
S – Site: design, navigability, ease of use
E – Ethics: disclosure of author, sponsor, site purpose
D – Date: Is information current, updated regularly
it is used to critically evaluate info found on the internet
67
What is C-HOBIC?
A model endorsed by the Canadian Nursing Informatics Association for documenting standardized clinical outcomes reflective of nursing practice in Canada.
68
What are the three ways C-Hobis supports the nursing profession?
1. systematically articulating outcomes reflective of nursing interventions
2. supporting the aggregation of nursing data across practice settings to enable comparative analysis
3. positioning the collection and reporting of nursing data in a systematic format that supports the inclusion of nursing data in health information databases and discharge abstracts
69
What is an electronic health record(EHR) who has access?
- An individual’s health data are maintained and distributed over different systems in different locations, such as a hospital, clinic, physician’s office, and pharmacy.
- The focus is on the individuals’ health, encompassing both wellness and illness.
- Includes all information about an individual’s lifetime health status and health care
- Is a replacement for the paper health record as the primary source of information
- Documentation is an important purpose but EHR also permits health information to be used to support the generation and communication of knowledge
- Meets all clinical, legal, and administrative requirements
70
What is the security of computer based patient record systems 3 components?
*Privacy*: the right of an individual to keep information about him- or herself from being disclosed to anyone
*Confidentiality*: the act of limiting disclosure of private matters
*Security*: the means to control access and protect information from accidental or intentional disclosure to unauthorized persons and from alteration, destruction, or loss
71
What are the elements of communication process?
- sender, encoding, message, media, decoding, receiver, response, feedback, noise
72
What are the channels of communication?
1. visual (seeing)
2. auditory (hearing)
3. kinaesthetic (touching)
73
What is the three levels of communication?
1. Public communication
2. Intrapersonal communication
3. Interpersonal communication
74
What is public communication?
- Directs the message to an audience or group of people with a common interest
- Tends to provide little opportunity for feedback
75
What is intrapersonal communication?
- Internal communication that takes place within an individual
- This is used to process observations, analyze situations, resolve doubts, or reaffirm beliefs.
76
What is interpersonal communication?
Communication between individuals: person-to-person, or in small groups
77
What is organizational communication?
Avenues of communication are often defined by an organization’s formal structure.
- includes upward, downward, lateral, diagonal and grapevine communication
78
What is upward communication?
originates at some level below the top of the structure and moves upward.
79
What is downward communication?
originates at the
top or upper levels of organization and works downward.
80
What is lateral communication?
occurs among people at similar levels within the organization.
81
What is diagonal communication?
occurs when
people who may be on different levels of
the organizational chart communicate with each other.
82
What is grapevine communication?
An informal and unstructured avenue of communication (major benefit is speed—major drawback is its unreliability)
83
What are barriers to communication?
language, gender, culture, generational differences, health literacy, anger, incongruent response(blaming, placating..), conflict
84
What are the five approaches to conflict resolution?
1. Avoiding
2. Accommodating
3. Competing
4. Compromising
5. Collaborating
85
What is CNO and what do they do?
College of Nurses of Ontario
- to protect the public by promoting safe nursing practic
86
What is RNAO and what do they do?
Registered Nurses' Association of Ontario
- the professional body representing registered nurses, nurse practitioners and nursing students in Ontario
87
What is CNA and what do they do?
Canadian Nurses Association (CNA)
--> the national and global professional voice of Canadian nursing
88
What is the workload measurement system?
measurement tool used to articulate the nursing workload for a specific client or group of clients over a specific period of time.
89
What is client acuity?
is the measure of nursing workload that is generated for each client.
Measurements are made to assess the nursing care required to care for a client over a 24 hour period.
90
What is client acuity?
is the measure of nursing workload that is generated for each client.
Measurements are made to assess the nursing care required to care for a client over a 24 hour period.
91
What is direct expenses?
costs of providing service such as staffing
92
What is indirect budgeting?
items such as phones
93
What is Human Resources expenses?
Salaries & benefits account for 80% health care budgets
Calculations are made according to amount staff time required to complete a service
94
What is staffing expenses?
staffing models outline the number of staff required (based on the procedures or clients) most cost effective combination of staff important to consider
95
What is delegation?
transfer of responsibility for a task when it is not part of the scope of practice of the care provider.
96
What is the unregulated care provider(UCP)?
- UCPs can deliver supportive care and are expected to document and report information related to these activities.
- UCPs cannot practise nursing or provide total patient care and cannot be delegated to assess or evaluate responses to treatment.
- The RN has an increased scope of liability when delegating to a UCP.
97
What are the five principles of delegation?
1. Right task
2. Right circumstances
3. Right person
4. Right direction/communication
5. Right supervision
98
What is the perspectives on delegation?
- Delegation of certain tasks helps reduce health care costs by making more efficient use of nursing time and the facility’s resources.
- It is imperative that today’s nurse is able to delegate appropriately to ensure client safety.
- Efficient delegation of care protects the client and provides desirable outcomes.
99
What can be delegated?
People who are not authorized by legislation to perform it. (RPN, RN, UPN)
- Nurses are accountable to follow their provincial/territorial standards of practice and legislation, the policies of their health care organization, and the CNA code of ethics.
- The nurse retains accountability for the delegation process (when delegating, the nurse must follow the appropriate provincial/territorial nursing scopes of practices for the delegate).
100
What are RPNs accountable for with UPNs?
- responsibility to analyze data that unregulated workers may complete
- When working with unregulated workers, it is important to:
----> consider the complexity of care required and the safety of the client
---->respect personal autonomy and rights of clients to participate in decision making
101
What are the functions of RPNs?
- teaching from a standard care plan
- reinforcing teaching
- updating initial assessments
- removal of sutures
- client assessment, nursing diagnosis, planning, implementation, and evaluation of the quality of care delegated
102
What is direct delegation?
verbal direction by the RN delegator regarding an activity or task in a specific nursing care situation.
103
What is indirect delegation?
done using an approved listing of activities or tasks that have been established in the policies and procedures of the health care institution or facility.
104
What is inappropriate delegation?
Delegating duties to others who lack the education and experience to carry out the task safely and competently is inappropriate and dangerous.
105
What is deontology in ethical theories?
focuses on duties or the means rather than focusing on the end to a goal
106
What is ethics?
Can be defined as a way of understanding
and reflecting upon social morality that encompasses moral issues, norms, and practices
107
What is morality?
Can be defined as beliefs or traditions about what is determined to be right or wrong in terms of conduct toward ourselves and others
108
What is bioethics?
- Arose in the 20th century
- Referred to as health care ethics
- Developed in response to new technologies, choices, and concerns in maintaining and intervening in the lives of human beings
- The nature of the relationship between the health care professional and client has changed from paternalistic to empowered.
109
What are the 4 "A's" for addressing moral distress?
Ask—is there unease or discomfort with a situation that may be causing moral distress?
Affirm—affirm distress and commit to self-care
Assess—assess the source and severity of
the moral distress (along with one’s readiness to act)
Act—work toward a positive sustainable change
110
What is principles?
A framework for considering ethical issues that includes the following guiding principles:
1. Respect for autonomy
2. Beneficence
3. Non-maleficence
4. Justice
111
What is the four ethical issues that arise from nursing practice?
1. Consent and autonomy
2. Resource allocation
3. End-of-life care
4. Truth telling
112
What is the Donner-Wheeler Career Planning and Development Model?
113
How does constitutional law affect nursing?
Report of the Commission on the Future of Health Care in Canada (2002), prepared by Roy Romanow, recommended that the Health Council of Canada should establish a national framework for measuring and assessing the quality and safety of Canada’s health care system.
114
What is constitutional law?
The Canadian Constitution (1982), including the Canadian Charter of Rights and Freedoms (1982), is the highest law in Canada.
- deals with rights and powers of provinces/territories and federal government.
115
What is a tort?
civil wrong committed by one person against another (injury or damage to person or property) and can be intentional or unintentional.
116
What is informed consent?
Client must receive all information pertaining to the treatment that a reasonable person in the same circumstances would need to make a decision about the treatment.
Consent must: relate to treatment, be informed, be voluntary, not be obtained through fraud
117
What is Ontario’s Health Care Consent Act (1996)?
Ontario law that has to do with the capacity to consent to treatment.
118
What is a living will?
written advance directive voluntarily signed by clients that specifies the type of care they desire if and when they are in a terminal state and cannot sign a consent form or convey this information verbally.
119
What is civil law?
body of rules and legal principles that govern relations, rights, and obligations among individuals, corporations, or other institutions.
120
What is civil law?
body of rules and legal principles that govern relations, rights, and obligations among individuals, corporations, or other institutions.
121
What is the Canada Health Act?
- federal statute.
- requires each province and territory to provide care that is publicly administered, universal, portable, accessible, and comprehensive (also prohibits user fees and extra billing by physicians).
122
What is the three necessary components os positive learning?
1. Knowledge about the subject gained by study
2. Skills that are taught or learned from experience
3. Attitude (possibly the hardest to change)
123
What is holistic care?
to provide support that looks at the whole person, not just their mental health needs
124
What are the different models to describe holistic care?
- Consists of physical, emotional, intellectual, and spiritual pieces
- Spirit is at the core of our individual being.
125
Why are spiritual assessments not completed?
All persons are spiritual in nature—not all persons are religious.
126
What is the tall to flat structure? Chapter 17
127
What are some Responses to Change?
—most common is resistance which can be affected
- level of trust
- ability to cope with change
- predictability and capability
-Other responses to change may include grief, denial, anger, depression & bargaining
128
What is the four parts of the PDSA cycle?
Plan, Do, Study, Act
129
What is the PDSA cycle?
an iterative, four-stage problem-solving model used for improving a process or carrying out change
130
What are the keys to successful change?
1. Clear articulation of the vision
2. Establish timelines & steps
3. Plant seeds to key individuals of what is expected
4. Select the change project team carefully
5. Consistent meeting times, have an agenda
6. Good communication with those not on team
7. Regular updates to executives
8. Deal with conflict promptly
9. Positive attitude
10. Reach consensus on big issues & stay tuned to politics
11. Know informal & formal leaders (build relationships)
12. Self confidence in self & team
131
What does incapacitated when it comes to safety?
member has a physical or mental condition, and the disorder affects the member’s ability to practice safely.
132
What is the three key components to incompetence?
1. it must relate to the nurse’s professional care of a patient;
2. the nurse must display a lack of knowledge, skill or judgment; and
3. the deficiencies must be of a nature or to an extent that demonstrates that the nurse is unfit to continue to practise, or that her or his practice should be restricted.
133
What is staffing in expenses?
staffing models outline the number of staff required (based on the procedures or clients) most cost effective combination of staff important to consider
134
What is qualitative research?
Ethnography, Phenomenology, Grounded theory, Narrative inquiry
135
What is quantitative research?
- Emphasizes experimentation & statistical analysis
- Focus is on measurable observations that can be reported as numbers
- Objective & value free
**example:**experimental, quasi-experimental. surveys, evaluation research
136
What is longitudinal studies in quantitative research?
follow research participants over time
137
What is descriptive studies in quantitative research?
describe the population, no treatment is done
138
What is methodological research in quantitative research?
aimed at developing tolls to be used in future research studies.
139
What is ADPIE?
Assessment, Data, Planning, Implementation, Evaluation
140
What Is the standards of practice?
- Are objective guidelines for nurses to implement and provide care
- Assure clients and families that they are receiving the best possible care
- Are developed by each professional organization in provinces and territories
- Are the responsibility of all Nurses to apply to their practice
141
What is consent?
Participants must know they are going to be part of a study & give consent. May withdraw at any time. Patient safety is always at the forefront.
142
What is Nuremberg code?
International code of conduct developed after WWII. A set of principles to govern research on human subjects.
143
What is sources of evidence in research?
- Scientific evidence in journals
- Non-research evidence, quality assurance, and risk management data
- Individual client data
144
What is personal change?
Voluntary change with the goal of self-improvement
145
What is professional change?
Deliberate change with the goal of improving professional ability/status
146
What is organizational change?
Mandated change with the goal of improving the organization’s efficiency
147
What is the five aspects of organizational change?
1. Culture
2. Structure
3. Technology
4. Physical setting
5. Human resources
148
What is the four traditional change theories?
1. Lewin’s force-field model
2. Lippitt’s phases of change
3. Havelock’s six-step change model
4. Rogers’s diffusion of innovations theory
149
What is the three parts of Lewin's force-field model in traditional change?
1. unfreezing
2. movement
3. refreezing
150
What is unfreezing in Lewin's force-field model in traditional change?
thawing of the current or old way of doing things (individuals realize need for change)
151
What is movement in Lewin's force-field model in traditional change?
intervention or change is introduced and explained (benefits and disadvantages are discussed); the move occurs
152
What is refreezing in Lewin's force-field model in traditional change?
new way of doing things is incorporated
153
What is the seven phases of change in Lippitt's phases of changes?
1. Diagnosis of problem
2. Assessment of motivation and capacity for change
3. Assessment of change agent’s motivation and resources
4. Selection of progressive change objectives
5. Choosing an appropriate role for the change agent
6. Maintenance of the change once it has been started
7. Termination of the helping relationship
** Communication and involvement of key personnel are pivotal to successful change.**
154
What is Havelock’s six-step change model?
**Emphasized the planning stage**: Believed resistance can be overcome with
good planning and inclusion of affected
**1. Planning**
--> Building a relationship
-->Diagnosing the problem
-->Acquiring resources
**2. Moving **
-->Choosing the solution
-->Gaining acceptance
**3.Refreezing**
-->Stabilization and self-renewal
155
What is Roger's diffusion of innovations theory?
Five-step innovation/decision-making process:
1. Awareness
2. Interest
3. Evaluation
4. Trial
5. Adoption
156
What in commonalities in traditional change theories?
- All the theories relate to the process of “unfreezing, moving, freezing.”
- Many of the theories describe linear processes that move in a step-by-step manner.
157
What is Specialized Knowledge and
Evidence-Based Practice in nursing?
Evidence-based nursing within practice setting is a valuable accepted standard for providing professional care to clients
158
What does the CNA say about Specialized Knowledge and
Evidence-Based Practice in nursing?
Optimize outcomes for clients and families, improve clinical practice, achieve cost-effective nursing care, and ensure transparency and accountability in decision-making
