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Flashcards in issues trends and health policy Deck (90):
1

Lack of eye contact is a sign of respect in which culture

Asian

2

Offering to call the clergy is not always the best answer because

not all people are religious

3

Name four fundamentals of therapeutic communication

listen more than you talk 

open ended questions "tell me..."

Don't use "why", "why did you ride with a drunk driver"

ask about feelings, label feelings "mad, sad, afraid, ashamed"

no euphamisms (no indirect or vague terms)

be direct (I'm sorry they died.)

 

4

Who do you call if a person in the hospital is a danger to himself or others?

hospital security (they are the police of the hospital)

5

Offering self means

Telling the patient "I am here to help you"

 

6

In a grief situation, using therapeutic communication it is important to:

acknowledge their feelings (Im sorry you are feeling sad)

offer self (I am here, is there something I can do for you)

7

The written statement regarding about the patient's intent regarding medical treatment, according to the patient self determination act any hospitalization has the right to execute one. 

advance directive

8

Specifies life prolonging measures that one does or doesn't want to have done should they be incapacitated/incompetent.  Often identifies proxy/durable power of attorney.

living will

9

What is the job of a proxy?

to articulate the wishes outlined in the advance directive

10

HIPPA title two protects what?

information, healthcare records, confidentiality

11

HIPPA title one protects what?

workers and health insurance for workers when they lose their job for up to 18 months (COBRA, consolidation omnibus reconciliation act)

12

What entities are required to follow HIPPA?

healthplans (insurance)

healcare providers

healthcare clearing houses (collect data for death rates, census)

13

Can you violate HIPPA without naming the patient?

yes

14

A patient has the right to see their chart, have correction made to their chart, file a complaint if their information is inappropriately being shared, determine who their information is shared with

HIPPA

15

What entities are not required to follow HIPPA?

life insurance

police

employers

schools

state agencies

16

The patient safety and quality imrovement act

established allowance of reporting of medical errors, its confidential, greater reporting and analysis should results in better patient care (quality improvement)

17

Duty to warn supercedes the right to confidentiality IF the patient is:

a threat to himself or others, endangers others

18

What are the two goals of healthy people 2020?

Increase the quality of years of healthy life

eliminate health disparities

19

Increase the quality of years of healthy life

eliminate health disparities

the goals of healthy people 2020

20

Criminal acts and danger with a weapon must be reported by the NP to who?

police

21

Are the police allowed to read medical records without a subpeona?

 no, but they can with a record

22

What 5 things have to be reported to the health department by the NP in most states?

Gonorrhea

Chlamydia

Syphilis

 

HIV

TB

23

Animal bites have to be reported to 

animal control

24

Suspected or actual child or elder abuse is legally required to be reported to 

social services, and then social services reports further to the police as needed

25

Are you legally required to report domestic violence?

no, because it is two adults in a consensual relationship

26

True partnership where all players have and desire power, they share common goals, and recognize separate areas of responsibility and activity 

collaborative practice per ANA

27

Who helps with domestic violence, elder abuse, help with resources for the uninsured?

social services

28

Anybody who is a danger to himself or others is referred to who?

psych

29

Who deals with joints, ROM, walking, strengthening, gross motor?

physical therapy

30

Who deals with fine motor, things to help pt's get back into a job?

occupational therapy

31

Requirements for hospice include:

have a death diagnosis

prognosis death within 6 months

only comfort measures

32

SNF

skilled nursing facility

basically a nursing home with a room for therapy (PT/OT)

33

What are evaluation and management codes (E &M codes) used for? 

identify the level of care that is provided

the codes match the level of service matching the complexity of the problem

the more codes generated the higher the reimbursement

34

How many levels of service are there in billing?

1-5

level one lowest

level 5 highest (most complex)

35

Who sets the standard of cost/reimbursement for reimbursement in this country?

Medicare

36

In the physical exam there are 4 options for levels of documentation of physical exam:

1. limited exam of the affected body area or organ system

2. expanded problem focus: limited exam of the affected body organ or system, and any other symptomatic or related body system (i.e. cellulitis + lower extremity assessment)

3. detailed:  extensive exam of the body system and organs and any other related 

4. comprehensive: general multisystem exam OR a complete exam of a single system and any other symptomatic or related ones (i.e. new complaint of SOB because you are working up multiple symptoms)

37

If they ask you what type of exam you would do on a new patient (limited, detailed, comprehensive) you would choose: 

comprehensive (because you don't know the patient)

38

Medicare part A covers what?

inpatient hospital services and post hospital associated care

We are all supposed to get this at age 65 if we worked enough 

Medicare part A does not require a premium

39

Medicare part B covers what?

outpatient labs, medical equipment, diagnostic procedures

outpatient visits

supplemental insurance (the patient has to pay a premium)

 

40

How much do NPs get reimbursed from medicare if they don't fulfill the "incident to" clause?

85% of the physician fee

41

Medicare part C, AKA medicare advantage.  You must have A+B to get C.  C allows you to ________ your HMO/PPO from a list.

Medicare part C allows you to Choose your HMO/PPO

Medicare part C does not require a premium

42

Medicare part D covers what?

D = Drugs

LIMITED prescriptive drug coverage

the patient has to pay a premium and a copay

 

43

Which two forms of medicare require the patient to pay a premium?

medicare part B and medicare part D require a premium

44

What can the NP bill for by ICD 9 and CPT code?

diagnosis 

therapy

consultation

care plan oversight

45

According to Barkley, what services do not meet physician services definitions?

Well patient screenings and regular physical exams under medicare

46

For an NP to qualify to be a medicare provider they must:

hold a state liscense

be certified by a national certifying body

hold at least a master's degree

no facility or other provider charges are paid (you can't double bill)

47

For procedures, medicare reimburses _______of the 85% of the physician fee when the NP bills under her number.

80%

48

Incident to billing means: 

Incident to a physicians service

the services are billed under the MD provider number even though the patient is seen by the NP

the service must be provided by an employee under direct supervision of the MD

the MD doesn't have to be in the same room, but must be in the same office at that time and immediately available

The MD must see the patient at some undefined interval

THERE IS NO INCIDENT TO BILLING IN THE HOSPITAL

49

Is incident to billing allowed in the hospital?

No, you must bill under your provider number for 85% reimbursement.

However, if the MD comes after you and charts "agreed" on your charting and signs, they can now bill 100%.

The MD is NOT cosigning your chart, but doing it for billing.

50

For inpatients can both the NP and MD bill medicare?

No, double billing is not allowed even if you see the patient and then later the MD sees the patient.

51

Who is medicaid for?

low income

federally administered, varies from state to state

52

This evaluates the care of patients based on established standards:

QA: quality assurance

53

Root cause analysis helps move beyond the culture of blame and move to a process of:

safety

54

To be credible the root cause analysis must include:

participation within the organization

include 5 whys (asking why 5 times, why did that happen)

drilling down

 

55

Sentinal events are:

events that cause death

serious psychological or physical injury or risk thereof

(i.e. loss of limb or function)

*not all sentinal events are the result of error

 

56

Sentinel events require what type of analysis? 

sentinel events require a root cause analysis

57

Who mandates your scope of practice?

The state board of nursing, the state nurse practice act 

it is based on the legal allowances in that state

*You cannot prescribe medications to patients on vacation in other states.  You do not have priviliges outside your state of licensure.

58

Prescriptive authority is determined by:

the state board of nursing, the state practice act

59

Credentials

your required education, license, certification to practice as an NP.

They establish minumum standard

60

What is the difference between licensure and certification?

Licensure is granted by a government body, implies minimum basic competency

 

Certification is granted by a non-governmental agency and implies mastery

61

Who said that NPs could admit to the hospital?

JCAHO

62

Credentialing/privileging

the privilege to work in the hospital

 granted by the hospital

63

What constitutes patient medical abandonment?

terminate a relationship without reasonable arrangements for follow up

1) Did you accept the assignment?

2) Did you provide reasonable notice for termination of care?

64

If you refuse an assignment for a double shift is that patient abandonment?

Not if you gave enough notice

65

Risk management is

a systematic effort to reduce the risk

begins with a formal written plan

articulates immunity from retaliation for those that report sensitive information

66

What is the most common method of documentation of risk management?

incident reports

67

Satisfaction surveys are a part of risk management because:

they help to identify problems before they happen

68

Interventions that are unlikely to procude any significant benefit is called 

medical futility

69

To give informed consent the patient must be competent which means they must be able to do what 4 things?

differentiate between good and bad

understand 

reason

communicate

70

Informed consent is assumed in what situations?

life threatening situations

71

What are the 7 major ethical principles?

veracity: truth

fidelity: faithful

justice: fairness

autonomy: independence

beneficence: doing good, an act that is done for the benefit of other 

non-maleficence: do no harm  

utilitarianism: greatest good for the greatest number (like military mass casualty mindset)

72

How long must you keep medical records?

5 years

73

Where did the first NP program began and in what area?

pediatrics, Colorado

74

What three things contributed to the development of the ACNP role?

1. managed care

2. decrease in hospital residency program hours

3. hospital restructuring

75

What are the four distinct roles of the NP?

clinician

consultant

educator

researcher

76

What type of research includes descriptive and ex post facto/correlational data?

Non-experimental

77

What type of research requires a randomized experiment/intervention AND a control and test group?

experimental research

78

What type of research includes manipulation of variables but lacks either a comparison group OR control group?

quasi-experimental

79

What type of research includes case studies, ethnography, observation, has no likert scale, may have a small sample but produces rich findings?

qualitative research

80

What are some problems with qualitative research?

1) researcher bias

2) the generalizability of the findings are questionable

 

81

In statistics, an interval with the specified probability of including the parameter being estimated, the tighter the more useful

confidence interval

82

the average amount of deviation from of values from the mean

standard deviation

(think of the bell curve)

83

The probability level of which the results of a statistical analysis are judged to indicate a statistically significant difference

level of significance

p-value

84

What is a t-test?

A test to evaluate a difference of means between two groups

85

What is the difference between reliability and validity?

Reliability: support that the results are the same over time or repeatedly, consistantly

 

Validity: the degree to which a variable measures what it is intended to measure

86

CLAS culturally and linguistically appropriate services

aim to eliminate racial and ethnic health disparities and improve the health of all Americans.

 

You are legally required to use an interpreter because the patient has a right to understand. 

87

Assault vs. battery

assualt (threat of bodily harm with apparent ability to follow through)

battery (actually hurting the person with contact)

 

88

Who is responsible to document the reason for restraints and that the circulation checks were documented?

the NP is responsible for both

Yes, you are responsible to ensure the nurse documented circulation checks or the NP could be liable

89

If we aid at the scene of the accident what statute protects us as long as we stay in our scope of practice?

Good Samaritan

90