Lack of eye contact is a sign of respect in which culture
Offering to call the clergy is not always the best answer because
not all people are religious
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.)
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)
Offering self means
Telling the patient "I am here to help you"
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)
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.
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.
What is the job of a proxy?
to articulate the wishes outlined in the advance directive
HIPPA title two protects what?
information, healthcare records, confidentiality
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)
What entities are required to follow HIPPA?
healthcare clearing houses (collect data for death rates, census)
Can you violate HIPPA without naming the patient?
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
What entities are not required to follow HIPPA?
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)
Duty to warn supercedes the right to confidentiality IF the patient is:
a threat to himself or others, endangers others
What are the two goals of healthy people 2020?
Increase the quality of years of healthy life
eliminate health disparities
Increase the quality of years of healthy life
eliminate health disparities
the goals of healthy people 2020
Criminal acts and danger with a weapon must be reported by the NP to who?
Are the police allowed to read medical records without a subpeona?
no, but they can with a record
What 5 things have to be reported to the health department by the NP in most states?
Animal bites have to be reported to
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
Are you legally required to report domestic violence?
no, because it is two adults in a consensual relationship
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
Who helps with domestic violence, elder abuse, help with resources for the uninsured?
Anybody who is a danger to himself or others is referred to who?
Who deals with joints, ROM, walking, strengthening, gross motor?
Who deals with fine motor, things to help pt's get back into a job?
Requirements for hospice include:
have a death diagnosis
prognosis death within 6 months
only comfort measures
skilled nursing facility
basically a nursing home with a room for therapy (PT/OT)
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
How many levels of service are there in billing?
level one lowest
level 5 highest (most complex)
Who sets the standard of cost/reimbursement for reimbursement in this country?
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)
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)
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
Medicare part B covers what?
outpatient labs, medical equipment, diagnostic procedures
supplemental insurance (the patient has to pay a premium)
How much do NPs get reimbursed from medicare if they don't fulfill the "incident to" clause?
85% of the physician fee
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
Medicare part D covers what?
D = Drugs
LIMITED prescriptive drug coverage
the patient has to pay a premium and a copay
Which two forms of medicare require the patient to pay a premium?
medicare part B and medicare part D require a premium
What can the NP bill for by ICD 9 and CPT code?
care plan oversight
According to Barkley, what services do not meet physician services definitions?
Well patient screenings and regular physical exams under medicare
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)
For procedures, medicare reimburses _______of the 85% of the physician fee when the NP bills under her number.
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
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.
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.
Who is medicaid for?
federally administered, varies from state to state
This evaluates the care of patients based on established standards:
QA: quality assurance
Root cause analysis helps move beyond the culture of blame and move to a process of:
To be credible the root cause analysis must include:
participation within the organization
include 5 whys (asking why 5 times, why did that happen)
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
Sentinel events require what type of analysis?
sentinel events require a root cause analysis
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.
Prescriptive authority is determined by:
the state board of nursing, the state practice act
your required education, license, certification to practice as an NP.
They establish minumum standard
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
Who said that NPs could admit to the hospital?
the privilege to work in the hospital
granted by the hospital
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?
If you refuse an assignment for a double shift is that patient abandonment?
Not if you gave enough notice
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
What is the most common method of documentation of risk management?
Satisfaction surveys are a part of risk management because:
they help to identify problems before they happen
Interventions that are unlikely to procude any significant benefit is called
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
Informed consent is assumed in what situations?
life threatening situations
What are the 7 major ethical principles?
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)
How long must you keep medical records?
Where did the first NP program began and in what area?
What three things contributed to the development of the ACNP role?
1. managed care
2. decrease in hospital residency program hours
3. hospital restructuring
What are the four distinct roles of the NP?
What type of research includes descriptive and ex post facto/correlational data?
What type of research requires a randomized experiment/intervention AND a control and test group?
What type of research includes manipulation of variables but lacks either a comparison group OR control group?
What type of research includes case studies, ethnography, observation, has no likert scale, may have a small sample but produces rich findings?
What are some problems with qualitative research?
1) researcher bias
2) the generalizability of the findings are questionable
In statistics, an interval with the specified probability of including the parameter being estimated, the tighter the more useful
the average amount of deviation from of values from the mean
(think of the bell curve)
The probability level of which the results of a statistical analysis are judged to indicate a statistically significant difference
level of significance
What is a t-test?
A test to evaluate a difference of means between two groups
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
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.
Assault vs. battery
assualt (threat of bodily harm with apparent ability to follow through)
battery (actually hurting the person with contact)
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
If we aid at the scene of the accident what statute protects us as long as we stay in our scope of practice?