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Fundamentals > Management of Care > Flashcards

Management of Care Flashcards

1
Q

who are the participants in health care systems

A
  1. consumers (px)
  2. licensed providers
  3. unlicensed providers (assistive personnel)
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2
Q

provide examples of licensed providers

A
  1. RN
  2. licensed practical/vocational nurses
  3. advanced practice nurses (APN)
  4. medical doctors
  5. pharmacists
  6. dentists, dietitians
  7. physical, respiratory, and occupational therapists
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3
Q

who are eligible for medicare

A

for px 65 yo+ + those who have permanent disabilities

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4
Q

medicare program consists of

A

Part A: insurance for hospital stays, home health, and hospice

Part B: insurance for outpx and provider services (voluntary and requires a monthly premium)

Part C: a medicare advantage or supplement plan
(covering parts A & B, sometimes D)

Part D: medication coverage for those eligible and requires monthly premium

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5
Q

who are eligible for medical

A

for px who have low income

individual states determine eligibility requirements

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6
Q

patient protection and affordable care act of 2010 aimed at

A

a federal statute aimed at:

  1. increasing access to healthcare for all individuals and instituting an individual mandate for health insurance
  2. decreasing healthcare costs
  3. providing opportunities for uninsured ppl to become insured at a affordable cost
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7
Q

state children’s health insurance program provide

A

coverage for uninsured children up to 19yo at low cost to parents

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8
Q

lvls of healthcare: preventive health care

A

focuses on educating & equipping px to reduce and control RF for disease
ex:
1. programs that promote immunization
2. stress management
3. occupational health, and seat belt use

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9
Q

lvls of healthcare: primary health care

A

emphasizes health promotion and includes prenatal and well-baby care, fam planning, nutrition counseling, and disease control
ex:
1. office/clinic visits
2. community health centers
3. scheduled school- or work-centered screenings (vision, hearing, obesity)

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10
Q

lvls of healthcare: secondary health care

A

includes the diagnosis and tx of acute illness/injury
ex:
1. care in hospital settings (inpx and ER)
2. diagnostic centers
3. urgent and emergent care centers

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11
Q

lvls of healthcare: tertiary health care

A 
acute care, involving the provision of specialized and highly technical care
ex:
1. intensive care
2. oncology centers
3. burn centers
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12
Q

lvls of healthcare: restorative health care

A 
intermediate follow-up care for restoring health and promoting self-care
ex:
1. home health care
2. rehab centers
3. SNIFFs
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13
Q

lvls of healthcare: continuing health care

A 
addresses long-term/chronic health care needs over a period of time
ex:
1. end-of-life care
2. palliative care
3. hospice
4. adult day care, assisted living
5. in-home respite care
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14
Q

quality and safety education for nurses (QSEN) components

A
  1. safety; minimize RF and maintain secure environment for px, self, and others
  2. px-centered care; providing caring, compassionate, and culturally sensitive px care that addresses px’s physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values. The px is included in the decision-making process
  3. evidence based practice; the use of current knowledge from research/other credible sources for clinical judgement and px care
  4. informatics; the use of info tech as a communication and info-gathering tool that supports clinical decision-making and scientifically-based nursing prac
  5. quality improvement; care-r/t and organizational processes that involve the development and implementation of a plan to improve health care services
  6. teamwork and collaboration; the delivery of px care w/ working with interprofressional members of health care team
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15
Q

the interprofessional team:

spiritual support staff

A

provides spiritual care (pastors, rabbis, priests)

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16
Q

the interprofessional team:

registered dietitian

A
  • assesses, plans, and educates px regarding nutrition needs.
  • makes special diets and supervises meal prep
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17
Q

the interprofessional team:

lab technichian

A

-obtains specimens of body fluids and performs diagnostic tests

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18
Q

the interprofessional team:

occupational therapists

A

assesses & plans for px to regain ADL skills, esp motor skills of the upper extremities

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19
Q

the interprofessional team:

pharmacist

A

provides, monitors, and evaluates px medication.

-supervises pharmacy technicians in states that allow practice

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20
Q

the interprofessional team:

physical therapist

A

assesses and plans for px to increase musculoskeletal function, esp of the lower extremities to maintain mobility

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21
Q

the interprofessional team:

provider

A

assesses, diagnoses, and tx diseases and injury

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22
Q

the interprofessional team:

radiologic technologist

A

positions px and performs xrays and other imaging procedures for providers to review for diagnosis

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23
Q

the interprofessional team:

respiratory therapists

A

evaluates resp status and provides resp tx including

  • o2 therapy
  • chest physiotherapy
  • inhalation therapy
  • mechanical ventilation
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24
Q

the interprofessional team:

social worker

A

works w/ px and their fam by coordinating inpx and community resources to meet psychosocial and envmtal needs that are needed for recovery and discharge

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25
Q

the interprofessional team:

speech-language pathologist

A

evaluates and makes recommendation regarding the impact of disorders or injuries on: speech, language, and swallowing.
-teaches techniques and exercises to improve function

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26
Q 
the nursing personnel: 
registered nurses (RN) roles and responsibilities
A
  1. work legally under state nurse practice acts
  2. perform assessments, make N diagnoses, goals, and interventions, and conduct on-going px eval
  3. develop interprofessional plans for px care
  4. share appropriate info among team members, initiate referrals for px assistance, provide health education, and identify community resources
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27
Q 
the nursing personnel: 
practical nurses (PN) roles and responsibilities
A
  1. work under RN supervision
  2. collab w/n the nursing process, assist w/ the px plan of care, consult w/ other team members, and recognize the need for referrals to assist w/ actual or potential probs
  3. possess technical knowledge and skills
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28
Q 
the nursing personnel: 
assistive personnel (AP) roles and responsibilities
A
  1. work under supervision of RN or PN
  2. eligible tasks include:
    - feeding px
    - preparing nutritional supplements
    - lifting, basic care (grooming, bathing, transferring, toileting, positoning)
    - measuring and recording vitals
    - ambulating px
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29
Q

what are the basic principles of ethics

A
  1. advocacy; support & defend px’s health, wellness, safety, wishes, and personal rights (privacy)
  2. responsibility; willing to respect obligations and follow thru w/ promises
  3. accountability; ability to answer for one’s own actions
  4. confidentiality; protection of privacy w/o diminishing access to high-quality px care
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30
Q

what are the ethical principles for px care

A
  1. autonomy; the right to make ones own personal decisions, even if it may not be the best decision
  2. beneficence; actions that promote goodness for others, w/o any self-interest
  3. fidelity; fulfilling promises
  4. justice; fairness in care delivery and use of resources
  5. nonmaleficence; a commitment to do no harm
  6. veracity; a commitment to tell the truth
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31
Q

what are ethical dilemmas

A

issues that involve more than 1 choice and stem from diff values and beliefs of decision makers

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32
Q

a problem is an ethical dilemma when:

A
  1. a review of scientific data is not enough to solve it
  2. it involves a conflict b/n 2 moral imperatives
  3. the answer has profound effect on the situation + px
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33
Q

when making an ethical deicsion:

A
  1. identify whether the issue is actually an ethical dilemma
  2. gather as must relevant info abt dilemma
  3. reflect on ur own values as they relate to the dilemma and state the ethical dilemma, including all surrounding issues and the ppl involved
  4. list and analyze all possible options for solving dilemma and review the implications for each option
  5. select the option that’s aligned w/ the ethical principle that applies to the situation, the profession’s values for px care, and justify selecting that one option in light of other relevant variables
  6. apply chosen decision to the dilemma, and eval outcomes
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34
Q

ethics committees

A

addresses unusual/complex ethical issues

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35
Q

moral distress

A

occurs when the N is placed in a difficult situation where the actions taken are diff from what the N feels is (ethically) correct

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36
Q

examples of federal regulations

A
  1. HIPAA
  2. ADA
  3. MHPA
  4. PSDA
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37
Q

examples of criminal and civil laws

A
  • relates to the relationship b/n individual and government

ex) a nurse who falsifies a record to cover up a serious mistake can be guilty of breaking criminal law

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38
Q

examples of state laws

A
  1. each state has their own nursing practice
  2. the boards of nursing have the power to adopt rules and regulations that further regulate nursing practice.
  3. boards of nursing have the power to revoke a nursing license
  4. boards of nursing also set standards for nursing programs
  5. all states have some type of good samaritan law that protects healthcare workers from liability when they intervene at the scene of emergency
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39
Q

types of torts:

examples of unintentitional torts

A
  1. negligence; a N fails to implement safety measures for a px at risk for falls
  2. malpractice (professional negligence); a N administers a large dose of meds due to a calculation error. The px has cardiac arrest and dies
40
Q

types of torts:

examples of quasi-intentional torts

A
  1. breach of confidentiality; a N releases a px’s medical diagnosis to a member of the press
  2. defamation of character; a N tells coworker that they believe the px has been unfaithful to partner
41
Q

types of torts:

examples of intentional torts

A
  1. assault; actions of one person that makes another person fearful and apprehensive
  2. battery; intentional and wrongful physical contact w/ a px that involves injury/offensive contact
  3. false imprisonment; a px confined/restrained against their will
42
Q

px’s rights

A
  1. informed consent
  2. refusal of tx
  3. advance directives
  4. confidentiality
  5. information security
43
Q

informed consent

A

a legal process by which a px or the px’s legal guardian has given written permission for a procedure/tx

  • consent is informed when a provider explains and the px understands:
    1. the reason the px needs the tx/procedure
    2. how the tx/procedure will benefit the px
    3. the risks of tx/procedure
    4. other options to tx the problem, including not tx at all
44
Q

the N role in informed consent

A

witness the px’s signature on the informed consent form and to ensure that the provider has obtained the informed consent responsibly

45
Q

provider responsibilities for informed consent

A

give px -
1. purpose of the procedure

  1. a complete description of the procedure
  2. a description of the professionals who will performs and participate on the procedure
  3. a description of the potential harm, pain, or discomfort that may occur during/post procedure
  4. options for other tx
  5. the option to refuse procedure and the consequences of doing so
46
Q

Nurse responsibilities for informed consent

A

witnesses informed consent by

  1. ensuring that the provider gave the px the needed info
  2. ensuring that the px understood the info and is competent to give informed consent
  3. px signing the informed consent document
  4. notifying the provider if the px has more questions or appears not to understand any info. The provider is then responsible for giving clarification
  5. documenting questions that the px has, notification of the provider, reinforcement of teaching, and using an interpreter if needed
47
Q

examples of ethical guidelines

A
  1. American nurses association’s code of ethics for nurses w/ interpretive statements (2015)
  2. international council of nurses the ICN code of ethics for nurses (2012)
48
Q

negligence issues that cause most malpractice suits include

A
  1. failure to follow professional and facility-established standards of care
  2. failure to use equipment in a responsible and knowledgeable manner
  3. communicate effectively and thoroughly w/ px & complete prescribed tx
  4. document care the N provided and notify the provider of any changes in the px condition
49
Q

informed consent guidelines

A
  1. px gives IMPLIED consent which is acceptable as an informed consent when px adheres to instructions the N provides
    ex) the N is preparing to perform a TB skin test, and the px holds out their arm for the N
  2. for an invasive procedure/surgery:
    - the px must give WRITTEN consent
  3. state laws prescribe who is able to give informed consent.
    - these laws vary in age limits and emergencies
    - N are responsible for knowing the laws in the state they practice
  4. a competent adult must sign the form for informed consent
    - if px is unable to communicate d/t language barrier, a trained medical interpreter is used
  5. emancipated minors can consent for themselves
50
Q

refusal of tx guidelines

A
  1. compotent adult px have the right to refuse tx, including the right to leave facility w/o a discharge prescription from provider
  2. if px refuses tx:
    - the px signs a document indicating that they understand the risk involved w/ refusing tx
    - N notifies the provider and discusses w/ the px the risks to expect when leaving the hospital before discharge
    - the N asks the px to sign an AGAINST MEDICAL ADVICE form and documents for refusing tx
51
Q

standards of care (practice) guidelines

A
  1. standards of care define and direct the lvl of care N should give, and they implicate N who did not follow these standards in malpractice lawsuits
  2. N should refuse to practice beyond the “legal scope” of practice/outside their areas of competence regardless of reason (staffing shortage, lack of appropriate personnel)
  3. N should use the formal chain of command to verbalize concerns r/t assignment in terms of current legal scope of practice, job description, and area of competence
52
Q

what is a advance directives

A

the purpose of a advance directives is to communicate a px’s wishes regarding end-of-life care should the px become unable to do

53
Q

advance directives guidelines

A
  1. the PSDA requires asking all px UPON ADMISSION to a healthcare facility whether they have advance directives
  2. staff should give px who do not have adv. directives written info abt their rights r/t healthcare decisions and how to formulate adv. directives
  3. a health care rep should be available to help w/ this process
54
Q

types of advance directives:

living will

A

a legal document that expresses the px’s wishes regarding medical tx in the event that the px becomes dead and is facing end-of-life issues

55
Q

types of advance directives:

durable power of attorney for health care

A

a document in which pc designate a healthcare proxy to make healthcare decisions for them if px is unable to do so themselves
-the proxy can be any competent adult the px chooses

56
Q

types of advance directives:

provider’s orders

A

unless a provider writes “DNR” or “allow natural death” (AND) prescription in px’s medical record, the N initiates CPR when the px has no pulse or RR.
-the provider consults the px and the fam prior to admin a DNR or AND

57
Q

N role in advance directives

A
  1. provide written info above adv. directives
  2. document the px’s adv. directive status
  3. ensure that the adv. directives reflect the px’s current decisions
  4. inform all members of the healthcare team of the px’s adv. directives
58
Q

elements of documentation

A
  1. factual:
    - document subjective (direct quotes w/n quote marks, summarize and identify the info as the px’s statements) & objective data (what the N sees, feels, and smells)
  2. accurate and concise:
    document facts and info precisely w/o any interpretations of situation
    -avoid unnecessary/irrelevant words
    -exact measurements ensures accuracy
    -only abbreviations and symbols approved by the joint commission and the facility is ok
  3. complete and current:
    - document info that’s comprehensive & timely
    - never pre-chart before assessment, intervention, or eval
  4. organized:
    - communicate info in a logical sequence
59
Q

documentation legal guidelines

A
  1. begin each entry w/ the date and time
  2. record entries legibly, in non-erasable black ink, and do not leave blanks in the N’s notes
  3. do not use correction fluid, erase, scratch out, or blacken out errors
  4. sign all documents, w/ name and title
  5. documentation should reflect assessments, interventions, and evaluations (NOT personal opinions/criticism about px or healthcare professional’s care)
60
Q

documentation formats:

flow charts

A

shows trends in vitals, serum glucose lvls, pain lvls, and other FREQUENT assessments

61
Q

documentation formats:

narrative documentation

A

records info as a sequence of events in a story-like manner

62
Q

documentation formats:

charting by exception

A

uses standardized forms that identify norms and allows SELECTIVE documentation of abnormal norms

63
Q

documentation formats:

problem-oriented medical records

A

organized by problem/diagnosis and consist of a database, prob list, care plan, & progress notes
ex) SOAP, PIE, & DAR

64
Q

documentation formats:

electrical health records ADVANTAGES & CHALLENGES

A 
ADVANTAGES 
1. standardization, easy access for multiple users
2. accuracy
3. confidentiality
4. provide ease in maintaining ongoing health record of px's condition and rapid acquisition and transfer of px's info
CHALLENGES
1. learning the system
2. knowing how to correct errors
3. maintaining security
65
Q

reporting formats:

change of shift report define

A

N give this report at the end of each shift to the N taking responsibility over ur pxs

66
Q

change of shift report formats include

A
  1. face-to-face
  2. audiotaping
  3. presentation during walking rounds in each px’s room
67
Q

an EFFECTIVE change of shift report should include

A
  1. significant (objective) info abt the px’s health probs
  2. proceed in logical sequence
  3. include no gossip/personal opinions
  4. relate recent changes in meds, tx, procedures, and discharge plan
68
Q

reporting formats:

telephone reports define

A

used for when contacting the provider or other members of the interprofessional team

69
Q

an EFFECTIVE telephone report should include

A
  1. having all the data prepared before contacting any interprofessional team
  2. use a professional demeanor while using exact, relevant, and accurate info
  3. document the name of the person who made the call and to whom the info was given
    - document the time, content of message, and the instructions/info received during report
70
Q

reporting formats:

an EFFECTIVE telephone/verbal prescriptions should include

A

(best to avoid phone/verbal prescriptions, only use for emergencies and at unusual times)

  1. have a 2nd N listen to telephone prescription
  2. rpt it back, making sure to include the meds name, dose, time, and route
  3. question any prescription that seems inappropriate for px
  4. make sure the providers signs the prescription in person w/n the time frame the facility specifies, usually 24hr
71
Q

reporting formats:

transfer (hand-off) reports includes

A
  1. demographic info, adv directives, and resuscitation status, discharge plan (teaching), and fam involvement in care and healthcare proxy
  2. medical diagnosis, an overview of health status (physical, psychosocial), plan of care, recent progress
  3. any alt. that may become an urgent/emergent situation, directives for any assessments, or px care that’s essential w/n the next few hrs
  4. most recent vitals, meds and last doses, allergies, diet, activity, specific equipment/adaptive devices (o2, suction, wheelchair)
72
Q 
reporting formats:
incident reports (unusual occurence) includes
A
  1. documentation of facts w/o judgement/opinion
  2. do not refer to an incident report in a px’s medical record
  3. incident reports contribute to changes that help improve healthcare quality

ex of incidents)
-med errors, falls, omission of prescription, and needlesticks

73
Q

what ensures information security

A

mandatory adherence w/ the health insurance portability and accountability act of 1996 (HIPAA) began in 2003 to help ensure the confidentiality of health info

74
Q

what is the privacy rule

A

a rule that requires N to protect all written and verbal communications abt px.

75
Q

what are the components of the privacy rule

A
  1. only healthcare team members directly responsible for px care can access the px’s record
    - N cannot share info w/ other staff not caring for px
  2. px have a right to read/obtain copy of their medical record
  3. N cannot photocopy any part of the medical record except for authorized exchange of documents b/n facilities and providers
  4. staff must keep medical records in a secure area to prevent inappropriate info access
    - cannot use public display boards to list px names and diagnoses
  5. electronic records are password-protected, the public cant see them
    - staff must use only their OWN passwords to access info
  6. N must not disclose px’s info to unauthorized ppl/fam members who request it in person/by mail/by telephone
    - many hospitals use a code system to identify those who can get info abt px
    - N should ask any ppl asking abt a px’s status for the code and disclose info only when the ppl can give the code
76
Q

SOAP mnemonic meaning

A

S (ubjective data)
O (bjective data)
A (ssessment)
P (lan)

77
Q

PIE mnemonic meaning

A

P (problem)
I (intervention)
E (evaluation)

78
Q

DAR mnemonic meaning

A

for focus charting:

D (data)
A (action)
R (response)

79
Q

define delegation

A

the process of transferring a task to another member of the health care team while still having accountability for the outcome

80
Q

define supervision

A

process of directing, monitoring, and evaluating the performance of tasks done by another team member.

-N are responsible for supervising the performance of px care tasks they delegate to others

81
Q

define licensed personnel/nursing assistive personnel (NAP)

A

Ns who have completed a course of study in nursing and passed wither a PN/RN exam

82
Q

define unlicensed personnel/assistive personnel (AP)

A

individuals who had training to function in an assistive role to licensed nurses in giving px care
ex)
1. certified nursing assistants (CNAs)
2. certified medication assistants (CMAs)
3. non-nursing personnel (dialysis technicians, monitor technicians, phlebotomists)

83
Q

examples of tasks N may delegate to PNs

A
  1. monitoring findings (as input to the RNs ongoing assessment)
  2. reinforcing px teaching from a standard care plan
  3. performing tracheostomy care, suctioning, checking NG tube patency, admin enteral feedings
  4. inserting urinary catheter, administering meds (excluding IV in some states)
84
Q

examples of tasks N may delegate to APS

A
  1. ADLs
    (bathing, grooming, toileting, feeding of px that have no swallowing precautions, ambulating, dressing, position)
  2. routine tasks
    (bed making, specimen collection, intake and output, vitals of stable px)
85
Q

before delegating px care, N should consider what

A
  1. predictability of the outcome
    - will the completion of the task have a predictable outcome?
    - is it a routine tx? is it a new tx for px?
  2. potential for harm
    - change that something negative could happen to px (aspiration, bleeding)?
    - is the px unstable?
  3. COMPLEXITY of care
    - does the px care require complex tasks?
    - does the states practice act/facility policy allow the delegate to perform this task, and does the delegate have the needed skills to complete task?
  4. need for prob solving and innovation
    - is judgement needed while performing task/?
    - does it require nursing assessment or data-collection skills?
  5. lvl of interaction w/ the px
    - does the delegate need psychosocial support/education during the task?
86
Q

what are the guidelines for delegation and supervision

A

use the 5 rights of delegation + professional judgement and critical thinking to decide:

  1. tasks to delegate (right task)
  2. under what circumstances (right circumstances, setting and resources)
  3. to whom (right person)
  4. what info to communicate (right direction and communication)
  5. how to oversee and appraise (right supervision and evaluation)
87
Q

5 Rights of Delegation and Supervision:

RIGHT TASKS

A
  1. identify which tasks are appropriate to delegate for each specific px
  2. a RIGHT task is repetitive, needs little supervision, and is non-invasive for the px
  3. delegate tasks in regards to diff lvls of team members (RN, PN, AP)

Right task: delegate an AP to assist a px who has pneumonia to use a bedpan

Wrong task: delegate an AP to administer a nebulizer tx for a px who has pneumonia

88
Q

5 Rights of Delegation and Supervision:

RIGHT CIRCUMSTANCES

A
  1. determine the health status and complexity of care the px needs
  2. match the complexity of care demands to the skill lvl of delegate & consider the workload for delegate

Right Circumstance: delegate AP to measure the vitals of a px who is postop and stable

Wrong Circumstance: delegate AP to measure vitals of px who is postop and needs naloxone to reverse respiratory depression

89
Q

5 Rights of Delegation and Supervision:

RIGHT PERSON

A
  1. determine and verify the competence (have the required training to perform task) of delegate
  2. the task must be w/n the delegate’s scope of practice/job description
  3. continually review the performance of the delegate and determine care competence
  4. evaluate delegate’s performance according to standards, and take steps to remediate any failures to meet standards

Right Person: delegate a PN to administer enteral feedings to a px who has head injury

Wrong Person: delegate a AP to administer enteral feedings to a px who has head injury

90
Q

5 Rights of Delegation and Supervision:

RIGHT DIRECTION AND COMMUNICATION (in writing, orally, or both)

A
  1. communicate what data to collect and provide a method and timeline for reporting (including when to report concerns and assessment findings)
  2. communicate specific tasks to perform and px-SPECIFIC instructions
  3. detail expected results, timelines, and expectations for followup communication

Right Direction&Communication: delegate an AP to assist MR Martin in room 312 w/ a shower before 0900

Wrong Direction&Communication: delegate an AP to assist MR martin in em 312 w/ morning hygiene

91
Q

5 Rights of Delegation and Supervision:

RIGHT SUPERVISION AND EVALUATION

A
  1. provide supervision (directly/indirectly) and monitor performance
  2. intervene if needed (for unsafe clinical practice) and provide feedback
    - did delegate complete task on time?
    - was the performance satisfactory?
    - did the delegate document and report unexpected findings?
  3. evaluate the px and determine the px’s outcome status
  4. evaluate task performance and identify the needs for perfomance-improvement activities and additional resources

Right Supervision & Evaluation: delegate an AP to assist w/ ambulating a px after RN completes the admission assessment

Wrong Supervision & Evaluation: delegate an AP to assist w/ ambulating before the RN performing an admission assessment

92
Q

what is the nursing process framework & what are its advantages

A

nursing process:
-Assessment/data, Analysis/data collection, Planning, Implementation, Evaluation

-use of the nursing process results in a comprehensive, individualized, px-centered plan of N care that Ns can deliver in a timely and reasonable manner

93
Q

assessment/data collection involves

A

the systematic collection of info about px’s PRESENT health statuses to identify needs and additional data to collect based on findings
-N can collect data during an initial assessment (baseline data), focused assessment, and ongoing assessments

94
Q

methods of data collection during nursing process includes

A
  1. observation
  2. interviews w/ px and fam
  3. medical history, comprehensive/focused PE, diagnostic and lab reports, and collab w/ other interprofessional team members
95
Q

to collect data effectively during nursing process

A
  1. ask px appropriate question and listen carefully to responses and have excelllent H-to-T assessment skills
  2. practice clinical judgement and critical thinking to accurately recognize when to collect assessment data
    + recognize the need to collect assessment data BEFORE interventions
96
Q

N collect subjective data (s/s) during

A

during a nursing history (part of nursing process)
they include:
-px feelings, perceptions, and descriptions of health status
-px are the only ones who can describe and verify their own s/s

Fundamentals (2 decks)

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