Continuity of Care

d) Community health nursing Explanation: Examining birth rates and death rates of a community is the focus of community health nursing. Community health nursing focuses on clients and populations of the community.

A community health nursing student is assessing the birth rates and death rates of his local municipality and comparing these rates to the nation and the world. This is an example of what type of nursing? a) Statistical nursing b) Community-based nursing c) Epidemiologic nursing d) Community health nursing

b) Clearly defining the purpose and expectations of the admission Explanation: During the admission to the healthcare system, clients should understand the purpose and expectations of admission.

A nurse is covering all aspects of admission procedures for a client who is receiving home health services. The nurse explains what procedures will be covered during his visits. Which of the following aspects of the admission process does this represent? a) Establishing rapport and showing willingness to listen b) Clearly defining the purpose and expectations of the admission c) Documenting the procedure d) Assisting in participation of the care-related decisions

d) Explain how the patient's health information will be protected and obtain his signature acknowledging this teaching. Explanation: HIPAA requires that all patients entering a healthcare setting of any type must sign a statement that they understand the protection of their medical information. The informed consent process is not within the scope of HIPAA and the care team is not obliged to explain the specific measures taken to foster accountability for practice. Variations in health insurance coverage are known to have tangible effects on the care that patients receive.

A patient has been admitted to the hospital the morning of his scheduled transurethral prostatic resection (TUPR). The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the care team to do which of the following upon the patient's admission? a) Explain the potential risks and benefits of the patient's scheduled surgery and have him sign a document acknowledging these. b) Explain to the patient that his choice of health insurance provider and level of coverage will not impact the care he receives. c) Teach the patient what measures are taken to ensure that all members of the care team are accountable for the care they provide. d) Explain how the patient's health information will be protected and obtain his signature acknowledging this teaching.

b) Encourage active participation of the client and family in health care decisions. Explanation: In a community-based health care setting, the nurse should involve the client and the family in all health care decisions for the client. The nature of the relationship is that of partnership based on respect, appreciation, and cooperation. The nurse's concern is for the health of the whole person, not just physiologic needs, but also psychosocial and spiritual needs in relation to the person's environment. The nurse should understand that health does not mean merely the absence of disease. It involves broader, quality-of-life issues. The nurse should acknowledge that health issues are not independent of social issues. Treatment effectiveness, rather than technology imperatives, drives decisions in such a setting.

A registered nurse is providing community-based health care for a client and family. Which of the following would be most important for the nurse to do? a) Acknowledge that the client's health issues are independent of social issues. b) Encourage active participation of the client and family in health care decisions. c) Ensure that the client is categorized as healthy if no disease is detected. d) Determine outcomes that are based primarily on technologic imperatives.

Kardex

A system used to provide patient information in a brief format

c) Demonstrate and explain the procedure and then have the daughter perform it. Explanation: All steps of a procedure such as a dressing change should be demonstrated, practiced, and provided in writing. The patient or caregiver should then perform the procedure or treatment in the presence of the nurse to demonstrate his or her understanding and ability to carry out the procedure. This is more likely to facilitate success than providing a passive multimedia resource, explaining, or providing written instructions alone without reciprocal demonstration.

In anticipation of discharge, a nurse is teaching the daughter of an elderly patient how to change the dressing on her mother's venous ulcer. Which of the following teaching strategies is most likely to be effective? a) Use a multimedia strategy that combines animation with narration. b) Provide explicit written and verbal instructions and ask the daughter to explain back to the nurse how she would perform the dressing change. c) Demonstrate and explain the procedure and then have the daughter perform it. d) Explain the procedure clearly and slowly while providing multiple opportunities for the daughter to ask questions.

d) Ensuring that room preparation responsibilities that may have been delegated to ancillary staff have been completed Explanation: Although the nurse might delegate most of the activities in preparing the room for admission, it is the nurse's responsibility to ensure that the other personnel complete the preparation. It is not necessary for all care staff to be present when the patient arrives and, in fact, it might be quite overwhelming to the patient to have them all present. The nurse will greet the patient and family members upon their arrival to the unit. An admission assessment is the responsibility of the nurse, not a nursing assistant, who is not educated to perform this skill.

In preparing for a patient's admission to the unit, what is the nurse's responsibility? a) Greeting the patient in the emergency room or admitting office b) Delegating the admission assessment to a nursing assistant c) Ensuring that all staff caring for the patient are in the patient's room when he/she arrives onto the unit d) Ensuring that room preparation responsibilities that may have been delegated to ancillary staff have been completed

d) All of the above are covered Explanation: Individual health information that would identify a person and is protected by the HIPAA privacy rule includes name, age, address, gender; past, present, or future payments; the healthcare that was provided; and the past, present, or future physical or mental health condition(s).

Individual health information that would identify a person and is protected by the HIPAA privacy rule includes all but one of the following. Which of the following is not covered under HIPAA? a) Name, age, address, gender b) Past, present, or future payments c) Healthcare that was provided d) All of the above are covered

a) The nurse collaborating with other members of the health care team Explanation: Continuity of care is a process by which health care providers give appropriate, uninterrupted care and facilitate a client's transition between different settings and levels of care. To do this, the nurse must, along with other responsibilities, collaborate with other members of the health care team in meeting all the needs of each client. The other answers are incorrect because they are not examples of the idea of the continuity of care.

Nursing continues to recognize and participate in providing appropriate, uninterrupted care and facilitate clients' transitions between different settings and levels of care. What would be an example of this continuity of care? a) The nurse collaborating with other members of the health care team b) The nurse taking detailed notes on how each client wants to continue care c) The nurse attending an appointment with the client in some place other than where the nurse works d) The nurse accompanying the physician on rounds

a) provides healthcare for the community. Explanation: Public health nursing focuses on the population and the health of the community.

Public health nursing is the branch of nursing that: a) provides healthcare for the community. b) administers care for a defined geographic community. c) assesses individuals for community care. d) provides primary care to individuals.

c) every patient should be assessed thoroughly by a registered nurse upon admission. Explanation: The Joint Commission has established standards for hospital admission stating that each patient must be assessed by an RN upon admission. This initial assessment cannot safely be delegated. Patients are frequently required to share rooms, even when their acuity is high, and a physician does not necessarily perform a physical assessment after each patient's admission.

The Joint Commission has established standards for admission to a hospital dictating that: a) high-acuity patients must be admitted to a single-bed room. b) the admission process may be safely delegated to unlicensed care providers. c) every patient should be assessed thoroughly by a registered nurse upon admission. d) a physician must perform a physical assessment of a patient within 3 hours of admission.

d) The use of a wristband for identification of the patient. Explanation: The Joint Commission accredits health care organizations and has required that to maintain client safety the wristband with the identification number/bar-code, client's name, physician's name, and other important identifying information be worn by the client. It does not require clients to sign advanced directives, and does not regulate nursing practice regarding medications and standard precautions.

The Joint Commission is one agency that accredits health care institutions. The nurse understands that the Joint Commission has mandated the use of which national safety practice to protect clients admitted to a health care facility? a) Upon admission all clients sign advanced directives. b) Nurses use the Rights checklist prior to administering medications. c) The use of standard precautions in the operating room. d) The use of a wristband for identification of the patient.

a) Client focused Explanation: Community-based nursing practice, admission and discharge from a health care setting, transfer from one setting to another, and readiness for home health care all have to do with the continuity of care and are client-focused. In other words, they focus on a client's needs and the nurse's role in providing that continuity. The other answers are incorrect.

The models of nursing care delivery have been many and varied throughout the history of nursing. Which of the following best describes the idea of the continuity of care? a) Client focused b) Functional nursing c) Money focused d) Primary nursing

b) Identifying the immediate needs of the client. Explanation: Among the nurse's important functions in health care delivery is identifying the client's immediate needs and working in concert with the client to address them. The other nursing functions are important but they are not the most important function.

The nurse is admitting a patient to an ambulatory care facility. What is the most important nursing function at this time? a) Obtaining a baseline set of vital signs. b) Identifying the immediate needs of the client. c) Allowing the family to be with the client. d) Checking the admitting physician's orders.

a) the client assists in developing the goals. Explanation: If the client is involved in establishing the goals, it is more likely that the expected outcomes of the discharge plan will be met. The client may fail to follow the plan if the goals are not mutually agreed on, or are not based on a complete assessment of the client's needs.

The nurse recognizes that the goals established for a client's discharge are more likely to be accomplished when ... a) the client assists in developing the goals. b) the physician develops the goals. c) the multidisciplinary team develops the goals. d) the nurse develops the goals.

c) to provide continuity of care that is goal directed. Explanation: The purpose of discharge planning is to provide for continuity of care, so that the needs of patient and family are consistently met as the patient goes from hospital to home. The others may be additional goals.

The nurse understands that planning for discharge actually begins at admission to the facility. The purpose of discharge planning is best described as: a) to ensure patient safety and health maintenance. b) to decrease stress for patient and family members. c) to provide continuity of care that is goal directed. d) to promote less dependence on others.

d) The physician must write an order for all services, and the patient must meet eligibility criteria. Explanation: For home healthcare visits to be reimbursed, the physician must write an order for all services and the patient must meet eligibility criteria.

What criterion must be met for home care visits to be reimbursed? a) The patient's home must have adequate room for storage of supplies and work space for the healthcare personnel. b) The patient's family must be present for each home care visit and offer to assist. c) The nurse must visit the patient daily and complete daily documentation of the visit. d) The physician must write an order for all services, and the patient must meet eligibility criteria.

a) Provide a verbal report to the nurse at the long-term care facility on the client, the hospital care, and the client's current condition. Explanation: The nurse at the hospital will provide a verbal report to the nurse at the long-term facility. The client's belongings will accompany the client to the long-term facility, and the nurse should assure that this occurs. The original chart will not accompany the client, but copies of the chart or sections of the chart may be sent based upon agency protocols. The nurse should also recognize and inform the client that while a transfer may be a welcome event, it also can be stressful.

What role will the nurse play in transferring a client to a long-term care facility? a) Provide a verbal report to the nurse at the long-term care facility on the client, the hospital care, and the client's current condition. b) Arrange for the client's belongings to remain at the hospital until discharge from the long-term care facility. c) Assure that the client's original chart accompanies the client. d) Inform the client that transferring should be a stress-free situation.

a) that the patient has made his wishes for terminal care known. Explanation: It is important to determine if the patient has advanced directives, which indicate what he wants should he become incompetent or dying. Advanced directives may be documented in a living will or durable power of attorney for healthcare document. A copy should be placed in the patient's hospital record.

When a patient is admitted to the hospital, admissions personnel are required to determine if the patient has a document indicating advanced directives. If so, a copy is made for the patient's medical record. The advanced directive document indicates: a) that the patient has made his wishes for terminal care known. b) that the patient assigned a relative to act on their behalf. c) that he refuses to have resuscitation measures or any life-prolonging care. d) that an attorney has verified the living will papers.

d) sign the form releasing the facility and doctor from legal responsibility. Explanation: The patient is free to leave the hospital, but should be informed of the risks of leaving against medical advice (AMA) and is required to sign a form releasing the hospital and physician of responsibility.

You are assigned to care for a middle-aged patient who is very agitated and wants to go home. He states that he doesn't have time to waste in the hospital, and no one is doing anything anyway. You try to engage him in conversation and to listen to him. It soon becomes clear that you need to contact the nurse manager. The patient cannot be held in the hospital against his will. However, if he leaves the hospital against medical advice (AMA), he must: a) obtain a copy of his diagnosis and care plan in case he becomes ill again. b) sign the hospital discharge form. c) sign a form that he is responsible for himself and understands his health risk. d) sign the form releasing the facility and doctor from legal responsibility.

chart

computerized or paper medical record containing information such as medical orders, assessments, and care; nursing documentation of plan of care, assessments, and in narrative notes

continuity of care

coordination of services provided to patients before they enter a healthcare setting, during the time they are in the setting, and after they leave the setting

HIPAA privacy rule

federal law enacted to ensure that health information is protected while allowing the flow of health information needed to provide and promote high-quality healthcare and to protect the public's health and well-being

community-based care

healthcare that is provided to people who live within a defined geographic region or who have common needs; designed to meet the needs of people as they move between and among healthcare settings

discharge planning

systematic process of preparing the patient to leave the healthcare facility and for maintaining continuity of care