Health Policy
copays
An abbreviation of copayment, a copay is a fixed amount a consumer pays for health care typically at the time services are received.
Health in All Policies
An approach to public policy making that systematically accounts for the health implications of all decisions. For example, laws imposing restrictions on automobile emissions aimed at protecting the environment also affect health (e.g., clients with chronic obstructive pulmonary disease [COPD], asthma, or other chronic respiratory illnesses).
Sort the following safeguards used to protect Mr. Alvarez's and other clients' electronic health information into their correct category. (Match each description with the applicable category.)
Administrative safeguards: The facility provides annual HIPAA training to all employees. Physical safeguards: Electronic health information data are backed up on a routine schedule. Computers are placed in locations where access is restricted. Technical safeguards: Employees are required to enter a login ID and password to access protected information. Electronic protected information is encrypted.
deductibles
A fixed amount of money a client must pay before health insurance begins to cover, calculated annually.
Accountable Care Organizations
Accountable care organizations (ACOs) consist of networks of providers of health care services that join together to share the costs and coordination of services for a population.
Health Information Technology for Economic and Clinical Health (HITECH)
Act was signed into law to promote the use of information technology in health care settings in a meaningful way. An example of how this benefits clients is the ability to access portions of their health records from home.
endorsement
Being granted single state licensure based on reciprocity for nurses who have passed the National Council Licensing Exam (NCLEX).
social justice
Change in health policy aimed at analysis and critique of social structures, laws, and customs that harm groups through exclusion. Every individual has the right to quality health care.
The nurse in the scenario is determining how to respond to the primary care provider's request for information about Mr. Alvarez. Which of the following actions should the nurse take? (Select all that apply.)
Review the policies and procedures of the facility before disclosing Mr. Alvarez's information.
Nursing Practice Act
Each state legislature enacts a Nurse Practice Act, the law that governs the scope and standards of nursing practice. Nurse Practice Acts define the authority of the state board of nursing, identify the types of licenses and titles for nurses, and prescribe the requirements for licensure and nursing education in each state.
determinants of health
Factors that impact health other than health care services, including location, environment, genetics, income, relationships, and gender.
Match the organization with its role. (Match the option from the left column with the description in the right column.)
Grouped by nurse interest such as specialty area or nurse role; provide collegiality, access to scholarly literature, and potential monies to support education and research: Professional nursing organizations Ensures health care organizations have safety measures in place, participates in quality improvement and risk management, and maintains performance excellence: The Joint Commission (TJC) Law that defines the authority of the state board of nursing, identifies the types of nursing licenses and titles, and regulates nursing scope and standards of practice: Nurse Practice Act Grants status to health care organizations to designate excellence in nursing, including nurse leadership, nurse sensitive quality indicators, mutual respect, autonomy, and shared values: Magnet Recognition
Emergency Medical Treatment and Active Labor Act
In 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) was passed to prevent "patient dumping"—the practice of one health care organization moving a client based on the client's inability to pay or lack of insurance coverage. This law ensures that any individual who presents to an emergency department in a health care organization will receive, at minimum, a medical screening examination and treatment until stabilized.
A nurse is caring for a client who has terminal cancer and wishes to stop further treatment. The client's family does not support this decision. Which of the following actions should the nurse take?
Inform the family that the client has the right to immediately stop treatment.
durable power of attorney for health care
Legal document that allows an individual to choose a designated person, a proxy, to make health care decisions on their behalf.
living wills
Legal document that allows individuals to decide what lifesaving measures they desire towards the end of life. A living will is used only when a person is terminally ill or permanently unconscious as determined by two health care providers. When writing a living will, clients should consider whether they want to be resuscitated with cardiopulmonary resuscitation (CPR), kept alive through the use of ventilators, given fluids via intravenous access or food via a tube feeding, or administered pain or antinausea medications, and whether they want to donate organs after death. It is important for clients to understand that they can revoke a living will at any time.
Match the term with its definition. (Match the option from the left column with the description in the right column.)
Nurse staffing: The process of determining the skill mix (RNs, PNs, assistive personnel) and number of nurses required to care for a number of clients. Acuity: Amount of time each client will need nursing care, based on personal needs and how ill each client is. Telehealth: Provision of nursing care using electronic devices such as telephones and computers. Nurse-to-patient ratio: The maximum number of inpatient clients each nurse is assigned, sometimes mandated by care area or state.
Professional Nursing Organizations
Nurses collaborate with other nurses to form professional organizations based on similar interests, specialties, and roles. While state boards of nursing, accreditors, and best practices are established to protect the public, professional nursing organizations promote the interests of nurses through health policy. Professional nursing organizations are based on the various roles that nurses have, such as educator, manager, or bedside nurse in any specialty area—for example, the nurse who works in a critical care area or with the pediatric population
American Nurses Association
One of the largest nursing organizations, representing approximately 3.6 million nurses, is the American Nurses Association. ANA is a professional organization concerned with advancing the nursing profession by protecting the interests of nurses, promoting a safe and ethical work environment, and advocating on health care issues that affect the public.
Patient Self-Determination Act
Passed in 1990, the Patient Self-Determination Act requires all health care organizations to inform clients of their rights to make decisions regarding their care and to indicate whether the client has made an advance directive. This act gives clients the right to refuse treatment, such as taking a medication that has been prescribed or undergoing treatment or diagnostic testing.
Mental Health Parity and Addiction Equity Act
The Mental Health Parity and Addiction Equity Act ensures that individuals with mental illness receive coverage equal to those with medical illness or need for surgical intervention. Mental health disorders are characterized by alterations in thinking, judgment, mood, or behavior and are among the most common causes of disability.
uninsured
People without health insurance coverage. Correlated with poor access to care and lack of preventative care. 25 million people in the United States remain uninsured.
P&P manuals
Policies and procedures that provide the standard of care that meets regulatory and accreditation requirements and promote safety. P&Ps should include a purpose statement; policy statements regarding who can perform the intervention; indications and contraindications; specific equipment needed; room entry procedure; procedure steps; required client monitoring; and documentation.
Dianne is the nurse caring for Jessica. Jessica recently had surgery to repair a ventral hernia and has been admitted to the surgical unit. She has type 1 diabetes mellitus and is dependent on insulin to control her blood glucose level. Jessica is a 30-year-old mother of two daughters, ages 8 and 4 years; she is single and unemployed. She and her daughters live with Jessica's mother Carol, a 60-year-old widow in good health. Jessica has no insurance. Which health policies may apply to Jessica's hospitalization? (Match each option with the applicable category.)
Policy applies: Controlled Substances Act Health Insurance Portability and Accountability Act (HIPAA) Patient Protection and Affordable Care Act (ACA) Patient Self-Determination Act (ACA) Policy does not apply: Mental Health Parity and Addiction Equity Act Newborns' and Mothers' Health Protection Act
health disparities
Preventable differences in incidence and prevalence of disease, injury, or violence among populations, based on race, ethnicity, gender, gender identity, LGBT, age, or socioeconomic status.
Match the terms regarding access to care with their definitions. (Match the option from the left column with the description in the right column.)
Preventable differences in the incidence and prevalence of disease, injury, or violence, based on race; ethnicity; gender; gender identity; lesbian, gay, bisexual, transgender, queer or questioning, intersex, or asexual (LGBTQIA) status; age; or socioeconomic status: Health disparities Unjust, avoidable, uneven distribution of resources that impact health, stemming from systematic racism and discrimination based on race, ethnicity, gender, gender identity or LGBTQIA status, or low socioeconomic status: Health inequity
Match the health care policy with its provisions. (Match the option from the left column with the description in the right column.)
Requires that health care organizations that offer emergency services provide a medical screening examination and stabilizing treatment to anyone who presents for care, regardless of the individual's insurance status or ability to pay.: Emergency Medical Treatment and Active Labor Act (EMTALA) Regulates medications with a potential for abuse by placing them in categories called schedules and requiring health care organizations to ensure scheduled drugs are stored with additional locking mechanisms: Controlled Substances Act Requires insurers to cover a minimum stay for mothers and neonates for at least 48 hr after giving birth vaginally and 96 hr after cesarean birth: Newborns' and Mothers' Health Protection Act Requires insurers and federal payers to reimburse for mental illness and substance use disorder care equally to medical illness or surgical intervention and mandates no lifetime or annual dollar limit for services: Mental Health Parity and Addiction Equity Act
advocacy
Speaking up for clients' needs when the clients are unable to speak for themselves and supporting clients to make choices for their own health. Defending the rights, interests, and safety of someone who is vulnerable. The act of defending the interests, rights, and safety of those who cannot do it for themselves.
culture of safety
Systems approach to change that leads to safer procedures taking blame away from individuals who make errors based on systems issues.
Commission on Collegiate Nursing Education
The AACN's accrediting arm is the CCNE. This autonomous commission protects the health and well-being of recipients of nursing care by maintaining high standards for baccalaureate, master's, and doctoral programs. Accreditation standards ensure program quality and effectiveness by confirming institutional support for the nursing program, excellence in curriculum and teaching practices, and assessment of program outcomes.
Accreditation Commission for Education in Nursing
The ACENaccredits clinical doctoral, master's, baccalaureate, associate, diploma, and practical nursing programs. Each nursing program undergoes a peer-reviewed, self-regulatory process in which the program demonstrates that it meets or exceeds the published standards.
Administration for Children and Families
The Administration for Children and Families advises on issues such as child care, child welfare, child support enforcement, and family assistance. Children are considered vulnerable because they are dependent on their families for food security, shelter, and health and wellness.
Administration on Aging
The Administration on Aging (AoA) is the federal agency responsible for protecting the concerns and interests of older adults and the people who provide their care.
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Qualityhelps the health care industry maintain and improve safety, quality, accessibility, and affordability through its provision of evidence. It has developed recommendations for a culture of safety, a systems approach to safety that moves away from individual blame in the case of medical errors.
Americans with Disabilities Act
The Americans with Disabilities Act (ADA) prohibits discrimination against individuals living with a physical or mental impairment that substantially hinders life activities. Examples include vision or hearing impairments, physical challenges, and stigmatized disease processes such as human immunodeficiency virus (HIV).
Centers for Disease Control and Prevention
The Centers for Disease Control and Preventionserves as an official authority on disease processes, injury and violence, and overall health and safety of the public. Some examples commonly used in health care facilities are tools for personal protective equipment (PPE) and guidelines for the prevention of catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), ventilator-associated events (VAE), and surgical-site infections. CDC is the authority on vaccines and immunization and works to prevent and cure communicable diseases.
Food and Drug Administration
The Food and Drug Administration (FDA) has responsibility for protecting consumers' health by ensuring the safety and quality of many products. It regulates prescription and nonprescription (over-the-counter [OTC]) medications, vaccines, blood and blood products, food and food products including bottled water and food additives, medical devices like pacemakers, electronic products that produce radiation like x-ray equipment and microwave ovens, cosmetics like makeup and skin cleansers, tobacco products, and even veterinary products like livestock feed.
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act of 1996, also known as the Privacy Act, legislation to protect insurance coverage and private information of clients. Its purpose is to protect client's privacy and personal health information from security breaches, particularly electronic data. It was established by the federal government with the goal of making health care more efficient. Established in 1996 to reduce fraud and deter inappropriate use of client health care information.
Commission for Nursing Education Accreditation
The NLN's Commission for Nursing Education Accreditation (CNEA) is a national accreditation agency concerned with continuous quality improvement of nursing programs across the academic spectrum. This includes programs for practical nurses, diploma, associate, bachelor, master's, and clinical doctoral degrees. The CNEA values include caring, diversity, integrity, and excellence.
Newborns' and Mothers' Health Protection Act
The Newborns' and Mothers' Health Protection Act requires group health plans to pay for a 48-hour hospital stay or 96-hour stay in the case of cesarean birth, beginning at the time of delivery.
Occupational Safety and Health Administration
The Occupational Safety and Health Act was passed in 1970 and requires employers to comply with Occupational Safety and Health Administration (OSHA) standards. OSHA sets and enforces safe and healthful working conditions for nurses and workers in the private sector and for some state employees.
Omnibus Reconciliation Act
The Omnibus Reconciliation Act provides for regulation and oversight of long-term care facilities in an effort to protect residents. It requires specific care standards and includes language forbidding the use of chemical restraints—antipsychotic and sedative medications that are used to manage uncooperative or violent behavior, rather than for a specific medical condition.
Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administrationprovides leadership through programs, policies, information, data, and personnel to reduce the impact of mental illness and substance abuse. It offers resources for treatment to those affected by mental illness and substance abuse, and evidence-based resources for health care providers and families. Approximately 46.6 million U.S. adults are currently living with a mental illness.
U.S. Department of Agriculture
The U.S. Department of Agriculture works to support farmers, ranchers, foresters, and producers, and to ensure a safe and secure food supply. Its Food and Nutrition Service division works to increase food security and reduce hunger through special assistance programs for people of all ages. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritious foods to supplement diets, nutrition education, and breastfeeding support based on financial need and nutrition risk.
Department of Defense
The U.S. Department of Defense (DOD) provides health care to all of the country's military personnel. The military health system administers health care to approximately 9.5 million service members, families, and retirees.
U.S. Department of Justice
The U.S. Department of Justice has authority to enforce laws and seek justice for those guilty of unlawful behavior. In the case of health policy, it enforces laws surrounding Medicare and Medicaid to fight health care fraud, for example. As another example, in March 2020, a company began selling "vaccine kits" for the novel coronavirus, COVID-19, when no legitimate vaccine was available; the Department of Justice stepped in to halt the sales.
Department of Labor
The U.S. Department of Labor provides oversight to protect consumers' interests with regard to health insurance benefits and nurses' interests and safety. It requires equal-opportunity hiring practices and enforces fair wages, safety and health, and benefit security regulations.
Uniform Anatomical Gift Act
The Uniform Anatomical Gift Act prohibits another person from revoking the consent of an organ donor after death. Currently, more than 112,000 adults and children are on the national transplant list, and 20 people die each day while waiting for an organ.
epidemiology
The incidence and prevalence of illness and injury.
National Institutes of Health
The mission of the National Institutes of Health is to obtain and apply knowledge about health, life, illness, and disability. This agency's goals include fostering knowledge through conducting research, funding research, and promoting scientific integrity. NIH serves as a credible repository of health information supported by research, also known as evidence.
nurse-to-patient ratio
The number of clients each nurse is assigned. The ratio is based on the service area and client acuity.
mortality
The number of deaths due to a specific illness or injury.
morbidity
The number of individuals affected by a specific illness or injury.
incidence
The number of individuals newly afflicted with an illness or injury, expressed as a percent of a larger population.
prevalence
The number of individuals who have an illness or injury at a given point in time, expressed as a percent of a larger population.
nurse staffing
The process of determining the correct number and skill mix of nurses for the number and acuity of patients needing care. Affects the ability of nurses to deliver safe care.
telehealth
The provision of both clinical and nonclinical aspects of health care delivery through the use telecommunication devices such as the internet and telephone.
chemical restraints
The use of antipsychotic medications to control uncooperative behavior rather than for a specific medical condition.
underinsured
Those with insurance who pay more than 10% of annual income, or 5% if below the poverty level, on health care costs out-of-pocket. Since the ACA was enacted, 20 million people have gained health insurance coverage—yet, as just noted, 25 million are still not covered.
health inequity
Unjust, avoidable, uneven distribution of resources that impact health, stemming from systemic racism and discrimination of marginalized groups based on race, ethnicity, gender, gender identity, LGBT, and low socioeconomic status.
health equity
Valuing all individuals equally and removing obstacles to optimal health and health care across different populations.
diversion
When a health care professional replaces a controlled substance with another and takes the substance for personal use.
Advance directives
are written documents outlining individuals' wishes in the event they cannot make decisions for themselves. They allow individuals a way to communicate and document health care decisions.
Occupational Safety and Health Administration (OSHA)
requirement that employers provide protection for employees who may be exposed to blood and body fluids. In 2000, a law was passed that mandated OSHA to update its standards on bloodborne pathogens. This standard, which became effective in 2001, requires employers to use engineering controls to help minimize exposure to sharps. Engineering controls are sharps injury prevention measures such as needles that retract or have a self-locking sheath or needleless systems for intravenous infusions. The standard requires employers to seek input from nonmanagerial frontline employees such as nurses and keep records regarding needlestick injuries.
