NU 270: Health Care Systems / Health Care Organizations
Which six trends in health care reflect the Institute of Medicine's (IOM) focus? "The system should be safe, effective, efficient, patient centered, timely, and equitable." "The system should be flexible, patient centered, bureaucratic, timely, safe, and efficient." "The system should be static, reliable, timely, equitable, efficient, and illness focused." "The system should be safe, efficient, centralized, wellness promoting, government driven, and patient centered."
"The system should be safe, effective, efficient, patient centered, timely, and equitable." A safe, effective, efficient, patient-centered, timely, and equitable system is what the IOM envisions. A bureaucratic, government-driven, illness-focused system is not advocated by the IOM.
What is the priority assessment for the nurse when developing a plan of care for a client living in poverty? Access to care Access to health insurance Access to affordable housing Access to financial assistance
Access to care Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.
Which is the largest single source of reimbursement for home health care services? Medicare Client's self-pay Private insurance Medicaid
Medicare Medicare is the largest single source of reimbursement for home health care services. Other sources of reimbursement may include Medicaid, private insurance, self-pay, and other public funding.
A client has a rare neurological disorder and will require complex management with specialists. Which level of care should the nurse anticipate this client requiring? Complex referral Primary Secondary Tertiary
Tertiary The client will require tertiary health care due to the complex and rare nature of the disease process. Primary health care deals with more common health care issues and preventive measures. Secondary health care would be related to issues that require more specialized clinical expertise than those addressed by primary health care but less specialized care than those addressed by tertiary care. "Complex referral" is not a level of health care.
The nurse is providing care to several clients. In which situation would the nurse be able to accept a verbal order from the healthcare provider? The client is hemorrhaging from a surgical wound. The client has just been admitted to the unit from the emergency department. The client reports new onset headache and has a blood pressure of 90/50 mm Hg. The client is being transported to the cardiac catheterization department.
The client is hemorrhaging from a surgical wound. In most facilities, the only circumstance in which an attending healthcare provider may issue orders verbally is in a medical emergency, when the healthcare provider is present but finds it impossible to write the order. The postoperative hemorrhage is the only scenario that could be considered an emergency. Although the one client's blood pressure is low, there is no evidence there this is a potentially life-threatening situation. When clients are transferred between facilities or departments, there is time to write prescriptions, so the healthcare provider should enter these directly into the medical record as the safest form of documentation.
The focus of a hospital's current quality assurance program is a comparison of the health status of clients on admission and with that at the time of discharge. This form of quality assurance is characteristic of: outcome evaluation. structure evaluation. process evaluation. nursing audit.
outcome evaluation Outcome evaluation focuses on measurable changes in the health status of the client or the end results of nursing care. Whereas the proper environment for care and the right nursing actions are important aspects of quality care, the critical element in evaluating care is demonstrable changes in client health status. Process evaluation addresses performance expectations during the various stages of the nursing process. Structure evaluation addresses the environment of care. A nursing audit focuses on the review of records.
A nurse is providing care to several clients at the clinic. When reviewing the clients' medical records, which client would the nurse identify as meeting the criteria for Medicare reimbursement? Select all that apply. 66-year-old male with heart failure 55-year-old female with a temporary disability 45-year-old male with a permanent disability receiving social security benefits 30-year-old male with blindness from an industrial accident 60-year-old female with a low income
66-year-old male with heart failure 45-year-old male with a permanent disability receiving social security benefits The 1965 Medicare amendments to the Social Security Act established national and state health insurance programs for older adults under Title XVIII. Within a decade, almost all citizens over 65 years of age held Medicare insurance for hospital care, extended care, and home health care. Medicare coverage was increased in 1972 to include permanently disabled workers and their dependents, if they also qualified for Social Security benefits. Medicaid was established in 1965 under Title XIX of the Social Security Act. Medicaid is a federally funded public assistance program for people of any age who have low incomes; for the blind, older adults, and disabled covered by supplemental security benefits; and for beneficiaries of Aid to Families with Dependent Children.
A nursing theorist examines a hospital environment by studying each ward and how it works individually, and then relates this information to the hospital as a whole working entity. This is an example of the use of which theory? Adaptation theory Developmental theory General systems theory Psychosocial theory
General systems theory General systems theory is an example of an interdisciplinary base for a nursing theory. This theory describes how to break whole things into parts and then to learn how the parts work together in "systems." It emphasizes relationships between the whole and the parts and describes how parts function and behave. Another example of an interdisciplinary base for nursing theory is the adaptation theory. Adaptation theory defines adaptation as the adjustment of living matter to other living things and to environmental conditions. A third interdisciplinary base for nursing theory is developmental theory. Developmental theory outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. Erikson's theory of psychosocial development is one type of developmental theory.
A nurse is providing care to a client recently admitted to the health care facility for treatment of an infection. The client experienced a traumatic brain injury several months ago that resulted in paralysis of both lower extremities and difficulty swallowing and speaking. The client's spouse is the primary caregiver. The client's spouse says to the nurse, "It's been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I'm just spent, physically and emotionally." A referral for which service would be appropriate? Respite care Parish nursing services Palliative care Hospice care
Respite care Respite care is a type of care provided for caregivers of homebound ill, disabled, or older clients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. Although parish nursing and palliative care may be helpful in providing the spouse with support, it would not necessarily provide the respite needed. Parish nursing emphasizes holistic health care, health promotion, and disease-prevention activities and combines professional nursing practice with health ministry, emphasizing health and healing within a faith community. Palliative care evolved from the hospice experience but also exists outside of hospice programs. It is not restricted to the end of life and can be used from the point of initial diagnosis. Palliative care, which may be given in conjunction with medical treatment and in all types of health care settings, is client- and family-centered. Hospice care is typically provided to clients with less than 6 months to live. There is no indication that the client is at this stage.
In preparation for discharge, the nurse is reviewing information related to new dietary guidelines with the client. This is an example of which step in discharge planning? providing client teaching assessing the client's needs and identifying problems developing goals with the client making home healthcare referrals
providing client teaching The nurse is teaching the client important information about self-care at home prior to discharge. The initial step in discharge planning is collecting and organizing data about the client because this provides information on the client's healthcare needs. Home referrals may be made after the teaching process based upon orders provided by the physician. Developing goals may occur after the teaching process because the goals need to be realistic.
