(PrepU) Chapter 11: The Healthcare Delivery System

A nurse says, "We have so many drills and safety checks for everything. It is almost like we are preoccupied with the possibility of failure." How should the charge nurse respond to this statement?

"Highly reliable organizations think about the possibility of failure and what to do to avoid it." Characteristics of high reliability organizations include preoccupation with failure, reluctance to simplify, sensitivity to operations, deference to expertise, and commitment to resilience.

At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new nurse on the unit just learned "the old way" and is frustrated to now have to learn a new methodology. Several other nurses comment that the change is "all about money." The charge nurse must educate the staff about the importance of this new policy. Which explanation by the charge nurse is most appropriate?

"Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost." Evidenced-based practice improves client outcomes, thereby increasing the quality of care; quality care leads to decreased cost. Cost is a driver in quality health care delivery. Evidenced-based practice is not just a trend in care; it is an expectation in health care delivery. Clients are consumers of care, but they often do not understand evidenced-based care or the cost associated with care. Today's greater focus on quality makes it less likely that clients will suffer unnecessary or harmful treatment, reduces waste, and increases safety.

While at a clinic visit, a client asks the nurse, "I'm going to be eligible for Medicare soon. Can you help explain what this involves?" Which information would the nurse likely include in the explanation? Select all that apply.

"Part A pays for inpatient hospital costs; Part B covers most outpatient costs." "It's good to have an extra policy to supplement what might not be covered." People who receive Medicare pay both a deductible cost and a monthly premium for full insurance coverage. Part A of Medicare, which pays most inpatient hospital costs, is paid by the federal government. Part B of Medicare, which is voluntary, is paid by a monthly premium; it covers most outpatient costs for physician visits, medications, and home health services. Because the full cost of some services is not covered by Medicare, a supplemental insurance policy offered by a private insurance company is recommended. Also, because Medicare is federally funded, benefits may change annually according to Congressional decisions related to the federal budget.

Which statement regarding health care reform trends is most accurate?

"Systems are in place to pay for performance and penalize hospitals for excessive readmissions." Health care trends already include paying for performance (HEDIS, HCAHPS) and penalizing hospitals for excess readmissions. In the United States, private insurers dominate over public, unlike in most countries. The United States is first in health care spending worldwide, and it is estimated that 20% of the gross domestic product will be spent on medical services by 2021.

A nurse is conducting a class about health care trends for a group of newly graduated registered nurses at the community hospital. Which of the following six trends stated by the nurse reflects the Institute of Medicine's (IOM) focus?

"The system should be safe, effective, efficient, patient centered, timely, and equitable." A safe, effective, efficient, patient-centered, timely, and equitable system is what is envisioned by the IOM. A bureaucratic, government-driven, illness-focused system is not advocated by the IOM.

It is recommended that a client go to a convalescent center upon discharge following a minor stroke. The client says, "I don't want to go anywhere, I want to go home." Which information should the nurse offer?

"You will only stay until you are well enough to go home." Those entering convalescent centers remain only until they have recovered. The nurse should explain this even though the client does have the right to refuse. There is no indication that the client will not be able to care for oneself again. There is a difference between a convalescent center and a nursing home.

Which client would a nurse correctly refer to Medicare services?

A 66-year-old client with diabetes Medicare is a federal health care plan for individuals over the age of 65. An individual with a disability might be referred to Medicare, but other federal organizations must be involved for this to occur. A low-income family with infants needing immunizations would be referred to Medicaid. The client with cancer in this question is not noted to be over age 65.

The nurse is caring for several clients with chronic conditions that need to be evaluated for long-term care. After evaluating each client, the nurse determines which client is most appropriate to receive long-term care?

A client who suffered a stroke who has mobility issues and problems completing activities of daily living (ADLs). Long-term care facilities provide health care and help with daily living for people of any age who are physically or mentally unable to care for themselves independently. This care may extend for periods ranging from days to years. A client who suffered a stroke who has mobility issues and problems completing ADLs is an appropriate client to receive long-term care services. A client requiring medication monitoring needs primary health care, not long-term care. The client with a back injury and physical therapy needs treatment and outpatient therapy, not long-term care. The client diagnosed with pneumonia requiring mechanical ventilation requires acute care, not long-term care.

A nurse demonstrates understanding of Healthy People 2030 by supporting which statement?

A client's health is affected by social, economic, and political factors. People believe "quality of life" to be synonymous with a healthy community. There is growing recognition that to achieve the goals of Healthy People 2030 a model inclusive of multiple health determinants is needed. Clinical care has typically focused on diagnosing and treating symptoms. Understanding health in relation to personal behaviors, social factors, and other determinants provides a holistic context and not a quick resolution of needs. As an example, it is important to know whether an individual has access to a grocery store with fresh fruits and vegetables to comprehend that client's nutritional needs. To affect social, economic, political, and educational health determinants, health initiatives are more effective if they are based in the community and incorporate community collaboration. While physical therapy can be helpful for a client in the home, it does not have a basis for the community emphasis in Health People 2030.

The nurse is providing care to several clients. For which client should the nurse include secondary care in the nursing plan of care?

A middle-aged client who presents with new-onset angina A middle-aged client who presents with new-onset angina requires a referral to a cardiologist and probably additional testing. Secondary care occurs when the primary caregivers refer clients for consultation and additional testing, such as with the referral of a client to a cardiac catheterization laboratory. The remainder of the clients require only primary care.

When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what?

A prospective payment plan based on a predetermined fixed cost The nurse must understand that Medicare is a federal insurance program for older adults. It is based on a prospective payment plan that pays a predetermined fixed amount for in-hospital costs. Medicare does not pay physician groups and is not for indigent older adults. Retrospective payment plans pay for services after they have been received.

Which is an emerging trend in health care delivery?

Active involvement of consumers Trends in health care delivery include the active involvement of consumers, continuing nursing shortage, increased complexity of client care, and a technology explosion. Other trends include changing demographics, increasing diversity, globalization of economy and society, increasing costs of health care, and the effects of health policy and regulation.

Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge?

Affordable Care Act As part of the Affordable Care Act, hospitals may accrue penalties for readmissions of clients with certain diagnoses within 30 days of discharge. To improve client outcomes and avoid penalties, care transitions are being implemented to improve the continuity of services from hospital to home and to reduce readmissions. A collaborative discharge plan that includes the client's primary care services as well as any home care is essential for transitional care to be successful. The Americans with Disabilities Act (ADA) became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. American Nurses Association (ANA) bylaws are rules established by the ANA to govern members of the ANA. The National Commission for Minorities is an organization based in the country of India.

A home health care nurse is providing visits for a 65-year-old widower who needs some assistance with performing activities of daily living (ADLs) but is living independently. What option might the nurse recommend that would enable the client to maintain independence for as long as possible?

Aging in place The nurse might recommend for this client aging in place. In this type of care, clients remain in their homes or move to a living space, such as an apartment, while they are still physically able to care for themselves, and then have access to services that are a part of the health care community as needed. Someone who is living independently but only needs some assistance with ADLs would not be placed in a long-term care facility or transitional subacute care facility. A medical home is an enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated client-centered care.

Which scenario is using a prospective payment plan to reimburse for services?

An older adult client is admitted to the hospital and treated for pneumonia. The hospital is reimbursed based on a predetermined fixed price. A prospective payment system uses financial incentives to decrease total healthcare charges by reimbursing hospitals on a fixed rate basis. Reimbursement is based on the diagnostic-related group (DRG). Therefore, the scenario in which the hospital is reimbursed is an example of a prospective payment plan. The other scenarios demonstrate other types of payment plans.

The nurse is providing care to several clients on a medical-surgical unit. For which client's plan of care should the nurse include information regarding extended care?

An older adult client who fell at home and required a hip replacement Extended care meets the health needs of clients who no longer require acute hospital care but require rehabilitation and skilled nursing care, such as an older adult following a hip replacement surgery, who may need additional assistance with mobility and more time for physical therapy before being ready to be discharged home. The other clients do not require, or would not benefit from, extended care.

During a hospice visit, the client's spouse suddenly begins to cry and says, "I am so tired. I just can't do this anymore. I am not getting to sleep and I just eat sandwiches when I can." What is the nurse's best intervention?

Arrange for short-term inpatient care for the client. This spouse is exhausted and needs respite care. The hospice nurse can arrange for short-term inpatient care for the client so that the spouse can rest. The other options will not be effective for exhaustion.

Which statement is most accurate in comparing nursing care provided in the acute care setting and that provided in the home care setting?

Both settings focus on the holistic care of an individual. Although the setting for care and the type of intervention may change, the nursing focus is always the same: the holistic care of an individual. Wherever the nurse practices, the primary concern is to provide for health care that focuses not only on physiologic needs but also psychosocial and spiritual needs of the person in relation to the environment. Both care settings require the participation of the client, but only the home care setting requires the participation of the client's family. The home care setting can be initiated before the client returns to full function. Both settings focus on the client's needs.

Unlicensed assistive personnel (UAP) include which workers?

Certified nursing assistants, orderlies, attendants, and technicians Certified nursing assistants, orderlies, attendants, and technicians are considered UAP. Volunteers, admission clerks, and housekeepers, although invaluable to hospital function, are not UAP.

A new nurse is considering getting a job in either an acute care setting or a home care setting. Which statement about these care settings is most accurate?

Clients play a large role in helping themselves in the home care setting. In nursing practice in the hospital, client needs include physiologic monitoring, complete or partial personal care, exercise, nutritional support, pain management, treatment and medication administration, anticipatory guidance, counseling, and education, which requires the complexity of health care teams. Nurses are involved in a variety of teams and care needs are complex. Clients are not encouraged to help each other in the acute care setting. Because of the trend toward shorter lengths of stay, the clients are discharged to home, where they may be more involved in helping meet their own care needs. Communication skills are critical in both the acute care and home care settings.

Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important new role in health care. Which is an example of this new role?

Collaborating with all agencies to provide for the client's home health needs As the various components of the ACA are phased in, nurses have begun to play an influential role in the implementation of new health policy. The newest opportunity is collaborating with all agencies to provide for the client's home health needs. Nurses have already been involved in screening individuals for type 2 diabetes mellitus and providing postoperative teaching for ostomy care. Nurses recheck paperwork for consent prior to surgery, but this is not just limited to nurses. Other health care providers also review consent prior to surgery.

A nurse is helping clients access the health insurance marketplace. What is the goal of this health insurance coverage concept?

Comparison of available health care plans The health insurance marketplace was designed to help people more easily find health insurance that fits their budget. Every health insurance plan in the new marketplace must offer comprehensive coverage, from doctors to medications to hospital visits. People can compare all their insurance options in terms of price, benefits, quality, and other features that may be important to them, in plain language that makes sense. Plans available on the marketplace are for people of all ages and genders, not just older people, women, or children. Providing insurance coverage specifically for people needing orphan drugs is not a goal of the marketplace.

Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today's society. What role of the nurse is most important in preventing this effect?

Coordinator of care The most important role of the nurse in preventing fragmentation of care would be coordinator of care. Care coordination is the deliberate organization of client care activities between two or more participants (including the client) involved in a client's care to facilitate the appropriate delivery of health care services. The roles of care provider, counselor, and educator are all important roles, but the priority role is as the coordinator of care.

The growth in home health care is largely attributed to which factor?

Early discharge of clients from the hospital setting Home health care is one of the most rapidly growing areas of the health care system. The prospective payment system of reimbursement encourages early discharge from the hospital and has created a new, acutely ill population that needs skilled nursing care at home. Though some nurses may desire to work in the community and hospitals may have a shortage of nurses, these are not the primary factor related to the increase in home health care. It is not that hospitals cannot care for an increasing number of clients so much as it is that they will not be reimbursed by payers for costs associated with longer client stays; thus, they are motivated to discharge clients earlier even though clients are often not yet ready to provide all of their own needed care, leading to the need for and prevalence of home health care.

Which is a priority nursing function in a rehabilitation center that specializes in emotional rehabilitation related to chemical dependency?

Encouraging independent self-care The role of the rehabilitation nurse is to encourage and facilitate independent self-care. Facilitating lay volunteers and support groups is a mostly a parish nurse responsibility. Making referrals to deal with other medical conditions and providing information on health maintenance, although tasks that nurses commonly perform in most settings, are not priority functions in a rehabilitation center; they would be priority functions for a nurse who sees clients in a homeless shelter.

A nurse has an older adult home care client who lives alone with no family nearby. On a recent visit, the nurse notices that his clothes are very loose, and he has difficulty letting the nurse leave when the visit is ending. After talking with him, the nurse learns that he has not been cooking for himself and he can't get to the grocery store easily. What service could the nurse suggest as an immediate response until a long-term plan can be formed?

Enroll the client in Meals on Wheels. The best option that can be arranged quickly is to enroll the client in Meals on Wheels, a voluntary agency. The other responses may be helpful in later planning for a long-term situation.

Nurses have an important role in healthcare reform. The goals of healthcare reform include which of the following?

Focus on cost containment with improved access and quality of services for everyone. The goals of healthcare reform focus on cost containment, improved access, and increased quality of services for all citizens. Nurses are becoming a stronger and more educated voice in the healthcare reform movement.

The goals of health care reform include which?

Focusing on cost containment with improved access and quality of services for everyone The goals of health care reform focus on cost containment, improved access, and increased quality of services for all citizens. Health care reform seeks to increase, rather than decrease, the number and quality of services provided.

A nurse is reviewing the different types of health care delivery services available in the community. Which method would the nurse identify as having the primary care goal of reducing costs by preventing illness?

Health maintenance organization (HMO) Health maintenance organizations (HMOs) are prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers. Their primary care goal is to reduce costs by preventing illness. Preferred provider organizations provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. Accountable care organizations offer incentives to provide integrated, well-coordinated care. Community health centers ensure that everyone who needs care has access regardless of the ability to pay.

A hospitalized client with advanced metastatic lung cancer states, "I want to go home. I don't have much time left. I want to be with my family." Which type of care referral by the nurse is most appropriate?

Hospice Hospice is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying people, their families, and other loved ones, often provided in the client's own home. Because the client is near the end of life, hospice care would be the most appropriate referral. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older adults, to give them some time away from the responsibilities of day-to-day care. This type of care would not be appropriate for this client because the client has been hospitalized and wants to be with family. Extended-care services provide medical and nonmedical care for people with chronic illnesses or disabilities. Extended care occurs outside the home, however, which is not what the client desires. 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 patient- and family-centered care that optimizes the quality of life by anticipating, preventing, and treating suffering. Palliative care alone is not as appropriate as hospice care in this case, given that the client is near the end of life.

Which type of facility employs the greatest number of nurses?

Hospitals Although the trend is changing, hospitals still employ more nurses than any other type of facility. The percentage of registered nurses (RNs) working in hospitals is declining, but about 61% of RNs are still employed in hospitals (Bureau of Labor Statistics, U.S. Department of Labor, 2017).

Which is the acute care setting for people who are too ill to care for themselves at home, are severely injured, or require surgery?

Hospitals Hospitals are the most appropriate acute care setting for people who are too ill to care for themselves at home, are severely injured, require surgery or complicated treatments, or are having babies. An ambulatory care center, which may be referred to as an outpatient care center, is a medical care facility that provides outpatient services. These include diagnosis, treatment, consultation, and intervention services. Day care centers have a variety of purposes: some care for healthy infants and children whose parents work; some care for children with minor illnesses; some provide a place for older adults to socialize and to receive care while family members work; some provide health-related services and care to people who do not need to be in a health care institution but cannot be at home alone. Primary care is the day-to-day health care given by a health care provider and can be provided in an outpatient facility.

Which cost-cutting measure in health care is most likely to facilitate improved client outcomes?

Improving transitions across settings Improving transitions across settings is most likely to improve client outcomes because it involves better client hand-offs during changes from one level of care to another. DRGs help reduce costs but do not directly improve client outcomes. Comparative effectiveness analysis encourages the provider to carefully select technologies with cost in mind. Capitation and managed care may actually decrease positive client outcomes if there is too much emphasis on cost cutting.

Which is the primary criterion for admission to a long-term care facility?

Inability to provide self-care Long-term care facilities exist to provide care for individuals who are mentally or physically unable to care for themselves independently. These individuals are frequently older, have multiple health problems, and lack family caregivers, but these factors in and of themselves are not criteria for admission to long-term care.

Which is a current trend in health care consumers?

Increased knowledge of health care Health care consumers (clients) are increasingly knowledgeable about health, prefer to control and make decisions about their own health, and want to be active participants in planning and implementing their health care. Consumers of health care services are better educated about the services they require and the services that are available, largely because so much health information is available on the Internet. Clients are also concerned about access to services, the cost of those services, and the quality of the care received. Consumers are questioning escalating costs and the proliferation and duplication of services. Consumers have become actively involved in the administration of health care facilities and have helped develop standards for care, client rights, and cost-containment measures as protection for clients when they enter a health care setting.

The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?

Medicare The federal government implemented a system of prospective payment in 1983 for people enrolled in Medicare. A prospective payment system uses financial incentives to decrease total health care charges by reimbursing hospitals on a fixed rate basis. Reimbursement is based on the diagnostic-related group, which is a classification system used to group clients with similar diagnoses. Medicaid provides health care through funds obtained from federal, state, and local sources. In capitation strategy, a preset fee per member is paid to a health care provider, regardless of whether the member requires services. AmeriCare provides health care services through employers.

A nurse is discharging a client who was admitted for observation following a motor vehicle accident. The client is a single parent who is living in a new community. What service would be an appropriate referral for this client?

Parish nursing Parish nursing is an expanding area of specialty nursing practice that emphasizes holistic health care, health promotion, and disease prevention activities. It combines professional nursing practice with health ministry, emphasizing health and healing within a faith community. Hospice care is appropriate for an individual with an advanced chronic illness who has a life expectancy of 6 months or less. 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. A medical home is an enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated client-centered care.

What nursing function would be most commonly found in an ambulatory care facility?

Providing direct client care Ambulatory care centers and clinics (agencies that deliver outpatient medical care) may be located in hospitals, may be a freestanding service provided by a group of health care providers who work together, or may be managed by an advanced practice registered nurse. Although a nurse may serve as an administrator or manager in such a facility, the nursing function most commonly found in this setting is providing direct client care. Educating individuals or groups would be a nursing function more commonly found in a primary care facility. Assessing the home environment would be a nursing function more commonly found in home health care.

Who provides care in the primary nursing model?

Registered nurses In the primary nursing model, one registered nurse (RN), frequently with the assistance of a licensed practical or vocational nurse or nursing assistant, is responsible for providing (either directly or by delegating to others) all care for a group of clients throughout their stay in a hospital unit or department. Nursing students, who are not yet licensed, cannot independently provide care to clients. Nursing assistants assist RNs in providing care to clients, but the RN is responsible for the client's care. An RN need not have a Master's degree to provide care in the primary nursing model.

A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care?

Relief from physical, mental, and spiritual distress The chief focus of palliative care is relief or management from physical, mental, and spiritual distress. The goal of palliative care is to prevent and relieve suffering by early assessment and treatment of pain and other physical problems (such as difficulty breathing, nausea, fatigue, and problems with sleeping). Like hospice care, palliative care is provided by an interdisciplinary team. Physical rehabilitation and occupational therapy would be the goal of home care, moving the client from the functional level at discharge from the hospital to a higher level of functioning, closer to the level prior to the hospitalization. Provision of a dignified death experience would be the goal of hospice.

The nurse is providing care for a client who has a tracheostomy and whose pulse oximeter has recently alarmed, showing the client's oxygen saturation to be 77%. The nurse has repositioned the client and applied supplementary oxygen, interventions that have raised the client's oxygen levels to 80% and have somewhat decreased his work of breathing. The client is not in immediate distress, and his level of consciousness remains high. The nurse should page which practitioner?

Respiratory therapist A respiratory therapist is an expert in lung function and oxygenation whose expertise is needed in the care of this client. Because the client is not experiencing severe distress or respiratory arrest, the nurse is justified in foregoing contact with the physician in the short term. A physical therapist or occupational therapist is not likely able to provide needed interventions at this time.

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 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.

The wife of an elderly man with Alzheimer's disease contacts a community health nurse because she is planning to visit her sister in a neighboring state and needs assistance in arranging care for her husband while she is away. Which type of care is the wife seeking?

Respite care The wife of the client is seeking respite care. Respite care is a type of care provided for caregivers of homebound ill, disabled, or elderly clients. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care. Hospice services provide care to dying persons and their family members. Rehabilitation care specializes in services for clients requiring physical or emotional rehabilitation and for treatment of chemical dependency. Parish nursing is often volunteer-based and situated within the church.

Which statement is true when comparing home care with acute care?

The nurse is the guest in the client's home. An essential difference in home care versus acute care is that the home care nurse is a "guest" in the client's home. In the home, clients and families retain the power and control that they give to providers in other settings. Nurses in the home usually work as members of a therapeutic team that includes the client and other members of the health care team working collaboratively. The client does not direct the education of the caregivers.

The nurse is a member of the multidisciplinary team in a large primary healthcare setting. The nurse understands that which healthcare team member is responsible for a client's swallow evaluation following a cerebral vascular accident?

Speech pathologist/therapist It is within the speech pathologist's/therapist's scope of practice to conduct a swallow evaluation for a client but outside the scope of the occupational therapist, the physical therapist, and the physician assistant.

A nurse is a member of an interdisciplinary team providing home health care to a client who was discharged home after experiencing a stroke. The client has been receiving services to assist with swallowing. The nurse would collaborate with which member of the team to discuss the client's progress?

Speech therapist A speech therapist diagnoses and treats swallowing problems in clients who have had a head injury or a stroke. A physical therapist seeks to restore function or to prevent further disability in a client after an injury or illness. Occupational therapists evaluate the client's functional level and teach activities to promote self-care in activities of daily living. Social workers assist clients and families in dealing with the social, emotional, and environmental factors that affect their well-being.

A nurse works with clients in a crisis intervention center. What ability would be most important for this nurse to develop?

Strong communication and counseling skills Strong communication and counseling skills are the most important skills or abilities that the nurse would need to develop to work with clients in a crisis intervention center. The ability to relate to coworkers on a professional level is important but not the priority answer. Well-developed technical skills and high tolerance for frustration would be important, but not the priority skill to have for the position.

You are the nurse employed in an acute care hospital. The head nurse states that you will be caring for 12 clients with the help of two nurse assistants. This is considered to be what type of nursing care delivery?

Team nursing Team nursing is the provision of care with a nurse supervising the work of one or more aides.

A nurse is considering accepting a new position in an ambulatory care center. What roles does the nurse understand are likely in this setting? Select all that apply.

Triaging walk-in clients Teaching clients about wellness and illness Assisting with minor surgical procedures Performing physical assessments Prioritizing patient care tasks, teaching, assisting in surgery, and performing physical assessments are all within the registered nurse's (RN) scope of practice. Prescribing medications is outside the RN scope of practice.

A home health nurse is scheduled to make a visit to a client who was discharged from the hospital yesterday following an appendectomy. The nurse understands that the scope of practice for a home health nurse allows the nurse to perform which psychomotor tasks?

Wound care, medication administration, teaching, and ensuring a reasonably safe environment Nurses who provide care in the home make assessments (including of home safety) and provide physical care (including wound care), administer medications, teach (including dietary instruction), and support family members. They also collaborate with other health care providers, such as physicians, physical therapists, occupational therapists, respiratory therapists, and social workers, to plan and provide client care. Home health nurses may not prescribe medications.

One of the primary advantages of the managed care model is:

economic, quality care. The primary advantage of the managed care model is provision of high-quality care in the most efficient and economic manner. Managed care often results in decreased client satisfaction due to a lack of choice of health care provider. Managed care is provided by a diverse health care team with many different specialties and areas of care represented, not an all-RN staff or only one distinct area of care.

The Nursing Agenda for Health Care Reform (American Nurses Association [ANA]) identifies the recipients of health care. This reform's main focus is on:

health promotion. Recent health care reform efforts, in particular the Affordable Care Act (ACA), have made strides toward realizing nursing's vision of health care that is focused on health promotion, delivered where the individual needs it, and focused on wellness rather than disease management; however, there is much work still to be done as the effects of the ACA become known. Health care is currently focused on high-quality disease management and technology and not the prevention of disease. Accurate assessments are already part of the admission process in all health care settings.

What is one of the most significant trends in health care today?

shift from hospitals to community-based care The shift to community-based care is related to the public's desire to participate more actively in health care decisions, issues, and choices.