Chapters 1, 3, & 19

Health care reform stimulated the development of these two systems:

*Accountable Care Organizations (ACO)* and *Patient Centered Medical Homes (PCMH)*.

The Patient Protection and Affordable Care Act of 2010 focuses on:

*The major goals of increasing access to health care services for all, reducing health care costs, and improving health care quality *Provisions in the law include insurance industry reforms that increase insurance coverage and decrease costs, increased funding for community health centers, increased primary care services and providers, and improved coverage for children.

Accountable care organizations

*This organization is developed to coordinate medical care by primary care and specialty physicians, hospitals, and other health care providers with the goal of providing high-quality coordinated care. *It also works to make sure that patients receive the right care at the right time, without duplication of services or incidence of medical errors. *In this organization the health care providers are accountable for the quality of care and cost of care delivered to patients

The nurse, in considering the difference between autonomy and accountability, recognizes that autonomy is: 1. initiating nursing interventions that do not require medical orders. 2. the legal responsibility for nursing interventions. 3. incorporating values into practice. 4. generating knowledge to support practice.

1

In the Caring Assessment Tool (CAT), an example of mutual problem solving with a patient is when a nurse: 1. discusses health issues with the patient and family. 2. pays attention to the patient. 3. provides privacy for the patient. 4. includes the family members in the patient's care.

1

A nurse is discussing with her peers how much a patient matters to her. She states that she does not want the patient to suffer. The nurse is implementing the theory described by: 1. Patricia Benner. 2. Jean Watson. 3. Kristen Swanson. 4. Madeleine Leininger

1

Health care costs are generally reduced with: 1. treatment in an outpatient facility. 2. use of new technology. 3. prescription medications. 4. identification of acuity levels for hospitalized patient

1

A subdimension of Swanson's process of caring "doing for others as he/she would do for self" involves: 1. being there. 2. performing skillfully. 3. generating alternatives. 4. offering realistic optimism.

2

A graduate of a nursing program is interested in the occupational health field. The graduate nurse decides to pursue a position at: 1. the local medical center. 2. a car manufacturing plant. 3. an urgent care center. 4. a physician's office.

2

Additional teaching is required if a nurse observes that a nursing assistant working with an older adult patient: 1. has the patient select the clothes to wear. 2. addresses the patient as "Honey." 3. carefully organizes the patient's personal items. 4. combs and styles the patient's hair.

2

An individual has a type of managed care plan that limits an enrollee's choice to a list of "preferred" hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list. The nurse recognizes that this individual is covered by a(n): 1. managed care organization (MCO). 2. preferred provider organization (PPO). 3. exclusive provider organization (EPO). 4. private insurance company.

2

A new graduate is assigned to a surgical unit in which there are a large number of procedures to be performed during each shift. This nurse demonstrates a caring behavior in this situation by: 1. avoiding situations that may be uncomfortable or difficult. 2. attempting to do all the treatments independently and quickly. 3. seeking assistance before performing new or difficult skills. 4. telling patients that he or she is a new graduate and unfamiliar with all the procedures.

3

A nurse manager would like to promote more opportunities for the staff on the busy unit to demonstrate caring behaviors. The manager elects to implement: 1. more time off for the staff. 2. a strict schedule for patient treatments. 3. staff selection of patient assignments. 4. staff appointment to hospital committees.

3

A patient was admitted to the hospital to have diagnostic tests to rule out a cancerous lesion in the lungs. The nurse is sitting with the patient in the room awaiting the results of the tests. The nurse is demonstrating the caring behavior of: 1. knowing. 2. comforting. 3. providing presence. 4. maintaining belief

3

An older woman was recently diagnosed with Alzheimer's disease. Her daughter expresses her concern that, while she is at work, her mother has been found wandering around the neighborhood in a disoriented state. This family may benefit from the services of a(n): 1. hospice. 2. sub-acute care unit. 3. adult day care center. 4. residential community.

3

A new graduate is looking at theories of caring. He selects Leininger's theory because it is most agreeable with his belief system. Leininger defines caring as a(n): 1. new consciousness and moral idea. 2. nurturing way of relating to a valued other. 3. central, unifying domain necessary for health and survival. 4. improvement in the human condition using a transcultural perspective.

4

A nurse attempts to understand the specific cultural concerns of a patient and how they relate to his illness. What caring factor is applied? 1. Attentive reassurance 2. Encouragement 3. Provision of basic human needs 4. Appreciation of unique meanings

4

A nurse is working with a patient who has been admitted to the oncology unit for treatment of a cancerous growth. This nurse is applying Swanson's theory of caring and demonstrating the concept of maintaining belief when: 1. performing the patient's dressing changes. 2. providing explanations about the medications. 3. keeping the patient draped during the physical exam. 4. discussing how the radiation therapy will assist in decreasing the tumor's size

4

A nurse's next-door neighbor has recently experienced some health problems. The neighbor visits the nurse to ask about Medicaid coverage. The nurse informs the neighbor that this program is: 1. catastrophic long-term care coverage for older adults. 2. a fee-for-service plan that provides preventive health care. 3. a two-part federally funded health care program for older adults. 4. a federally funded and state-regulated program for individuals of all ages with low income.

4

A patient is being discharged from the medical unit of the hospital. While working with the patient, the nurse identifies that intermittent supervision will be required. The patient will also need to rent durable medical equipment for use in the home. There is family support for the patient upon discharge. The nurse will refer this patient to: 1. a subacute care unit. 2. an extended care facility. 3. a home health agency. 4. an urgent care center.

4

An example of the caring process of "enabling" is: 1. performing a catheter insertion quickly and well. 2. reassuring the patient that the lab results should be fine. 3. providing pain medication before a procedure. 4. assisting a patient during the birth of a child

4

An inaccurate statement regarding nursing and health care is: 1. the majority of the public rank nurses highest among professionals for honesty. 2. acting in a professional manner influences consumer perceptions of health care providers. 3. public policy can be influenced by nursing involvement. 4. there is less public access to health care information.

4

The family of a patient has requested that the hospice agency become involved with the patient's care. The nurse recognizes that the services provided by hospice for this patient include: 1. extensive rehabilitative measures. 2. daytime coverage for the working caregivers. 3. residential care with an emphasis on a return to functioning. 4. provision of symptom management and comfort measures for the terminally ill

4

The nurse is aware that a characteristic of today's health care system is: 1. costs are decreasing. 2. more services are hospital based. 3. there are less underserved individuals. 4. the population aged 65 and older is increasing.

4

As a result of flourence's effort, the mortality rate at Barracks hospital has reduced from ____ to ______ in 6 months.

42.7% 2.2%

Intensive care unit

A hospital unit in which critically ill, unstable patients receive close monitoring and intensive medical care. This is the most expensive delivery site for medical care because each nurse is usually assigned to care for only one or two patients at a time and because of all the treatments and procedures the patients require.

Why was Florence nightingale known as the "lady of the night"?

She volunteered during the crimean war and traveled the battlefield hospitals at night carrying her lamp to help those who are injured.

intrapersonal

A spiritual connection that connects one with oneself

Transpersonal

A spiritual connection that connects one with the unseen, God, or a higher power.

Interpersonal

A spriritual connection that connects one with others and the environment

Caring Assessment Tool

A tool that is used to measure caring from a patient's point of view to show the value of nursing. It involves eight categories of care: 1) Mutual problem solving 2) Attentive reassurance 3)Human respect 4) Encouraging manner 5) Appreciation of unique meaning 6)Healing environment 7) Affiliation needs 8) Basic human needs

Harriet Tubman

Active in the Underground Railroad movement

Who is the most independently functioning nurse?

Advanced practice registering nurse.

The NLN and the ANA are professional organizations that deal with a) Nursing issues of concern b) Political and professional issues affecting health care C) financial issues affecting health care d) all of the above

D

A patient who needs nursing and rehabilitation following a stroke would most benefit from receiving care at a a) Primary care center b) Restorative care center c) Assisted-living center d) respite center

B

Nursing is defined as a profession because nurses a) Perform specific skills b) Practice autonomy c) Utilize knowledge from the medical discipline d) charge a fee for services rendered

B

Lillian Wald

Began the Henry Street Settlement

Describe how caring and spirituality are connected?

Caring and spirituality are connected in the way that the nurse identifies and provides for the patient's spiritual needs. Spirituality offers intrapersonal (connected with oneself), interpersonal (connected with others and the environment), and transpersonal (connected with the unseen, God, or a higher power) connectedness.

Who was the founder of the american red cross?

Clara Barton

There are four different types of APRN's CNS, NP, CNM, and CRNA or...

Clinical nurse specialist, nurse practitioner, certified nurse midwife, certified RN anesthetist.

______ with coordination of services begins the moment a patient is admitted to a health care facility.

Discharge planning

Case Study: *Mrs. Levine is an 82-year-old patient diagnosed 2 months ago with lymphoma, a cancer of the lymph tissue. She has been experiencing weakness and fatigue. Over the past 4 weeks, she has lost 8 pounds. *Mrs. Levine had been relatively independent before her diagnosis, playing bridge each week with friends and going to lunch with fellow church members. But now, she has much less energy to do the things she enjoys.

Evaluation: Due to Mrs. Levine's weakness and fatigue, which prohibit her from engaging in the activities she enjoys, she will become isolated from her friends and support group. Because of this, Mrs. Levine may experience depression, anxiety, hopelessness, and loss of faith. Additionally, Mrs. Levine may experience further health complications if she doesn't have the distraction of a busy social schedule

Identify at least three external influences on the practice of nursing today.

External influences on nursing include health care reform, demographic changes of the population, increasing numbers of medically underserved, workplace issues, the nursing shortage, and the threat of bioterrorism.

It is important to identify the primary caregiver in the patient's family and care for them also. This is called...

Family care

Mary Mahoney

First professionally educated African-American

Mary Adelaide Nutting

First professor of nursing at Columbia University

The first school of nursing was established in 1860 by

Florence nightingale

Who was the first practicing epidemiologist?

Florence nightingale

Isabel Hampton Robb

Founder of the Nurses' Associated Alumnae of the US and Canada

ICN; improve standards of health and the availability of health care, to foster high standards for nursing, and to promote the professional development and general and economic welfare of nurses. *ANA is a part of it.*

International council of nursing

The three types of spiritual connections are:

Intrapersonal, Interpersonal, and transpersonal

NSNA

National Student nurses association

NLN; advances excellence in nursing education to prepare nurses to meet the needs of a diverse population in a changing health care environment.

National league for nursing

How can nurses care for eachother?

Nurses can care for each other by recognizing signs of compassion fatigue, providing mentorship, assisting in patient care activities, and allowing for discussion of concerns and feelings.

What is the Center of the nursing profession?

Patient

(Case Study) Three hours into the infusion, Mrs. Levine asks Sue for a glass of water and begins to talk about her pet cat and her desire to return home and be able to visit with one of her bridge partners tomorrow. Sue has another patient down the hall who has an infusion that has been under way for about an hour. What should Sue do to show her caring for Mrs. Levine?

Sue should visit with Mrs. Levine for several minutes to learn more about Mrs. Levine's cat and social plans for the following day. Then Sue should excuse herself by telling Mrs. Levine that she will return in approximately 30 minutes to check on her. Before Sue goes, she should offer Mrs. Levine a distraction such as a book, magazine, TV remote, or deck of cards. Sue should then check on her other patient and spend some time with her other patient before returning to visit with Mrs. Levine.

Dorothea Dix

Superintendent of the female nurses in the Union army

Health care organizations that decide to apply for Magnet status must demonstrate high-quality patient care, nursing excellence, and innovations in professional practice. Who established the magnet recognition program?

The american nurses credentialing center or ANCC

Patient centered medical homes

The goal of this institution is to make care for patients more efficient, effective, continuous, comprehensive, patient centered, and coordinated.

A patient is to have an IV line inserted. The nurse demonstrates caring behaviors by...

The nurse demonstrates caring behaviors during an IV insertion by explaining the procedure to the patient in advance and during the intervention, using skillful and gentle technique, and maintaining eye contact.

Nurses recognize that the use of genomics in health care allows providers to:

The use of genomics in health care allows providers to determine how genomic changes contribute to patient conditions and influence treatment decisions such as assessment and symptom management and titration of medications based on a patient's response.

Kristen swanson

Theory of five processes and subdimensions (the science of caring) was written by:

Madeleine Leininger

Theory of transcultural caring (cultural focus)

Jean Watson

Theory of transpersonal caring (holistic model)

Patricia Benner and Judith Wrubel

Theory that caring is primary

Health Services pyramid

What is the name of this pyramid?

Select all of the examples of the QSEN competency for patient-centered care: a. Determining the patient's meal preferences b. Using a flow chart for the nursing care plan c. Identifying the cultural needs of the patient d. Documenting on the patient's electronic health record e. Resolving a staff conflict over vacation time f. Implementing a patient fall protocol

a and c

What services does a nursing center provide? Select all that apply. a. 24-hour intermediate care b. Dietary management c. Acute care services d. An interdisciplinary approach e. Focus on a young adult patient population

a b d

Nursing Practice act does the following: a. Regulate the scope of practice b. Determine ethical guidelines c. Use standards from the ANA d. Vary greatly from state to state e. Originate from federal legislation

a c

While working in the community health agency, a nurse visits an older adult patient who is having difficulty performing activities of daily living (ADLs) in her own home. The patient recognizes that she needs some supervision with medications. In discussions with this patient, the nurse refers the patient to a(n): a) sub-acute care unit. b) assisted living facility. c) rehabilitation hospital. d) primary care institution.

b

ANA: Improves standards of health in america

american nurses association

clinical nurse specialist

an APRN who is an expert clinician in a specialized area of practice, such as geriatrics, critical care, diabetes, rehabilitation, or pain.

Nursing is both an ____ and a s_____

art science

A female patient has just found a large lump in her breast. The physician needs to perform a breast biopsy. The nurse helps the patient into the proper position and offers support during the biopsy. The nurse is demonstrating: A. Enabling. B. Comforting. C. A sense of presence. D. Maintaining belief.

c

Three essential componenets of professional nursing are ____, ____, and ____

care cure coordination

Florence nightingale began the nursing practice in the ____ war in the ____

crimean 1850

NPA

nurse practice acts

____ health care services include: school health, occupational health, physicians offices, nursing centers, block and parish nursing, and community centers.

primary

____ and ____ care services include: Hospitals, discharge planning, intensive care, mental health facilities, and rural hospitals

secondary tertiary

The healthcare system has ____ levels of care: Preventative, primary, secondary, tertiary, restorative and continuing care.

six

Nursing and their professional organizations have lobbied on behalf of

state legislators in the us congress to improve the quality of healthcare.