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3. Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system? a. Total patient care b. Partnership nursing c. Team nursing d. Functional nursing

ANS: A In total patient care, nurses provide all aspects of patient care. Partnership nursing, or coprimary nursing, pairs the RN with a partner, usually a licensed practical/vocational nurse (LPN/LVN) or nursing assistive personnel (NAP), allowing the RN to spend more time on tasks such as assessment and patient education. In team nursing, an RN directs the other members of the team, which can consist of care providers at various levels. In functional nursing, staff are assigned to tasks rather than to patients. DIF: Application REF: Pages 430-431

10. The nurse manager is planning staffing levels and realizes that the first step is to: a. know the intensity of care needed by patients according to physical and psychosocial factors. b. examine the educational level of the staff. c. assess the skill level of caregivers. d. review the budget to determine the financial consequences of past staffing patterns.

ANS: A The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients. Educational level requirements must be matched to patients' acuity levels. Assessing the skill level of staff is necessary to match staff with patients according to patients' acuity level. Past staffing patterns cannot predict the needs of the current population. DIF: Application REF: Page 427

2. Which factors would be considered in the first steps of developing an effective patient classification system? (Select all that apply.) a. Planned procedures b. Ethnic diversity of patients c. Clinical competency of staff d. Educational level of nurses e. Age of patients

ANS: A, B, E The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. The second step is to match the skill level of staff with the care needs of patients. The educational level of nurses is part of the second step and involves matching the educational preparation of staff with the care needs of patients. DIF: Comprehension REF: Page 428

MULTIPLE RESPONSE 1. While participating in a task force to proactively plan for nursing care delivery over the next 20 years, dramatic changes will occur as a result of: (Select all that apply.) a. the increase in the number of minimally invasive procedures being performed for disease treatment. b. care provided for patients over an extended period in acute care settings. c. the reduction in the number of nurses and other health care professionals who are available to provide care. d. the widespread illiteracy and decreased self-efficacy of the aging patient population. e. the need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient. f. the devaluing of nursing as a means of improving patient outcomes.

ANS: A, C, E Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. Care will focus on the unique lifestyle and values of a diverse population. Patients are discharged much more quickly and with more complex care needs, rather than having a longer stay in acute care settings. Consumers, especially the aging baby-boomer generation, are proactive about learning and participating in health care. Nursing is increasingly valued and has been shown to improve patient outcomes and patients' satisfaction with care. DIF: Application REF: Page 440

7. A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to as a: a. patient classification system. b. clinical pathway. c. patient-centered plan of care. d. diagnosis-related group (DRG).

ANS: B A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition. A classification system categorizes patients according to specific criteria and care requirements and thus helps to quantify the amount and level of nursing care needed. Patient centered, as used in this chapter, refers to a nursing care delivery model that is focused on interprofessional care, with the patient as the focus. A DRG places patients into a predetermined reimbursement rate on the basis of diagnosis. DIF: Application REF: Pages 437-438

6. A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG), and according to the clinical pathway should be extubated and discharged from critical care the day after surgery. During surgery the patient's oxygen saturation decreased drastically as a result of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation represents a: a. patient outcome. b. variance. c. goal. d. standard.

ANS: B A variance is a deviation from the planned path. The patient outcome is the end result of care, not just a single specific incident or deviation. The goal is to provide high-quality cost-effective care. A standard is the criterion from which safe, effective care is derived. DIF: Application REF: Page 438

4. A hospital converts to a system of care delivery in which RNs, LPNs, and nursing assistive personnel (NAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. This type of delivery system is: a. total patient care. b. functional nursing. c. team nursing. d. primary nursing.

ANS: B In functional nursing, members of the team are assigned specific tasks such as assessment or medication administration Total patient care involves an RN who provides every aspect of patient care. With team nursing, the team leader, an RN, delegates care to other team members. In primary nursing, the RN assumes 24-hour responsibility for the care of assigned patients. DIF: Application REF: Pages 431-432

9. A nurse manager is mentoring an inexperienced manager in determining staffing needs. The mentor explains, "We must determine the acuity level of the patient by: a. assessing patient satisfaction with nursing care." b. quantifying the amount and intensity of care required." c. examining the skill mix and educational preparation of the staff." d. determining the number of hospital days required by the patients."

ANS: B Patient acuity is measured by determining the amount and intensity of care required. Patient satisfaction is based on interactions or experiences while the patient is receiving care, although staffing can affect patient satisfaction. Examination of the skill mix and educational preparation of the staff is the criterion for delegation of care. The number of hospital days required by the patient is a criterion that is used on care pathways to predict required resources. DIF: Comprehension REF: Page 427

8. The nurse manager determines that four RNs, five LPN/LVNs, and two nursing assistive personnel (NAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with: a. assignments. b. staffing. c. output. d. productivity.

ANS: B Staffing is the activity that is involved in determining that an adequate number and mix of health care team members are available to provide safe, quality patient care. Assignment is the distribution of work that each staff member is responsible for during a given work period; assigned activities must fall within the individual's scope of practice and/or job description. Output is the work produced, such as the number of patient care hours provided. Productivity is the ratio of the amount of output produced, such as patients receiving care or home visits, to the specific amount of input (i.e., nursing hours worked) and is the measure of staffing efficiency. DIF: Application REF: Page 427

14. A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association's (ANA) Safe Staffing Saves Lives recommendations? a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in quality safe patient outcomes. c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix. d. RN staffing is not cost effective, thus is it important for staffing models to limit the number of RNs assigned per shift.

ANS: B The ANA recommends that nurses have time to exercise professional judgment. Patient needs constantly change and staffing adjustments may be necessary. As patient acuity levels increase, the need for RN coverage increases. RNs have shown to be cost-effective and increase the value of care because of their contributions to improving patient outcomes. DIF: Analysis REF: Page 427

15. A nursing unit is comparing team nursing to the partnership model and found: a. with the partnership model, an RN does not have to be part of the mix. b. leadership abilities of the RN is a major determinant of effectiveness of care for both models. c. the RN teaches the LPN/LVN or nursing assistive personnel (NAP) how to apply the nursing process in team nursing. d. with team nursing the RN cares for the patient while the team members work with the family or significant others.

ANS: B The RN leads regardless of whether partnership model or team nursing is practiced. An RN is the leader of the pair. Applying the nursing process is not an appropriate role for the LPN/LVN or NAP. The team is led by an RN, and the team provides those tasks that are not required by the RN; however, team members can also be additional RNs but they are not in a leader role. DIF: Application REF: Pages 432, 434

5. The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a: a. nurse manager. b. case manager. c. coordinator of patient-centered care delivery. d. team leader in team nursing care delivery.

ANS: B The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness. The nurse manager is responsible for handling the day-to-day operations of the nursing unit and for ensuring that the unit's philosophy and mission are congruent with those of the parent organization. The coordinator of patient-centered care delivery works with an interdisciplinary team in providing a wide range of services. The team leader coordinates and delegates care for a specific group of patients. DIF: Comprehension REF: Pages 435-436

12. A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery? a. Modular b. Primary c. Team d. Functional

ANS: B The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present. In modular care delivery, a small team is assigned to a geographic location during their assigned shift. In team nursing the RN directs members of the team who are providing care but does not assume 24-hour responsibility. Functional nursing focuses on completion of tasks rather than on specific patients. DIF: Application REF: Page 433

13. When deciding which staffing option to use on a nursing unit that will open soon, the manager realizes that: a. continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on 3 consecutive days per week. b. the use of part-time nurses provides the variability needed to meet diverse patient needs. c. satisfaction of the staff equates to satisfaction of patients. d. nurses provide the same level of care, regardless of the work environment.

ANS: C High nurse satisfaction is generally equated with higher patient satisfaction and improved patient outcomes. Errors increase with long shifts over consecutive days. The use of part-time nurses may result in decreased patient satisfaction and lack of continuity of care. Research has found that nurses who practice in positive and autonomous work environments provide cost-effective care of better quality. DIF: Application REF: Pages 428-429

2. Customer satisfaction is primarily based on: a. access to modern, up-to-date facilities. b. availability of an extensive menu selection. c. personal interactions with employees. d. having to undergo fewer invasive procedures

ANS: C Interactions between employees and patients/families actually affect clinical outcomes, functional status, and even physiologic measures of health. Customer satisfaction is primarily based on relations with employees. As stated in A, interface with employees is the means to customer satisfaction. Patients may fear or dislike invasive procedures, but the important consideration in customer satisfaction is the quality of interactions with employees. DIF: Knowledge REF: Page 429

11. A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To enhance employee satisfaction related to staffing, the management team: a. negotiates for additional agency nurses. b. hires more part-time employees. c. prioritizes participatory management into staffing decisions. d. uses "float" nurses to cover vacancies.

ANS: C Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction. The use of temporary, part-time, or agency nurses can result in a lack of continuity of care, thereby decreasing patient satisfaction, which affects employee satisfaction. Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention. Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention. DIF: Comprehension REF: Page 428

1. Accrediting and licensure agencies such as The Joint Commission address staffing by: a. imposing maximum staffing levels. b. requiring a specific staff mix. c. stipulating nurse/patient ratios. d. looking for evidence that patients receive satisfactory care.

ANS: D Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing. Accrediting agencies do not impose maximum staffing levels. Staff mix is not addressed by accrediting agencies; however, long-term care facilities specify minimum RN coverage for the facility. Agencies do not stipulate mandatory staffing ratios, with the exception of those in California, a state that recently enacted legislation mandating specific nurse/patient ratios. DIF: Comprehension REF: Page 429

3. The implementation of a "Medication Nurse" is an example of what nursing care delivery model? Total Patient Care Functional Primary Team

B. In the functional nursing method of patient care delivery, staff members are assigned to complete certain tasks for a group of patients rather than care for specific patients. In total patient care nurses are responsible for planning, organizing, and performing all care for specific clients. In team nursing the RN functions as a team leader and coordinates a small group (generally no more than four or five) of ancillary personnel to provide care to a small group of patients. In primary nursing the RN, or "primary" nurse, assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge. REF: Page 365

5. An emergency department nurse will likely provide care according to which care delivery model? Team Primary Functional Total care

C. Emergency departments often use functional approaches to care because emphasis is on efficient assessment and immediate treatment. The team model is often used in medical-surgical units while the primary care model can be used in long-term care facilities. Some aspects of home health nursing function under the total care model. REF: Page 371

2. The nurse responsible for unit staffing recognize that client care is most affected positively by: a mix of high- and low-acuity client needs. units that implement the job-sharing model. nurses who report high levels of job satisfaction. nursing staff that hold advanced nursing degrees.

C. Nurses who are satisfied with their work generally provide higher-quality, more cost-effective care. Staffing systems should consider the quality of work life for the nursing staff as important as the quality of patient outcomes. Although the other options are factors to be considered, they are all influenced by whether the staff is satisfied with their work environment. REF: Page 363

4. When considering clinical pathways, the nurse recognizes that an outcome is: the result of a collaborative intervention of the health care team. an event that can prevent or help a patient reach wellness. the end result of interventions provided by the health care team. an unexpected event that determines a need to change the plan of care.

C. Patient outcomes are the end result of intervention by the health care team. Interprofessional intervention is the collaborative effort by all disciplines. Variance is any event that may alter the patient's progress through the clinical pathway. Triggers alert the caregiver that an unexpected event has occurred and a change in the plan of care may be indicated. REF: Page 370

1. When considering staffing needs, the registered nurse (RN) is primarily concerned with: the number of available licensed staff. the history of staff absenteeism. the availability of support staff. client acuity.

D. The primary considerations for staffing a specific nursing unit are the number of patients followed by the level of intensity of care required by those patients (commonly referred to as patient acuity). Knowing only the number of patients that require care is an ineffective way to plan staffing because of the wide range of care requirements needed by individual patients. The other options may in some degree affect the delivery of care but not to the degree that client acuity does. REF: Page 362