Exam 2 Transitions

Mal ojo

"Evil eye"

Bioethical dilemmas regarding life

-Abortion (when does life begin?) -Reproduction (cloning, genetic engineering)

Mastery over nature

-Belief that one can overcome the natural forces of nature -Anticipate good results from medicine/surgery -White people

Subject to nature

-Belief that one has little control over what happens -May not be compliant with treatments -African Americans & Mexican Americans

What are common biological variations in different cultures?

-Body build/structure -Genetic Variations (ex. African Americans have lower cholesterol) -Skin color (variations in amt. of melanin) -Susceptibility to disease

What are common communication issues between different cultures?

-Direct eye contact -Formality -Agreement -Interpreters

What are marginalized populations? (examples of)

-Gays, -lesbians, -older adults, -Recent immigrants from Russia, Rwanda & Afghanistan

Harmony with nature

-Illness represents disharmony -Rely on naturalistic remedies because medications seen as only relieving symptoms, not curing -Asians & American Indians

Nonmaleficence

-Implies a duty not to inflict harm -To abstain from injuring others -To help others further their own well-being by removing harm

School-age children stage of values & morals development

-Learn that good behavior is rewarded and bad behavior is punished -Begin to make choices that are based on an understanding of good and bad

Ethical challenge of autonomy

-Makes way for the crucial legal steps of informed consent -When are patients competent to make informed consent decisions?

Why do we need cultural competence?

-Nurse's culture often differs from patients -Culturally incompetent care is more costly & ineffective -Necessary to meet specific objectives outlined by Healthy People 2000 -Disparities in health & health care -Nursing is committed to social justice -Global infectious disease epidemics (ebola)

Ethical challenge of accountability

-Nurses have an obligation to uphold highest standards of practice, to assume full responsibility for actions, and to commit to maintaining quality -Obligated to denounce a harmful action or potentially threatening situation

Space

-People's attitudes and comfort level regarding personal space -Vast cultural differences in comfort level associated with distance between individuals

What are the 3 types of being time-oriented?

-Present oriented -Past oriented -Future oriented

Autonomy

-Principle of respect for the person -Unconditional intrinsic value for all persons -People are free to form their own judgements and actions as long as they do not infringe on the autonomous actions of others -Concepts of freedom & informed consent

Veracity

-Principle of truth telling

What are the recommended standards for Culturally and Linguistically Appropriate Health Care Services? (CLAS)

-Promote & supports attitudes, behaviors, knowledge, and skills -Comprehensive management strategy -Recruit, retain, promote culturally competent staff -Require & arrange ongoing cultural education -Provide clients access to bilingual staff -Inform of rights to interpreter service -Translate & make available patient education material and signage -Ensure appropriate interpreter services -Ensure that primary language & race/ethnicity are in the organization's system -Collect & use appropriate data and asses needs/resources of the community -Ongoing self-assesment of cultural competence -Develop procedures to address cross-cultural ethical & legal conflicts -Prepare an annual progress report related to CLAS

What responsibilities do health care facilities have for cultural care?

-Provide resources for education & practice -Employ/consult transcultural clinical specialists -Offer continuing education programs about cultural issues

Ethical challenge of paternalism

-Provider tries to act on behalf of the patent and believes that his/her actions are justified because of a commitment to act in the best interest of the patient -Interferes with a patient's right to self-determination

Bioethical dilemmas regarding death

-Quality of life and definition of death -Euthanasia/assisted suicide

Adolescent stage of values & morals development

-Questions existing moral values and his/her relevance to society -Becomes more aware of contradictions in adults' value systems

What are other major bioethical dilemmas?

-Right to health care -Allocation of scarce resources

What is deontology

-Rooted in the assumption that humans are rational & act out of principles that are consistent and objective, and compel them to do what is right -A decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty

Kohlberg's moral development theory states that...

-Rules are imposed by authority -Conformity to expected social and religious norms -Autonomous thinker: one who strives for a moral code beyond the issues of authority and reverence

Adult stages of values & morals development

-Strives to make sense of the contradictions and learns to develop own set of morals & values -Begins to make choices that are based on an internalized set of principles

Beneficence

-To promote goodness, kindness, and charity -To abstain from injuring others and to help others further their own well-being by removing harm; risks of harm must be weighed against possible benefits

Infant stage of values & morals development

-begin with no concept of right or wrong -if the need for basic trust is met, infants will develop the foundation for secure moral thought

What are the effects of people living longer

-increased opportunity to develop chronic illness -Social isolation & depression resulting from aging -Primary care providers faced with promoting max functional status & identifying health/independence risks

What order should you do a cultural assessment in?

1. Cultural self assessment 2. Cultural client assessment 3. Cultural client nutrition assessment 4. Cultural beliefs about sickness & cures

Steps of the Ethical decision-making model

1. Identify the ethical issues and problems 2. Identify and analyze available alternatives for action 3. Select one alternative 4. Justify the selection

A consumer is learning about electronic health records at a local health fair and states, "I am worried that someone can read my health information and I really don't understand the difference between privacy and confidentiality." The nurse explains that an example of confidentiality would be: a. a pledge that states, "I will hold matters pertaining to my patients in strict intimacy." b. a patient who does not tell the physician that he has been treated for a sexually transmitted disease. C. a teenager who sustains a broken arm and in the emergency department and withholds information about her use of recreational drugs. D. locking medical records in cabinets to prevent unauthorized users from accessing patient information

A

A nurse is preparing a presentation using different websites to collect information. The nurse is concerned that contact information and the author's credentials are not listed for one of the websites reviewed. Which criterion required to establish a reputable website is missing? A. Authority b. Objectivity c. Usability d. Currency

A

A nurse works on a unit where electronic health records (EHR) are being initiated and asks, "What is meant by 'meaningful use' standards that are in our education packet?" The best answer is that "meaningful use": a. identifies a set of EHR proficiencies and benchmarks that EHR systems must meet to be certain that they are functioning to their maximum capacity and meeting this standard allows companies/organizations to qualify for funds to defray cost of the EHR from Medicare. B. refers to training competencies that all users must achieve to be able to access and transfer patient data/information. C. refers to a requirement that at least 50% plus one of all patients have data entered into the EHR. d. the requirement that rigorous confidentiality security is in place to protect all patient information from sources which have no right to the data.

A

An advanced practice nurse inputs into a computer software program the following clinical manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of consciousness. The computer diagnosis of fat emboli is generated by a system known as: a. decision support. B. telehealth. C. robotic technology. D. biometric technology

A

Consumers are concerned with security issues related to their confidential health information being placed in an electronic health record (EHR). However, when the security of the EHR is compared with that of paper-and-pencil records, the EHR is: a. more secure. B. less secure. C. equivalent. D. not comparable with the paper-and-pencil record

A

The Institute of Medicine (IOM) (2003) recommends that EHR systems offer eight functionalities. A patient has a severe allergy to eggs and penicillin. Which of the eight functions of the EHR would address sharing this information? A. Health information and data capture B. Results/data management c. Provider order entry management d. Clinical decision support

A

Fiscal year

A 12 month period used for calculating annually financial reports in business

Abstract

A brief overview of a research study

Civil law

A category of law (tort law) that deals with conduct considered unacceptable. It is based on societal expectations regarding interpersonal conduct. Common causes of civil litigation include professional malpractice, negligence, and assault and battery

Constituent

A citizen who has the opportunity to vote for candidates in elections for representation at the local, state, and federal levels

Health policy

A course of action undertaken by governments or health care organizations to achieve a particular health outcome

Experimental design

A design that includes randomization, a control group, and manipulation between or among variables to examine probability and causality among selected variables for the purpose of predicting and controlling phenomena

Bilis

A disease brought on by anger

Error

A failure of a planned action to be completed as intended or the use of a wrong plan to achieve a specific aim

Medicaid

A jointly sponsored state and federal program that pays for medical services for persons who are elderly, poor, blind, or disabled and for certain families with dependent children who meet specified income guidelines

Gross negligence

A legal concept that means extreme carelessness showing willful or reckless disregard for the consequences to a person

Strict liability

A legal doctrine, sometimes referred to as absolute liability, that can be imposed on a person or entity without proof of carelessness or negligence

Provider

A licensed health care professional who or an organization that receives reimbursement for providing health care services

Policymaker

A local, state, or federally elected or appointed official who can propose and directly affect legislation, regulations, or programs that can become actualized

Private health insurance

A method for individuals to maintain insurance coverage for health care costs through a contract with a health insurance company that agrees to pay all or a portion of the cost of a set of defined health care services such as routine, preventive, and emergency health care; hospitalizations; medical procedures; and/or prescription drugs. Typically, the private insurance is provided through an individual's employer with a portion paid by the employee. Private insurance policies can also be purchased by individuals but are generally much more expensive than when provided through an employer's group plan

Single payer system

A method of reimbursement in which one payer, usually the government, pays all health care expenses for citizens; funded by taxes; decisions about covered treatments, drugs, and services are made by the government. Through the terms universal health care and single payer system are sometimes used interchangeably, universal health care could be administered by many different payer groups; both offer all citizen health insurance coverage

Retrospective payment system

A method of reimbursing health care providers in which professional services are rendered and charges are billed based on the basis of the individual service provided; also known as the "fee for service" payment system. This system may encourage overuse of healthcare services because the more services rendered or procedures performed, the more revenue received by providers

Prospective payment system

A method of reimbursing health care providers in which the amount of payment for care is predetermined on the basis of the patient's diagnosis; encourages increased efficiency in the use of healthcare services because providers are reimbursed at a predetermined level regardless of how many services are rendered or procedures performed to treat a particular diagnostic category; the most common method of payment in today's health care system

Healing touch

A multilevel energy healing program that incorporates aspects of therapeutic touch with other healing measures

Constituent

A person who is eligible to vote in federal election

Ethical issue

A problem that requires a person or organization to choose between alternatives that must be evaluated as right or wrong

Disclosure

A process in which the patient's primary provider gives the patient, and when applicable, family members, complete information about unanticipated adverse outcomes of treatment and care

Code of ethics

A set of statements encompassing rules that apply to people in professional roles

Comparative negligence

A type of liability in which damages may be apportioned among two or more defendants in a malpractice case. The extent of liability depends on the defendant's relative contribution to the patient's injury

Guidelines supported by the American Nursing Association (ANA) for communicating with government policy members include: (select all that apply) A) be brief and concise about what you want to communicate B) be specific about the issue you are communicating about C) be sure to identify yourself by name and address D) be persistent by using various accepted forms of communication E) be aggressive in stating your views and expectations

A) be brief and concise about what you want to communicate B) be specific about the issue you are communicating about C) be sure to identify yourself by name and address D) be persistent by using various accepted forms of communication

How does health policy become law? A) legislative action B) popular initiative C) executive directive D) Judicial decision E) grassroots lobbying

A) legislative action C) executive directive D) judicial decision

Examples of state health policies would include: select all that apply. A) nursing licensure B) smoke free public zones C) Medicaid programs D) health insurance exchanges E) children's health insurance program (CHIP)

A) nursing licensure C) Medicaid programs D) health insurance exchanges E) children's health insurance program (CHI

What are the functions of budgeting that help assure an organization will achieve its strategic goals? (Select all that apply.) A) Evaluating performance B) Planning C) Coordinating D) Monitoring progress E) Investing profits

A, B, C, D

Which of the following would a hospital consider to be revenue producing? (Select all that apply.) A) Medicare payments Employee benefits C) A federal grant D) Staff salaries E) Charitable donations

A, C, D, E

What are the two major sources of funding for nursing research?

AHRQ and the NINR

A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility? a. The Emergency Medical Treatment and Active Labor Law b. Health Insurance Portability and Accountability Act c. Patient Self-Determination Act d. The Patient Safety and Quality Improvement Act

ANS: A

A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient's condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under what issue? a. Compliance with the Health Insurance Portability and Accountability Act (HIPAA) b. Performance in accordance with the American Nurse's Association (ANA) Scope and Practice Act c. Nursing role in the securing of implied consent d. Personal liability with floating and cross-training

ANS: A

A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with which legal claim? a. Negligence b. Assault c. Defamation of character d. Tort

ANS: A

A nurse testifies at trail that a professional with the knowledge and skill of an RN should understand that, before administering digoxin, the client's potassium level and pulse level is always checked to prevent negative effects on cardiac output. The nurse's testimony as to what constitutes reasonable care is based on what criteria source? a. The legal definition of standard of care b. The legal definition of the informed consent process c. The doctrine of res ipsa loquitur d. The concept of governmental immunity

ANS: A

When differentiating between slander and libel, the nurse knows that libel is characterized by what action? a. Defamation caused by subjective comments written in the nurse's notes b. Negative subjective comments made to those who are not providing care c. Verbally describing to the oncoming nurse assigned to the client objective data that place the client in a negative light d. Repeating prejudiced comments made by the primary caregiver to a neighbor at the local supermarket

ANS: A

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 Correct: In total patient care nurses provide all aspects of patient care.

A nurse groups patients with criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit. The nurse is using: a. a patient classification system to determine safe staffing levels. b. diagnostic-related groups for Medicare billing. c. case management to coordinate care. d. clinical pathways to determine care.

ANS: A Correct: Patient classification systems group patients according to care needs to determine safe staffing levels.

A nurse answers phone questions related to health care questions and to triage the need for urgent care of member patients. Established patient guidelines are used to educate, direct, or provide follow-up. The nurse is providing care via: a. Telehealth. b. clinical pathways. c. functional nursing. d. case management.

ANS: A Correct: Telehealth involves telecommunication to deliver nursing care.

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 Correct: The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients.

A nurse groups patients with criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit. The nurse is using: a. a patient classification system to determine safe staffing levels. b. diagnostic-related groups for Medicare billing. c. case management to coordinate care. d. clinical pathways to determine care.

ANS: A Patient classification systems group patients according to care needs to determine safe staffing levels.

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.

Which components must be included regarding informed consent? (Select all that apply.) a. Identification of risks for non-treatment b. Discussion of expected benefits c. Identification of known risks d. Acknowledgement of alternative therapy e. Communication of the estimate cost involved

ANS: A, B, C, D

A nurse responsible for staffing a medical-surgical unit must consider: (Select all that apply.) a. the patient census. b. physical layout of the unit. c. complexity of care required. d. educational level of all staff. e. task preferences of the nurses.

ANS: A, B, C, D Correct: The primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity); contextual issues, such as architecture, geography of the environment, and available technology; level of preparation and experience of the staff members providing the care; and the quality of the nurses' work life.

A nurse responsible for staffing a medical-surgical unit must consider: (select all that apply) a. the patient census. b. physical layout of the unit. c. complexity of care required. d. educational level of all staff. e. task preferences of the nurses.

ANS: A, B, C, D The primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity); contextual issues, such as architecture, geography of the environment, and available technology; level of preparation and experience of the staff members providing the care; and the quality of the nurses' work life.

Which factors would be considered in the first steps in 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 Correct: 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.

Which factors would be considered in the first steps in 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.

While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that 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 Correct: a. Invasive surgical procedures are being replaced by laparoscopic procedures. c. 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. e. Care will focus on the unique lifestyles and values of a diverse population.

While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that 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 lifestyles and values of a diverse population.

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.

Although a hospital reversed all charges when a client was the victim of wrong site surgery, the court awarded the client $1.5 million. The client could return to work in 6 weeks and had no permanent damages. This monetary compensation is referred to by what term? a. Lability b. Punitive damages c. Vicarious liability d. Immunity

ANS: B

When the client is unable to make medical decisions, authorization that allows another person to make these decisions is referred to by what term? a. A living will b. Durable power of attorney c. Informed consent d. Immunity

ANS: B

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 patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient 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.

A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via: a. patient classification systems. b. clinical pathways. c. functional nursing. d. case management.

ANS: B Clinical pathways plans patient care activities and interprofessional interventions and desired patient outcomes within a specified time period for a particular diagnosis or health condition.

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 Correct: 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 patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient 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 Correct: A variance is a deviation from the planned path.

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) 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 Correct: In functional nursing members of the team are assigned specific tasks such as assessment or medication administration

A nurse manager is mentoring a novice nurse 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 Correct: Patient acuity is measured by determining the amount and intensity of care required.

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is termed: a. Partnership. b. Patient-centered. c. case management. d. total patient care.

ANS: B Correct: Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients' wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs.

The nurse manager determines that four RNs, five LPN/LVNs, and two Unlicensed assistive personnel (UAP) 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 Correct: Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care.

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, high-quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-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 Correct: The ANA recommends that nurses have time to exercise professional judgment.

A nursing unit is comparing team nursing to the partnership model and finds that: 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 unlicensed assistive personnel (UAP) 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 Correct: The RN leads regardless of whether partnership model or team nursing is practiced.

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 Correct: The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness.

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 Correct: 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

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) 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.

A nurse manager is mentoring a novice nurse 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.

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is termed: a. Partnership. b. Patient-centered. c. case management. d. total patient care.

ANS: B Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients' wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs.

The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive personnel (UAP) 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 of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care.

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) 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, high-quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-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.

A nursing unit is comparing team nursing to the partnership model and finds that: 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 unlicensed assistive personnel (UAP) 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.

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.

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.

What examples should the nurse provide to best describe an advance directive? (Select all that apply.) a. Preserving cord blood for possible future needs of a child b. Providing instructions about personal preferences regarding life-sustaining medical procedures c. Giving someone the legal right to act on one's behalf when one becomes incapacitated d. Completing hospital admission paperwork before being admitted to the hospital

ANS: B, C

A nurse learns in orientation that an incident report does not "blame" anyone but concisely documents the events leading up to an occurrence. Which events would warrant completion of an incident report? (Select all that apply.) a. The client is crying and distraught when learning of a diagnosis of cancer. b. An intravenous antibiotic given preoperatively does not infuse because of a faulty pump. c. The nurse is unable to carry out orders written by the specialist because of illegibility. d. A client falls while in the shower, after being instructed not to get up alone. e. The registered nurse is not available to complete the preoperative checklist.

ANS: B, C, D, E

Which types of abuse are the nurse required to report or be subject to fines and imprisonment for not reporting? (Select all that apply.) a. Animal b. Child c. Alcohol d. Infant e. Emotional

ANS: B, D

A blood reaction occurrence is noted in a client who did not receive pre-transfusion care as clearly documented in the facility's policies and procedures. The nurse providing care is liable for which legal tort? a. Comparative negligence b. Punitive damages c. Criminal negligence d. Involuntary tort

ANS: C

A client states, "I am leaving. No one here knows what they are doing." The nurse completing the Against Medical Advice form must implement what intervention to best assure client safety? a. Notify the primary health care provider of the client's wish to leave. b. Alert family that the client will be leaving the facility. c. Inform the client that leaving could result in complications and impairment. d. Require security staff to accompany the client to the facility's main entrance.

ANS: C

A nursing student planning to apply for licensure knows that being charged with which offense would result in a misdemeanor criminal offense? a. Solicitation of illegal drugs b. Stealing a car c. Failing to report elder abuse d. Billing Medicare for services not rendered

ANS: C

A physician shares with the patient's family that, while a central line was being inserted, the patient's lungs were inadvertently punctured, which required oxygen administration. The physician also explains that a chest x-ray indicated the lung remained intact and no additional treatment was required. The physician's role in this instance is based on what legal principle? a. Comparative negligence b. Gross negligence c. Disclosure d. Emergency Medical Treatment and Active Labor Act (EMTALA)

ANS: C

A primary health provider prescribes a drug for a patient with a known allergy, it is administered and results in anaphylactic shock. What statement is accurate regarding disclosure of this event? a. Disclosure of the error will result in more severe ramifications for the agency than if the negligence is discovered by the patient or family. b. Disclosure of the occurrence should occur before notification of the prescribing health provider c. Disclosure as an essential component of the national patient safety movement. d. Disclosure to the patient's insurance company is focused on decreasing costs.

ANS: C

All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a living will or a durable power of attorney. What legislative act makes this action mandatory? a. Emergency Treatment and Active Labor Law b. Americans with Disabilities Act c. Uniform Health Care Decisions Act d. Patient Self-Determination Act

ANS: C

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 Correct: High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes.

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 Correct: Interactions between employees and patients/families actually affect clinical outcomes, functional status, and even physiologic measures of health.

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. includes participatory management into staffing decisions. d. uses "float" nurses to cover vacancies.

ANS: C Correct: Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction.

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 high patient satisfaction and positive patient outcomes.

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.

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. includes 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.

A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse completes the following interventions: places the client on the examining table, completes a thorough history and physical, covers the client with a sheet, places the call button within reach, and goes out in the hall to speak with the client's primary care provider. The client tries to get up to speak with his family and falls, sustaining a hematoma on the head and a broken hip. The nurse's actions reflect which legal claim? a. Invasion of privacy b. Libel c. Slander d. Negligence

ANS: D

A nurse who functions in the role of team leader can be held negligent for matters involving what focus? a. Adequate training b. Policies and procedures c. Staff discipline d. Delegation

ANS: D

When can a nurse detain a client by implementing restraints? a. Staffing resources are insufficient to monitor a patient. b. The client is demonstrating behaviors associated with confusion. c. The family requests the restraints to prevent the client from leaving the facility. d. There are current prescribed instructions for their use.

ANS: D

Accrediting 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 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 Correct: 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.

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery? a. Team b. Partnership c. Primary d. Functional

ANS: D Correct: Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the Unlicensed Assistive Personnel provide hygiene, and the RN is assigned to task that require the nursing process.

A nurse makes patient care assignments as follows: RN 1 has rooms 200-210; RN2 has rooms 211-221; RN3 has room 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. The care delivery model used in this situation is: a. Team. b. Primary. c. partnership. d. Modular.

ANS: D Correct: Modular (or geographic) assignments are based on a geographic location in the nursing unit.

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery? a. Team b. Partnership c. Primary d. Functional

ANS: D Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the unlicensed assistive personnel provide hygiene, and the RN is assigned to task that require the nursing process.

A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. The care delivery model used in this situation is: a. Team. b. Primary. c. partnership. d. Modular.

ANS: D Modular (or geographic) assignments are based on a geographic location in the nursing unit.

Ethnicity

Affiliation resulting from a shared linguistic, racial, or cultural background

What are the federally defined minority groups (4)

African Americans, Hispanics, American Indian/Alaskan Native, Asian/Pacific Islanders

______ is a concern for the welfare of others

Altruism

Essential values for the professional nurse

Altruism, autonomy, human dignity, social justice

Capital expenditures

Amount spent on items that will have long-term value to an organization; typically includes buildings and equipment

Clinical nurse researcher

An advanced practice nurse who is doctorally prepared and directs and participates in clinical research.

Incremental budgeting

An approach to budget development that extrapolates from the prior period's budget and adjusts for future growth or decline in revenues or expenses to determine the budget for the next period

Marginal

An economic term that refers to a small or insignificant change in some variable

Accountability

An ethical duty stating that one should be answerable legally, morally, ethically, or socially for one's activities

Veracity

An ethical duty to tell the truth

Nonmaleficence

An ethical principle stating the duty not to inflict harm

Deontology

An ethical theory stating that moral rule is binding

Utilitarianism

An ethical theory stating that the best decision is one that brings about the greatest good for the most people

Minority

An ethnic group smaller than the majority group

Expense

An even or item that requires the outlay of money for purchase or the incurrence of an obligation for future payment; major expenses for healthcare organizations include employee salaries, medical supplies and equipment, and facility maintenance

Third-party payer

An organization other than the patient and the provider, such as an insurance company, that assumes responsibility for payment of health care charges. An individual's health insurance plan provided by his or her employer is considered a third-party payer

Reflexology

Application of pressure to pressure points on the hands and feet that correspond to various parts of the body

Sentinel event

As defined by TJC, an unintended adverse outcome that results in death, paralysis, coma, or other major permanent loss of function. Examples include patient suicide while in a licensed healthcare facility, surgical procedure on the wrong organ or body side, and a patient fall

Federally defined minority groups

Asian American, Black or African-American, Hispanic or Latino, Native Hawaiian and other Pacific Islander, and American Indian and Alaska Native

Stereotyping

Assigning certain beliefs and behaviors to groups without recognizing individuality

_____ is a right to self-determination

Autonomy

A nurse is caring for a patient who is to receive an antibiotic drug that causes severe skin damage when infiltrated. The order reads, "infuse over 1 hour by portacath." The nurse accesses the Personal Digital Assistant for software that lists the steps to access a portacath. The nurse is using: a. electronic health records. B. point-of-care technology. C. data management. D. telehealth.

B

A nurse is interested in locating reliable information concerning noninvasive blood glucose monitoring. Information is located, and the author is a scientist who conducted studies within the last year on the effectiveness of a particular noninvasive blood glucose monitor. The scientist received funding from a pharmaceutical company to support the studies. The URL indicates the pharmaceutical company site.com. The nurse is concerned about this information's: a. Authority. B. objectivity. C. accuracy. D. currency.

B

A nurse providing care at the bedside receives an "alert" that a patient's stat potassium level is 2.5 and digoxin (Lanoxin) is scheduled. The nurse holds the medication and prevents a possible complication. This feature of the Electronic Health Record is available through which core function of EHR? A. Order entry/order management b. Decision support c. Patient support d. Administrative support

B

A nurse walks up to a computer in the hallway and presses the index finger to the sensor, thereby gaining access to patient data. A few moments later another nurse performs the same steps and is granted access. A visitor who is watching from a room walks over and places the index finger on the sensor, only to receive an "error and access denied" message. Security is being maintained by: a. robot technology. B. biometric technology. C. telehealth. D. ubiquitous computing.

B

Which organization represents nurses and addresses health care issues on a national level? A) America's medical association (AMA) B) American nurses association (ANA) C) national league of nursing (NLN) D) Sigma Theta Tau (STT)

B) American nurses association (ANA)

A reliable private source of information about major health issues and health care reform is the : A) institute of medicine. B) Kaiser family foundation C) health care reform initiatives D) agency for healthcare research and quality

B) Kaiser family foundation

The most effective means for a nurse to impact the health and wellness of those being cared for at a local hospital is to: A) volunteer at a local health screenings held for a variety of health and wellness issues B)be active in local politics by lobbying city policy makers on health and wellness issues C) regularly attend the hospitals board meetings to be awake of discussions on policy changes D)donate to the national political party that advocates health policies that support health and wellness

B) be active in local politics by lobbying city policy makers on health and wellness issues

The Department of Health and Human Resources is a part of the executive branch of the federal government and: A) determines whether the regulation of health care services is constitutional B) manages federally funded health care programs passed by Congress. C) has the sole power to allocate federal health care spending D) can override a presidential veto regarding health care services

B) manages federally funded health care programs passed by Congress

Which question should the nurse manager ask when setting budget assumptions as a part of developing the yearly budget? A) How will the budget best support the achievement of the organization's goals? B) What salary range should be considered in order to attract high-quality nurses? C) What are the stated goals for the operational units to be included in the budget? D) What are the projected revenue predictions for this budget period?

B. What salary range should be considered in order to attract high-quality nurses? Budget assumptions address issues that affect the future performance of the organization and address questions such as what salary ranges are necessary to attract high-quality nurses in a certain area. Goals, whether institutional or for the operational unit, would be part of the review of the organizational strategic plan. Projected revenues are considered after setting budget assumptions.

Transcultural

Being grounded in one's own culture, but having the skills to be able to work in a multicultural environment

Liability

Being legally responsible for harm caused to another person or property as a result of one's actions; compensation for harm is normally monetary

Accountability

Being responsible for one's actions; a sense of duty in performing nursing tasks and activities

Ethnocentric

Believing that one's own ethnic group, culture, or nation is best

Case law

Body of written opinions created by judges in federal and state appellate cases; also known as judge-made law and common law

Salaries, wages, and benefits (SWB)

Budget category that typically includes direct payment for hours worked, bonuses, accrued paid-time-off, health benefits, employer portion of payroll taxes, and workers' compensation

A physician has installed a computer-based patient records system. An outside care provider who requests medical information must obtain the patient's signed consent and then is assigned a password to gain access to the medical information. A monthly audit is conducted to determine for whom and for what purpose patient records have been accessed. This protection is referred to as: a. Privacy. B. confidentiality. C. security. D. data capture.

C

During a search for the term informatics, when the nurse finds the domain ".edu," the site is affiliated with a(n): a. government agency. B. commercial site. C. educational institution d. Internet service provider.

C

When paper-and-pencil medical records are compared with computer-based records: a. paper-and-pencil records provide controls to determine who has viewed the health information. B. information contained in a paper-and-pencil record has the capability of being more in-depth than that found in computer-based records. C. patients have the right to know that the confidentiality of their records is strictly maintained, regardless of the type of medical record used. D. patients must sign for each item of information released on the computer record

C

The nurses role in the process of utilization review was a direct result of which federal health policy? A) Hill-Button Act (1950) B) Nurse Practice Act (1910) C) The creation of Diagnosis- Related groups (DRGs)(1983) D) Balanced Budget Amendment (1997)

C) The creation of Diagnosis- Related groups (DRGs)(1983)

Which statements related to strengths and weaknesses are associated with incremental budgeting? (Select all that apply.) A) Complexity of the process encourages teamwork between clinical and financial personnel. B) Process is resource intensive. C) Does not account for significant changes that are found to be needed D) Does not address past mistakes that have been incorporated into the budget E) Best suited when applied to well-run departments

C, D, E

Which nursing intervention has the greatest impact on health care cost for an elderly client diagnosed with end-stage renal failure and diabetes mellitus? A) Advocating for the client's right to request do not resuscitate status B) Ensuring that the client has sufficient in-home care C) Discharge planning that focuses on early signs of relapses in chronic conditions D) Requesting a social service consult to assess the client's financial status

C. Discharge planning that focuses on early signs of relapses in chronic conditions. As discharge advocates, nurses can ensure appropriate discharge instructions and proper follow-up—especially for patients with one or more chronic conditions—to reduce costly readmissions to the hospital and significantly reduce costs. The other options are directed toward quality of life.

Who recruited African American nurses during WWll?

Cadet Nurse Corps

CMS

Centers for Medicare & Medicaid Services- federal

What was the National African-American nursing society who had chapters throughout the country?

Chi Eta Phi

Values

Customs, ideas of life, and ways of behaving that society regards as desirable

A nurse is preparing a scholarly publication on the prevalence of hepatitis A worldwide. The most efficient and effective means of conducting an Internet search to gather information for this publication is to use: a. a search engine such as Google or Yahoo. B. a consumer health website. C. a decision support system. D. MEDLINE database.

D

A nurse who is teaching a class to introduce telehealth to the staff would include which example? A. A robot performs menial housekeeping chores for an invalid patient. B. A computer software program alerts the nurse or physician who is reviewing orders that an order for a new drug can cause synergy of the theophylline inhaler. C. A physician speaks into a computer, and the admission history is recorded and saved in the patient file. D. While a patient in Wyoming performs peritoneal dialysis, a nurse watches remotely from California to ensure that all steps are being followed correctly

D

How does a never event have a negative impact on the cost of health care? A) They are directly related to the client's noncompliance with prescribed care. B) The cost of such care significantly increases the cost to the client's copay. C) Insurance companies are reluctant to reimburse hospitals for such care. D) Medicare will no longer pay for client care that result from such events.

D

Which statement most effectively defines what a budget is? A) A document that typically includes direct payment for hours worked, benefits received, and taxes paid by employees B) Amount spent on items that have value to the working of an organization in the delivery of care and services C) A 12-month period used for calculating an annual report to explain expenses and project needs regarding the delivery of services D) A plan for the distribution of the organization's resources and a control for making sure that results support that plan

D. A plan for the distribution of the organization's resources and a control for making sure that results support that plan. A financial plan for the allocation of the organization's resources and a control for ensuring that results comply with the plan is referred to as a budget. Capital expenditures are the amount spent on items that will have long-term (greater than 1 year) value to an organization. A fiscal year is a 12-month period used for calculating annual (yearly) financial reports. A salaries, wages, and benefits (SWB) document describes payment for hours worked, benefits received, and taxes paid by employees.

How does a never event have a negative impact on the cost of health care? A) They are directly related to the client's noncompliance with prescribed care. B) The cost of such care significantly increases the cost to the client's copay. C) Insurance companies are reluctant to reimburse hospitals for such care. D) Insurance companies are reluctant to reimburse hospitals for such care.

D. Medicare will no longer pay for client care that result from such events. As advocates for patient safety, nurses can have a significant effect on the hospital's bottom line by preventing hospital-acquired conditions such as injuries from falls and hospital-acquired infections. Hospitals are no longer paid by Medicare for the cost of treating specified medical errors, commonly referred to as never events, which are largely preventable and have serious consequences for patients.

What cost would be considered an indirect cost to the delivery of maternity care at an acute care hospital? A) The cost of nursing salaries to ensure adequate staffing B) The cost of antibiotics given to newborns on the unit C) The cost of replacement linens D) The cost of maintaining a security system to protect against abductions

D. The cost of maintaining a security system to protect against abductions. Costs that are incurred as a result of the organization's operating expenses but are not directly related to providing the unit-of-service (such as the cost of security systems) are referred to as indirect costs. Direct costs such as medications, supplies, and salaries vary with changes in client census and can be traced directly to the production of the unit-of-service.

The ethical decision-making model is applicable to both the ____ _____ and ______ levels

Daily practice; policymaking

EHR interoperability

EHR systems that have the ability to share and transfer patient data seamlessly across health care systems and settings in a standardized manner that protects the reliability, confidentiality, privacy, and security of the information

Define value system

Entire framework on which actions are based

Purposes of ethical principles

Establish common ground among nurse, patient, family, health care professionals, and society for discussion of ethical questions and ethical decision making -Permit people to take a consistent position on specific or related issues -Provide an analytical framework by which moral problems can be evaluated

_____ ______ is a system of principles by which a person can determine what ought and ought not to be done

Ethical theory

Cultural sensitivity

Experienced when neutral language, both verbal and nonverbal, is used in a way that reflects sensitivity and appreciation for the diversity of another

Legal liability

Failure of a person or an entity to meet legally defined responsibilities and allows a lawsuit for resulting damages

Malpractice

Failure of a professional to meet the standard of conduct that a reasonable and prudent member of his or her profession would exercise in similar circumstances that results in harm. The professional's misconduct is unintentional

Negligence

Failure to act in a manner that an ordinary, prudent person would act in similar circumstances that results in harm. The failure to act in a reasonable and prudent manner is unintentional

Medicare

Federal for disabled, persons with ESRD and persons over 65 who qualify for SS benefits

Health care law

Federal, state, and local laws and associated rules and regulations applicable to the health care industry and health care workers

Budget

Financial plan for the allocation of the organization's funds and a control for ensuring that results comply with the plan

A business establishes a consistent 12-month period to use for calculating annual financial reports referred to as their _________________

Fiscal year. Fiscal year is a 12-month period used for calculating annual (yearly) financial reports in business; the fiscal year does not have to constitute the calendar year (January to December) but may be any 12-month period (i.e., August through July) established and maintained consistently by the business.

Susto

Fright sickness

What is the scale of attitudes toward culturally diverse groups?

Hate-Contempt-Tolerance-Respect-Celebration

Empirical

Having a foundation based on data gathered through the senses rather than purely through theorizing or logic

The life expectancy of whites is 78 years; it is 72.7 for African Americans. What is this an example of?

Health disparity

What are the highest and lowest represented minorities in nursing?

Highest- African Americans; Lowest- American Indians

___ _____ is respect for the inherent worth and uniqueness of individuals and populations

Human dignity

What are recent population trends with immigrants and the elderly

Immigration laws have increased the number of immigrants. The number of adults over both 65 and 85 has increased

Standard of care

In civil cases, the legal criteria against which the nurse's conduct is compared to determine whether s negligent act or malpractice occurred; commonly defined as the knowledge and skill that is ordinary, reasonably prudent person would possess and exercise in the same or similar circumstances

Stakeholder

Individual who has an interest in and may be affected by policy

Stakeholders

Individuals, groups, or organizations who have a vested interest in and may be affected by policy decisions and actions being taken, and thus may attempt to influence those decisions and actions

What is bioethics

Interdisciplinary field within health care that has evolved with modern medicine to address questions that arise as science and technology produce new ways of knowing

Ethical challenge of veracity

Issues of alternative treatments and acknowledgment of uncertainty test truth-telling -Which treatment is best for the patient? Which new drug should be used?

Minorities have limited access to health care insurance & health care. Why?

Joblessness, homelessness, poverty. The high cost of insurance & lower wages make it difficult for minorities to access health care.

Statute or statutory law

Law enacted by a legislative body; separate from judge-made or common law

Licensing Laws

Laws that establish the qualifications for obtaining and maintaining a license to perform particular services. Persons and institutions may be required to obtain licenses to provide particular healthcare services

Immunity

Legal doctrine by which a person is protected by a lawsuit for negligent acts or an institution is protected from a suit for the negligent acts of its employees

Vicarious liability

Legal doctrine in which a person or institution is liable for the negligent acts of another because of a special relationship between the two parties; a substituted liability

Respondeat superior

Legal doctrine that holds an employer indirectly responsible for the negligent acts of employees carried out within the scope of employment; a Latin phrase meaning "let the master answer"

Res ipsa loquitor

Legal doctrine that holds an employer indirectly responsible for the negligent acts of employees carried out within the scope of employment; a Latin phrase meaning "the thing speaks for itself"

What are some bioethic dilemmas for health professionals?

Life & death, quality of death, right to decide, informed consent, alt. treatments, stem cell research, therapeutic/reproductive cloning, IVF, surrogates, organ transplants,

What are the three different beliefs about environmental control?

Mastery over nature, subject to nature, harmony with nature

Supplies

Materials used in performing tasks within the organization; typically include clinical disposables, pharmaceuticals, and office supplies

Punitive damages

Monetary compensation awarded to an injured person that goes beyond what is necessary to compensate for losses and is intended to punish the wrongdoer

Damages

Monetary compensation the court orders paid to a person who has sustained a loss or injury to his or her person or property through the misconduct of another

Revenue

Money that a healthcare organization received in exchange for providing healthcare or other related services through normal business activities; synonymous with income

_____ ________ is forming a worldview and value system through an evolving, continuous, dynamic process that moves along a continuum of development

Moral development

Swedish Massage

Most prevalent form of massage; uses long strokes, friction, and kneading of muscles

Before World War ll, who recruited African America nurses?

National Association of Colored Graduate Nurses (NACGN)

Cultural competence in nursing education

Need to teach... -Beliefs/practices of various cultural groups -Disease prevalence and mortality rates -Cultural factors related to situations (birth, death) -Specific culture-bound syndromes -Roles/responsibilities of family members

Criminal negligence

Negligence that indicates "reckless and wanton" disregard for the safety, well-being, or life of an individual; behavior that demonstrates a complete disregard for another, such that death is likely

What was one of the first written code of ethics in nursing

Nightingale pledge

What are the three different types of family structures?

Nuclear families, single parent families, extended families

Breach of duty

Occurs when one person or company has a duty of care toward another person or company but fails to live up to that standard

Paternalism

On the basis of the health care provider's belief about what is in the best interest of the patient, he/she chooses to reveal or withhold patient information such as diagnosis, treatment, or prognosis

Define value

Personal belief about worth that acts as a guide to behavior

Anglo-American Values vs. Other cultures

Personal control vs. fate; Change vs. tradition; Time vs. human interaction; Human equality vs. hierarchy/rank/status; Individualism vs. group welfare; Self help vs. cooperation

Lobbying

Persuading, educating and or convincing

Prejudice

Preconceived, deeply held, usually negative, judgment formed about other groups

Risk management

Process of identifying, analyzing, and controlling risks posed to patients; involves human factor and incident analysis, changes in systems operations, and loss control and prevention

____ __ ______ is when a nurse must remove themselves from a decision because they are not able to respect the wishes of a patient

Right of conscience

What is utilitarianism

Rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or the fewest possible bad consequences -Strongest approach for bioethical decision making

Ethics

Science of study of moral values

In the 1960s and 70s, how did they try to recruit economically disadvantaged nurses?

Sealantic Fund- Rockefeller Foundation "Breakthrough to Nursing"

culture

Shared values, beliefs, and practices of a particular group of people that are transmitted from one generation to the next and are identified as patterns that guide thinking and action

Empacho

Sharp pains brought on by food lodged in the intestinal tract

_____ ____ is acting in accordance with fair treatment regardless of status, race, ethnicity, age, citizenship, disability, or sexual orientation

Social justice

Standards of Practice for Culturally Competent Nursing Care

Social justice, critical reflection, knowledge of cultures, culturally competent practice, cultural competence in health care systems and organizations, patient advocacy and empowerment, multicultural workforce, education and training in culturally competent care, cross-cultural communication, cross-cultural leadership, policy development, and evidence-based practice and research

Decision support tools

Software programs that process data to produce or recommend decisions by linking with an electronic knowledge base controlled by established rules for combining data elements; the knowledge base and rules mimic the knowledge and reasoning an expert health professional would apply to data and information to solve a problem

Medicaid

State & fed program that pays for medical services for persons who are elderly, poor, blind, or disabled and certain families with dependent kids meeting specified income levels

platform

Statement of principles and policies

Budget assumptions

Statements that reflect issues affecting the future performance of the organization; used as the framework for developing the budget

What are nursing ethics

System of principles that govern the actions of the nurse in relation to patients, families, other health care providers, policymakers, and society

Qualitative research

Systematic, subjective approach used to describe life experiences and give them meaning

Feldenkrais Method

Teaches movement re-education by using gentle manipulations to heighten awareness of the body; based on belief that each person has an individualized optimal style of movement

Point-of-Care technology

Technologies that allow real-time data retrieval, documentation, and decision support at the bedside or wherever direct care is provided

Fidelity

The agreement to keep promises and commitments, based on the virtue of caring

Nursing Practice Act

The body of state law that sets out the scope of practice and responsibilities of the registered nurse in order to protect the health and welfare of individuals or communities under the care of the registered nurse

Nursing case law

The body of written legal opinions developed by judges through court decisions that eventually contribute to the expected standard of nursing conduct

Rights of conscience

The civil right that protects conscientious health care providers against discrimination, allowing them the right to act according to the dictates of the consciences

Plaintiff

The complaining person in a lawsuit; the person who claims he or she was injured by the acts of another

Ethics acculturation

The didactic and experiential process of developing ethical reasoning abilities as a part of ongoing professional preparation

variance

The difference between the planned budget and the actual results

Assignment

The distribution of work that each staff member is responsible for during a given work period; includes routine care, activities, and procedures that are within the staff member's authorized scope of practice and/or job description

Justice

The equal and fair distribution of resources, regardless of other factors

Information technology

The hardware and software that enable information to be stored, retrieved, communicated, and managed

Defendant

The individual who is named in a person's complaint as responsible for an injury; the person who the plaintiff claims committed a negligent act or malpractice

Electronic health record (EHR)

The longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting; has the ability to support other care-related activity such as evidence-based decision, support, quality management, and outcomes reporting

Variance analysis

The process of analyzing the differences in the planned budget results and the actual results; involves quantitative and qualitative analysis

Platform

The statement of principles and policies of a political party, candidate, or elected official

Nurses must examine whose value system closely for values clarification

Their own

Accountability

To be answerable to oneself and others for one's own choices, decisions, and actions

_______________ nursing programs are increasing to become more knowledgeable in several cultures

Transcultural

The __________ ________ ______ offers certification as a transcultural nurse

Transcultural Nursing Society

Trager Approach

Use of gentle, rhythmic rocking and touch to promote relaxation and energy flow

Rolfing (structural integration)

Use of manual manipulation and stretching of body's fascial tissues to establish balance and symmetry

______ __________ is a process by which people attempt to examine the values they hold and how those values function as part of the whole

Values classification

Difficult ethical questions to answer

What is safe care? When staffing is inadequate, what care should be accepted or refused? What does it mean to be ill or well? What's the proper balance between science/technology and the good of humans? How much do we allow science to experiment with the origins of life?

Advance directives

Written or verbal instructions created by the patient that describe specific wishes about medical care in the event he or she becomes incapacitated or incompetent. Examples include living wills and durable powers or attorney

DRGs (diagnosis-related groups)

a common method of reimbursement for healthcare services based on a predetermined fixed price-per-diagnosis

EHR "meaningful use"

a defined set of EHR capabilities and standards that EHR systems must meet to ensure that their full capacity is realized and for the users to quality for financial incentives from Medicare

Patient Protection and Affordable Care Act (PPACA)

a federal statute enacted in 2010 that requires US citizens and legal residents to have health insurance through comprehensive health care reform; expands health care coverage access to millions of people who were previously uninsured

Medicare

a federally funded health insurance program for the disabled, persons with end-stage renal disease, and persons 65 years of age and older who qualify for Social Security benefits

Naturalistic paradigm

a holistic view of nature and the direction of science that guides qualitative research

Patient outcome

a measurable condition that results from interventions by the healthcare team; a change in a person's health after treatment; outcomes may be positive or negative

Survey

a nonexperimental research design that focuses on obtaining information regarding the status quo of a situation, often through direct questioning of participants

Clinical nurse leader

a nurse with an advanced degree who is a clinical expert in the care of a distinct group of patients, and who may provide direct patient care

Meta-analysis

a procedure for statistically combining the results of many different research studies

Peer review

a process by which a scholarly work is checked by a group of experts in the same field to make sure it meets the necessary standards before it is published or accepted

Ethnography

a qualitative research method for the purpose of investigating cultures that involve data collection, description, and analysis of data to develop a theory of cultural behavior

Seconary analysis

a research design in which data previously collected in another study are analyzed for different aims than the original study

When considering the financial aspects of business, the term income is synonymous with the term ________________________

a revenue. Revenue is money that a health care organization receives in exchange for providing health care or other related services through normal business activities; synonymous with income.

Health policy

a set course of action(s) undertaken by governments or healthcare organizations in order to achieve a particular health outcome; private health policy is made by healthcare organizations, such as hospitals, whereas public health policy refers to local, state, and federal legislation, regulations, and court rulings that govern healthcare within a certain area

Pilot study

a small study carried out to test the feasibility of a larger one

Labor budget

a subset of the operating budget; allocates funds for salaries, overtime, benefits, and staff development and training

Reiki

a therapy that uses techniques to direct universal life energy to specific sites

Quasi-experimental research

a type of quantitative research study design that lacks one of the components of an experimental design

Consumers expect _____ and precise information revealed in an _____ and respectful manner

accurate; honest

Integrity

acting in accordance with an appropriate code of ethics

Social justice

acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation

Capital budget

allocates funds for construction projects and/or long-life medical equipment, such as cardiac monitors, defibrillators, and computer hardware

Operating budget

allocates funds for daily expenses, such as salaries, utilities, repairs, maintenance, and patient care supplies

Nursing care delivery model

also called care delivery system or patient care delivery model; details the way work assignments, responsibility, and authority are structured to accomplish patient care; depicts which healthcare worker is going to perform what tasks, who is responsible, and who has the authority to make decisions

Health Insurance Exchange

also known as the "health insurance marketplace," an online market place for individuals to shop for and purchase health insurance at affordable rates and identify whether they qualify for cost assistance subsidies to help pay the cost of the insurance; states established health insurance exchanges as a component of the Patient Protection and Affordable Care Act to provide access to affordable health insurance options for American citizens and legal residents

Clinical nurse specialist

an APRN who is an expert clinician in a specialized area of practice

Clinical nurse specialist

an advanced practice nurse who provides direct care to clients in a particular field for direct application in clinical environments

Zero-based budgeting

an approach to budget development that begins as though the budget were being prepared for the first time

Beneficence

an ethical principle of compassion and patient advocacy, stating that one should do good and prevent or avoid doing harm

Clinical practice guidelines

an evidence-based guide to clinical practice developed by experts in a particular field for direct application in clinical environments

Preventable adverse event

an injury caused by medical management rather than the patient's underlying condition. An adverse event attributable to error is a preventable adverse event

Durable power of attorney for healthcare

an instrument that authorizes another person to act as one's agent in decisions regarding healthcare if one becomes incompetent to make one's own decisions

Tuskagee Syphilis Study

an unethical study from 1929 to the 70s, U.S. Public Health Service sponsored a study in which poor, uneducated African-American men in Alabama suffered and died of untreated syphilis while researchers studied the severe physiological disabilities that appear in advanced stages of the disease. Even when penicillin to treat the disease was available

Jewish Chronic Disease Hospital Study

an unethical study involving the injection of cancer cells into subjects without their consent

13. period shortened and are being placed in charge nurse positions. The nurse has documented unsafe care and decisions by these novice nurses. To be protected from retaliation by the employer, this nurse must "blow the whistle" by doing what? a. Holding a public forum in the agency cafeteria to discuss concerns b. Reporting concerns to state and/or national agencies regulating the agency c. Calling coworkers outside the workplace to informally discuss wrongdoing d. Contacting The Joint Commission to report unsafe conditions

b. Reporting concerns to state and/or national agencies regulating the agency

Empirical

based on observation or experiment

Clinical practice must be...

based on scientific knowledge

Minority populations are less knowledgeable about specific health problems, especially the prevalence of ______

cancer

Clinical pathway

clinical management plans that specify the optimal timing and sequencing of major patient care activities and interventions by the interprofessional team for a particular diagnosis, procedure, or health condition and that are designed to standardized care delivery; may also be called critical paths, practice protocols, or care maps

Staff max

combination of categories of workers employed to provide patient care

Altruism

concern for the welfare of others

Pilot study

conduct of a smaller version of a proposed study that develops or refines methodology prior to use in a larger study

In determining whether this staffing concern should be reported to an outside agency, the nurse understands that what statement is true concerning the process identified as "whistle-blowing"? a. Reporting unsafe staffing levels to The Joint Commission provides protection from the employer. b. Keeping copies of documented inappropriate staffing patterns in the nurse's personal file is illegal. c. When observing inappropriate staffing, the nurse should record his/her personal thoughts concerning the outcomes. d. One should seek guidance from a trusted individual who can provide an objective point of view.

d. One should seek guidance from a trusted individual who can provide an objective point of view.

What happened between 1970-1980?

doctorally prepared nurses are doing research and improving patient care

Staffing

ensuring that an adequate number and mix of healthcare team members are available to provide safe, quality patient care

Efficiency

extent to which resources (energy, time, money) are used to produce intended result

Three basic organizational needs that are affected by staffing

financial resources, licensing regulations and TJC or other accreditation standards, and customer satisfaction

Quantitative research

formal, objective, systematic process used to describe and test relationships and examine cause and effect interactions among variables

Components of the research process

formulating the research question or problem; defining the purpose of the study; reviewing related literature; formulating hypotheses and defining variables; selecting the research design; selecting the population, sample, and setting; conducting a pilot study; collecting the data; analyzing the data; communicating conclusions

Key functions of the EHR

health information and data capture; results/data management; provider order entry management; clinical decision support; electronic communication and connectivity among providers, the healthcare team, and patients; patient support; administrative process support; and reporting and population health management

Naturalistic paradigm

holistic view of nature and the direction of science that guides qualitative research

What is the mission of the AHRQ?

improve quality, safety, efficiency, and effectiveness of health-care for all Americans

Cultural humility

incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-clinician dynamic, and to developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations

Patient acuity

indication of the severity of the patient's illness and the amount and complexity of nursing care required; high acuity indicates a need for more intense, complex nursing care, and lower acuity indicates a need for moderate, less complex nursing care

Unlicensed assistive personnel (UAP)

individuals who have not received practice licenses but who are trained to function in an assistive role to the RN by performing patient care activities as delegated by the nurse; may include nursing assistance, clinical assistants, orderlies, health aides, and those with other titles designated within the work setting

Metasynthesis

interpretive translations produced from the integration or comparison of findings from qualitative studies

Common law

law that is created through the decisions of judges as opposed to laws enacted by legislative bodies

Patient classification system

method used to group or categorize patients according to specific criteria and care requirements and thus help quantify the patient acuity, or amount and level of nursing care needed

Integrative research review

methodology that simultaneously synthesizes several experimental and non-experimental research findings to provide a comprehensive understanding of the phenomena of interest

What happened in the 1980's?

more qualified nurse researchers, computers help with statistics and data, realization that research is vital to nursing

Doctor of nursing practice

nurses who earn a PhD in nursing - required to assume advanced practice roles such as nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist

What was researched between 1900 and 1940?

nursing education - student satisfaction and what kind of person becomes a nurse

Single payer

one payer (usually feds) pays all HC expenses, funded by taxes

Three types of budgets

operating budget, labor budget, capital budget

Third-party payer

organization other than patient and provider, such as insurance co that assumes responsibility for payment

Grassroots lobbying

personal advocacy by individual constituents - everyday citizens - in support of a problem/position/option related to a policy issue

Autonomy

personal freedom and the right of competent people to make choices

Components of health traditions assessment model

physical, mental, spiritual

Effectiveness

production of a desired outcome; taking the right action to achieve the expected result

grant

proposal developed to seek research design used to collect and analyze data aiming to develop theories grounded in real-world observations

Functions of a palliative nurse

provides age-appropriate culturally, ethically, and spiritually sensitive care and support; maintains a safe environment; educates patients/families to identify appropriate settings and treatment options; ensures continuity of care and safe transitions to the next appropriate setting; coordinates care across settings and among caregivers; manages information and protects confidentiality; communicates promptly and effectively

Phenomenology

qualitative research design employing inductive descriptive methodology to describe the lived experiences of study participants

Clinical practice guidelines

recommendations based on evidence that serve as useful tools to direct clinical practice

Clinical practice guidelines

recommendations for appropriate treatment and care for specific clinical circumstances; guidelines are developed through a systemic process to integrate the best evidence for treating specific medical conditions and assist healthcare providers to make decisions about appropriate treatment

DRG

reimbursement for health care services based on predetermined fixed price-per-case or dx

Retrospective payment system

reimbursement to HCP for services rendered and billed "fee-for-service" - over serviced to get

Prospective payment system

reimbursement to HCP on a predetermined amount based on pt dx "set price per dx"

Capitation

reimbursement to providers in which insurance company pays provider a set payment per month - per-member-per-month payment

Methodologic

research design used to develop the validity and reliability of instruments that measure research concepts and variables

Florence Nightingale

research during the Crimean War

Quantitative research

research that collects and reports data primarily in nume​rical form (survey and analysis)

Qualitative research

research that relies on what is seen in field or naturalistic settings more than on statistical data (phenomenology, ethnography, and grounded theory)

Practice guidelines

research-based recommendations stated as standards of practice, procedures, or decision algorithms

Human dignity

respect for inherent worth and uniqueness of individuals and populations

Autonomy

right to self-determination

Bioethical dilemmas are dilemmas that pose a choice between perplexing alternatives in the delivery of health care because of the lack of a clear sense of _____ vs. ____

right vs wrong

Regulations

rules used to implement legislation and translate concepts into actions that can be put into practice

Meta-analysis

statistical method of quantitative synthesis of findings from several studies to determine what is known about a phenomenon

Needs assessment

study in which the researcher estimates the resource needs of a group

Control group

subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. When a true experimental design is not used, this group is called a comparison group

What does the NINR do?

supports research on biological and behavioral aspects of critical health problems that confront the nation

What are the themes of the NINR?

symptom science, wellness, self-management, and end of life and palliative care

Effectiveness

taking the right action to achieve the expected result

Alexander technique

teaches improved balance, posture, and coordination by using gentle hands-on guidance and verbal instruction

What was researched from 1940-1970?

teaching, administration, and curriculum

Competency

the ability of an individual to perform defined behaviors proficiently by demonstrating the appropriate knowledge, skills, attitudes, and professional judgment required for a specific role or setting

supervision

the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity or task

randomization

the assignment of subjects to treatment conditions in a random manner

efficiency

the extent to which resources, such as energy, time, and money, are used to produce the intended result

Centers for Medicare and Medicaid Services (CMS)

the federal government agency that administrers Medicare and Medicaid

generalizability

the inference of findings can be generalized from the sample to the entire population

GDP (gross domestic product)

the measure of the total value of goods and services produced within a country; the most comprehensive overall measure of economic output; provides key insight into the driving forces of the economy

Full-time equivalent (FTE)

the number of hours worked or paid that is equal to that expected of a full-time employee working a 40-hour workweek

Data collection

the process of acquiring existing information or developing new information

Evidence-based practice

the process of systematically finding, appraising, and using research findings as the basis for clinical practice

Evidence-based practice

the process of systemically finding, appraising, and using research findings as the basis for clinical practice

Constituent/State Nurses Association (C/SNA)

the professional organization unit member of the ANA that represents all professional nurses within a state or territory or other defined organizational entity or boundary

Ethnography

the scientific study of the customs of individual peoples and cultures.

bioethics

the study of ethical problems resulting from scientific advances

Phenomenology

the study of individuals' own unique, first-person, conscious experience.

Grounded theory

the study of social processes

triangulation

the use of a variety of methods to collect data on the same concept

Triangulation

the use of multiple methods to study one research question

Health information technology

the use of various forms of technology to improve the quality of health services to individuals and communities

Why does nursing exist?

to provide high-quality nursing care to individuals in need of health-promoting, health-sustaining, and health-restoring strategies

What is the outcome of research?

to put the knowledge gained in healthcare delivery

Delegation

transferring to a competent staff member the authority and responsibility to perform a selected nursing task that the staff member would not normally be allowed to perform; the RN retains accountability for the delegated task

Nazi experiments

unethical research using human subjects during World War II