II nursing - C
A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet multiple service needs of clients and families is known as: a. case management. b. total client care. c. private duty nursing. d. managed care.
a
An overarching organizational strategy to ensure accountability of all employees, to incorporate evidence-based health care quality indicators, and to improve care delivered to various populations is best known as: a. the accreditation and certification process. b. continuous quality improvement. c. a performance improvement program. d. lean value-stream strategy.
c
A model of population care coordination would include: a. data analysis of population, population needs assessment, identification and selection of health services, multidisciplinary planning, implementation of wellness and prevention interventions, and monitoring/evaluation of care management. b. population needs assessment, prioritization of needs, community wellness resources, provider prevention services, and health education services. c. population needs surveys, community funding, emergency medical services, medical home clinic services, school health programs, and occupational health for workers. d. population needs surveys, community engagement, community planning, emergency medical services, medical home clinic services, school health programs, and occupational health education services.
a
Health care quality and safety principles and practices form the foundation of any accessible, reliable care services. In establishing this foundation, which of the following statements helps guide it? a. The importance is on outcomes rather than process and structure. b. Risk management programs are designed to ensure a high level of quality. c. Three areas in which quality can be measured are structure, process, and cost. d. When an incident report is filled out, it absolves the person from responsibility for the occurrence.
a
Identify the elements of organizational structure that address patient safety. What structural changes do you recommend for further improving safety in an organization using organizational design principles? a. Empowering employees to report problems or potential problems, encouraging innovations and improvements in processes, and rewarding continual learning and exploration b. Keeping administrators out of the way of staff and allowing staff to improve the environment in their organization c. Safety teams, who evaluate near-misses and report errors to know who risk managers should discipline, direct educational offerings d. Root cause analysis when a problem is reported so that all aspects of an error situation can be avoided
a
Shared governance requires slow, gradual development, role modeling, and mentoring by nurse leaders, and continual coaching, nurturing, and education for nursing staff and management. Select the statement that is an accurate statement about shared governance. a. Shared governance models empower nurses to provide quality care and efficient point-of-service expertise. b. All clinical nurses are in favor of a shared governance system in which accountability and decision making are encouraged. c. Implementation of shared governance systems is costly and requires considerable time and effort. d. Shared governance remains out of reach to some and a simple process to others.
a
The integration and coordination of health services to a specified population of individual patients has been described as case management. Select the best statement to describe this approach. a. A comprehensive process to identify individuals who would benefit from activities of assessment, problem identification, care planning, care delivery, advocacy, monitoring, and evaluation of care provided for relevance to client and caregiver and health care team's ability to meet desired outcomes and established goals b. A systematic integration and organized way to finance and deliver health care to achieve specific client outcomes, given fiscal and other resource constraints c. A comprehensive integrated approach to care and reimbursement based on the natural course of a disease d. A comprehensive process of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation of resident care activities and rehab services that will promote quality of life and activities of daily living.
a
The organization and individuals engaged in scientific investigation using methods and variables that influence the rate and extent of adoption of practices to improve clinical services is known as: a. translation research. b. evidence-based practice. c. research utilization. d. best practice.
a
What is the administrative and systematic process to be responsive to environment-related and future-oriented changes that are sensitive to the correct positioning of the organization known as? a. Strategic management b. Tactics c. Strategy d. Performance effectiveness
a
When nurses actively engage in making decisions regarding nursing practice, quality of patient care, education, nursing peer issues, and issues in the work environment, what model is likely being used? a. Shared governance model b. Administrative model c. Councilor model d. Congressional model
a
Nurse leaders who encourage transformation through their commitment to the journey will find roles changing. Which of the following statements best describe the role of nurse managers? (Select all that apply.) a. Staff members in decentralized organizations are more accountable because fewer people provide functional supervision, quality monitoring, or unit-specific responsibilities. b. Nurse managers are accountable for transactional processes such as budgets, productivity, and quality monitoring, on top of their roles as coaches, mentors, and leaders to staff nurses. c. Nurses have an opportunity to take leader roles in integrated care networks with shared governance, and the nurse manager's role shifts to one of facilitating, enabling, and supporting the staff personnel. d. Nurses have depth of experience in attending and conducting committee meetings, setting agendas, developing consensus, and dealing with conflict. e. A nurse's individual performance and activities can reduce errors and promote patient-centered care.
a,b,c
Nurses involved in the selection or development of a nursing care delivery system should consider which of the following as important? (Select all that apply.) a. Fiscal accountability, client characteristics, staffing composition, case mix severity, and clinical service intensity b. Practice guidelines and new medication information and technology c. Role of the RN, practice expectations, accountability of nurses, decision making about care, and provider competencies and experience d. Direct and indirect client nursing care interventions, end of shift reporting, physician-prescribed care, and communication e. Reimbursement models within the Affordable Care Act and American Health Care Act that cover preexisting diseases and other illness across a larger insured population
a,b,c,d
Which of the following are the building blocks that nurses should use to develop the organizational structures to support an evidence-based practice environment? (Select all that apply.) a. Incorporate evidence-based practice terminology into mission, vision, strategic plan, and performance appraisals. b. Establish explicit expectations about evidence-based practice for nursing leaders with a culture that values clinical inquiry. c. Demonstrate the value of evidence-based practice through administrative behaviors of the chief nurse executive. d. Educate nurse executives, nurse managers, nurses, physicians, and other health care professionals about the value of evidence-based practices. e. Integrate evidence-based practice into the governance structure of nursing departments and the health care system.
a,b,c,e
Multiple unique goals are achieved with case management services that are different from the goals of managed care. Nurses as case managers contribute to which of these goals? (Select all that apply.) a. Coordinating client-focused care by planning and arranging access to appropriate services and interventions b. Providing nursing interventions to meet diagnosed client needs in the most cost-effective manner c. Seeking to reduce costs, conserve resources, and maximize the value of services d. Tracking outcomes and guiding services across time and settings through ongoing evaluation of assessments e. Measuring access, satisfaction, health care costs, resources and service processes available, and goals of entity
a,b,d
Which of the following describe the four tenets embraced by members of the IOM Committee on Quality of Health Care in America and how these tenets incorporate into nursing practice? (Select all that apply.) a. Nurses use standardization of processes when using nursing diagnoses to identify issues with clients and using nursing interventions to identify best practice to improve client's status. b. Nurses are members of multidisciplinary teams, and people are the problem, not the processes and systems. c. Nurses use assessments to collect patient data to diagnose problems and risk and to identify the state of optimal health care across the continuum. d. Using the methodology of PDCA (plan-do-check-act) is like the nursing process. e. Nurses depend on quality department to get data to evaluate quality and cost-effectiveness for complying with accreditation and regulatory compliance with reporting.
a,c,d
New policies, programs, projects, and services are developed to meet the needs of patients. Which statements are descriptions of when nurses take steps to use these items? (Select all that apply.) a. Strategic management is the processing of an organization's vision or mission. b. Strategic planning is a process of developing an action plan for actualizing the mission. c. Strategic management is nurses making decisions about the delivery of care. d. Nurses use strategic planning to help them meet personal and professional goals. e. Nurses use the principles of strategic planning with other stakeholders to explore programs, projects or services to promote population health, patient satisfaction, and decreased health care costs.
a,c,e
Quality can be defined in which of the following ways? (Select all that apply.) a. When outcomes compare favorably with standards b. When activities and interventions are examined c. The measurement of effectiveness, efficiency, benefits, and appropriateness of care services d. The existence of a program or actions to show effort in the pursuit of excellence e. When higher volume of procedures is associated with lower mortality
a,c,e
A complex combination of a hierarchical structure with project teams is the definition of which type of organization structure? a. Decentralized b. Matrix c. Centralized d. Divisionalized
b
A number of industry-based models for quality management and measurement have been adopted by the health care industry over the past two decades. The model that provides a holistic approach to enterprise transformation and focuses on stakeholder's value propositions and interdependencies to determine effective processes before achieving efficiency in work flow across the enterprise would be: a. Six Sigma. b. Lean Enterprise. c. High-Reliability Organization. d. Baldrige National Quality Award (BNQA).
b
Although all clients need coordinated care, population health management best serves the needs of targeted, high-risk populations for: a. coordinating the care of the individual client in relation to one or more diseases or health conditions after hospitalization. b. building personal relationship to identify knowledge deficits, counseling needs, facilitate monitoring, treatment adherence, and stabilization. c. a specific disease or health condition of a population group, with subsequent application to individuals over time. d. managing services for patients using beyond what is typically expected in order to reduce cost and focus on only necessary medical services.
b
Implementation of a strategic plan can be accomplished when a priority order for achieving the strategic objectives or outcomes exists, responsibility for achieving these objectives has been determined, and some available financial support is provided within an expected timetable. The role of nurses would include: a. finding out who is responsible for the implementation. b. waiting to implement until administration develops an action plan that breaks the plan into manageable parts. c. integrating the strategy into daily activities and keeping the strategy a major agenda item for their nursing department or service. d. waiting until the workable action plan is presented by nurse leaders.
c
Managers and executives in practice will struggle to make decisions regarding staffing and practice to achieve best outcomes. Staffing levels have often but not always been associated with a number of unfavorable outcomes, including increased surgical mortality, failure to rescue, and rates of complications due to errors in care such as urinary tract infections, intravenous line infections, decubitus ulcers, and patient falls. Managers and executives can take steps to: a. review the literature in nursing outcomes research to find a valuable point of reference for managers that lowering staffing levels and skill mix in hospitals associates with decreased risk of negative outcomes. b. identify and use data systems that are comprehensive for outcomes management in order to support the monitoring of nursing-sensitive outcomes and establish continuous monitoring of outcomes against internal and external benchmarks using a national database of quality indicators. c. use a wealth of information available to them and hire data analysts and others to determine what data indicate a need for action. Incorrect d. contribute unit-specific data on nursing-sensitive indicators to a national nursing database registry and use balanced scorecard for administrative discharge data evaluation.
b
The accountable care organization (ACO) will need to measure progress toward optimized population health. The measures for the ACO would include: a. benchmarks that provide frames of reference against which an organization can compare itself relative to others. b. population health measures on clinical process and outcome indicators, patient satisfaction, functional status, quality of life, economic and utilization indicators, and changes in health disparities. c. structured care methodologies, such as critical pathways or streamlined interdisciplinary tools, identification of best practices, facilitated standardization of care, quality enhancement, and outcomes measurement. d. variances identifying positive and negative differences between what was expected from a standard and what actually occurred with client- and family-related, systems-related, or provider-related factors.
b
The degree to which a client or population with common personal or environmental characteristics continues a negotiated treatment is a parameter. To measure this indicator in a community or interdependent organizations, such as ACOs, would be: a. compliance. b. adherence. c. maintenance. d. noncompliance.
b
Valid, reliable, and operationally defined measures that are important, feasible, and have clinical logic and measurement properties are known as: a. end results. b. indicators. c. outcomes. d. findings.
b
Variables that influence nursing practice and client care delivery include: a. client-centered versus task-focused versus provider-focused perspective. b. skill mix for client condition severity, nurse-to-client ratio, use of temporary staff, workload, nursing education and experience, and technology level. c. medical home structure for more integrated or coordinated between acute and primary care. d. RN preparation, critical thinking, and delegation skills.
b
Which of the following describes ways in which nurse managers can create an environment devoted to health care safety? a. Developing a punitive work environment to remove staff who lack behaviors for safety b. Establishing a culture of safe, effective, patient-centered, timely, efficient, and equitable care c. Examining processes and systems issues regarding people, providing feedback, and rewarding achievement of safety goals d. Mentoring others toward the goals of excellence and finding external data for comparison
b
Leaders and managers should know the many aspects of case management. Identify the two correct statements. (Select all that apply.) a. Case management focuses on continuity of the plan. b. Case management entails providing holistic care, conservation of resources, and care across episodes and settings. c. A current trend is the push for accountability and accreditation for case management organizations. d. Case management frequently is associated with health maintenance organizations and preferred provider organizations. e. Case management is focused on stabilization of costs and clinical care for chronic disease and recovery from debilitating injury and accomplished by frequent phone communication.
b,c
Changing the operational process of an organization is often necessary when adding or updating patient care and health information technologies. Three key dimensions of the organization design to engage in making this change are: (Select all that apply.) a. linear process. b. centralization. c. coordination. d. formalization. e. position specialization.
b,c,d
What are two health care trends that can affect the use for measuring and managing outcomes? (Select all that apply.) a. The lack of documentation of effectiveness of client services and the variations in practice have triggered the demand for outcomes measurement. b. Management decision making should be evidence based wherever possible in order to optimize quality of care. c. Pay-for-performance reimbursement systems provide for direct payment of services if within a medical home model. d. Cost-containment strategies often involve a focus on decreasing staff coverage or reducing the proportions of registered nurses in staff mixes without forethought to the potential consequences. e. Measuring nursing-sensitive patient outcomes and nursing interventions within health care's Big Data systems will require skilled data analysts and less effort by nurses.
b,d
A health care organization plans to integrate an electronic health record (EHR), health information network, and clinical data analysis into all clinical areas. Using the five theories of organization as a social system would put forward to manage the challenge, which approach is best for nursing? a. Scientific management school where leaders choose a single best technology and implementation process for the organization with EHR implementation in all units and settings b. Classic management theory where a top-down approach is used, and administration selects the system and determines the implementation process c. Open systems theory where the leaders emphasize the dynamic interaction and interdependence of the organization with its external environment and internal subsystem d. Bureaucratic theory where leaders aim toward mass production and technical efficiency in implementing an EHR system
c
A strategy of demonstrating an opportunity for improvement at baseline, outlining current practice related to specific care process indicators is: a. outreach or academic detailing. b. change champions. c. performance gap assessment. d. audit and feedback.
c
Outcomes management is a process that can be described accurately by which of these statements? a. Outcomes management provides relatively little data for internal use in health care organizations. b. Effects of outcome management are used as measures of all three of Donabedian's (1985) aspects of quality: structure, process, and outcomes. c. Outcomes management is an interdisciplinary process designed to provide quality care, decrease fragmentation, and constrain costs. d. Variances with outcome management are complex, interactive, and only occur at a single level, such as that of organization level.
c
Similarities between the nursing process and the strategic planning process allow nurses to shortcut the learning curve and begin to move forward with the implementation phase. Strategic management involves: a. assessing the nursing mission, diagnosing outcomes for needed services, developing a plan to achieve the outcomes, implementing the strategies, and evaluating the changes toward the outcome. b. identifying the organization's needs, establishing the purpose for new services, planning the action steps, and evaluating the outcomes for the new services. c. developing a strategic mission or vision, setting objectives, developing strategies to achieve the objectives, implementing the strategies, and evaluating the results. d. assessing the service needs, planning goals and objectives, implementing the action plan, and evaluating the goals and objectives.
c
The individual in a clinical nurse specialist role would be known as holding the: a. analyst position. b. line position. c. staff position. d. support staff position.
c
When clients are grouped together and cared for by one nurse, this is known as: a. functional nursing. b. team nursing. c. group nursing. d. primary nursing.
c
Leadership is necessary across all organizational levels, and different roles can support implementing evidence-based changes. Which of the following roles are important to the success of this transformation of practice? (Select all that apply.) a. Senior leaders b. Medical staff directors c. Chief nurse executives d. Opinion leaders e. Project director
c,d
Implementation of a shared governance model is best accomplished when which of the following steps are considered within the organization? (Select all that apply.) a. Administrators must justify the initial cost in terms of personnel time, effort, and financial commitment. b. The cost of shared governance is not operationalized into the budget, because the philosophy of accountability must be implemented by someone. c. Organizational executives, managers, and point-of-care staff receive education and support. d. Establish an organizational purpose is to share the work through developing the culture that supports, encourages, and maintains it. e. Offer opportunities for formal empowerment to advance practice and time for nurses' involvement in leading practice.
c,e
A business approach that ensures a competitive advantage over similar enterprises involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. Which of the following statements is correct? a. The best strategic planning is from the top down. b. The strategic planning process is threatening to employees and creates decreased job satisfaction. c. A basic form of strategic planning is a detailed written business plan with a comprehensive market analysis. d. Strategic management involves strategic planning and implementation.
d
A rigorous scientific process used to combine findings from research into a powerful and clinically useful report to guide practice is: a. performance appraisal. b. practice guideline. c. implementation science. d. systematic review.
d
Case managers were deployed to decrease fragmentation; reduce expense by streamlining care; and control costs by linking, advocating, coordinating, negotiating, educating, and monitoring. Today the model that guides hospitals and clinics to case manage is best described in which of the following statements? a. Social services, rehabilitation, and public health have addressed coordination of care for the ill and the poor to manage catastrophic injury or illness. b. Traditional public health nursing has addressed the coordination of client-centered care within the community setting. c. Tertiary care has addressed the treatment of acute, episodic health care conditions. d. Public health guides the health care organization to coordinate and integrate services across the continuum from hospital to community to reduce costs and eliminate redundancy of services.
d
Centralization and decentralization are organizational philosophies about where decision-making authority resides in the institution. What is the best description of centralization and decentralization? a. Confident administrators will decentralize during crisis and centralize during stable times. b. An organization may use selective decentralization for decision making in the functional areas of staffing and operations, while centralizing the decisions of purchasing at very low dollar limits. c. Centralization is the concentration of decision-making authority at the service lines of the organization. d. Decentralization is dispersing decision-making authority throughout the organization.
d
Given the interdisciplinary nature of case management, who would be best in the case manager role? a. Associate degree nurses are skilled in the coordination of client care. b. Geriatric advanced practice nurses are skilled in the coordination of client care for specialized services. c. Registered nurses after 5 years possess expert knowledge, experience, and education and are qualified to be case managers. d. Advanced practice nurses draw on a wealth of knowledge to lead and coordinate the health care team.
d
Nurse managers, in collaboration with nursing leadership, design nursing systems for the provision of client care and the betterment of the organization. Nurse managers should consider which of the following as important? a. Two factors that nurse managers must consider when designing a care delivery system are the type of nursing skilled staff and turnover. b. Mixed model approaches offer a confusing type of nursing care delivery system, with trying to balance nurse's needs with those of clients, physicians, and organizations. c. Models that promote professional practice have implications for job satisfaction, the character of professional practice, and the amount of control staffing leading to turnover. d. They should include staff nurses in the development and selection process of the professional practice model.
d
Professional nurses develop performance and quality improvement programs and conduct evidence-based improvement studies and research. Which statement is true about standards? a. Structure standards measure whether the services provided by the organization make any difference. b. A standard of care is outcome-oriented and focuses on the nurse as a provider. c. Standards can be set only by professional organizations. d. Standards essentially define quality, against which performance and outcomes are measured.
d
The process for determining better scientific evidence on the effect of different treatments on client-centered health outcomes is: a. research using risk adjustment. b. health services research. Incorrect c. outcomes research. d. comparative effectiveness research.
d
Which of the following statements correctly describes case management? a. Primary therapists have therapeutic relationships with the clients and provide primary case management functions. b. Physicians must document the effects of interventions on client outcomes to demonstrate that they can provide cost-effective services. c. Social workers can coordinate care for all patients and provide case manager functions to coordinate health care services for high-risk populations across community, acute, and long-term care settings. d. Registered nurses (RNs) have emerged as the large majority of case managers, especially in hospitals, because of their specialized expertise for the function of determining medical necessity for health care payment and because of care coordination for complex medical discharge planning needs.
d