Leadership

The core element common to all provider interventions in case management (CM), disease management (DM), and population health management (PHM) is:

a. disease preventative care. b. care coordination. c. client-centered. d. population-focused. ANS: B Care coordination is the core element common to all provider interventions in CM, DM, and PHM.

A clinical nurse specialist is meeting one on one with staff nurses while they are working to discuss data about the evidence-based practice. This is known as: a. academic detailing. b. champion coaching. c. individual instruction. d. professional mentoring.

ANS: A Academic detailing is a marketing strategy in which a trained individual meets one on one with practitioners in their setting to provide information about the evidence-based practice.

Community health means meeting the: a. collective needs of a group by identifying problems and managing interactions. b. needs of an individual within the community by identifying problems and managing interactions. c. needs of the health care system within a population or area. d. needs of a population by identifying problems and managing interactions.

ANS: A Community health means meeting the collective needs of a group by identifying problems and managing interactions within the community and between the community and larger society.

Functional nursing: a. divided and distributed nursing tasks. b. enhanced client-oriented care. c. provided a smooth care delivery system. d. was expensive once implemented.

ANS: A Functional nursing focused on task accomplishment rather than individualized and holistic care. The division of labor was assigned according to specific tasks and technical aspects of the job, such as medication administration and taking vital signs.

Mercy Hospital compares its surgical site infection rate to General Heart Hospital, which is known as a best-in-class hospital for its surgical site infection rates. Mercy Hospital studies General Heart Hospital's methods for reducing surgical site infection rates and uses that information to improve its own performance. This quality performance method is called: a. benchmarking. b. evidence-based practice. c. enterprise risk management. d. continuous quality improvement.

ANS: A In ambulatory care (and other settings), benchmarking "is the process of comparing a practice's performance with an external standard. Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others" (Agency for Healthcare Research and Quality [AHRQ], 2013a, p. 11).

The Collaborative Care Model of CM is best used for: a. patients with co-occurring physical and mental health needs. b. individuals and small systems. c. hospital-based case management programs focusing on episodic care. d. the transition of high-risk clients from acute care to community or long-term care settings.

ANS: A In the Collaborative Care Model, dedicated team members address the needs of patients through a comprehensive and strategic care delivery process. Included in the team are a primary care provider, a case manager who is trained in behavioral health, and psychiatric consultants and/or behavioral health specialists (Unützer et al., 2013). This comprehensive approach to care serves as a proactive means to screen and track mental health conditions within the primary care setting.

A population health approach: a. aims to improve the health of the entire population. b. is funded by local, state, and national governments. c. strives to care for people who already exhibit optimal health. d. treats community-acquired diseases in area clinics.

ANS: A Population health is an approach to health that aims to improve the health of the entire population and reduce health inequities among population groups.

A professional practice model is a: a. conceptual framework and philosophy of nursing within an organization. b. staffing grid that outlines nursing unit work schedules. c. mechanism by which care is actually provided to patients and families. d. blueprint for developing specific measurable objectives and actions.

ANS: A Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization.

Sentinel Event Alerts are published by TJC to do which of the following? a. Allow facilities to learn from sentinel events that have occurred in other facilities and incorporate recommendations for prevention into their policies. b. Notify hospitals that if a sentinel event occurs during an alert, the hospital will be subject to withdrawal of Medicare and Medicaid certification and reimbursement. c. Prevent a near-miss from occurring. d. Assist hospitals to find national standardized performance measures to benchmark themselves against other similar hospitals.

ANS: A Sentinel Event Alerts are published by TJC to review the lessons learned from those facilities that had experienced these sentinel events. The hope is that other hospitals will incorporate the recommendations into their policy to avoid making similar errors.

A patient is admitted with congestive heart failure, diabetes mellitus, and dementia. He has a new dark spot on the top of his toes on his right foot. The nurse contacts the primary care physician, consults with the wound care specialist nurse, writes a nursing order for a referral to the diabetic educator, and contacts the discharge planner to facilitate future discharge plans. Which of the following care delivery models best describes how the nurse is providing care? a. Case management b. Group nursing c. Functional nursing d. Private duty nursing

ANS: A The Case Management Society of America (CMSA) definition of case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes" (CMSA, 2016).

Which of the following statements is true about the New England Medical Center (NEMC) case management model? a. It has a client-centered approach instituted during episodes of acute illness. b. It is known as a beyond-the-walls, medical-social, across-the-continuum of care model. c. It emphasizes the case manager's traditional linkage function. d. CM functions are undertaken as a part or an extension of therapeutic intervention.

ANS: A The NEMC model is a client-centered approach instituted during episodes of acute illness. It focuses on resource utilization, nursing accountability, and outcomes.

Nursing outreach programs are the core element of: a. population health management. b. disease management. c. case management. d. care management.

ANS: A The newest generation of PHM programs involves proactive outreach. Nursing outreach programs are the core element. Personal communications (usually via telephone) between an expert nurse and the health plan participant build a personal relationship, help identify knowledge deficits and counseling needs, facilitate close monitoring and progress toward goals, enhance treatment adherence, and promote clinical and cost stabilization.

An example of a traditional nursing care delivery model is: a. case management. b. patient- and family-centered care. c. transitional care. d. patient-centered medical home.

ANS: A There are five traditional nursing models of care: (1) private duty, (2) functional, (3) team, (4) primary, and (5) case management. Of these, functional, team, primary, and case management were and are currently associated with hospital nursing practice. Private duty and case management were associated with public health, home health care, and community health but have been adapted to the inpatient setting.

_____ has garnered considerable attention in health care in part because of the publication Crossing the Quality Chasm, a health care quality initiative of the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division). a. Disease management b. Development research groups c. Case management d. Diagnosis-related groups

ANS: A Two major forces triggered the rise of a DM perspective: (1) the abundance of managed care systems as a prevailing form of organized health care delivery (the influence of health plans), and (2) the national attention generated by Crossing the Quality Chasm, a health care quality initiative of the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division).

A disease management program usually focuses on patients with: a. chronic conditions. b. mental health issues. c. outpatient procedures. d. surgical diagnoses.

ANS: A While CM programs serve a smaller percentage of the overall population, enrollees are complex from a medical-behavioral, health-social vulnerability perspective. DM programs serve a larger percentage of patients whose main problem is one or more chronic condition(s). These individuals generally have similar primary needs regarding health condition education and accommodation strategies.

A framework for understanding health care improvement has been proposed by the IOM Committee on Quality of Health Care in America. The aims for health care quality improvement propose that health care systems ensure that care is: (Select all that apply.) a. safe. b. timely. c. efficient. d. cost-controlled. e. patient-centered.

ANS: A, B, C, E A framework for understanding health care improvement has been proposed by the IOM Committee on Quality of Health Care in America. These six aims for health care quality improvement propose that health care systems ensure that care is safe, effective, patient-centered, timely, efficient, and equitable.

The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. The standards in areas of excellence include: (Select all that apply.) a. leadership. b. strategic planning. c. environment of care. d. human resource focus. e. medication management.

ANS: A, B, D The standards in seven areas of excellence established by the BNQA are: (1) leadership, (2) strategic planning, (3) customer and market focus (focus on patients, other customers, and markets), (4) information and analysis, (5) human resource focus, (6) process management, and (7) business results (organizational performance results).

The CM dyad team model—composed of a nurse case manager and social worker—has been widely adopted in hospitals. Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on: (Select all that apply.) a. minimization of inpatient transitions. b. promotion of patient and family satisfaction through efforts of advocacy. c. maximization of health care benefits. d. reduction of cost by decreasing the length of stay. e. enhanced discharge planning.

ANS: A, B, D, E Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on (1) minimization of inpatient transitions, (2) reduction of cost by decreasing the length of stay, (3) promotion of patient and family satisfaction through efforts of advocacy, and (4) enhanced discharge planning (Carr, 2009).

A successful enterprise risk management (ERM) program will: (Select all that apply) a. identify risks. b. improve quality. c. prevent damage. d. control occurrences. e. control legal liability.

ANS: A, C, D, E ERM program is defined as an organization-wide program to identify risks, control occurrences, prevent damage, and control legal liability; it is a process whereby risks to the institution are evaluated and controlled.

Which of the following governmental agencies tracks population and health trends? (Select all that apply.) a. U.S. Census Bureau b. The Joint Commission c. CDC d. Bureau of Labor Statistics (BLS) e. Health Resources and Services Administration (HRSA)

ANS: A, C, D, E Population and health trends are tracked by governmental agencies such as the U.S. Census Bureau, CDC, BLS, and HRSA, as well as private foundations and organizations.

Which of the following components are common to all case management models? (Select all that apply.) a. Client identification and outreach b. Population management c. Monitoring service delivery d. Individual assessment and diagnosis e. Evaluation f. Environmental management

ANS: A, C, D, E There are eight main service components common to all case management models. They are client identification and outreach; individual assessment and diagnosis; service planning and resource identification; linking clients to needed services; service implementation and coordination; monitoring service delivery; advocacy; and evaluation.

Population health management (PHM) is viewed as a major health care strategy to improve health outcomes. This is because effective population health management programs: (Select all that apply.) a. have proactive interventions. b. promote client satisfaction through advocacy. c. coordinate care for chronic conditions. d. have consistency of care for at-risk populations. e. customize care support. f. encourage adherence to treatment.

ANS: A, C, D, E, F PHM is now being viewed as a major health care strategy to improve health outcomes across multiple populations while lowering costs and improving patient satisfaction. PHM has demonstrated effectiveness across disease states, including integrated behavioral health, chronic illness (e.g., diabetes, congestive heart failure), and assorted payers (e.g., Medicare, Medicaid, third-party populations) (Fortney et al., 2015; Lyles, 2016; Rushton, 2015; Sidorov & Romney, 2016). Attractive features include effective population management, coordination of care for chronic conditions, consistency of care for at-risk populations, customization of care support, encouragement of adherence to treatment, and proactive interventions.

Which of the following collaborative processes assesses, plans, facilitates, coordinates, advocates, and evaluates options and services required to meet an individual's comprehensive health needs? a. Care management b. Case management c. Disease management d. Population health management

ANS: B Case management (CM) is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes" (Case Management Society of America, 2016a).

A nursing quality improvement supervisor is proposing to enhance the current quality improvement program. One of the most important themes that a nursing quality improvement supervisor should consider is: a. budgetary considerations. b. collaboration between health care teams. c. regular staff training programs. d. suggestions from patients.

ANS: B Collaborative partnerships are part of this imperative and shape the way professional nurses act clinically and how they participate in performance and quality improvement efforts. As the complexity of care increases, multidisciplinary and inter-professional teamwork is used to solve complex problems in practice.

A concept involving a system that guides and tracks patients over time through a comprehensive array of health services to span all levels of intensity of care is known as: a. transition of care. b. continuum of care. c. rounds. d. disease management strategies.

ANS: B Continuum of care is a concept involving a system that guides and tracks patients over time through a comprehensive array of health services to span all levels and intensity of care (Young et al., 2014). The services incorporated in each patient's unique continuum vary based on the individualized health and/or behavioral health needs of each person.

Which of the following scenarios would require disease management? a. A blood pressure screening clinic is started at the senior citizen center. b. A person with multiple chronic illnesses is admitted to the hospital. c. A program is started to address diabetes in the Native American population. d. An initiative is developed to promote fluoride treatments in schools.

ANS: B DM programs serve a larger percentage of patients whose main problem is one or more chronic condition(s). These individuals generally have similar primary needs regarding health condition education and accommodation strategies. Assessments focus on health condition-specific issues, and programs take a more standardized approach to education and resources (Chen et al., 2000).

Hospitals must submit specific quality performance data regarding Medicare patients or risk: a. an increase in federal tax. b. decreased payments. c. fewer physician referrals. d. sanctions by The Joint Commission (TJC).

ANS: B In 2011, CMS developed the Hospital Value-Based Purchasing Program, which applied to payments beginning in fiscal year 2013 for discharges occurring on or after October 1, 2012. Under the program, CMS makes value-based incentive payments to 3500 acute care hospitals based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a baseline period. Reimbursement is based on quality of care, not quantity. The higher a hospital's performance or improvement during the performance period for a fiscal year, the higher the hospital's value-based incentive payment for the fiscal year would be (CMS, 2015).

The hospital's disease management program has gathered data collected from health assessments in order to categorize patients into like groups with the intention of providing population management interventions. This practice or strategy is referred to as: a. analogizing. b. stratification. c. comparing. d. data exchanging.

ANS: B In population health management, stratification has two meanings (PHA, 2015): a method of randomization and a process for sorting a population of eligible members into groups relating to their relative need for total population management interventions. The stratification process harvests information that can be used to divide the patient population into different levels to ensure a return on investment (ROI) based on resources allowed.

Which of the following is an example of a nurse-sensitive indicator? a. Cardiac patient mortality b. Hospital-acquired pressure ulcers c. Pulmonary embolus after knee surgery d. Iatrogenic pneumothorax after central line placement

ANS: B Nurse-sensitive indicators refer to the structure, process, and outcomes of professional nursing care. These include falls and falls with injury, hospital-acquired pressure ulcers, health care-associated infections, nursing care hours per patient day, nursing care hours, nursing turnover, physical restraints, RN survey, and skill mix.

Components of a systematic review include: a. publication of study data. b. assessment of a study. c. determination of statistical tests. d. development of research guidelines.

ANS: B Standard components of a systematic review are processes for (1) initiating, (2) finding and assessing individual studies, (3) synthesizing the body of evidence, and (4) reporting using a standard format (Institute of Medicine, 2011b).

Which of the following is true about team nursing? a. It includes only registered nurses (RNs) and licensed practical/vocational nurses (LPN/LVNs). b. Each team member has his or her own patient assignments. c. Team members must have dual degrees. d. The nurse with a bachelor's of science in nursing degree is the leader of the team.

ANS: B Team nursing is a delivery approach that provides care to a group of patients by coordinating a team of RNs, licensed practical nurses, and care aides under the supervision of one nurse, called the team leader. Each team member has his or her own patient assignments, and team members are expected to assist and support each other as needed

A health care management continuum: a. deals strictly with health promotion. b. controls problems at the population level. c. is a linkage of health services across settings. d. provides another health care option for the homeless.

ANS: B The health care management continuum is better known as population health management (PHM). One definition of population health management is "the process of addressing population health needs and controlling problems at a population level" (Nash et al., 2016).

To provide the best care to every patient every day through integrated clinical practice, education, and research is an example of a(n): a. accountability agreement. b. mission statement. c. organizational standard. d. vision and value proposal.

ANS: B The mission statement of an organization is a concise statement that answers the question: What business are we in today?

Case management and disease management are similar because both are interventions designed to coordinate care for better outcomes and lowered costs. Which statements are true regarding the differences between the two terms? (Select all that apply.) a. Disease management is client focused. b. Case management focuses on coordinating care of individuals and families. c. Disease management is more population-based than client-centered. d. Disease management is more episodic in its approach. e. Case management is more population-focused.

ANS: B, C Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes. Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.

Which of the following statements accurately describe disease management? (Select all that apply.) a. Disease management is care coordination that is organized to achieve specific client outcomes, given fiscal and other resource constraints. b. Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. c. Disease management relies on a structured system of interventions that focus on a specific condition. d. Disease management program content and interventions are evidence and guideline based. e. Disease management is the medical management of chronic disease.

ANS: B, C, D Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. DM programs usually focus on a single condition, rely on a structured system of interventions that focus on a single condition; and program content and interventions are and guideline based.

Which of the following are never events? (Select all that apply.) a. A minor medication error b. A foreign object left in the body during surgery c. Surgery on the wrong body part d. A mismatched blood transfusion e. Hip fracture acquired in the hospital f. Pressure ulcer acquired in the home g. Catheter-associated urinary tract infection h. Surgical site infection

ANS: B, C, D, E, G, H A never event is an event that should never happen. The insurer will never pay. Insurers will no longer pay for never events. A pressure ulcer will be covered if it was not acquired in the hospital facility. A minor medication error that causes no harm to the patient will not cause an insurer to withhold payment.

Tenets embraced by health care professionals and promoted by health care leaders and organizations such as TJC and the IOM include which of the following? (Select all that apply.) a. People and systems are the problems, not processes. b. Quality measurement and monitoring is everyone's job. c. Quality cannot be enhanced by non-punitive work cultures. d. Standardization of processes is key to managing work and people. e. The impetus for quality monitoring is not primarily for accreditation or regulatory compliance.

ANS: B, D, E Tenets embraced by health care professionals and promoted by health care leaders and organizations such as TJC and the IOM include the following: processes and systems are the problems, not people; standardization of processes is key to managing work and people; quality can be enhanced only in safe, non-punitive work cultures; quality measurement and monitoring is everyone's job; the impetus for quality monitoring is not primarily for accreditation or regulatory compliance, but rather as a planned part of an organization's culture to continuously enhance and improve its services; based on continuous feedback from employees and customers, consumers and stakeholders must be included in all phases of quality improvement planning; consensus among all stakeholders must be gained to have an impact on quality and safety; and health policy should include a focus on continuous enhancement of quality and safety.

Critical paths: a. are designed only for critical care or trauma patients. b. determine lifesaving interventions for a specific population. c. outline optimal care and time milestones for the routine patient. d. provide a list of supplies and equipment needed for care.

ANS: C A critical path is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes during an appropriate length of stay in a hospital setting.

Evidence-based practice includes: a. collaborative practice dynamics between health care professionals. b. documentation of patient care as evidence of nursing practice. c. integration of research with clinical expertise and patient values. d. mutual goal setting and application in the clinical setting.

ANS: C Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values in health care decision making (Sackett et al., 2000).

Primary nursing is a type of care delivery in which the nurse: a. cares for a patient 24 hours a day. b. is responsible for the client's daily care. c. monitors care from admission to discharge. d. provides total care for the patient.

ANS: C In the primary nursing model, the primary nurse has 24-hour-per-day accountability for the patient's plan of care from admission to discharge. Associate nurses oversee patient care delivery when the primary nurse is not on shift, although associate nurses are expected to follow the primary nurse's plan of care.

Opinion leaders are: a. formal leaders who lead evidence-based practice development teams. b. formal leaders who write new evidence-based practice guidelines. c. informal leaders who influence peers by evaluating innovations for use in certain settings and promoting clinicians use of evidence in clinical decision making. d. informal leaders who gather data about nursing practice changes.

ANS: C Informal leaders who influence peers by evaluating innovations for use in certain settings and promoting clinicians' use of evidence in clinical decision making are referred to as opinion leaders. Opinion leaders are likeable, trustworthy, informative, and influential (Flodgren et al., 2011).

The industry-based model for quality management and measurement whose premise is that operational waste needs to be eliminated is: a. Six Sigma. b. ISO 9000. c. Lean Enterprise. d. Baldrige National Quality Award Program.

ANS: C Lean Enterprise is a model of quality measurement that was originally associated with Deming but reintroduced to the United States by Womack in the mid-1990s (Jones & Womack, 2003). The premise of this model is that operational waste in an organization needs to be eliminated.

Which comment by the nurse manager would indicate that the hospital places a high value on patient safety? a. We have safety posters throughout the hospital that encourage people to report problems. b. We have monthly safety in-services. c. We encourage patients and families to participate in their care. d. All employees are required to update their knowledge of safety practices each year.

ANS: C Nurse leaders will continue to play an important role in designing care delivery systems that promote patient and family engagement (Pelletier & Stichler, 2014a). Various toolkits have been developed to assist staff nurses and managers who desire to engage patients and their families in hospitals (AHRQ, 2013c; Pelletier & Stichler, 2014b) and ambulatory and primary care (Caplan et al., 2014; Robert Wood Johnson Foundation, 2014).

A clearly recognizable process of providing care that has an evidence base demonstrating that it reduces the likelihood of harm is: a. risk adjustment. b. a sentinel event. c. a patient safety practice. d. a performance measure.

ANS: C Patient safety practices are "discrete and clearly recognizable processes or manners of providing care that have an evidence base demonstrating that they reduce the likelihood of harm due to the systems, processes, or environments of care" (National Quality Forum [NQF], 2009, p. 3).

Stakeholders are informed of an organization's key goals through its: a. vision. b. values statement. c. mission statement. d. organizational philosophy.

ANS: C Publicly posted mission statements inform key stakeholder groups, such as the public and employees, of the organization's key goals.

The degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge is known as the: a. care delivery quotient. b. excellence index. c. quality of health care. d. standard of care.

ANS: C Quality of health care is defined as the degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge (Lohr, 1990).

The risk manager wants to illustrate the causes that have been leading to an increase in patient misidentification. The most appropriate tool to use is a: a. pareto chart. b. control chart. c. fishbone diagram. d. detailed flowchart.

ANS: C The fishbone diagram resembles diagramming sentences. The effect is illustrated in a box at the end of a midline (or head of the fish). The causes are generally four or five categories of elements that might contribute to the effect (e.g., machines, methods, people, materials, and measurements) and the specific activities. Under each of these category headings, individual items that might lead to the effect are listed. By diagramming all of the possible contributors, the predominant or root causes may be found more readily.

The first step in the development of a case management program is: a. to identify high-volume or high-risk case types. b. to develop a pilot program. c. to assess the organization and the client population served. d. to form an interdisciplinary care team.

ANS: C The general process for the development of a case management is to assess the organization and the client population served; identify high-volume or high-risk case types; determine the usual client care problems, issues, or difficulties related to the high-volume or high-risk case types, with desired goals; form an interdisciplinary care team of the interrelated care providers who will be involved with the case types; develop and design an interdisciplinary critical pathway for each selected case type; develop a pilot program or trial site; and then evaluate the pilot program and consider system-wide implementation.

Mary Lou is a nurse in the critical care unit. She works 12-hour shifts. Each shift she is assigned to one or two critical care patients. She is responsible for planning and delivering the care and treatment for each one of the patients she is assigned to. This is an example of which nursing model? a. Team nursing b. Managed care c. Total patient care d. Functional nursing

ANS: C The term total patient care has come to mean the assignment of each client to a nurse who plans and delivers care during a work shift (Minnick et al., 2007).

To be effective at population care management, both CM and DM need to: a. assess and plan health initiatives within an area. b. implement and evaluate health programs within a community. c. assess and define the populations to be served. d. organize and regulate health professions across the country.

ANS: C To be effective at individual and population-based care management, both CM and DM programs need to identify, assess, and define the populations to be served early in the program planning effort.

Attributes of a total quality organization according to BNQA include: (Select all that apply.) a. accreditation by TJC. b. a commitment to obtaining Magnet designation. c. strategic planning. d. focus on patients, other customers, and markets. e. organizational performance results.

ANS: C, D, E The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. Named after the Secretary of Commerce, the BNQA "was established by Congress in 1987 to enhance the competitiveness and performance of U.S. businesses" (National Institute of Standards and Technology, 2007, p. 1). The standards in seven areas of excellence are: (1) leadership, (2) strategic planning, (3) customer and market focus (focus on patients, other customers, and markets), (4) information and analysis, (5) human resource focus, (6) process management, and (7) business results (organizational performance results). Organizations committed to quality improvement choose to adopt the BNQA approach as another means of defining and improving their organizational processes to achieve quality outcomes.

According to the Centers for Disease Control (CDC), chronic diseases account for _____% of deaths in the United States. a. 20 b. 40 c. 50 d. 70

ANS: D Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. Chronic diseases account for 70% of all deaths in the United States, which is 1.7 million each year. These diseases also cause major limitations in daily living for almost 1 out of 10 Americans, a total of about 25 million people.

The responsibility for making decisions about and designing strategies to create a climate and environmental context around the provision of nursing and health care services lies with: a. staff nurses. b. care councils. c. the nurse manager. d. executive leadership.

ANS: D Executive leadership is responsible for making decisions about and designing strategies to create a climate and environmental context around the provision of nursing and health care services.

Which of the following responses from the nurse manager is consistent with a culture that promotes patient safety? a. We make sure that we don't have any errors on this unit. b. We identify who made the error and take corrective action. c. We provide remedial training for all staff on the unit when there is an error. d. We report any medical error or near-miss to help us find the root cause of the problem.

ANS: D Health care organizations that embrace a fair and just culture identify and correct the systems or processes of care that contributed to the medical error or near-miss. Managers believe that more health care professionals will report more errors and near-misses when they are protected by a non-punitive culture of medical error reporting, and this will further improve patient safety through opportunities for improvement and lessons learned (CAPSAC, 2016). The American Nurses Association has endorsed just culture as a means of ensuring safe care (ANA, 2010).

Janice is assigned to pass medications this shift. Mary is assigned to do wound care, Jennifer will give all the baths, and Jim will take all the vital signs. This model of nursing care is called _____ nursing. a. team b. primary c. modular d. functional

ANS: D In functional nursing the division of labor is assigned according to specific tasks and technical aspects of the job. It has been defined as work allocation by functions or tasks, such as passing medicine, changing dressings, giving baths, or taking vital signs. Under functional nursing, the nurse identifies the tasks to be done for a shift. The work is divided and assigned to personnel, who focus on completing the assigned tasks.

The conceptual framework and philosophy under which the method of delivery of nursing care is a component is known as: a. core values. b. mission statement. c. care delivery model. d. professional practice model (PPM).

ANS: D PPMs refer to the conceptual framework and philosophy under which the method of delivery of nursing care is a component. PPMs describe the environment and serve as a framework to align the elements of care delivery. The PPM can be thought of as a link between the problems presented by client populations, the purposes of professional occupations, and the purposes of health care organizations.

Which nursing care model was prominent before the Great Depression? a. Functional nursing b. Group nursing c. Hospital staffing d. Private duty nursing

ANS: D Private duty nursing is the oldest care model in the United States. Between 1890 and 1929 in the United States, graduate nurses acted as private duty nurses, caring for patients in their homes (Shirey, 2008).

Lilly, an RN, works full time in her client's home providing total care for him. She bathes and dresses him, provides tracheostomy care and wound care, and feeds him. She is paid directly by her client. This type of nursing care is commonly known as: a. primary nursing. b. functional nursing. c. case management. d. private duty nursing.

ANS: D Private duty nursing, sometimes called case nursing, is the oldest care model in the United States. Private duty nursing is defined as one nurse caring for one client. In this model, complete and total care is provided by one nurse, but the nurse carries only one client assignment.

Responding to a code called in the psychiatric unit where she works, a staff nurse finds that a patient has committed suicide. The staff nurse correctly identifies this as a: a. benchmark incident. b. quality improvement issue. c. performance breach. d. sentinel event.

ANS: D Specific sentinel event outcomes are considered "reviewable" by TJC. Reviewable sentinel events are events that have resulted in an unanticipated death, permanent harm, or severe temporary harm and include suicide of any patient receiving care, treatment, and services in a staffed around-the-clock care setting.

The brokerage model and the comprehensive service center model are examples of which type of care model? a. Collaborate b. Inter-professional c. Interdisciplinary d. Social work

ANS: D The brokerage model, the primary therapist model, the interdisciplinary team model, and the comprehensive service center model are all examples of social work models.

The purpose of a root cause analysis (RCA) is to: a. discipline the staff involved in the patient safety event. b. disclose the medical error to the patient/patient s family. c. identify the person(s) responsible for committing the error. d. identify the systems issues that led to a sentinel event.

ANS: D The purpose of the RCA is to drill down to the most common cause(s) for the event and determine what process improvements can be made to prevent the sentinel event from occurring in the future.

Which of the following factors best suggests an individual is motivated to engage in a disease management program? a. Mistrust of insurance companies b. Enrollment at initial contact c. Can afford the cost of enrollment d. Has a need that would benefit from the program

ANS: D The results of a 2014 study that examined factors driving engagement suggest that individuals most motivated to engage are those who are well informed of the program benefits and have a perceived need that would benefit from said program (e.g., living alone, needing a supportive person to discuss ideas) (Hawkins et al., 2014).

A patient has a history of diabetes mellitus, myocardial infarctions, and hypertension. His HgbA1c level dropped from 7.8% to 6.2% 2 months after he began a walking exercise program. The nurse case manager had provided diabetic education and suggested ways to enhance his cardiac reserve. This is an example of: a. nursing empowerment. b. nursing knowledge. c. patient expertise. d. patient participation in care.

ANS: D The scenario depicts an example of a case manager's intervention resulting in a positive clinical outcome. This is the result of the patient's participation in his own care.

A team has formed to determine which methods have worked best and which factors influence the implementation of an evidence-based practice program. This is known as _____ research. a. authoritarian b. autocratic c. transformational d. translational

ANS: D Translational research includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by nurses, physicians, and other health care providers and describing organizational, unit, and individual variables that affect the use of evidence in clinical and operational decision making.

The nurse who uses collaboration to coordinate care for an individual's and family's comprehensive health needs through communication and available resources to promote patient safety and quality, cost-effective outcomes is performing:

a. population health management. b. managed care. c. disease management. d. case management. ANS: D Case management (CM) is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes" (Case Management Society of America, 2016a).