Management Exam 3 Quizlets Combined

Which of the following statements best describes a desirable characteristic of a good management information system? a. Data should be sorted and labeled within 2 weeks. b. For accurate interpretation, data should reflect a health bias. c. Information gathering should be comprehensive and cost-effective. d. The management information system operating system should be Windows-based.

: C Ten criteria or desirable characteristics for a good management information system are the following: (1) informative, (2) relevant, (3) sensitive, (4) unbiased, (5) comprehensive, (6) timely, (7) action-oriented, (8) uniform, (9) performance-targeted, and (10) cost-effective

The collection of data to measure performance is required by: a. the Health Insurance Portability and Accountability Act (HIPAA). b. the Centers for Medicare & Medicaid Services. c. The Joint Commission (TJC). d. Health Information Technology

: C The collection of data to measure performance is a requirement of TJC.

Effectiveness research: a. is the study of relationships among health care problems. b. provides solutions to serious global health care issues. c. reflects sound, reliable, and valid data that can be examined closely. d. supplies data that are critical and worthy of gathering.

: A Effectiveness research applies epidemiological methods to large databases to study relationships among health care problems, interventions, outcomes, and costs, and determine alternatives and their effects with different patient characteristics and intervening variables.

10. The ability to continue the employment of qualified individuals, that is, nurses and/or other health care providers/associates who might otherwise leave the organization is called: a. transfer. b. selection. c. turnover. d. retention.

: D Retention is the ability to continue the employment of qualified individuals, that is, nurses and/or other health care providers/associates who might otherwise leave the organization. The impact of this action is to maintain stability and enhance the quality of care while reducing cost to the organization

11. An important predictor of job satisfaction with new graduates is: a. culture. b. compensation. c. benefit package. d. staffing adequacy.

: D Stam and colleagues (2013) found that new graduates viewed "staffing adequacy" as an important predictor of job satisfaction. In addition to the relationship between staffing levels and nurse satisfaction, there is also a growing body of literature demonstrating a correlation between nurse staffing levels and patient outcomes.

A budget functions as a: a. capital constraint. b. employee management tool. c. human resource tool. d. planning instrument.

: D A budget is defined as a written financial plan aimed at controlling the allocation of resources. It functions as both a planning instrument and an evaluation tool useful for financial management

A(n) _____ is the difference between the budgeted and actual amounts. a. expense b. margin c. revenue d. variance

: D A variance is the difference between the budgeted and the actual amounts. A variance may be favorable or unfavorable relative to the budget amount.

16. A shortcoming that needs to be addressed related to the advertising of open nursing positions is: a. inadequate use of Internet advertising. b. insufficient funds allotted for advertising. c. lack of follow-up with potential candidates. d. short supply of advertising space in nursing journals.

: C A shortcoming that needs to be addressed related to advertising is that organizations often spend a considerable amount of money on advertising only to miss the most important aspect, that of a quick, effective, courteous follow-up with potential candidates (Curran, 2003).

6. The average age of the registered nurse (RN) population is _____ years. a. 26 b. 36 c. 45 d. 56

: C According to the Bureau of Health Professions' (BHPr, 2013) report The U.S. Nursing Workforce: Trends in Supply and Education, the average age of the RN has increased by almost 2 years, moving from 42.7 years in 2000 to 44.6 (2010).

The field in health care that aims at a better understanding of the end results of health care practices and interventions is called: a. patient safety. b. risk management. c. outcomes research. d. quality management

: C Outcomes research aims at a better understanding of the end results of health care practices and interventions, such as the impacts of care that are most important to patients, families, payers, and society.

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.

: 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"

Supply budgets are a major component of the operating budget. Items such as office supplies, intravenous solutions, instruments, linen, gloves, and other personal protective equipment are examples of _____ costs a. fixed b. flexible c. variable d. resource

: C Supply items such as office supplies, intravenous solutions, instruments, linen, gloves and other personal protective equipment, medical/surgical supplies, and drugs are examples of supplies that would vary with a higher volume of patient days. These supply items are variable (the amount used will vary based on the volume of service provided).

8. 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.

7. 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.

13. 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).

10. 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(n) _____ is a written financial plan aimed at controlling the allocation of resources

: budget A budget is defined as a written financial plan aimed at controlling the allocation of resources. It functions as both a planning instrument and an evaluation tool useful for financial management.

A(n) _____ is the result or results obtained from the efforts to accomplish a goal.

: outcome An outcome is the result or results obtained from the efforts to accomplish a goal. The term outcomes has also been defined as the conditions in patients and others that health care delivery aims to achieve.

A(n) _____ is the difference between the budgeted and the actual amounts.

: variance A variance is the difference between the budgeted and the actual amounts. A variance may be favorable or unfavorable relative to the budget amount.

3. 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.

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.

: 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.

1. In the context of a nurse shortage, recruitment is a major human resources strategy. List the nine major processes or phases of recruitment in the appropriate order. a. Selecting b. Orienting c. Screening d. Advertising e. Interviewing f. Position posting g. Staff development. h. Counseling/coaching i. Performance evaluation

: F, D, C, E, A, B, H, I, G

1. Authentic respect for others requiring time, presence, engagement, and intention to seek common ground is called _____.

: civility Civility is authentic respect for others requiring time, presence, engagement, and intention to seek common ground. 2. _____ is the process in which the application is reviewed before determining whether the nurse meets the preestablished criteria for the position. ANS: Screening Screening is the process in which the application is reviewed before determining whether the nurse meets the preestablished criteria for the position. During this activity, the reviewer selects who should be interviewed.

14. According to McHugh et al. (2008), a major barrier to the recruitment of IENs has been related to: a. limited visas. b. language barriers. c. cultural differences. d. the inability of IENs to pass state board exams.

: A According to McHugh et al. (2008), major barriers to recruitment of IENs have been related to both limited visas and ethical concerns related to depletion of nursing resources in other countries.

9. Nursing jobs need to be developed that increase nurses' professional: a. autonomy. b. behavior. c. culture. d. salaries.

: A Managerial visibility and support are viewed as strengths in promoting autonomy. Nurses also wanted to have control over their practice (autonomy) and collaborative relationships with physicians relative to care management. This study and the follow-up study conducted by Kramer and Hafner (1989) 5 years later were the basis for the ANA'S Magnet Recognition Program®.

8. Factors that affect supply include nursing education factors, work environment factors, and _____ factors. a. demographic b. geographic c. socioeconomic d. psychological

: A Three factors that affect the supply of RNs are nursing education, work environment, and demographics.

The management team of a large hospital is attempting to identify the specific cost of providing nursing services. This process is known as: a. costing out services. b. fee-for-service care provision. c. priority nursing management. d. quality versus cost balance.

: A Costing out nursing services was defined as the determination of the costs of services provided by nurses.

The data analysts within a health care organization pull core measure data from patient records on a quarterly basis. This data is then analyzed and collated into a report that is uploaded to TJC for analysis of adherence to core measure requirements. This is an example of: a. health information exchange (HIE). b. effectiveness research. c. health information management. d. management information systems.

: A Health information exchange (HIE) is defined as the electronic movement of health-related information among organizations according to nationally recognized standards that allow health care providers to access and securely share vital medical information electronically (HealthIT.gov, 2014a). The HIE is a process within either a state health information network or a regional health information organization (RHIO), often for a geographic area.

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

: 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"

The specific tools used to make quality visible to stakeholders in health care are called: a. indicators. b. outcomes. c. variable selections. d. quality measures.

: A Indicators are valid and reliable measures related to performance. They are the specific tools used to make quality visible to stakeholders in health care.

Management information systems describe a broad scope of activities that includes but is not limited to the management of: a. decision support systems. b. merchandise. c. products. d. nursing services

: A Management information systems (MIS) describe a broad scope of activities that includes but is not limited to managing: decision support systems, resource and people management applications, project management, and database retrieval applications.

The manager of a rural, thriving, nurse-managed clinic is considering purchasing equipment to furnish two additional examination rooms. The resource he must consider is the _____ budget. a. capital b. expense c. operating d. product line

: A The capital budget is the plan for the purchase of major equipment or assets.

The operating budget covers a specific period, called a _____ year. a. fiscal b. budget c. calendar d. federal government

: A The operating budget covers a specific period, called a fiscal year. The fiscal year may begin July 1, may correspond to the calendar year beginning January 1, or may follow the federal government year that starts on October 1.

The implementation of an electronic health record (EHR) could enhance patient care by facilitating: a. communication across the health care continuum. b. diabetes mellitus education and ongoing care delivery. c. one-on-one counseling between the provider and the client. d. physical and occupational therapy dispensing errors.

: A The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the CCD from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care

What are some of the expected outcomes in the client domain of nursing data? (Select all that apply.) a. Patient satisfaction b. Achieved care outcomes c. Continuity of care d. Level of dependency e. Intensity of nursing care

: A, B, C In the client domain, the cost and continuity of care for the client are important because data are now shared among providers within the HIE to manage care. Patient satisfaction and the achievement of care outcomes are also expected within the client domain. Some of the variables include diagnosis, age, gender, marital status, level of dependency, and intensity of nursing care.

6. Using the targeted interview ensures that all candidates are interviewed based on the same criteria. The targeted selection process is built on: (Select all that apply) a. organizational values. b. analysis of work per job. c. development of interview skills. d. clear identification of competencies for key positions. e. compliance with equal opportunity employer guidelines.

: A, B, C, D The targeted selection process is built on analysis of work per job, organizational values, clear identification of competencies for key positions, and development of interview skills and confidence of the interviewers. Using the targeted interview ensures that all candidates are interviewed based on the same criteria.

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.

: 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 goals of meaningful use include: (Select all that apply.) a. improve quality of care and safety. b. engage patients and their families in care. c. improve population health. d. reduce costs associated with health care. e. improve care coordination.

: A, B, C, E Meaningful use of HIT brought with it four goals: improve quality of care and safety, engage patients and their families in care, improve care coordination, and improve population health (

TJC requires accredited organizations to participate in their core measure initiative. The current core measure sets include: (Select all that apply.) a. stroke. b. tobacco treatment. c. pneumonia measures. d. iatrogenic pneumothorax. e. venous thromboembolism. f. acute myocardial infarction.

: A, B, C, E, F The current core measure sets include perinatal care, stroke, venous thromboembolism, substance use, tobacco treatment, hospital outpatient department, pneumonia measures, heart failure, acute myocardial infarction, surgical care improvement project, hospital-based inpatient psychiatric services, emergency department, children's asthma care, and immunization (TJC, 2016d).

Which of the following statements are true regarding health information technology (HIT) applications in nursing services? (Select all that apply.) a. HIT involves nursing administration, clinical informatics, and effectiveness research. b. Health information data allow nursing leaders to make informed decisions regarding patient care. c. HIT is used primarily for financial decision making. d. Clinical decision support utilizes tools for downloading, collecting, organizing, and analyzing data. e. HIT is used by senior leaders only.

: A, B, D HIT applications in nursing services arise from the intersection of three areas: nursing administration; clinical informatics; and effectiveness research, including research on client outcomes. The technologies are tools for downloading, collecting, organizing, and analyzing vast amounts of complex data, and clinical decision support. Having these data in an accessible format increases nursing leaders', managers', and administrators' ability to make informed decisions regarding the organization and delivery of patient care.

The phases of the budget process are: (Select all that apply.) a. preparation. b. completing the forms. c. auditing and monitoring. d. revision and submission. e. selection and evaluation

: A, B, D The budget process consists of three time periods. During preparation, the manager reviews the organization's strategic plan and the last year's budget for the cost center. The manager will then be given budget documents to use in preparing the cost center budget. As budget documents go through review by senior management, requests tend to exceed the available resources. This necessitates review, adjustment, and appeal.

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.

: 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).

9. Stacy has been asked by the corporate financial officer to report on the current organizational costs for nurse turnover. To determine the cost of nurse turnover, Stacy should review: (Select all that apply.) a. vacancy costs. b. accident rates. c. competitor wages. d. advertising expenses. e. orientation and training.

: A, B, D, E The most common factors used in determining nurse turnover costs include advertising and recruitment, vacancy costs, hiring, orientation and training, decreased productivity, termination, potential patient errors/decreased quality of care, poor work environment and culture, loss of organizational knowledge, increased accident and absenteeism rates, and increased nurse and medical staff turnover (Hunt, 2009).

Areas of data evaluation on a balanced scorecard include: (Select all that apply.) a. metrics. b. key performance indicators. c. environmental. d. turnover rates e. benchmarks

: A, B, E Metrics (specific measurement standards like operating room start time), key performance indicators (a metric with a performance indicator such as revenue by year end), and benchmarks (the gold standard or best practices such as the pulse should be between 50 and 80 beats per minute) are the specific elements for collecting, monitoring, and analyzing quality improvement and decision-making data

Nurse managers utilize outcomes data to make decisions about nursing care effectiveness. Which NMMDS data elements would be most effective in evaluating nursing care? (Select all that apply.) a. Nursing diagnosis b. Turnover c. Population served d. Client accessibility e. Intensity of nursing care

: A, B, E The NMMDS was developed to meet the need for "sharable and comparable" data, especially regarding the nursing workforce and the processes of patient care (Garcia et al., 2015). Such data are crucial for nurses to have in order to compare nursing practice and evaluate costs of care. Three categories of data elements are included in the NMDS: nursing care, demographic, and service. Data elements related to nursing care include nursing diagnosis, turnover, intervention, outcome, and intensity of nursing care.

What are the primary purposes and benefits of EHRs? (Select all that apply.) a. Single source of clinical, financial, and legal record b. Electronic format supports the storage and exchange of continuity of care c. Available within the health care facility to ensure confidentiality d. Originate from a single place e. Virtual record of retrospective, concurrent, and prospective information

: A, B, E The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the continuity of care document from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care

Quality planning establishes the design of a product, service, or process that will meet customer, business, and operational needs to produce the product before it is produced. Quality planning follows a universal sequence of steps. List the universal sequence of steps in order. a. Identify customers and target markets. b. Discover hidden and unmet customer needs. c. Develop a service or product that exceeds customer's needs. d. Transfer these designs to the organization and the operating forces to be carried out. e. Translate these needs into product or service requirements: a means to meet their needs. f. Develop the processes that will provide the service, or create the product, in the most efficient way.

: A, B, E, C, F, D Quality planning follows a universal sequence of steps, as follows: Identify customers and target markets. Discover hidden and unmet customer needs. Translate these needs into product or service requirements: a means to meet their needs (new standards, specifications, etc.). Develop a service or product that exceeds customer's needs. Develop the processes that will provide the service or create the product in the most efficient way. Transfer these designs to the organization and the operating forces to be carried out (Juran Institute, 2009, pp. 1-2).

According to the ANA, what elements are viewed as a relationship continuum as nurses apply them in decision making? (Select all that apply.) a. Data b. Technology c. Information d. Knowledge e. Wisdom

: A, C, D, E As defined by the ANA (2015a), the practice of nursing informatics views the relationship of data, information, knowledge, and wisdom as a continuum with increasing complexity and interrelations as nurses aggregate and apply them in decision making.

Successful implementation of a health information system requires a great deal of time, education, and support. The process will require which of the following expertise within the organization? (Select all that apply.) a. Quality experts b. Marketing specialists c. Clinical nurse leaders d. Nurse informaticians e. Nurse managers

: A, C, D, E Nurse managers are being asked to participate in the selection, design, and implementation of institutional information systems. Managers and clinical nursing leaders will serve as change agents to overcome resistance. Successful implementation and sustainability of these systems will require nurse managers, nurse informaticians, clinical nurse leaders, and quality experts to have leadership, vision, and commitment.

Key examples of patient-focused outcome indicators are: (Select all that apply.) a. patient satisfaction. b. birth rates. c. health status. d. quality of life. e. ability to function.

: A, C, D, E Patient-focused outcomes can include indicators such as disease status, symptom experience, or pain. Other outcomes indicators incorporate a broader impact of disease and its management on clients' lives. These outcomes, often measured through surveys of patient perceptions and experiences, include quality of life, functional status, health status, and patient satisfaction.

Principles of a fair and just culture include: (Select all that apply.) a. zero-tolerance for reckless behavior. b. reduction of personal accountability and discipline. c. recognition that competent professionals make mistakes. d. errors and unintended events being reported unless no patient harm occurs. e. acknowledgment that even competent professionals develop unhealthy norms.

: A, C, E A fair and just culture "is an approach to medical event reporting that emphasizes learning and accountability over blame and punishment" (CAPSAC, 2016, p. 1). Everyone throughout the organization is aware that medical errors are inevitable, but all errors and unintended events are reported--even when the events may not cause patient injury. This culture can make the system safer as it recognizes that competent professionals make mistakes and acknowledges that even competent professionals develop unhealthy norms (shortcuts or routine rule violations), but it has zero-tolerance for reckless behavior.

The Agency for Healthcare Research and Quality (AHRQ) developed a set of categories of desirable attributes of a quality indicator. The categories include: (Select all that apply.) a. feasibility. b. efficiency. c. importance. d. cost-effectiveness. e. scientific soundness.

: A, C, E Recently, the AHRQ developed a set of three broad categories of desirable attributes of a quality indicator: (1) importance; (2) scientific soundness, including clinical logic and measurement properties; and (3) feasibility.

Nursing's data needs fall into four domains. Which of the following statements accurately describe the sources for data in each of the domains? (Select all that apply.) a. Client data is located in the client's health care record. b. Provider data refers to physicians and is located within the medical board. c. Administrative data is located in registry and regulatory performance data. d. Research data is only available with informed consent. e. Existing and newly gathered data can be a source of obtaining research information.

: A, C, E The sources of client data are the client's health care record, their personal health record, and patient-provider messages. Administrative data is located in administrative, fiscal, population, registry, and regulatory performance data. Existing and newly gathered data, relational databases, and common data elements are sources of research data.

The formal process of using patient data for providing evidence for the design of care protocols is termed: a. evidence-based practice. b. practice-based evidence. c. data analysis. d. effectiveness research.

: B Collecting and extracting data that describe the processes and outcomes of nursing care electronically has provided evidence for the design of care protocols and delivery models (Horn & Gassaway, 2010). The formal process of using these patient data for providing this evidence is termed practice-based evidence

7. The Institute of Medicine recommends increasing the proportion of nurses with a baccalaureate degree to _______ by 2020. a. 40% b. 80% c. 60% d. 50%

: B One recommendation by the Institute of Medicine is to increase the proportion of nurses with a baccalaureate degree to 80% by 2020.

5. The future projected demand for nurses is related to the aging population and the increase in: a. acute illnesses. b. chronic illnesses. c. medication costs. d. primary prevention.

: B The future projected demand for nurses is related to the aging population and the increase in chronic illnesses.

The key advantage of activity-based costing is: a. workload is determined based on the required hours of nursing care. b. it reflects what it costs to provide services and identifies why costs were incurred. c. data can be used in constructing a personnel budget because it is linked to the volume indicator of patient days. d. the judgment of an expert nurse clinician must override an empirical system and be based on patient's needs in real time.

: B The key advantage of activity-based costing is that it reflects what it costs to provide services and identifies why costs were incurred.

17. The newest approach to orienting is referred to as: a. selecting. b. onboarding. c. submersion. d. precepting.

: B The newest approach to orienting is referred to as onboarding (Lee, 2008). Onboarding expands the orientation beyond the employee's initial introduction to the organization and role expectations by providing ongoing coaching and mentorship through a defined program.

Outcomes measurement is complex because: a. budgets are unable to allocate sufficient funds. b. health care is multidimensional. c. patients may not cooperate. d. treatments are not always necessary.

: B A patient-focused definition of outcomes considers them "the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives" that are "inherently condition-specific and multidimensional" (International Consortium for Health Outcomes Measurement

Using resources to maximize health benefits while simultaneously using resources to maximize cost-effectiveness is: a. costing out nursing services. b. fiscal responsibility. c. priority nursing management. d. capital constraint.

: B Fiscal responsibility is defined as using the resources of the patient to maximize health benefit while simultaneously using the resources of the institution to maximize cost-effectiveness. Fiscal responsibility is essential when trying to improve client care by improving managerial and clinical decisions in nursing.

Janice is going to give her patient a bath. She has the option of using prepackaged bathing wipes or a bath basin and washcloths. She chooses the bath basin and washcloths because she knows their performance is the same but they are less expensive. Janice's choice is an example of: a. rationing. b. fiscal responsibility. c. costing out services. d. activity-based costing

: B Fiscal responsibility is defined as using the resources of the patient to maximize health benefit while simultaneously utilizing the resources of the institution to maximize cost-effectiveness. Being fiscally responsible means making responsible resource allocation decisions.

The Office of National Coordinator for Health Information Technology (HIT) was created by: a. President Barack Obama. b. President George W. Bush. c. Hillary Clinton. d. President Bill Clinton

: B In 2004, President George W. Bush created the position of Office of National Coordinator for HIT within the U.S. Department of Health and Human Services. The coordinator's role involved leadership to develop the standards and interoperability framework and establish the infrastructure necessary to harness the use of information technology and exchange of health information nationwide to improve patient care and reduce health care costs.

Staff nurses involvement in budgeting is essential because they: a. have the final authority on the annual budget. b. have the ability to contain costs at the unit level. c. have a unique perspective on the budgetary process. d. are the largest user of the budgeted funds for the unit.

: B In many organizations, staff nurses are expected to be aware of their unit's financial performance and the impact their decisions may have on it. Staff nurses involvement is essential to the ability to contain costs at the unit level, because they make many decisions about supply and resource use

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

: 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. 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.

In the past, health care organizations viewed nursing services as primarily a(n): a. acute care asset. . expense. c. reimbursement tool. d. revenue generator.

: B Nursing has historically been seen as a cost center but not a revenue generator.

Nursing informatics includes the: a. coding and billing of hospital and physician services. b. management and communication of data, information, knowledge, and wisdom in nursing practice c. organization and selection of quality medical information. d. support and troubleshooting of computer software issues.

: B Nursing informatics is a "specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice"

_____ was recognized by the American Nurses Association (ANA) as a nursing specialty in 1992 and is one of the fastest growing practice areas in health care. a. Nurse anesthesia b. Nursing informatics c. Nurse-midwifery d. Clinical nurse specialist

: B Nursing informatics is one of the fastest growing practice areas in health care.

The outcomes concept that emphasizes the multidisciplinary process of providing health care is known as outcomes: a. maintenance. b. management. c. measurement. d. monitoring

: B Outcomes management is defined as a multidisciplinary process designed to provide quality health care, decrease fragmentation, enhance outcomes, and constrain costs

Outcome indicators such as nurse burnout, turnover, and job satisfaction are examples of which type of indicator? a. Patient-focused b. Provider-focused c. Organizational-focused d. Nursing-focused

: B Provider-focused outcomes include phenomena such as nurse burnout, turnover, and job satisfaction.

The incorporation of economic evaluation into clinical practice is important to productivity because: a. rationing must occur. b. health care resources are limited. c. providers may not turn away clients. d. uninsured clients get the same health care as insured clients

: B The incorporation of economic evaluation into clinical practice is important to productivity, because health care resources are limited and choices must, and will, be made.

Mary is the manager of the critical care unit. She would like to hire a wound care nurse for the unit. The type of organizational budget Mary would use to ensure she can hire the new nurse is called the _____ budget. a. capital b. personnel c. operating d. expense

: B The personnel budget is the staffing budget of the cost center.

The process of managing outcomes includes five steps. List the five steps below in the correct order. a. Variances are investigated. b. Data are collected about outcomes. c. Trends are identified from data analysis. d. Changes are implemented and reevaluated. e. Appropriate service delivery changes are determined.

: B, C, A, E, D In managing outcomes, the information derived from measuring client outcomes is collected, trends are identified, variances are examined, and appropriate care needs are determined to improve care to an individual, group, or population.

3. The new and enhanced recommendations in the IOM Future of Nursing report (2016) affect the nursing shortage by formally calling for: (Select all that apply.) a. more competitive salaries. b. increased workforce diversity. c. reduction in retirement age. d. maintaining current levels of nursing education. e. improved workforce data collection.

: B, E In 2016, The IOM published Assessing Progress on the Institute of Medicine Report: The Future of Nursing. The new and enhanced recommendations around diversity in the workforce and workforce data collection are designed to directly influence state implementation plans and initiatives. Thus the Future of Nursing report affects the nursing shortage by formally calling for increased workforce diversity and improved workforce data collection.

Implementation of the Transitional Care Model (TCM) has been associated with which of the following favorable outcomes? (Select all that apply.) a. Decreased length of stay b. Reductions in total health care costs c. Reductions in preventable hospital readmissions d. Increased overall satisfaction with the care experience e. Long-term improvements in physical health, functional status, and quality of life

: B, C, D The TCM is a delivery system innovation that is designed to increase the alignment of the care system with the preferences, needs, and values of high-risk individuals and their family caregivers and achieve higher-quality outcomes while reducing health care costs (Naylor, 2012). Implementation of the TCM has been associated with the following favorable outcomes: (1) reductions in preventable hospital readmissions; (2) short-term improvements in physical health, functional status, and quality of life; (3) increased overall satisfaction with the care experience; and (4) reductions in total health care costs.

8. Staff development has been identified in the literature as an important factor in job satisfaction. The areas of professional staff development defined in the Magnet studies include: (Select all that apply.) a. orientation. b. formal education. c. in-service education. d. career development. e. continuing education.

: B, C, D, E Staff development, as defined in the Magnet studies (Halfer, 2007; Kramer & Hafner, 1989; McClure et al., 1983), was identified as having four areas of professional development beyond orientation. The four areas included in-service education, continuing education, formal education, and career development.

1. 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

: 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.

5. The impact of the recessionary decade on the nursing workforce included: (Select all that apply.) a. nursing schools increasing their capacities. b. more young people enrolling in nursing programs. c. RNs delaying retirement or returning to work from retirement. d. licensed RNs working in non-traditional nursing jobs returning to traditional nursing. e. increasing the supply of nurses by motivating part-time RNs to work more hours or full time.

: B, C, E The impact of the recessionary decade increased the supply of nurses by motivating part-time RNs to work more hours or full time; RNs to delay retirement or return to work from retirement; licensed RNs working in non-nursing jobs to return to nursing; and young people to enroll in nursing programs, a demand occupation with future stability (Staiger et al., 2012).

1. To determine the presence of a nursing shortage, experts generally use indicators such as: (Select all that apply.) a. retention. b. vacancy rates. c. staffing levels. d. nursing salary. e. employer reports. f. forecasting models. g. organizational budgets.

: B, C, E, F Experts generally use indicators such as employer reports, vacancy rates, turnover, recruitment difficulty, staffing levels, RN supply per population, or forecasting models to determine a nursing shortage.

7. Inappropriate or illegal questions that should be avoided during the interview include which of the following examples? (Select all that apply.) a. What are your goals for the future? b. Do you plan on having any more children? c. How do you feel about taking call on weekends? d. How does your husband feel about you working? e. Will going to church interfere with Sunday shifts?

: B, D, E Questions that should be avoided during the interview relate specifically to personal information about the candidate, such as the following: age, marital status, living arrangements, children, limitations or disabilities, religion, substance abuse, and membership in professional organizations.

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.

: 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

Donabedian's aspects of quality include: (Select all that apply.) a. goals. b. process. c. policies. d. structure. e. outcomes

: B, D, E Indicators are used to measure all three of Donabedian's (1985) aspects of quality: structure, process, and outcomes. Donabedian's framework is useful to understand the relationship between outcomes and the structure and processes that have produced them

What are the roles of nursing informatics specialists? (Select all that apply.) a. Data analysis and reporting to governmental agencies b. Participation in education of nursing staff c. Providing direct patient care d. Providing information and evidence-based knowledge e. Supporting clinical decision making

: B, D, E Nursing informatics specialists assist practitioners by providing information and evidence-based knowledge to support clinical decision making and delivery of safe patient care. Although these specialists may not be directly involved with care delivery, their effort is integrally related to reengineering work flow for clinical and administrative practice. Nursing informatics specialists participate in analysis, design, and implementation of information and communication systems; effectiveness and informatics research; and education of nurses in informatics and information technology

Mary Lou is studying the 48-hour readmission rate of cardiac patients whose care was provided by nurses with associate degrees versus nurses with bachelor's degrees. The type of research Mary Lou is performing is called _____ research. a. quality b. patient outcomes c. nursing outcomes d. outcomes management

: C Nursing outcomes research is a subspecialty within the larger field of health outcomes research that focuses on determining the effect of different contexts and conditions, related specifically to nurses and nursing care, on the health status of patients. Nursing outcomes researchers are interested in the structures or management strategies for nursing care delivery, as well as the mix of health care workers best equipped to care for them.

15. The process of identifying applicants for potential employment is called: a. selection. b. retention. c. recruitment. d. human resources.

: C Recruitment, defined as replenishment, is the process used by organizations to seek out or identify applicants for potential employment. The impact is to ensure that an adequate number of qualified workers are available for selection and employment.

4. The failure to retain an employee who is performing at or above a satisfactory level is: a. selection. b. transfer. c. voluntary turnover. d. termination.

: C Resignation/voluntary turnover is the failure to retain an employee who is performing at or above satisfactory level. Although all turnovers have an associated cost to the organization, the most costly are those dealing with termination and resignations. The number of people who report directly to a single manager and encompass the functions of planning, organizing, and leading is known as the span of control.

2. The medical unit of the hospital conducts regular programs for nurses based on an annual staff survey. The recruitment and retention strategy is known as: a. counseling and coaching. b. orientation. c. staff development. d. performance evaluation.

: C Staff development has been identified in the literature as an important factor in job satisfaction. It provides employees with an opportunity to improve their practice, level of competency, or other areas of self-interest. Programs for staff development are typically determined based on annual staff surveys. Programs are usually posted for staff selection, and the institution provides scheduling flexibility and funding for employees to participate.

1. A situation in which the demand for employment of nurses (how many nurses employers would like to employ) exceeds the available supply of nurses willing to be employed at a given salary is known as a nursing: a. abundance. b. deficit. c. shortage. d. surplus.

: C The number of nurses that employers would like to employ in relation to the number of nurses willing to be employed at a given salary is known as a nursing shortage. In a nursing shortage, the demand for employment of nurses exceeds the available supply for employment at a given salary.

3. The total number of nurses who left a unit in 1 year divided by the total number of nurses employed on that unit is the _____ rate. a. actualized b. employable c. turnover d. vacancy

: C The total number of nurses who left a unit in 1 year divided by the total number of nurses employed on that unit is the turnover rate.

19. Marcy, the medical surgical unit manager, has promised her staff a pizza party if they reduce their patient fall rates by 10%. Which factor does Marcy consider when developing staff rewards? a. Staff mix b. Budget c. Generational diversity d. Unit culture

: C With four generational groups now in the workplace, it is important that managers and staff consider differences when developing strategies for change or rewards. Each generation has its own perspective, and diversity exists even within each generation. Therefore it is imperative that generational groups have representation or opportunity for input in planning and decision making.

The process of identifying the specific costs related to the delivery of nursing care to each client so that nurses have data to identify the actual amount of services received is: a. personnel budget development. b. evaluating budget expenditures. c. costing out nursing services. d. strategic financial planning.

: C Costing out nursing services is defined as the determination of the costs of the services provided by nurses. By identifying the specific costs related to the delivery of nursing care to each client, nurses have data to identify the actual amount of services received.

The costs or prices of activities undertaken in the organization's operations are called: a. budget. b. income. c. expenses. d. revenue

: C Expenses are defined as the costs or prices of activities undertaken in the organization's operations.

The first person to analyze patient outcomes associated with nursing care delivery was: a. Clara Barton. b. Dorothea Dix. c. Florence Nightingale. d. Luther Christman.

: C Florence Nightingale was the first person to analyze patient outcomes associated with nursing care delivery. This occurred in the nineteenth century.

Revenues minus expenses equals: a. cash flow. b. expense incurred. c. income. d. total reimbursement

: C Income (or profit) is defined as the excess of revenues over expenses, or revenues minus expenses

To determine whether her patient has responded favorably to a nursing intervention, a staff nurse should observe the client for: a. improved health. b. increased complaints. c. outcome indicators. d. signs and symptoms

: C Indicators are valid and reliable measures related to performance. They are specific markers used that make quality and quality differences visible to stakeholders in health care.

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.

: 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.

Nursing data need to include which of the following domains? a. Fiduciary data b. Outcome data c. Client data d. Tertiary data

: C Nursing's data needs fall in four domains: client care, provider competencies and staffing, administration of care and sustainability of the organization, and knowledge-based research for evidence-based practice.

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.

: 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.

4. One of the findings of a study by Aiken and colleagues (2002) was that nurses with the highest nurse-to-patient ratios were more likely to describe feelings of: (Select all that apply.) a. grief. b. anger. c. burnout. d. job dissatisfaction. e. emotional exhaustion.

: C, D, E One of the findings of a study by Aiken and colleagues (2002) was that nurses with the highest nurse-to-patient ratios (fewer nurses for the number of patients) were more likely to describe feelings of burnout, emotional exhaustion, and job dissatisfaction than nurses with lower ratios (more RNs for the number of patients).

2. The nursing shortage cycles over the past few decades have been primarily driven by factors including which of the following? (Select all that apply.) a. Aging of current nurses and inability of hospitals to meet nursing salary demands b. Younger nurses in the workforce and their preference for non-traditional nursing jobs c. Significant changes in the health care delivery system as the nation moves into health care reform d. Aging of the American population and struggles to expand capacity to meet demand for care e. Lower numbers of students entering nursing as a career

: C, D, E The nursing shortage cycles over the past few decades have been primarily driven by five factors: aging of current nurses in the workforce and their preparation for retirement, lower numbers of students entering nursing as a career and a shift in need for both bachelor's- and master's/doctorate-prepared nurses, aging of nursing faculty and inability of schools of nursing to meet education demands, aging of the American population and struggles to expand capacity to meet demand for care, and significant changes in the health care delivery system as the nation moves into health care reform.

In the provider domain, what are some of the variables that are used to measure variability in nursing? (Select all that apply.) a. Certification b. Hours of work c. Education level d. Years of experience e. Attitudes and beliefs

: C, D, E In the provider domain, professional skills/knowledge and intensity of nursing care are variables that may be measured to monitor variability and to control workforce capacity. The quality and types of services are dependent on the competencies of the professional workforce.

Nurse managers can create an environment that is devoted to health care safety by doing which of the following? (Select all that apply.) a. Adopting and embracing the concept of disciplining staff who commit errors b. Learning the concepts and tools related to quality improvement and quality assurance c. Becoming a role model for staff and peers in practicing health care safety concepts d. Encouraging staff to be constantly vigilant in identifying potential risks in the care environment e. Creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks

: C, D, E Nurse managers can personally create an environment that is devoted to health care safety by doing the following: learning the concepts and tools related to risk identification, analysis, and error reduction; adopting and embracing the concept of non-punitive error reporting; advocating for the establishment of a non-punitive culture if it is not currently a strong ideal within the organization; encouraging staff to be constantly vigilant in identifying potential risks in the care environment; creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks; and becoming a role model for staff and peers in practicing health care safety concepts.

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.

: 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.

13. The United States recruits more internationally educated nurses (IENs) than any other country. The largest group of IENs in the United States is from: a. India. b. Canada. c. Great Britain. d. the Philippines.

: D According to McHugh and colleagues (2008), the United States recruited more internationally educated nurses (IEN) than any other country. Approximately half of the IENs were originally from the Philippines (48.7%), 11.5% from Canada, and 9.3% were from India (BHPr, 2010).

12. An important factor in nurse retention is managerial leadership. Which leadership style has the greatest impact on nurse job satisfaction? a. Democratic b. Laissez-faire c. Authoritarian d. Transformational

: D Another important factor in retention of nurses is managerial leadership (Acree, 2006; Kleinman, 2004). The two leadership styles that predominate in the literature are transformational and transactional. Managerial use of transformational leadership has been shown to have the greatest impact on nurse job satisfaction.

It is estimated that nurses spend approximately _____ of their time documenting information in the EHR. a. 7% b. 17% c. 20% d. 35%

: D Nurses spend approximately 19% of their time in patient care, 7% with assessments, 17% managing medications, 20% coordinating care, and 35% documenting patient information in EHRs (Burnes-Bolton, 2009).

18. A mechanism for giving feedback related to progress to employees new and experienced is called: a. coaching. b. mentoring. c. counseling. d. performance evaluation.

: D Performance evaluation is a mechanism for giving feedback to employees new and experienced.

Nursing outcome databases are critical because nurses must be able to: a. assess the differences between an associate degree in nursing and a bachelor's of science degree in nursing. b. compare interventional care strategies between physicians. c. evaluate nurse's aide- and licensed practical/vocational nurse-sensitive outcomes. d. measure how nurses influence patient outcomes.

: D Nursing outcome databases are critical for two reasons: (1) nurses are able to measure and document how nurses influence patient outcomes across care providers for populations of patients, and (2) the study of nursing-sensitive outcomes allows comparisons among interventional strategies and advances the science of nursing care delivery

The relationship between output and the goods and services used to produce them is called: a. acuity. b. revenue. c. variability. d. productivity

: D Productivity is defined as the relationship between output and the goods and services used to produce them

A staff nurse's accurate recording of all services and supplies used to provide care to each client in her assignment is necessary for determining calculations used in which of the following budgets? a. Expense b. Gross c. Inpatient d. Revenue

: D Revenue is defined as income or amounts owed for purchased services or goods. Total operating expenses are the result of summing the costs of all resources (e.g., labor, patient consumable supplies, small medical equipment, utilities, office supplies, and other related miscellaneous fees and materials) used to produce services.

The results people care about most when seeking treatment is known as a(n): a. achieved benefit. b. benchmark. c. expected response. d. outcome.

: D Simply put, an outcome is the result or results obtained from the efforts to accomplish a goal. A patient-focused definition of outcomes considers them "the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives" that are "inherently condition-specific and multidimensional" (International Consortium for Health Outcomes Measurement

The Nursing Minimum Data Set (NMDS) was designed to: a. determine differences in care delivery between the holder of an associate degree in nursing and a bachelor's of science in nursing. b. evaluate the nursing language of NANDA, Nursing Interventions Classification, and Nursing Outcomes Classification. c. provide data for leaders to make decisions about staffing patterns. d. standardize the collection of nursing data across populations.

: D The formulation of the NMDS was an effort to standardize the collection of essential nursing information for comparison of nursing data across patient populations.

Nurses utilize _____ through critical thinking and clinical reasoning skills to determine when and how to apply evidence-based knowledge. a. orders b. data c. information d. wisdom

: D Wisdom is the appropriate use of knowledge in managing and solving patient problems, risks, and needs for health enhancement. Wisdom is knowing when and how to apply the evidence-based knowledge with client information, which nurses exercise through critical thinking and clinical reasoning skills.

A Healthcare Failure Modes and Effects Analysis (HFMEA) for a new bar-coding system is being conducted by an interdisciplinary team. List the steps of the HFMEA in the correct order. a. Identifying prevention strategies b. Endorsing action plans for implementation c. Assessing risk points within the process steps d. Flowcharting the steps of the process being studied e. Designing out the most critical of the potential failures f. Recommending process improvements for prevention of the failures g. Ranking key risk points in terms of their impact on the potential failure of the system h. Reporting action plans for implementing prevention strategies to the enterprise leaders

: D, C, G, E, F, A, H, B The HFMEA is conducted by an interdisciplinary team of professionals who own the process being studied and is facilitated by someone with knowledge and skills in quality improvement tools. The HFMEA begins with flowcharting the steps of the process being studied. The team assesses risk points within the process steps, and these key risk points are ranked in terms of their impact on the potential failure of the system. Scores for severity and probability are calculated to give a hazard score to the identified breakdown, and detectability of the failure mode is factored into the analysis of its impact on the overall process. The team then designs out the most critical of the potential failures and recommends process improvements for prevention of the failures. Once these prevention strategies are identified, action plans for implementing them are reported to the enterprise leaders and endorsed for implementation

_____ is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

: Evidence-based practice Evidence-based practice is defined by Sackett and colleagues (1996) as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

_____ involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators.

: Risk adjustment Risk adjustment involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators. Comparisons of outcomes across settings or time periods are meaningful only when potentially important differences in the characteristics of patients involved are taken into account

A measure of the severity of illness of an individual patient or the aggregate patient population on a unit is called _____.

: acuity Acuity is defined as a measure of the severity of illness of an individual patient or the aggregate patient population on a unit

The improvement process in which an organization measures its strategies, operations, or internal process performance against that of best-in-class organizations within or outside its industry determines how those organizations achieved their performance levels, and uses that information to improve its own performance is known as _____.

: benchmarking 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).

17. 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.

18. 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.

15. 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.

5. _____ 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).

6. 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

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.

2. 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).

5. 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

4. 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.

1. 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.

6. 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

20. 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.

1. 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.

12. 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).

4. 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.

11. 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).

9. 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.

14. 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).

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

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

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?

3. 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.

2. 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 evidence and guideline based.

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

19. 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

16. 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

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

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

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.