Nursing 180 Week 1 exam book
Page 33- What is the focus of Public Health Nursing?
A public health nursing focus requires understanding the needs of a population or a collection of individuals who have one or more personal or environmental characteristics in common (Stanhope and Lancaster, 2014). Examples of populations include high-risk infants, older adults, or an ethnic group such as Native Americans. A public health nurse understands factors that influence health promotion and health maintenance,
Page 72 Define Risk Factor
A risk factor is any situation, habit, or other variable such as social, environmental, physiological, psychological, developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or accident. An example would be risk factors for falls, such as impaired gait, reduced vision, and lower extremity weakness. Risk factors and behaviors, risk factor modification, and behavior modification are integral components of health promotion, wellness, and illness prevention. Nurses in all areas of practice have opportunities to reduce patients' risk factors to promote health and decrease risks of illness or injury.
Page 26 - Although globalization has improved healthcare services worldwide, globalization has had a negative impact on health. What has globalization commonly resulted in?
Although globalization of trade, travel, and culture improves the availability of health care services, the spread of communicable diseases such as Ebola, tuberculosis, and severe acute respiratory syndrome has become more common. Finally, the results of global environmental changes and disasters affect health. Changes in climate and natural disasters threaten food supplies and often allow infectious diseases to spread more rapidly.
Page 17- List the six categories of health care services and the examples for each (Box 2-1 Examples of Health Care Services)
Box 2-1 Examples of Health Care Services Primary Care (Health Promotion) • Prenatal and well-baby care • Nutrition counseling • Family planning • Exercise, yoga, and mediation classes Preventive Care • Blood pressure and cancer screenings • Immunizations • Mental health counseling and crisis prevention • Community legislation (e.g., seat belts, air bags, bike helmets, no texting while driving) Secondary Acute Care • Emergency care • Acute medical-surgical care • Radiological procedures for acute problems (e.g., x-rays, computed tomography [CT] scans) Tertiary Care • Intensive care • Subacute care Restorative Care • Cardiovascular and pulmonary rehabilitation • Orthopedic rehabilitation • Sports medicine • Spinal cord injury programs • Home care Continuing Care • Assisted living • Psychiatric and older adult day care
Pages 35-37 - Describe the eight roles of the Community Health Nurse.
Caregiver. First and foremost is the role of caregiver (see Chapter 1). In the community setting you manage and care for the health of patients and families in the community. Use a critical thinking approach to apply the nursing process (see Unit III) and ensure appropriate, individualized nursing care for specific patients and their families. Historically well-baby and child care were integral to community nursing practices. Because of changes in the health care delivery system, changing economics, homelessness, and the medically underinsured, community child care services are increasing. Community nurses are undertaking more complex and expanded child health services for increasingly diverse client populations (Borrow et al., 2011). In addition, you individualize care within the context of a patient's community so long-term success is more likely. Together with the patient and family you develop a caring partnership to recognize actual and potential health care needs and identify needed community resources. As a caregiver, you also help build a healthy community, which is one that is safe and includes elements to enable people to achieve and maintain a high quality of life and function. QSEN Building Competency in Safety Jan Carrel is a 30-year-old single woman who has multiple sclerosis (MS). She owns a condo and is an executive for a car rental firm. Her MS has progressed to the point that she needs ambulatory assistive devices. Depending on her level of mobility, these devices range from a walker to a motorized chair; and the amount of assistance Jan requires changes during the week. She is able to stand to transfer to the toilet or to her handicapped-accessible vehicle or to reach items in the kitchen. However, because of her muscle weakness, her activity intolerance, and imbalance, she cannot stand for long periods of time. Both she and her doctor have requested a home safety assessment. What information do you need to begin this assessment? Case Manager. In community-based practice case management is an important competency (see Chapter 2). It is the ability to establish an appropriate plan of care based on assessment of patients and families and to coordinate needed resources and services for a patient's well-being across a continuum of care. Generally a community-based case manager assumes responsibility for the case management of multiple patients. The greatest challenge is coordinating the activities of multiple providers and payers in different settings throughout a patient's continuum of care. An effective case manager eventually learns the obstacles, limits, and even the opportunities that exist within the community that influence the ability to find solutions for patients' health care needs. Change Agent. A community-based nurse is also a change agent. This involves identifying and implementing new and more effective approaches to problems. You act as a change agent within a family system or as a mediator for problems within a patient's community. You identify any number of problems (e.g., quality of community child care services, availability of older-adult day care services, or the status of neighborhood violence). As a change agent you empower individuals and their families to creatively solve problems or become instrumental in creating change within a health care agency. For example, if your patient has difficulty keeping regular health care visits, you determine why. Maybe the health clinic is too far and difficult to reach, or perhaps the hours of service are incompatible with a patient's transportation resources. You work with the patient to solve the problem and help identify an alternative site such as a nursing clinic that is closer and has more convenient hours. To effect change you gather and analyze facts before you implement the program. This requires you to be very familiar with the community itself. Many communities resist change, preferring to provide services in the established manner. Before analyzing facts, it is often necessary to manage conflict among the health care providers, clarify their roles, and clearly identify the needs of the patients. If the community has a history of poor problem solving, you will have to focus on developing problem-solving capabilities (Stanhope and Lancaster, 2014). Patient Advocate. Patient advocacy is more important today in community-based practice because of the confusion surrounding access to health care services. Your patients often need someone to help them walk through the system and identify where to go for services, how to reach individuals with the appropriate authority, which services to request, and how to follow through with the information they receive. It is important to provide the information necessary for patients to make informed decisions in choosing and using services appropriately. In addition, it is important for you to support and at times defend your patients' decisions. Collaborator. In community-based nursing practice you need to be competent in working not only with individuals and their families but also with other related health care disciplines. Collaboration, or working in a combined effort with all those involved in care delivery, is necessary to develop a mutually acceptable plan that will achieve common goals (Stanhope and Lancaster, 2014). For example, when your patient is discharged home with terminal cancer, you collaborate with hospice staff, social workers, and pastoral care to initiate a plan to support end-of-life care for the patient in the home and support the family. For collaboration to be effective, you need mutual trust and respect for each professional's roles, abilities, and contributions. Counselor. Knowing community resources is a critical factor in becoming an effective patient counselor. A counselor helps patients identify and clarify health problems and choose appropriate courses of action to solve those problems. For example, in employee assistance programs or women's shelters, a major amount of nurse-patient interaction is through counseling. As a counselor you are responsible for providing information; listening objectively; and being supportive, caring, and trustworthy. You do not make decisions but rather help your patients reach decisions that are best for them (Stanhope and Lancaster, 2014). Patients and families often require assistance in first identifying and clarifying health problems. For example, a patient who repeatedly reports a problem in following a prescribed diet is actually unable to afford nutritious foods or has family members who do not support good eating habits. You need to discuss with your patient factors that block or aid problem resolution, identify a range of solutions, and then discuss which solutions are most likely to be successful. You also encourage your patient to make decisions and express your confidence in the choice the patient makes. Educator. In a community-based setting you work with single individuals and groups of patients. Establishing relationships with community service organizations offers educational support to a wide range of patient groups. Prenatal classes, infant care, child safety, and cancer screening are just some of the health education programs provided in a community practice setting. When the goal is to help your patients assume responsibility for their own health care, your role as an educator takes on greater importance (Stanhope and Lancaster, 2014). Patients and families need to gain skills and knowledge to care for themselves. Assess your patient's learning needs and readiness to learn within the context of the individual, the systems with which the individual interacts (e.g., family, business, and school), and the resources available for support. Adapt your teaching skills so you can instruct a patient within the home setting and make the learning process meaningful. In this practice setting you have the opportunity to follow patients over time. Planning for return demonstration of skills, using follow-up phone calls, and referring to community support and self-help groups give you an opportunity to provide continuity of instruction and reinforce important instructional topics and learned behaviors (see Chapter 25). Epidemiologist. As a community-based nurse, you also apply principles of epidemiology. Your contacts with families, community groups such as schools and industries, and health care agencies place you in a unique position to initiate epidemiological activities. As an epidemiologist, you are involved in case finding, health teaching, and tracking incident rates of an illness. For example, a cafeteria worker in the local high school is diagnosed with active tuberculosis (TB). As a community health nurse, you help find new TB exposures or active disease within the worker's home, employment network, and community. Nurse epidemiologists are responsible for community surveillance for risk factors (e.g., tracking incidence of elevated lead levels in children and identifying increased fetal and infant mortality rates, increases in adolescent pregnancy, presence of infectious and communicable diseases, and outbreaks of head lice). Nurse epidemiologists protect the level of health of the community, develop sensitivity to changes in the health status of the community, and help identify the cause of these changes.
Page 3 - Define/describe the Code of Ethics
Code of Ethics. The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. It is important for you to also incorporate your own values and ethics into your practice. As you incorporate these values, you explore what type of nurse you will be and how you will function within the discipline (ANA, 2015). Ask yourself how your ethics, values, and practice compare with established standards. The ANA has a number of publications that address ethics and human rights in nursing. The Code of Ethics for Nurses With Interpretive Statements is a guide for carrying out nursing responsibilities that provide quality nursing care; it also outlines the ethical obligations of the profession (ANA, 2015). Chapter 22 provides a review of the nursing code of ethics and ethical principles for everyday practice.
Pages 7-8 List the six QSEN competencies and define each (Table 1-1 Quality & Safety Education for Nurses)
Competency Definition with Examples Patient-Centered Care Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. Examples: Involve family and friends in care. Elicit patient values and preferences. Provide care with respect for diversity of the human experience. Teamwork and Collaboration Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Examples: Recognize the contributions of other health team members and patient's family members. Discuss effective strategies for communicating and resolving conflict. Participate in designing methods to support effective teamwork. Evidence-Based Practice Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Examples: Demonstrate knowledge of basic scientific methods. Appreciate strengths and weaknesses of scientific bases for practice. Appreciate the importance of regularly reading relevant journals. Quality Improvement Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Examples: Use tools such as flow charts and diagrams to make process of care explicit. Appreciate how unwanted variation in outcomes affects care. Identify gaps between local and best practices. Safety Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Examples: Examine human factors and basic safety design principles and commonly used unsafe practices. Value own role in preventing errors. Informatics Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Examples: Navigate an electronic health record. Protect confidentiality of protected health information in electronic health records. Adapted from Cronenwett L et al: Quality and safety education for nurses, Nurs Outlook 57:122, 2007.
Page 7 - Explain the importance of Evidence Based Practice.
Evidence-Based Practice Today the general public is more informed about their health care needs, the cost of health care, and the incidence of medical errors within health care institutions. Your practice needs to be based on current evidence, not just according to your education and experiences and the policies and procedures of health care facilities (see Chapter 5). Health care organizations can show their commitment to each health care stakeholder (e.g., patients, insurance companies, and governmental agencies) to reduce health care errors and improve patient safety by implementing evidence-based practices (National Quality Forum, 2010). In addition, many hospitals are achieving Magnet Recognition, which recognizes excellence in nursing practice (ANCC, 2014). A component of excellence in practice is quality of care, which is achieved by implementing evidenced-based practice (see Chapter 2).
Pages 71-72 List and describe each Leve of Preventive Care
External Variables External variables influencing a person's health beliefs and practices include family practices, psychosocial and socioeconomic factors, and cultural background. Family Practices. The way that patients' families use health care services generally affects their health practices. Their perceptions of the seriousness of diseases and their history of preventive care behaviors (or lack of them) influence how patients think about health. For example, if a young woman's mother never had annual gynecological examinations or Papanicolaou (Pap) smears, it is unlikely that the daughter will have annual Pap smears. Psychosocial and Socioeconomic Factors. Socioeconomic and psychosocial factors increase the risk for illness and
Page 5- Define/describe Compassion Fatigue.
Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress (Potter et al., 2013a). It occurs without warning and often results from giving high levels of energy and compassion over a prolonged period to those who are suffering, often without experiencing improved patient outcomes (Potter et al., 2010). Secondary traumatic stress is the trauma that health care providers experience when witnessing and caring for others suffering trauma. Examples include an oncology nurse who cares for patients undergoing surgery and chemotherapy over the long term for their cancer or a spouse who witnesses his wife deteriorating over the years from Alzheimer's disease. Burnout is the condition that occurs when perceived demands outweigh perceived resources (Potter et al., 2013a). It is a state of physical and mental exhaustion that often affects health care providers because of the nature of their work environment. Over time, giving of oneself in often intense caring environments sometimes results in emotional exhaustion, leaving a nurse feeling irritable, restless, and unable to focus and engage with patients (Potter et al., 2013b). This often occurs in situations in which there is a lack of social support, organizational pressures influencing staffing, and the inability of the nurse to practice self-care. Compassion fatigue typically results in feelings of hopelessness, a decrease in the ability to take pleasure from previously enjoyable activities, a state of hypervigilance, and anxiety.
Page 2 - List and describe the five levels of proficiency in nursing (Box 1-1 Benner from Novice to Expert)
From Novice to Expert • Novice: Beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g., an experienced operating room nurse chooses to now practice in home health). The learner learns via a specific set of rules or procedures, which are usually stepwise and linear. • Advanced Beginner: A nurse who has had some level of experience with the situation. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care. • Competent: A nurse who has been in the same clinical position for 2 to 3 years. This nurse understands the organization and specific care required by the type of patients (e.g., surgical, oncology, or orthopedic patients). He or she is a competent practitioner who is able to anticipate nursing care and establish long-range goals. In this phase the nurse has usually had experience with all types of psychomotor skills required by this specific group of patients. • Proficient: A nurse with more than 2 to 3 years of experience in the same clinical position. This nurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. This nurse focuses on managing care as opposed to managing and performing skills. • Expert: A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. He or she is skilled at identifying both patient-centered problems and problems related to the health care system or perhaps the needs of the novice nu
Page 23- List the competencies and provide examples for each competence included in Institute of Medicine competencies for the 2st Century (Box 2-4 Institute of Medicine Competencies)
Institute of Medicine Competencies for the Twenty-First Century Provide Patient-Centered Care • Recognize and respect differences in patients' values, preferences, and needs. • Relieve pain and suffering. • Coordinate continuous care. • Effectively communicate with and educate patients. • Share decision making and management. • Advocate for disease prevention and health promotion. Work in Interdisciplinary Teams • Cooperate, collaborate, and communicate. • Integrate care to ensure that it is continuous and reliable. Use Evidence-Based Practice • Integrate best research with clinical practice and patient values. • Participate in research activities as possible. Apply Quality Improvement • Identify errors and hazards in care. • Practice using basic safety design principles. • Measure quality in relation to structure, process, and outcomes. • Design and test interventions to change processes. Use Informatics • Use information technology to communicate, manage knowledge, reduce error, and support decision-making.
Pages 69-70 List the Internal and External Variables Influencing Health Beliefs and Practices
Internal variables include a person's developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors. Developmental Stage. A person's thought and behavior patterns change throughout life. A nurse considers a patient's level of growth and development when using his or her health beliefs and practices as a basis for planning care (see Chapter 11). The concept of illness for a child, adolescent, or adult depends on the individual's developmental stage. Fear and anxiety are common among ill children, especially if thoughts about illness, hospitalization, or procedures are based on lack of information or lack of clarity of information. Emotional development may also influence personal beliefs about health-related matters. For example, you use different techniques for teaching about contraception to an adolescent than you use for an adult. Knowledge of the stages of growth and development helps predict a patient's response to the present illness or the threat of future illness. Adapt the planning of nursing care to developmental expectations and to the patient's abilities to participate in self-care. Intellectual Background. A person's beliefs about health are shaped in part by the person's knowledge, lack of knowledge, or incorrect information about body functions and illnesses, educational background, traditions, and past experiences. These variables influence how a patient thinks about health. In addition, cognitive abilities shape the way a person thinks, including the ability to understand factors involved in illness and apply knowledge of health and illness to personal health practices. Cognitive abilities also relate to a person's developmental stage. A nurse considers intellectual background so these variables can be incorporated into communication and instructional approaches (Edelman and Mandle, 2014). Perception of Functioning. The way people perceive their physical functioning affects health beliefs and practices. When you assess a patient's level of health, gather subjective data about the way the patient perceives physical functioning such as level of fatigue, shortness of breath, or pain. Then obtain objective data about actual functioning such as blood pressure, height measurements, and lung sound assessment. This information allows you to more successfully plan and implement individualized approaches, such as self-care and mobility. Emotional Factors. The patient's degree of stress, depression, or fear can influence health beliefs and practices. The manner in which a person handles stress throughout each phase of life influences the way he or she reacts to illness. A person who generally is very calm may have little emotional response during illness, whereas another individual may be unable to cope emotionally with the threat of illness and may overreact or deny the presence of symptoms and not take therapeutic action (see Chapter 38). Spiritual Factors. Spirituality is reflected in how a person lives his or her life, including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. Spirituality serves as an integrating theme in people's lives (see Chapter 36). Religious practices are one way that people exercise spirituality. Some religions restrict the use of certain forms of medical treatment. For example, persons of the Jehovah Witness faith do not receive blood transfusions. You need to understand patients' spiritual dimensions to involve patients effectively in nursing care. External Variables External variables influencing a person's health beliefs and practices include family practices, psychosocial and socioeconomic factors, and cultural background. Family Practices. The way that patients' families use health care services generally affects their health practices. Their perceptions of the seriousness of diseases and their history of preventive care behaviors (or lack of them) influence how patients think about health. For example, if a young woman's mother never had annual gynecological examinations or Papanicolaou (Pap) smears, it is unlikely that the daughter will have annual Pap smears. Psychosocial and Socioeconomic Factors. Socioeconomic and psychosocial factors increase the risk for illness and influence the way that a person defines and reacts to illness. Psychosocial variables include the stability of the person's marital or intimate relationship, lifestyle habits, and occupational environment. A person generally seeks approval and support from social networks (neighbors, peers, and co-workers), and this desire for approval and support affects health beliefs and practices. Socioeconomic variables partly determine how the health care system provides medical care. The organization of the health care system determines how patients obtain care, the treatment method, cost to patients, and potential reimbursement to the health care agency or patients. Economic variables often affect a patient's level of health by increasing the risk for disease and influencing how or at what point the patient enters the health care system. A person's compliance with a treatment designed to maintain or improve health is also affected by economic status. A person who has high utility bills, cares for a large family, and has a low income tends to give a higher priority to food and shelter than to costly drugs or treatment or expensive foods for special diets. Some patients decide to take medications every other day rather than every day as prescribed to save money, which greatly affects the effectiveness of the medications. Cultural Background. Cultural background influences beliefs, values, and customs. It influences the approach to the health care systems, personal health practices, and the nurse-patient relationship. Cultural background also influences an individual's beliefs about causes of illness and remedies or practices to restore health (Box 6-2). If you are not aware of your own cultural patterns of behavior and language, you will have difficulty recognizing and understanding your patient's behaviors and beliefs. You will also probably have difficulty interacting with patients. As with family and socioeconomic variables, you need to incorporate cultural variables into a patient's care plan (see Chapter 9).
Page 31- What is the primary focus of community based health care?
It is important to understand the focus of community-based health care. Community-based health care is a model of care that reaches everyone in a community (including the poor and underinsured), focuses on primary rather than institutional or acute care, and provides knowledge about health and health promotion and models of care to the community. Community-based health care occurs outside traditional health care institutions such as hospitals. It provides services to individuals and families within the community for acute and chronic conditions (Stanhope and Lancaster, 2014). Today the challenges in community-based health care are numerous. Political policy and the Affordable Care Act (ACA); social determinants of health, increases in health disparities, and economics all influence public health problems and subsequent health care services. Some of these problems include a lack of adequate health insurance, chronic illnesses such as heart disease and diabetes, an increase in sexually transmitted infections, and underimmunization of infants and children (USDHHS, 2015). More than ever before, the health care system must commit to reform and bring attention and health care services to all communities.
Pages 67-68 Describe Maslow's Hierarchy of Needs Model.
Maslow's Hierarchy of Needs Basic human needs are elements that are necessary for human survival and health (e.g., food, water, safety, and love). Although each person has unique needs, all people share the basic human needs, and the extent to which people meet their basic needs is a major factor in determining their level of health. Maslow's hierarchy of needs is a model that nurses use to understand the interrelationships of basic human needs (Figure 6-3). According to this model, certain human needs are more basic than others (i.e., some needs must be met before other needs [e.g., fulfilling the physiological needs before the needs of love and belonging]). Self-actualization is the highest expression of one's individual potential and allows for continual self-discovery. Maslow's model takes into account individual experiences, which are always unique to that individual
Pages 3 & 4 - List and describe the Professional Responsibilities & Roles of Nurses
Professional Responsibilities and Roles You are responsible for obtaining and maintaining specific knowledge and skills for a variety of professional roles and responsibilities. Nurses provide care and comfort for patients in all health care settings. Nurses' concern for meeting their patient's needs remains the same whether care focuses on health promotion and illness prevention, disease and symptom management, family support, or end-of-life care. Caregiver. As a caregiver you help patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process. You provide healing through psychomotor and interpersonal skills. Healing involves more than achieving improved physical well-being. You need to meet all health care needs of a patient by providing measures to restore a patient's emotional, spiritual, and social well-being. As a caregiver you help patients and families set realistic goals and meet them. Advocate. As a patient advocate you protect your patient's human and legal rights and provide assistance in asserting these rights if the need arises. As an advocate you act on behalf of your patient and secure your patient's health care rights (Emrich et al., 2013). For example, you provide additional information to help a patient decide whether or not to accept a treatment, or you find an interpreter to help family members communicate their concerns. You sometimes need to defend patients' rights to make health care decisions in a general way by speaking out against policies or actions that put patients in danger or conflict with their rights (Wilson et al., 2013). Educator. As an educator you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient's progress in learning. Some of your patient teaching is unplanned and informal. For example, during a casual conversation you respond to questions about the reason for an intravenous infusion, a health issue such as smoking cessation, or necessary lifestyle changes. Other teaching activities are planned and more formal such as when you teach your patient how to self-administer insulin injections. Always use teaching methods that match your patient's capabilities and needs and incorporate other resources such as the family in teaching plans (see Chapter 25). Communicator. Your effectiveness as a communicator is central to the nurse-patient relationship. It allows you to know your patients, including their strengths, weaknesses, and needs. Communication is essential for all nursing roles and activities. You will routinely communicate with patients and families, other nurses and health care professionals, resource people, and the community. Without clear communication it is impossible to advocate for your patients or to give comfort and emotional support, give care effectively, make decisions with patients and families, protect patients from threats to well-being, coordinate and manage patient care, assist patients in rehabilitation, or provide patient education (Emrich et al., 2013). Quality communication is a critical factor in meeting the needs of individuals, families, and communities (see Chapter 24). Manager. Today's health care environment is fast paced and complex. Nurse managers need to establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes. A manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency. A manager uses appropriate leadership styles to create a nursing environment for patients and staff that reflects the mission and values of the health care organization (see Chapter 21).
Page 27 (Up until "Act" in PDSA) - Describe Quality Improvement (QI) and examples of QI Projects
Quality improvement (QI) is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy. The QI program of an institution focuses on improvement of health care-related processes (e.g., medication delivery or fall prevention). Performance measurement analyzes what an institution does and how well it does it. In performance improvement (PI) an organization analyzes and evaluates current performance and uses the results to develop focused improvement actions.
Page 72 List four categories of Risk Factors
Risk factors are often placed in the following interrelated categories: genetic and physiological factors, age, physical environment, and lifestyle.
Page 31- What are the overall goals of the Healthy People Initiative 2020?
The Healthy People Initiative was created to establish ongoing health care goals (see Chapter 6). The 2020 document strives to ensure that Healthy People 2020 is relevant to diverse public health needs and seizes opportunities to achieve its goals. Since its inception, Healthy People has become a broad-based, public engagement initiative with thousands of citizens helping to shape it at every step along the way. The overall goals of Healthy People 2020 are to increase life expectancy and quality of life and eliminate health disparities through improved delivery of health care services (USDHHS, 2015). Improved delivery of health care occurs through assessment of health care needs of individuals, families, and communities; development and implementation of public health policies; and improved access to care. For example, assessment includes systematic data collection on the population, monitoring the health status of the population, and accessing available information about the health of the community (Stanhope and Lancaster, 2014). A comprehensive community assessment sometimes leads to community health programs such as adolescent smoking prevention, sex education, and proper nutrition. Some examples of assessment include gathering information on incident rates such as identifying and reporting new infections or diseases, determining adolescent pregnancy rates, and reporting the number of motor vehicle accidents caused by teenage drivers.
Page 66- What is the World Health Organization's definition of health?
The World Health Organization (WHO) defines health as a "state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity"
Page 16 - Define and describe characteristics of PPO, Medicare, Medicaid, Private Insurance & Long Term Health Insurance (Table 2-1 Example of Health Care Plans)
Type Definition Characteristics Managed care organization (MCO) Provides comprehensive preventive and treatment services to a specific group of voluntarily enrolled people. Structures include a variety of models. Focuses health maintenance, primary care. All care is provided by a primary care physician. Referral is needed for access to specialist and hospitalization. May use capitated payments. Preferred provider organization (PPO) Type of managed care plan that limits an enrollee's choice to a list of "preferred" hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list. Contractual agreement exists between a set of providers and one or more purchasers (self-insured employers or insurance plans). Comprehensive health services are at a discount to companies under contract. Focus is on health maintenance. Medicare A federally administrated program by the Commonwealth Fund or the Centers for Medicare and Medicaid Services (CMS); a funded national health insurance program in the United States for people 65 years and older. Part A provides basic protection for medical, surgical, and psychiatric care costs based on diagnosis-related groups (DRGs); also provides limited skilled nursing facility care, hospice, and home health care. Part B is a voluntary medical insurance; covers physician, certain other specified health professional services, and certain outpatient services. Part C is a managed care provision that provides a choice of three insurance plans. Part D is a voluntary Prescription Drug Improvement (Sultz and Young, 2014). Payment for plan is deducted from monthly individual Social Security check. Covers services of nurse practitioners. Does not pay full cost of certain services such as skilled nursing facilities. Supplemental insurance is encouraged. Medicaid Federally funded, state-operated program that provides: (1) health insurance to low-income families; (2) health assistance to low-income people with long-term care (LTC) disabilities; and (3) supplemental coverage and LTC assistance to older adults and Medicare beneficiaries in nursing homes. Individual states determine eligibility and benefits. Finances a large portion of care for poor children, their parents, pregnant women, and disabled very poor adults. Reimburses for nurse-midwifery and other advanced practice nurses (varies by state). Reimburses nursing home funding. Private insurance Traditional fee-for-service plan. Payment is computed after patient receives services on basis of number of services used. Policies are typically expensive. Most policies have deductibles that patients have to meet before insurance pays. Long-Term Care (LTC) insurance Supplemental insurance for coverage of LTC services. Policies provide a set amount of dollars for an unlimited time or for as little as 2 years. Very expensive. Often has a minimum waiting period for eligibility; payment for skilled nursing, intermediate, or custodial care and home care. State Children's Health Insurance Program (SCHIP) Federally funded, state-operated program to provide health coverage for uninsured children. Individual states determine participation eligibility and benefits. Covers children not poor enough for Medicaid.
Page 34 - Define Vulnerable Populations.
Vulnerable populations are groups of patients who are more likely to develop health problems as a result of excess health risks, who are limited in access to health care services, or who depend on others for care. Individuals living in poverty, older adults, people who are homeless, immigrant populations, individuals in abusive relationships, substance abusers, and people with severe mental illnesses are examples of vulnerable populations. These vulnerabilities are often associated with the individual's/community's social determinants of health or individual health disparities. Public and community health nursing and primary care providers share health care responsibility for health promotion, screening, and early detection and disease prevention for vulnerable populations. These patients have intense health care needs that are unmet or ignored or require more care than can be provided in outpatient or hospital settings. Individuals and their families who are vulnerable often belong to more than one of these groups. In addition, health care vulnerability affects all age-group
Page 10- Define/describe Nurse Practice Acts.
ts In the United States the State Boards of Nursing oversee NPAs. NPAs regulate the scope of nursing practice and protect public health, safety, and welfare. This protection includes shielding the public from unqualified and unsafe nurses. Although each state defines for itself the scope of nursing practice, most have similar NPAs. The definition of nursing practice published by the ANA is representative of the scope of nursing practice as defined in most states. However, in the last decade many states have revised their NPAs to reflect the growing autonomy of nursing and the expanded roles of nurses in practice. For example, NPAs expanded their scope to include minimum education requirements, required certifications, and practice guidelines for APRNs such as nurse practitioners and certified RN anesthetists. The expansion of scope of practice includes skills unique to the advanced practice role (e.g., advanced assessment, prescriptive authority for certain medications and diagnostic procedures, and some invasive procedures).
Page 25- Define Nursing-Sensitive Outcomes
ursing-sensitive outcomes are patient outcomes and nursing workforce characteristics that are directly related to nursing care such as changes in patients' symptom experiences, functional status, safety, psychological distress, registered nurse (RN) job satisfaction, total nursing hours per patient day, and costs. As a nurse you assume accountability and responsibility for achieving and accepting the consequences of these outcomes. The American Nurses Association developed the National Database of Nursing Quality Indicators (NDNQI) to measure and evaluate nursing-sensitive outcomes with the purpose of improving patient safety and quality care (NDNQI, 2015) (Box 2-8). The NDNQI reports quarterly results on nursing outcomes at the nursing unit level. This provides a database for individual hospitals to compare their performance against nursing performance nationally. The evaluation of patient outcomes and nursing workforce characteristics remains important to nursing and the health care delivery system. Chapter 5 describes approaches for measuring outcomes.
