Nursing 104 Exam 2

No, literacy is not a demographic.

Is literacy a demographic?

Teamwork and Collaboration

DEFINITION: Function effectively within nursing and inter-professional teams, fostering open cmcn, mutual respect, and shared decision making to achieve quality patient care. KNOWLEDGE: Describe one's own strengths, limitations, and values in functioning as a team member. Describe examples of the effect of team functioning on safety and quality of care. SKILLS: Demonstrate awareness of one's own strengths and limitations as a team member. Follow cmcn practices that minimize risks associated with handoffs among providers and across transitions of care. ATTITUDE: Acknowledges one's own potential to contribute to effective team functioning. Appreciate the risks associated with hand-offs among providers & across transitions of care. Up to 66% of health care errors are related to poor working relationships and communication. Standardized communication strategies help team members share concerns, clarify decisions about care, and ensure accurate and complete information exchange.

Evidence-Based Practice

DEFINITION: Integrate best current evidence with clinical expertise & patient/family preferences and values for delivery of optimal health care. KNOWLEDGE: Demonstrate knowledge of basic scientific methods and processes. Discriminate b/w valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preference. SKILLS: Participate effectively in appropriate data collection and other research activities. Consult with clinical experts before deciding to deviate from evidence-based protocols. ATTITUDE: Appreciate strengths and weaknesses of scientific bases for practice. Acknowledge own limitation in knowledge and clinical expertise before determining when to deviate from evidence-based best practices.

1. Legislative process fundamental to movement from a public problem to a viable program. 2. Societal problem that may qualify for a policy solution are those brought to the attention of a policymaker who is willing to take definitive action through the policy process. 3. Analysis of issues for potential policy development: -Public perception of the problem -Definition of the problem -Societal consequences and number of people affected -Degree of support and opposition from stakeholders

Legislation and Health Policy Development

Safety

DEFINITION: Minimize risk of harm to patients and providers through the system effectiveness and individual performance. -Patient safety is emphasized as a new standard in QSEN project. -Focus is on patient safety and error prevention -Constant surveillance is used to manage the potential to make unintentional errors. KNOWLEDGE: Examine human factors and other basic safety design principles as well as commonly used unsafe practices. Discuss potential and actual effect of national patient resources, initiatives, and regulations. SKILLS: Demonstrate effective use of technology and standardization practices that support safety and quality. Use national patient safety resources for own professional development and to focus attention on safety in care settings. ATTITUDE: Value the contributions of standardization/reliability to safety. Value relationship b/w national safety campaigns and implementation in local practices and practice settings.

Patient-Centered Care

DEFINITION: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients' preferences, values, and needs. KNOWLEDGE: Integrate understanding of multiple dimensions of patient-centered care. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values. SKILLS: Elicit patient values, preferences, and expressed needs as part of clinical interview. Communicate patient values, preferences, and expressed needs to other members of the health care team. ATTITUDES: Value seeing health care situations "through the patients' eyes." Respect and encourage individual expression of patient values, preferences, and expressed needs.

Quality Improvement

DEFINITION: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continually improve the quality and safety of health care systems. KNOWLEDGE: Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice. Describe approaches for changing processes for care. SKILLS: Seek info about outcomes of care for populations served in care setting. Design a small test of change in daily work. ATTITUDE: Appreciate that continual quality improvement in an essential part of the daily work of all health professionals. Appreciate the value of what individuals and teams can do to improve care.

Clinical indicators

Measurable items that reflect the quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished; help identify the goals of quality improvement.

Informatics

DEFINITION: Use of info and technology to communicate, manage knowledge, mitigate error, and support decision making. Barriers: - Healthcare slow to adapt to informatics and information technology across systems of healthcare - Cost - Rapid technology development making it difficult to stay current - Informatics and IT are links to ensure patient safety through improved information access and data management - Nurses play a crucial role by helping to shape the design, purchase and implementation of technology to match clinical needs in the organization. - Nurses have IT related job responsibilities that include end-user education, workflow analysis, system implementation, and ongoing user support. KNOWLEDGE: Identify info that must be available in a common database to support patient care. Describe how technology and info management are related to the quality and safety of patient care. SKILLS: Navigate the electronic health record. Respond appropriately to clinical decision-making supports and alerts. ATTITUDE: Value techniques that support clinical decision making, error prevention, and care coordination. Value nurses' involvement in design, selection, implementation, and evaluation of info technologies to support patient care.

Root cause analysis

Defined by TJC (2011) as a process for identifying the basic or casual factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event. Focuses on systems and processes, not individual performance.

Sentinel event

Defined by TJC (2011) as an unexpected occurrence involving patient death or serious physical or psychological injury or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. These events signal the need for immediate investigation and response.

The development of health policy at the state or federal level is a complex, dynamic process that occurs in the various 3 ways: 1. Enactment of legislation & accompanying rules & regulations that carry the weight of law. 2. Administrative decisions made by various gov. agencies of executive branch. 3. Judicial decisions that interpret statutes, regulations, and settle legal conflicts within society. It involves all 3 branches of gov.

Describe how health policy is developed.

The IOM Future Nursing Report -A report calling attention to the essentiality of nursing in reforming the health care system. -4 Major Recommendations: 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians, and other health care professional in redesigning health care in the U.S. 4. Effective workforce planning and policymaking require better data collection and info infrastructure.

Describe the IOM future of nursing report and nursing policy initiatives.

1. What are we trying to accomplish? 2. How will we know change is an improvement? 3. What changes can be made that will result in improvement? Plan-do-check-act (PDCA) Cycle 1. Plan: develop action plan based on the three questions 2. Do: take action to test the action plan 3. Check: make refinements as needed 4. Act: implement resultant changes in real work settings

Describe the Institute for Healthcare Improvement (IHI) quality improvement model.

1. Elected officials 2. Officials from gov. agencies 3. Expert in related area 4. Stakeholders such as corporate representatives 5. Representatives from special interest groups 6. Other affected citizens

Developing a health policy involves numerous individuals and groups including:

Planning

Development of options and a determination of professional consequences with each option for action.

Specific Client Services

Nurses provide support and interventions with the insertion and maintenance of intravenous therapies, services might relate to: ostomy care, counseling, support groups, or health education related to a specialty area.

Patient Protection and Affordable Care Act 2010 a.k.a. Obama Care

PPACA

Grassroots lobbying

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

Quality management (QM)

Philosophic framework for managing organizations that recognizes quality is determined by customer needs and expectations. Attention is paid to how the work is done, with an emphasis on involving the people who best understand the detail of the work processes with which they are involved. Health care QM is specifically related to the quality of health care services provided.

Hill-Burton Act/The Hospital and Construction Act 1950

Provided federal funding for hospital construction. Caused a boom in hospital construction, shifting nurses' primary employment from public health to hospitals.

Renal disease program 1972

Provided funding for dialysis treatments and renal transplants for patients with kidney failure. Led to the development of a new area of nursing practice that is now-nephrology nursing.

Medicare program 1965

Provided funding for health care services to older adults and the disabled. Led to an increased # of hospitalized older adults and an increased need for nurses in acute care settings.

Children's Health Insurance Program (CHIP)

Provides health insurance coverage to uninsured children who do not qualify for Medicaid.

Equitable

Providing care that doesn't vary in quality b/c of personal characteristic (i.e. gender, ethnicity, geographic location, and socioeconomic status)

Patient-centered

Providing care that's respectful of & responsive to individual patient preferences, needs, and values; ensuring that patient values guide all clinical decisions.

Effective

Providing services based on scientific knowledge to all those who benefit and refraining from services not likely to benefit.

Timely

Reducing waits and sometimes harmful delays for both those who receive and give care.

Implementation

Requires political action and a set of strategies. Actions taken to put the plan in place.

Regulation

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

Quality Improvement

-**Future** -Planning and prevention oriented -Proactive to problems -Correction of common cause problems and improvement in work processes -Responsibility of all involved with the work -Cross-functional -Leadership actively leading -Problem solving by employees at all levels

Clinical Nurse Specialist

-APNs who possess clinical expertise in a defined area of nursing practice for a selected client population or clinical setting. -Functions as an expert clinician, educator, consultant, researcher, and administrator. -Monitors the care of clients and collaborates with the inter-professional team; -Emphasis is to provide clinical support that improves client care and outcomes. -Education: Graduate nursing programs and expertise are from graduate and clinical experience. -Educational programs feature intense study of nursing theories & knowledge from other disciplines. -Programs emphasize advanced specific concepts, research methodologies, & supervised clinical practice. - Functions as role model for generalists & nursing students.

Forensic Nurse

-Applies nursing science to public or legal proceedings in the scientific investigation and treatment of trauma and/or death of victims of violence, abuse, criminal activity, and traumatic accidents.

Home care

-As patients shift from hospital to ambulatory care & home care, the role of the community health nurse has evolved beyond the traditional public health nurse concept o dobutamine administration o chemotherapy o radiography or telemetry o uterine monitoring

Quality Management

-Assess compliance of the institution w/established standards; ensure that patient services are consistent w/standards through chart review & ongoing interaction w/staff.

Infection Control

-Assess total incidence of infection & conduct comprehensive review to ensure prompt & accurate treatment, so that it isn't passed to other patients; determine source & onset of infection.

Care Provider

-Assesses clients, plans therapeutic interventions, coordinates & evaluates care. -Caring: central to nursing interventions; essential attribute of the expert nurse. -Role is most basic to nursing profession.

Quality Manager

-Assesses opportunities for process improvement, implement changes, measure outcomes, and then start improvement process over again. - They research and describe findings and look for opportunities to improve care. -Ex: in the inpatient setting, the nurse needs strong clinical skills, such as those that might be acquired in medical-surgical practice, intensive care units, or the operating room. -Nurse must build relationship and rapport with people and groups across the organization. -Promotes improved care for health care recipients in a variety of settings.

"All one team"

-Belief in the people who are working to serve the customer. -Believe in people & treat everyone in the workplace with dignity, trust, and respect. -Everyone works together to enhance customer satisfaction. -People work together to serve the customer.

Informatics Nurse Specialist

-Computers & nursing -Focuses on mgmt. & processing of HC info

Advanced Practice Nurse (APN)

-Consists of licensed registered nurse prepared at the graduate/master's degree level. -Includes: Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs), Certified Registered Nurse Anesthetist (CRNAs), and Clinical Nurse Specialists (CNSs). -They make independent and collaborative health care decisions and engage in active practice as expert clinicians. -Assume responsibility and accountability for health promotion, assessment, diagnosis, and management of client problems, including prescription of meds.

Case Manager

-Coordinate resources to achieve health care outcomes based on quality, access, and cost. -Identify the best resources at the lowest cost to achieve the optimal health outcome for the client.

Coordinator of Inter-Professional Health Care Team

-Coordinating practice relationships among several HC disciplines to bond, interact, & unite toward common goals of patient care. -Using successful HC team models w/concepts related to interdisciplinary HC such as pain mgmt., nutritional support, skin care, rehabilitation, mental health, hospice, discharge planning, & patient education • **Case study 26-1 pg. 464 • *Interprofessional HC team members: Box 26-2 pg. 465 oTeam Members: Nurse (RN) Chaplain or pastoral rep Dietitian (RD or LD) Occupational therapist(OT) Pharmacist (RPh or PharmD) Physical therapist (PT) Physician (MD or DO) Physician assistant (PA) Respiratory therapist (RT) Social worker Speech/language pathologist (SLP)

Quality

-Customer defines this -Customers pay attention to both personal interactions and products or services. -If the "bundle" of products or services provided is seen as a good value, then customer loyalty is enhanced.

Occupational Health Nurse

-Designs & implements program of health promotion & disease prevention for employees - Assesses work environment to ensure safety of employees

Nurses Strategic Action Team (N-STAT)

-Empowers nurses by encouraging them to take action to make sure their opinions are heard and understood by Congress and the public. -Provides structure and coordination for nurses across the country to be involved in grassroots lobbying (through ANA) concerning healthcare legislation. -Helps members stay informed about legislation, political candidates, and already elected officials. -Helps nurses to be on decision making boards.

Doctor of Nursing Practice (DNP)

-Expert in advanced nursing practice who has an earned clinically focused doctorate degree in nursing. -Includes: Advanced Practice Nurses, such as: CRNAs, NPs, CNSs, CNMs, and nurse administrators. -This is a professional doctorate as opposed to the academic doctorate, which is the doctor of philosophy (PhD) that prepares individuals for research careers. -In 2004, the AACN published a DNP position statement that called for a transformational change in the education for advanced practice nurses. They recommended that nurses practicing at the highest level should receive doctoral degrees.

Federal health policy

-Funds health related research -Funds education for health professionals, including nurses and physicians. -Pay for health care through Medicaid, Medicare, CHIP, and the Veterans Administration health care system. -Plays a huge role in shaping nursing practice. -Passage of the Patient Protection and Affordable Care Act (PPACA) 2010. -Nurse practice acts and registration of nurses were established in 1910; this established the scope of practice and minimal educational requirements for nurses; implemented by most states. -Examples: •Sheppard-Towner Act (1921) •Hill-Burton Act (1950) •Medicare program (1965) •Renal disease program (1972) •Diagnosis-related groups (DRGs) (1983)

State health policy

-Governs nursing through nurse practice act. -Provides "invisible services" through regulatory activities such as: -Maintaining a safe meat supply through livestock inspections. -Ensuring safe food storage and preparation in restaurants. -Ensuring that health care facilities provide safe, quality care. -Pays for health care services through various programs: -Medicaid and State Children's Health Insurance Program (SCHIP), which are partially federally funded. -A key piece of the health care reform legislation is the opportunity for states to develop State Health Insurance Exchanges (SHIEs)--a set of state regulated and standardized health care plans from which individuals my purchase health insurance eligible for federal subsidies (PPACA)

Hospice Nurse

-Hospice & palliative care nurses treat the symptoms of those w/progressive terminal disease; work holistically w/clients & families to maximize quality of life

Change Agent

-Identifies client, patient safety, & healthcare delivery problems. -Assesses individual & organizational motivation & capacity for change. -Determines alternatives & explores possible outcomes of alternatives. -Assesses cost-effective resources. -Leads the change process.

Leader & Manager

-Improves health status & potential of individuals, families, or communities. -Ensures that safe, high-quality care is provided across all healthcare settings. -Enhances effectiveness & level of satisfaction among professional colleagues. -Raises citizens' & legislators' attitudes toward & expectation of nursing profession & healthcare system. -Manages multiple resources in healthcare facility.

Clinical Nurse Leader

-Is a Master's Degree-prepared generalist who oversees the care coordination of a distinct group of patients in any setting. -Actively provide direct patient care in complex situations, evaluate patient outcomes, and has the decision-making authority to change care plans when necessary. -Put evidence-based practice into action. -Works on an unit in a hospital; resource person.

Researcher

-Leads nursing research: nurses prepared at doctoral & post-doctoral levels. -Participates in research: nurses prepared at master's, baccalaureate's, & associate's degree levels. -Research utilization- how will research be brought into nursing? Done by master's degree nurses.

Run chart

-Measuring data over time, graph of data point as they occur over time. -Control chart- a more sophisticated run chart that helps distinguish b/w common and special cause variation. -Used very often in nursing.

School Nurse

-Most registered nurses employed in schools health are generalists prepared BSNs who function as consultants or coordinators. -School health manager or coordinator and includes functions, such as policymaking, case management and program management activities, and health promotion and protection activities. -"A specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement of students. -Facilitate positive student responses to normal development; promote health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning."

Nurse Administrator/Nurse Executive

-Not formally considered an APN -Knowledge in business administration. -Unites the leadership perspective of professional nursing with the various aspects of business and health administration. -Focuses on administration of health care systems for purpose of delivering services to groups of clients. -Holds a master's degree. -Concerned with costs of nursing care & examining relationships b/w nursing services & quality patient care. -Leads and directs large groups of nurses and ancillary personnel; manages large budgets.

Scientific Approach

-Organizational support for all employees to develop knowledge and skills in the science of quality improvement (QI). -Improvement decisions based on sound, valid data -Variation is processes that must be understood: -Common cause variation -Special cause variation -Actions to implement improvements different under variations.

Flight Nurse

-Practice is diverse; critical care experience, with certification in advanced cardiac life support -2 types: military such as Air Force Reserves or active duty and civilian flight nursing.

Nurse Practitioner

-Practices in a variety of specialty areas. -Assess, diagnose, & manage medical & nursing problems. -Emphasize on health promotion & maintenance, in addition to disease prevention. -Job Responsibilities: -Takes client histories - Conducts physical exams -Orders, performs, & interprets diagnostic tests -Prescribes pharmacologic agents, treatments, & therapies for mgmt. of client conditions. -Serves as primary care provider. -Advanced education emphasizing on pathophysiology & pharmacology -Certification is in area specialty -Achieve registration & licensure by state boards of nursing -State boards of nursing regulate NP practice and & prescriptive authority.

Certified Nurse Midwife

-Primary care providers of women healthcare -Focus on pregnancy, childbirth, postpartum period, care of newborn, and family planning and gynecologic needs of women. -Completed prescribed studies in midwifery & has met the requisite qualifications to be certified. -Care occurs within variety of settings.

Client Advocate

-Promotes what's best for the client. -Ensures the clients' needs are met. -Protects clients' rights.

Certified Registered Nurse Anesthetist

-Recognized as 1st clinical nursing specialty. -Educational curriculum in anesthesia specialty ranges from 24-36 months in an integrated program of academic & clinical study. -Academic curriculum consists of min. 30hrs of formalized grad study. -Provide anesthesia and related care on request, assignment, or referral by patient's Dr., mostly to facilitate diagnostic, therapeutic, or surgical procedures. -Makes independent judgment calls. -Perform consultation for mgmt. of pain associated w/obstetric labor & delivery, acute or chronic ventilator problems, or mgmt. of acute or chronic pain through the performance of selected diagnostic or therapeutic blocks.

Nursing Educator

-Should be competent in clinical practice either at the advanced generalist or specialist level. -They should be prepared in the specialty area in which they teach and match the needs of the institution that hires them. -They assume leadership in curriculum development, instruction, and evaluation. -They need to have a commitment to lifelong learning and to stay current in their practice.

Quality Assurance

-System to evaluate performance of services/product -**Inherent** the maintenance of a desired level of quality in a service or product, esp. by means of attention to every stage of the process of delivery or production. -Inspection oriented (detection) -Reactive to problems -Corrected special problems and didn't address overall process improvement -Responsibility of few people -Narrow focus -Leadership may not be vested. -Problem solving by authoriy

Nursing Roles

-Task of a job or different nursing careers/jobs. -2 Types: 1. traditional duties & responsibilities of the professional nurse, regardless of practice area or setting. 2. Duties & responsibilities of the prof. nurse are guided by specific prof. standards of practice & usually carried out in a distinct practice area.

Educator & Counselor

-Teaching health promotion & health maintenance. -Encourages clients to look at alternatives, recognize their choices, & develop a sense of control. -Increasingly important in the changing health care environment.

Cause-and-effect diagram

-Used for identifying and organizing possible causes of a problem in a structured format. It's sometimes caused a fishbone diagram b/c it looks like the skeleton of a fish. -Determines potential sources of a problem. -Lists potential causes, arranged by categories to show potential effect.

Telephone Triage Nurse (Telehealth Nurse)

-Uses technology to provide health services by various telecommunication tools -Utilize physician-approved protocols to guide clients to the most effective and cost-efficient level of care while educating and supporting the client to relieve anxiety.

Parish Nurse

-Works in religious area; nurse for the church parish -Participate in joint ministry w/other staff members, helping to integrate faith & health for healing & wholeness.

Process

Series of linked steps necessary to accomplish work. It turns inputs, such as info or raw materials, into outputs, such as products, services, and reports. Clinical ______________ are a series of linked steps necessary for the provision of patient care. It is through the improvement of ___________es that an organization improves its work and sustains itself.

Never events

Serious adverse events during an inpatient stay that should never occur or are reasonably preventable through adherence to evidence-based guidelines. The Centers for Medicaid and Medicare Services, through revisions in coverage and payment policies, provide hospitals with financial incentives to reduce occurrences of never events.

Core measures

Standardized sets of valid, reliable, and evidence-based quality measures used by the Joint Commission to integrate performance measures into the accreditation process and overall quality improvement processes.

1. Introduction 2. Committee action- looks at it and sees if it needs changing (amendments) 3. House and/or Senate action, and -(amendments) 4. Presidential action- (sign, veto, override 2/3rds) 5. Very complex and convoluted process, with on a fraction of legislation that is introduced actually making it through the final process to become a law. 6. After a law is passed, executive branch creates regulations to enforce new law, regulations are made public and are available for public input, then a date is set for the new law to become effective. 7. Once a bill becomes a law, implementation falls under jurisdiction of one of the departments of the executive branch. 8. Implementation of new legislation often can be very different from what was intended when the bill was pass by Congress.

The Steps in the Legislative Process

Lobbying

The act of persuading/or convincing policymakers to respond in their favor on an issue.

Process variation

The differences in how the steps in a work process might be accomplished and/or the variables that may affect each step in the process. Variation results from the lack of perfect uniformity in the performance of any process. Understanding variation in a process is necessary to determine the direction that improvement efforts must take.

Pareto chart

A graphic tool that helps break down a big problem into its parts and then identifies which parts are the most important. -Reflects frequency w/which events occur or effect events have on a process.

Policymaker

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

The Joint Commission (TJC)

A national agency that conducts surveys of inpatient and ambulatory facilities and certifies their compliance with established quality standards.

ISMP (Institute for Safe Medication Practices)

A nonprofit organization that is well known as an education resource for the prevention of medication errors.

IOM (National Academy of Sciences Institution of Medicine)

A nonprofit organization with a mission of advancing and disseminating scientific knowledge to improve human health. Provides objective, timely, authoritative info and advice concerning health and science policy to the gov., the corporate sector, the professions, and the public.

Health policy

A set course of action taken by govt's or health care organizations to obtain desired health outcomes.

State Health Insurance Exchanges (SHIEs)

A set of state regulated and standardized health care plans from which individuals my purchase health insurance eligible for federal subsidies (PPACA).

Failure mode and effects analysis (FMEA)

A systematic process for identifying potential design and process failures before they occur, with the intent to eliminate them or minimize the risk associated with them.

Health care reform

A term used to refer to policy initiatives to effect significant changes in how health care is delivered and how the healthcare costs are paid.

Private health policy

A type of health policy that is made by health care organizations such as hospitals and managed care organizations.

Public health policy

A type of health policy that refers to local, state, and federal legislations; regulation; and court rulings that govern the behavior of individuals and organizations in the provision of health care service health policy at the local, state, and federal levels.

Common cause variation

A type of variation that is stable, predictable, and in statistical control

Special cause variation

A type of variation that is unstable, unpredictable, and not in statistical control

Hospital-acquired condition (HAC)

Used to indicate an unintended and typically adverse patient-acquired condition occurring as a result of being cared for in a hospital.

NCQA (National Committee for Quality Assurance)

An accreditation body that has become the primary group that accredits health plans.

Lean methodology

An integrated system of principles, practices, tools, and techniques focused on reducing waste, synchronizing workflows, and managing variability in production flow.

Flowchart

Analysis of work process. Maps out what actually occurs in a work process vs. what's intended. Lists main steps and sub-steps in linear fashion (top-down), and who does the work.

Standardization

Approach to process improvement that involves developing and adhering to best-known methods and repeating key tasks in the same way, time and time again. until a better way is found, thereby creating exceptional service with maximal efficiency.

Efficient

Avoid waste (i.e. of equipment, supplies, ideas, and energy)

Safe

Avoiding injuries to patients from care that is intended to help them.

Faith and not for profit

Ways to describe a hospital?

Historic health care reform legislation has become a reality with passage of The Patient Protection and Affordable Care Act of 2010: -It provides affordable and accessible health care coverage for all Americans. Access to care is the most significant problem to address through health care reform: -Lack of insurance: greatest barrier to access to health care. -50% of uninsured have no regular source of health care. -Uninsured are more likely to delay or ignore needed treatment. -Uninsured are more likely to be hospitalized for avoidable conditions.

What are some examples of health policies that have influenced professional nursing practice and how was nursing practiced influenced by these?

1. Medicare and Medicaid reform 2. Patients' rights 3. Whistle-blower protection 4. Access to health care 5. Comprehensive health care reform 6. Environmental and occupational health for nurses

What are some examples of the ANA's (American Nurses Association's) Policy Issues?

-Registering to vote and voting in all elections. -Joining a professional nursing organization. -Working in candidates' campaigns. -Attending a "meet the candidates" town hall meeting to learn about the candidates' position on issues. -Visiting with policymakers on their stuff. -Communicating with policymakers by e-mail, fax, or phone.

What are some grassroots political strategies and ways in which nurses can be effective participants?

1. Care is based on continuous healing relationships. 2. Care is customized according to patient needs and values. 3. Patient is source of control. 4. Knowledge is shared and info flows freely. 5. Decisions are evidence based. 6. Safety is system property; prevent and mitigate errors. 7. Transparency is necessary. 8. Needs are anticipated. 9. Waste is continuously decreased. 10. Cooperation among clinicians is a priority.

What are the 10 simple rules to guide improvement initiatives? (CCPKDSTNWC)

1. Quality 2. Scientific Approach 3. "All one team"

What are the 3 cornerstones of quality management.

1. Safe 2. Timely 3. Effective 4. Efficient 5. Equitable 6. Patient-centered.

What are the 6 guiding aims detailed by the quality chasm report? STEEEP

STEEP

What are the contributions of the Institute of Medicine on quality and safety in health care?

1. Patient-centered care 2. Teamwork and collaboration 3. Evidence-based practice 4. Quality Improvement 5. Safety 6. Informatics

What are the six core competences for QSEN, (Quality and Safety Education for Nurses), that should form the practice base for all health care professionals as created as a result of the chasm report issued by the Institute of Medicine (IOM)?

Patient safety, patient rights, patient treatment, and infection control. Focuses on the agency's ability to provide safe high-quality care and requires evidence of actual performance and continued improvement.

What does the TJC look for when evaluating health care facilities?

-ANA is a professional nursing organization that represents 3.1 mill. RNs in the U.S. -ANA Organizational Affiliates: 1. American Nurses Credentialing Center (ANCC) 2. American Nurses Foundation (ANF) 3. American Academy of Nursing (AAN) 4. American Association of Critical-Care Nurses (AACCN)

What is ANA (American Nurses Association) and what are some organizations affiliated with it?

Team Strategies and Tools to Enhance Performance and Patient Safety -Developed as an evidence-based teamwork system aimed at optimizing patient outcome by improving cmcn & teamwork skills among healthcare professionals.

What is TeamSTEPPS?

It outlines decision paths that a practitioner might take during a particular care episode or need. (i.e. ACLS (Acute Coronary Syndrome & Stroke) algorithms)

What is a clinical algorithm?

o Serious, costly errors that should never happen o Examples: wrong site surgery, mismatched blood transfusions, patient falls, hospital-acquired infections o CMS(Centers for Medicare & Medicaid Services) will no longer pay the additional cost of hospitalization of such conditions as an incentive to hospitals to prevent the events

What is mean't by a "never events" as described by the centers for medicare and Medicaid services?

The Joint Commission (TJC) is a national agency that conducts surveys of inpatient and ambulatory facilities and certifies their compliance w/established quality standards. 2002: TJC required accredited hospitals to collect data on standardized "core" performance measures 2004: TJC and CMS aligned their current and future measure common to both organizations.

What is the Joint Commission?

Nurses Strategic Action Team (N-STAT)

What is the name of the ANA program that unifies nurses' political voices across the country to enact measures to enhance health care for all.

Marital status and age is a patient demographic.

What kind of demographic is marital status and age?

Evaluation

Evidence that determines the success (or not? and the why? or why not?) of the intervention.

Coordinator Positions

Examples: trauma nurses and organ donor coordinator. Nurse is responsible for the coordination and integration of the clinical and administrative requirements or patient.

Stakeholder

Financially or emotionally affected by decision of policy makers. May attempt to influence those decisions and actions.

Sheppard-Towner Act 1921

Funded prenatal and child health centers staffed by public health nurses. First federal policy to provide funding for nursing services.

Nursing process is effective in identifying broader professional and health care issues Policy process and nursing process are systematic approaches to address health care and nursing laws •1) Assessment, 2) Diagnosis, 3) Planning, 4) Implementation, 5) Evaluation

How does health policy relate to the nursing process?

Analysis/Diagnosis

Identification of issues (diagnosis): info analyzed to identify real issues or problems that need to be addressed.

Indicators that strongly affect clinical outcomes o 2 Major Purposes: 1. Provide comparative data to health care organizations to support quality improvement activities 2. Develop national data to better understand the link b/w nurse staffing and patient outcomes o Quality Indicators: 1. Nursing hours per patient day 2.Staff mix (RNs, LPNs, UAP) 3. Hospital-acquired pressure ulcers Falls/injury resulting from falls4. 5. Nurse staff satisfaction/RN survey 6. Pediatric/neonatal only: pain assessment and peripheral IV infiltration 7. Psychiatric only: physical/sexual assault 8. RN education and certification 9. Nurse turnover 10. Nosocomial infections

Identify examples of the National Database of Nursing Quality Indicators.

Customer

Individual or group who relies on an organization to provide a product or service to meet some need or expectation; they determine quality.

Executive Branch

COMPOSITION: President & 15 departments. ROLE IN HEALTH POLICY: Recommends legislation & promotes policy initiatives. Implements laws & manages programs after they are passed by Congress through regulation, oversight, and presidential funding priorities. Writes regulations that interpret laws. Has power to veto legislation pass by Congress. RESTRICTIONS TO POWER: Unable to enact a law w/o approval of Congress

Legislative Branch

COMPOSITION: Senate and House of Reps=Congress ROLE IN HEALTH POLICY: Possesses sole federal power to enact legislation & to tax citizens & allocate federal spending. Able to originate & promote major policy initiatives. Can override a president's veto. RESTRICTIONS TO POWER: U.S. Supreme Court may invalidate legislation a unconstitutional.

Judicial Branch

COMPOSITION: U.S. Supreme Court, federal district courts, and U.S. circuit court of appeals. ROLE IN HEALTH POLICY: Judicial interpretations of the Constitution or various laws may have a policy effect. Resolves questions regarding agency regulations that may affect policy. RESTRICTIONS TO POWER: Unable to recommend or promote legislative initiatives.

Diagnosis-related groups (DRGs) 1983

Changed Medicare reimbursement to hospitals from a fee-for-service method to a fixed-fee method. Forced hospitals to reduce patient's length of stay, cut costs, reduce staff; led to the development of new nursing roles--nursing case management and utilization review.

Local health policy

Cities or countries offer a variety of health care services to meet the needs of their residents. Ex: free or reduced-rate immunizations, RNs as school nurses in public schools, a community's requirement for tobacco-free public areas, and public health programs like: safe drinking water, enforcement for seat belts and child restraint laws, and emergency medical systems.

Constituent

Citizen w/ opportunity to vote in elections.

Assessment

Collection of info through assessment to develop understanding.