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APN > 1st APN Test > Flashcards

1st APN Test Flashcards

1
Q

Goldmark report

A
  1. Increase educational standards in nursing schools
  2. Focus student time on education (vs. staffing hospitals)
  3. Move educational programs to universities
  4. Require nurse educators to have advanced education
    However, continued to have variability in nursing education
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2
Q

CNS Role

A

ANA officially recognized CNS role
Expert practitioner
Change agent
Master’s degree requirement

CNSs are first and foremost clinical experts who provide direct care to patients with complex health problems

Psychiatric CNSs continued as leaders in education and clinical settings

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3
Q

Frontier Nursing Service (FNS)

A

Founded by Mary Breckinridge in 1925
Provided care through nurse-run clinics
Documented stellar outcomes

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4
Q

Dr. Loretta Ford

A

First PNP program marked inception of modern NP role with establishment of First NP education program (pediatric) at University of Colorado as post-BSN certificate program

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5
Q

Lillian Wald established

A

Henry Street Settlement (HSS) to address needs of poor

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6
Q

Mayo Clinic

A 
At St. Mary’s Hospital in Rochester, MN, Dr. William Mayo was among first physicians to recognize and train nurse anesthetists.
Alice Magaw (“mother of anesthesia”) was hired and kept excellent records.
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7
Q

Focus of Consensus Model for APRN Regulation

A

focus of practice beyond role and population focus

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8
Q

Graduate Education 3-P’s

A

Physiology/pathophysiology,
Physical health assessment,
Pharmacology

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9
Q

Hamric’s Integrative Model

A

Primary Criteria graduate education, certification in the specialty, focus on clinical practice with patients

Core Competencies direct clinical practice, collaboration, guidance and coaching, evidence-based practice, ethical decision making, consultation, leadership

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10
Q

Brooten’s Model of Transitional Care

A

APN transitional care was defined as “comprehensive discharge planning designed for each patient group plus APN home follow-up through a period of normally expected recovery or stabilization”

Intended to address outlier populations
Illustrates how a theory of clinical care can be studied to better understand what APNs do

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11
Q

Core of Implications for Practice

A

the core competencies of APN is the use of evidence-based practice

Leadership is not optional; it is a requirement

APNs must be a visible part of the solution to the health care system’s problems

APNs to enact advanced nursing skills rather than simply substitute for physicians

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12
Q

APN Scope of practice

A

Who, what, where, why, and how of nursing practice (ANA, 2010)

Specified in state practice acts

Specialty organizations have provided detailed and
specific descriptions for each APN role

Legal authority granted to a professional to provide and be reimbursed for health care services

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13
Q

Driving Forces for Common Understanding of APN Practice

A

Institute of Medicine (IOM)
Expansion of programs offering DNP
Affordable Care Act (ACA)
Accountable Care Organizations (ACOs)

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14
Q

Purpose of Conceptual Model

A

To articulate professional role identity and function

In practice, In research, & in education

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15
Q

Components of Conceptual Model

A 
Outside Circle: 
Technology - Person 
EBP - Nursing
Innovation - health
Research - heath systems

Inside Circle:
caring, collaborating, reflection. professional, life long learning

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16
Q

LACE

A

APRN regulation, culminating in the LACE

Licensure,
Accreditation
Certification
Education

Regulatory framework

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17
Q

Novice-to-Expert Skill

A

Expertise does not develop simply as a matter of time
The progression from novice to advanced-beginner and then to competent level is incremental

Embodiment of a skill occurs after repeated experiences of performing the skill “as if” one actually could do it skillfully

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18
Q

Strategies to Facilitate Role Implementation

A

Join local APN groups for both peer support and networking opportunities

Identify mentors

Keep a portfolio for self-evaluation and seek feedback

Request reasonable time frames for initial patient visits, because novices take longer than experienced practitioners

Reassess demands to guard against feeling overwhelmed

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19
Q

Barriers in the Work Setting

A

Pressure to manage large numbers of patients

Resistance from staff nurses

Lack of understanding of the NP role

New billing and coding guidelines

HIPAA regulations

Monitoring for fraud and abuse

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20
Q

Holism

A

Involves a deep understanding of each patient as a complex and unique person

Recognizes the multiple dimensions of each person: physiological, social, emotional, cognitive, and spiritual

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21
Q

Direct Clinical Practice

A

Direct care is the central competency of advanced practice nursing

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22
Q

Six Characteristics of APN’s Direct Clinical Care

A
  1. Use of a holistic perspective
  2. Formation of therapeutic partnerships with patients
  3. Expert clinical thinking performance
  4. Use of reflective practice
  5. Use of evidence as a guide to practice
  6. Use of diverse approaches to health and illness management
23
Q

Clinical Prevention

A

Counseling regarding personal health practices that can protect a person from disease or promote screening for the presence of disease

Immunization to prevent specific diseases

Chemoprevention (e.g., aspirin for prevention of cardiovascular events)

APN function aimed at early detection or prevention of problems related to treatments, disease progression, self-care deficits, or environment

24
Q

APN Indirect Care Activities

A 
Consultataion
Discharge planning
Care Coordination 
Communication with ins
Guidance of bedside rn's
Unit rounds 
Research
Care initiatives
25
Q

Collaboration

A

Competency is fundamental to successful APN practice and a critical component of collaboration

Collaboration affects patient care, including cost and quality of care

Clinical and interpersonal expertise is an underlying foundation for collaboration

26
Q

Collaboration is not

A 
Parallel communication
One-sided compromise
Parallel functioning
Information exchange
Coordination
Consultation
Co-management
Referral
27
Q

Transformational Leadership

A

Can lead to changes in values, attitudes, perceptions, and/or behaviors on part of leader and follower

Lays groundwork for further positive change and improvement in outcomes

Interaction in ways that inspire higher levels of motivation and morality among participants

28
Q

Situational Leadership

A

Interaction between individual’s leadership style and features of environment or situation

Leaders and followers assume interchangeable roles
APNs find themselves in both roles

29
Q

Attributes of Effective APN Leaders

A 
Vision
Timing
Self-confidence and risk taking
Expert communication and relationship building
Boundary management
Respect for cultural diversity
Global awareness
Balance in personal and professional life
30
Q

Failure to Mentor: Leaving Other Nurses Behind

A

Most distressing form and most common
Advancing nurses forget roots and leave novice nurses behind or undermine their advancement
Mentoring, apprenticing, “giving a leg up” not as common in nursing as in other professions

Role of APN leaders to create more empowering and humane work environment

31
Q

Evidence-based practice (EBP

A

Approach for clinical decision making and core competency for APN

Evidence-based practice (EBP) is conscientious, explicit, and judicious use of current best research-based evidence when making decisions about care of individual patients (Sackett et al., 1996)

32
Q

Step Process of EBP

A
  1. Formulation of a clinical question
  2. Identification and retrieval of pertinent research findings based on literature review
  3. Extraction and critical appraisal of data from pertinent studies
  4. Clinical decision making based on results of this process
33
Q

Quality Improvement (QI)

A

Systematic activity that is guided by outcome data in order to achieve rapid improvements in health care delivery in a specific setting(Arndt & Nestch, 2012; Glasziou, Ogrinc, & Goodman, 2010)

Designed to improve specific outcomes within local facility, clinic, and community

34
Q

Common Goal of Research, EBP, and QI

A

Improvement of patient care

35
Q

Randomized Controlled Trial (RCT)

A

Gold standard research design for generating evidence

First large-scale controlled trial compared streptomycin to standard care at time (bed rest)

36
Q

Critical Elements of RCT

A

Manipulation of experimental intervention

Comparison of experimental intervention to control or comparison group

Random assignment of subjects to intervention or control group

37
Q

Random Allocation

A

Most effective technique for spreading potentially confounding factors among treatment and control groups (Hill, 1937)

38
Q

Steps of Evidence-Based Process

A
  1. Formulate a measurable clinical question
  2. Search the literature for relevant studies
  3. Critically appraise and extract evidence
  4. Implement useful findings in clinical decision making
39
Q

PICO Model

A

PICO model aids nurses in formulating clinically relevant and measurable questions

40
Q

PICO stands for

A

P - Patient population? Who is the patient population?

I - Intervention. What is the potential intervention or area of interest?

C - Comparison. Is there a comparison intervention or control group?

O - Outcome. What is the desired outcome?

41
Q

National Guideline Clearinghouse

A

Administered by U.S. Agency for Healthcare Research and Quality (AHRQ)

Houses more than 3000 clinical practice guidelines formulated within past 5 years

42
Q

Evidence Pyramid

A

Base of pyramid:
In vivo, in vitro models

Second rung from base:
Case studies or series

Higher rungs:
RCTs, non-randomized comparison cohort trials, and cohort or case control studies

43
Q

Pyramid Illustrating

A 
MA
Systematic reviews
Randomized controlled trials 
Non Randomized cohort 
Cohort case control study 
Case studies 
In vivo
44
Q

Systematic Review and Meta-Analysis

A

Combine the results of multiple studies to determine the effect created by a specific intervention

45
Q

Systematic review

A

Uses a structured methodology to comprehensively seek out, select, appraise, and analyze studies based on measurable clinical questions(Engberg, 2008)

46
Q

Meta-analysis

A

Pools and analyzes results from more than one study to determine the direction and magnitude of an intervention’s effect (p-value)(Engberg, 2008)

47
Q

Institute of Medicine (IOM) Definition of Primary Care

A

The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health needs, developing a sustained partnership with patients, and practicing in the context of family and community

48
Q

NP Core Competencies

A

Independent Practice

Scientific Foundation

Practice Inquiry

Technology and Information Literacy

Policy

Health Delivery System

49
Q

Patient-Centered Medical Home (PCMH)

A

A personal clinician, coordinated care, and a long-term healing relationship

A relationship with a primary care clinician who leads a team that takes collective responsibility for patient care,

Providing for the patient’s health care needs and arranging for appropriate care with other qualified clinicians

50
Q

VA System

A

The U.S. Department of Veterans Affairs employs over 4800 NPs, the largest employer of NPs in the country.
VA Ruling on APRN Practice: A Breakthrough for Veterans Health Care 12/13/16

51
Q

Aging Populations and Primary Care

A

Moving to 20% of population
NPs central to addressing needs of this population
77% have two or more chronic illnesses

52
Q

Care Transitions and Primary Care

A

High readmission rates
High cost of readmission rates
NP directed transitional care is associated with fewer first re-hospitalizations or deaths

53
Q

Outcome Studies Related to Acute Care Nurse Practitioner Practice

A

Decreased costs,
Shorter hospital LOS
Decreased use of labs,
lower rates of UTIs and skin breakdown,

Time savings for house physicians, similar care outcomes compared with physician practices, patient/family satisfaction.

54
Q

Reimbursement for ACNPs

A 
Five major types of payers: 
Medicare
Medicaid
Indemnity-type insurance
Managed care organizations (MCOs)

APN (1 decks)

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