ANCC AGACNP Issues, Trends, and Health Policy

Question 1

What is a key to therapeutic communication?

Answer 1

Listening more than talking.

Question 2

What should you focus on during therapeutic communication?

Answer 2

Feelings (Mad, Sad, Glad, Ashamed)

Question 3

Should you use euphemisms for therapeutic communication?

Answer 3

NO

Question 4

What must you ensure during crisis intervention?

Answer 4

Safety and boundaries

Question 5

Who do you call during a crisis (if necessary)?

Answer 5

Security

Question 6

What should your goal be during crisis intervention?

Answer 6

Establishing trust/rapport

Question 7

What are 2 keys to therapeutic communication during crisis/acute grief?

Answer 7

1. Acknowledge feelings

2. Offer self

Question 8

What is an advanced directive?

Answer 8

A written statement of a patient’s intent REGARDING MEDICAL TREATMENT

Question 9

What law requires that all patients entering a hospital should be advised of their right to execute an advanced directive?

Answer 9

The Patient Self-Determination Act of 1990

Question 10

What is a healthcare directive?

Answer 10

A TYPE of AD that may (OR MAY NOT) include a living will and/or specifications regarding DPOA in 1-2 separate documents

Question 11

What is a living will?

Answer 11

Written compilation of statements in document format that SPECIFIES WHICH LIFE-PROLONGING MEASURES ONE DOES AND DOES NOT WANT TO BE TAKEN IF HE/SHE BECOMES INCAPACITATED

Question 12

What is the stance of most US states in regards to living wills?

Answer 12

Most states will abide by them if they are specific enough to address the problem at hand

Question 13

Other than stating one’s healthcare wishes in the event of incapacitation, what does a living will also often specify?

Answer 13

The DPOA

Question 14

What is a DPOA?

Answer 14

A significant other who may act as a proxy/agent/attorney-in-fact IN MAKING HEALTHCARE DECISIONS should the patient become incapacitated

Question 15

What is the essential responsibility of the DPOA?

Answer 15

Articulating the patient’s advanced directive

Question 16

What is a common requirement in order for the POA to be honored?

Answer 16

In writing

Question 17

What is the difference between an advanced directive and a living will?

Answer 17

• Living will vs AD: recall, AD talks about the MEDICAL care of the patient in the case of incompetence.
• Living will specifies life prolonging measures that one does or does not want to be done should they become incapacitated. Often, they include DPOA to a significant other, who acts as a proxy (aka agent aka attorney in that).

Question 18

What does Title I of HIPAA protect?

Answer 18

Health insurance coverage for workers and their families when they lose or change jobs

Question 19

What is the name of the health insurance coverage, granted under Title I of HIPAA, for workers and their families when they change/lose their jobs?

Answer 19

Comprehensive Omnibus Reconciliation Act (COBRA)

Question 20

What is Title II of HIPAA best known for?

Answer 20

Administrative Simplification (AS) provisions

Question 21

What do the Administrative Simplification provisions under Title II of HIPAA require?

Answer 21

1. the establishment of national standards for electronic health care transactions
2. National identifiers for providers, health insurance plans, and employers

Question 22

What department ENFORCES HIPAA?

Answer 22

The Office for Civil Rights

Question 23

What does HIPAA protect?

Answer 23

The privacy of individually identifiable health information

Question 24

What does the HIPAA Security Rule do?

Answer 24

Sets national STANDARDS for the SECURITY of electronic protected health information

Question 25

What doe the confidentiality provisions of the Patient Safety Rule protect?

Answer 25

Protect identifiable information from being used to analyze patient safety events improve patient safety

Question 26

What are "Covered Entities"

Answer 26

Those required to follow HIPAA Regulations

Question 27

List 3 examples of covered entities.

Answer 27

1. Health Plans (insurance co, HMOs, company health plans, Medicare, Medicaid) 2. Most health care providers (esp. those that use electronic billing to health insurers) 3. Health Care Clearinghouses (those that process nonstandard health info data received from another entity into a standardized [ie electronic] format)

Question 28

List examples of HIPAA Protected Information (4)

Answer 28

1. Written info in medical record 2. Conversations amongst HCPs 3. Pt info stored in health insurer's computer 4. Pt billing info stored at a clinic * Most health-related information about a patient

Question 29

In order to use or share a patient's health info, what generally must be required?

Answer 29

The patient's WRITTEN AUTHORIZATION

Question 30

What must be provided in order for a provider to disclose information to one's employer?

Answer 30

Patient's written authorization

Question 31

What must be provided in order for a provider to use or share a pt's info for marketing or advertising purposes?

Answer 31

Patient's written authorization

Question 32

What must be provided in order for HCPs to share private notes about a patient's health care?

Answer 32

Patient's written authorization

Question 33

What is outlined by the HIPAA Privacy Rule?

Answer 33

The patient's rights!

Question 34

List the Patient's Rights under the Privacy Rule (6)

Answer 34

1. See/receive a copy of their health records 2. Have corrections added to health info 3. Receive a notice telling pt how his info may be used/shared 4. Decide if they want to permit their health info to be used/shared (ie for marketing) 5. Receive a report of when/why their info was shared for certain purposes 6. File complaints w/ HCP, insurer, and/or US gov if their rights are being denied or if health info is not being protected

Question 35

Is this allowed to be viewed/shared: to ensure proper treatment and coordination of care

Answer 35

Yes

Question 36

Is this allowed to be viewed/shared: to pay for healthcare services

Answer 36

Yes

Question 37

Is this allowed to be viewed/shared: with a patient's family, relatives, friends, or others that the PATIENT IDENTIFIES as being involved with their healthcare/bill payment (unless patient objects)

Answer 37

Yes

Question 38

Is this allowed to be viewed/shared: to ensure quality care given by HCPs

Answer 38

Yes

Question 39

Is this allowed to be viewed/shared: To protect the health of the public (ie outbreak reporting)

Answer 39

Yes

Question 40

Is this allowed to be viewed/shared: To make required reports to the police (ie GSW)

Answer 40

Yes

Question 41

List entities NOT required to follow HIPAA (7)

Answer 41

1. Life insurers 2. Employers 3. Workers comp carriers 4. Schools/school districts 5. State agencies (CPS) 6. Law enforcement 7. Municipal offices

Question 42

What is the Patient Safety and Quality Improvement Act (PSQIA)?

Answer 42

Est a VOLUNTARY REPORTING SYSTEM to enhance the data available to assess and resolve patient safety and health care quality issues

Question 43

Under the Patient Safety and Quality Improvement Act, what is patient safety information called?

Answer 43

Patient safety work product

Question 44

What does the PSQIA provide for patient safety work product?

Answer 44

1. Confidentiality | 2. Federal privilege

Question 45

Why does PSQIA provide confidentiality and federal privilege for patient safety work product?

Answer 45

To encourage reporting and analysis of MEDICAL ERRORS

Question 46

What is included in patient safety work product?

Answer 46

Information collected and created during the reporting and analysis of patient safety events

Question 47

What is the purpose of the confidentiality provisions in the PSQIA?

Answer 47

To improve patient safety outcomes by creating an environment where providers may report and examine pt safety events without fear of increased liability risk.

Question 48

What is the ultimate aim of the PSQIA?

Answer 48

Greater reporting and analysis of patient safety events will yield INCREASED DATA AND BETTER UNDERSTANDING of patient safety

Question 49

What are Patient Safety Organizations (PSOs)?

Answer 49

External experts established by the Patient Safety Act to collect and analyze patient safety information

Question 50

Who has the responsibility of listing PSOs?

Answer 50

AHRQ (Agency for Healthcare Research and Quality)

Question 51

When does the "duty to warn" supersede confidentiality?

Answer 51

If the patient's condition may endanger others

Question 52

Other than the "duty to warn", which other scenario supersedes a patient's rights to confidentiality?

Answer 52

The duty to protect a patient from harming him/herself

Question 53

What is an "invasion of privacy"?

Answer 53

Damaging one's REPUTATION as a result of info being shared without the patient's permission

Question 54

Under which circumstances can the "invasion of privacy" not be charged?

Answer 54

If the info can be shown to be... - accurate - given in good faith & - receiver had a valid right to know (es: consulting practitioner had right to know specific pt info)