Chapter 1 - Health Care Delivery Systems - Fundamentals Flashcards
6 QSEN COMPETENCIES (QUALITY AND SAFETY EDUCATION FOR NURSES
SEPTIQ
SAFETY
PATIENT CENTERED CARE
EVIDENCED BASE CARE
INFORMATICS
QUALITY IMPROVEMENT
TEAMWORK AND COLLABORATION
QSEN
Quality and Safety Education for
Nurses
Safety:
minimization - risk factors of injury or harm while promoting quality care / maintaining secure environment for clients, self, and others
Patient-Centered Care:
caring / compassionate, culturally sensitive care
addresses clients’
physiological,
psychological,
sociological,
spiritual,
cultural needs,
preferences, and
values
Evidence-Based Practice:
use current knowledge from research / other credible sources to base clinical judgment / client care on
Informatics:
information technology for communication
information-gathering tool to supports clinical decision-making / scientifically based nursing practice
Quality Improvement:
development / implementation plan - to improve health care services / better meet clients’ needs.
Teamwork and Collaboration:
delivery of client care in partnership with multidisciplinary members of the
health care team
achieve continuity of care and positive client outcomes
Health care delivery systems incorporate
health care providers
Clients
financing mechanisms and
regulatory agencies.
Health care systems include
clients,
The settings in which health care takes place,
the agencies that regulate health care,
and the mechanisms that provide financial support.
COMPONENTS OF participants of HEALTH
CARE SYSTEMS
CONSUMERS
LICENSED PROVIDERS
UNLICENSED PROVIDERS
LICENSED PROVIDERS
● Registered nurses
● Licensed practical nurses (also known as licensed
vocational nurses)
● Advanced practice nurses (APN)
● Medical doctors
● Pharmacists
● Dentists
● Dietitians
● Physical, respiratory, and occupational therapists
CONSUMERS
CLIENTS
Unlicensed providers
(assistive personnel)
HEATLH CARE SYSTEM SETTINGS
● Hospitals
● Homes
● Skilled-nursing, assisted-living, and
extended-care facilities
● Community/health departments
● Adult day care centers
● Schools
● Hospices
● Providers’ offices
● Ambulatory care clinics
● Occupational health clinics
● Stand-alone surgical centers
● Urgent care centers
● Complementary therapy centers
● Urgent and emergent care centers
● Public health agencies
● Crisis centers
● Diagnostic centers
● Specialized services (dialysis, oncology, rehabilitation,
burn) centers
REGULATORY AGENCIES of health care system
● U.S. Department of Health and Human Services
● U.S. Food and Drug Administration (FDA)
● State and local public health agencies
● State licensing boards to ensure that health care providers and agencies comply with state regulations
● The Joint Commission to set quality standards for accreditation of health care facilities
● Professional Standards Review Organizations to monitor health care services provided
● Utilization review committees to monitor for appropriate diagnosis and treatment of hospitalized clients
HEALTH CARE FINANCING MECHANISMS
- PUBLIC FEDERAL FUNDED PROGRAMS
- PRIVATE PLANS
PUBLIC FEDERALLY FUNDED PROGRAMS
- Medicare - 65 years of age or older / or who have permanent disabilities
- Medicaid - low incomes.
- Patient Protection and Affordable Care Act of 2010 PPACA
- State Children’s Health Insurance Program uninsured children to 19 at low cost to parents CHIP
MEDICARE
● Part A: Insurance for hospital stays, home health, and hospice (available to those 65 years of age or older and those who have permanent disabilities)
● Part B: Insurance for outpatient and provider services (available to those 65 years or older and those who have permanent disabilities, but is voluntary and requires a monthly premium)
● Part C: A Medicare advantage or supplement plan (covering parts A and B, and sometimes D)
● Part D: Medication coverage for those eligible and requires a monthly premium
MEDICAID
● It is federally and state funded.
● Individual states determine eligibility requirements.
Patient Protection and Affordable Care Act of 2010 is
a federal statute aimed at:
● Increasing access to health care for all individuals and
instituting an individual mandate for health insurance.
● Decreasing health care costs.
● Providing opportunities for uninsured people to become
insured at an affordable cost.
State Children’s Health Insurance Program:
Coverage for
uninsured children up to age 19 at low cost to parents
PRIVATE PLANS
● Traditional insurance reimburses for services on a fee-for-service basis.
● Managed care organizations (MCOs): Primary care providers oversee comprehensive care for enrolled clients and focus on prevention and health promotion.
● Preferred provider organization (PPOs): Clients choose from a list of contracted providers and hospitals. Using non-contracted providers increases the out-of-pocket costs.
● Exclusive provider organizations (EPOs): Clients choose from a list of providers and hospitals within a contracted organization with no out-of-network coverage.
● Long-term care insurance: A supplement for long-term care expenses Medicare does not cover
LEVELS OF HEALTH CARE
- PREVENTIVE HEALTH CARE
- PRIMARY HEALTH CARE
- SECONDARY HEALTH CARE
- TERTIARY HEALTH CARE
- RESTORATIVE HEALTH CARE
- CONTINUING HEALTH CARE
Preventive health care focuses on
educating and equipping clients to reduce and control risk factors for
disease. Examples include programs that promote immunization, stress management, occupational health, and seat belt use.
Primary health care emphasizes
-health promotion (prenatal /well-baby care, family planning,
nutrition counseling /disease control).
-partnership between clients and providers. (office /clinic visits,
community health centers / school- or work-centered screenings (vision, hearing, obesity).
Secondary health care includes
-diagnosis / treatment of acute illness and injury. (inpatient and emergency departments / diagnostic centers / urgent/emergent care centers.
Tertiary health care, or
-acute care
-specialized /highly technical care. (intensive care, oncology centers, burn centers)
-Restorative - intermediate follow-up care (restoring health/ promoting self-care includes home health care,/ rehabilitation centers /skilled nursing facilities.
Continuing health care
long-term /chronic health care - over a period of time. (end-of-life care, palliative care, hospice, adult day care, assisted living, in-home respite care)
The level of care depends on
the needs of the client.
Licensed and unlicensed health care personnel work in
every level of care.
The settings for secondary and tertiary care are usually within
a hospital or specific facility. Settings for other levels of care vary.
Regulatory agencies help ensure
the quality and quantity of health care and the protection of health care consumers. Health care finance influences the quality and type of care by setting parameters for cost containment and reimbursement.
QSEN ASSISTS NURSING PROGRAMS IN
preparing nurses to provide safe, high-quality care.
- A nurse is discussing restorative health care with a newly licensed nurse. Which of the following examples should the nurse include in the teaching? (Select all that apply.)
A. Home health care
B. Rehabilitation facilities
C. Diagnostic centers
D. Skilled nursing facilities
E. Oncology centers
A,B,D -
- A nurse is explaining the various types of health care coverage clients might have to a group of nurses. Which of the following health care financing mechanisms should the nurse include as federally funded? (Select all that apply.)
A. Preferred provider organization (PPO)
B. Medicare
C. Long‑term care insurance
D. Exclusive provider organization (EPO)
E. Medicaid
- A nurse manager is developing strategies to care for the increasing number of clients who have obesity. Which of the following actions should the nurse include as a primary health care strategy?
A. Collaborating with providers to perform obesity screenings during routine office visits
B. Ensuring the availability of specialized beds in rehabilitation centers for clients who have obesity
C. Providing specialized intraoperative training in surgical treatments for obesity
D. Educating acute care nurses about postoperative complications related to obesity
- A nurse is discussing the purpose of regulatory agencies during a staff meeting. Which of the following tasks should the nurse identify as the
responsibility of state licensing boards?
A. Monitoring evidence‑based practice for clients who have a specific diagnosis
B. Ensuring that health care providers comply with regulations
C. Setting quality standards for accreditation of health care facilities
D. Determining whether medications are safe for administration to clients
- A nurse is explaining the various levels of health care services to a group of newly licensed nurses. Which of the following examples of care or care settings should the nurse classify as tertiary care? (Select all that apply.)
A. Intensive care unit
B. Oncology treatment center
C. Burn center
D. Cardiac rehabilitation
E. Home health care
Restorative health care involves
intermediate follow‑up care for restoring health and promoting self‑care.
Home health care is a type of restorative health care.
Rehabilitation facilities are a type of restorative health care.
Skilled nursing facilities are a type of restorative health care.
Secondary health care includes
the diagnosis and treatment of acute injury or illness.
Diagnostic centers are a type of secondary health care
Tertiary health care is
specialized and highly technical care.
An oncology center is a type of tertiary health care
PPOs are funded how
PRIVATELY
Long‑term care insurance is funded how
EPOs are privately funded how
Medicaid is funded how
- PRIVATELY
- PRIVATELY
- FEDERALLY FUNDED
Identify obesity screenings at office visits as an example of
primary health care.
Primary health care emphasizes health promotion and disease control, is often
delivered during office visits, and includes screenings.
care that is provided in a rehabilitation center is an example of
restorative health care.
Specialized and highly technical care is an example of
tertiary health care.
Acute care of clients is an example of
secondary health care
Utilization review committees have the responsibility of
monitoring for appropriate diagnosis and treatment according to evidence‑based practice for diagnosis and treatment of hospitalized clients.
State licensing boards are responsible for
ensuring that health care providers and agencies comply with state regulations.
The Joint Commission has the responsibility of
setting quality standards for accreditation of health care facilities.
The U.S. Food and Drug Administration has the responsibility of
determining whether medications are safe for administration to clients.
Tertiary health care involves
B. CORRECT: Tertiary health care involves the provision
of specialized and highly technical care
C. CORRECT: Tertiary health care involves the
provision of specialized and highly technical care
the provision of specialized and highly technical care
- (the care nurses deliver in intensive care units)
- (the care nurses deliver in oncology treatment centers).
- (the care nurses deliver in burn centers).
CARDIAC REHABILITATION IS WHAT TYPE OF CARE SETTING
This is an example of restorative care and also of tertiary prevention, but not of tertiary care.
HOME HEALTH CARE IS WHAT TYPE OF CARE SETTING
This is an example of restorative care.
CONCEPTS OF MANAGEMENT:
Identify roles/responsibilities of health care team members.
ASSIGNMENT, DELEGATION AND SUPERVISION:
Identify tasks for assignment or delegation based on client needs.
CONTINUITY OF CARE
Perform procedures necessary to safely admit, transfer, or discharge a client.
Provide and receive off of care (report) on assigned clients
ESTABLISHING PRIORITIES:
Prioritize the delivery of client care.
ETHICAL PRACTICE
Recognize ethical dilemmas and take appropriate action.
Practice in a manner consistent with a code of ethics for nurses.
INFORMATION TECHNOLOGY:
Utilize valid resources to enhance the care provided to a client.
LEGAL RIGHTS AND RESPONSIBILITIES:
Identify legal issues affecting the client.
REFERRALS:
Assess the need for referrals and obtain necessary orders
ADVANCE DIRECTIVES/SELF-DETERMINATION/LIFE PLANNING:
Assess client and/or staff member knowledge of advance directives.
INFORMED CONSENT:
Participate in obtaining informed consent.
CONFIDENTIALITY/INFORMATION SECURITY:
Assess staff member and client understanding of confidentiality requirements.
REPORTING OF INCIDENT/EVENT/IRREGULAR OCCURENCE/VARIENCE:
Identify need/situation where reporting of incident/event/irregular occurence/cariance is appropriate.
HEALTH PROMOTION/DISEASE PREVENTION:
Assist the client in maintaining an optimum level of health
Major client needs categories
Safe and effective care environment
Health promotion and maintenance
Psychosocial integrity
Physiological integrity
Safe and effective care environment includes what two thins
Management of care
Safety and infection control
Physiological integrity includes what four things
Basic care and comfort
Pharmacological and parenteral therapies
Reduction of risk otential
Physiological adaptaton
● State licensing boards to ensure
that health care providers and agencies comply with state regulations
What does The Joint Commission set
The Joint Commission to set quality standards for accreditation of health care facilities
●
Professional Standards Review Organizations
● Utilization review committees to monitor for
- to monitor health care services provided
- appropriate diagnosis and treatment of hospitalized clients
- Patient Protection and Affordable Care Act of 2010
Increase access to health care
Decrease health care cost
Chance for Uninsured to become insured
