Chapter 22 Key Terms

Question 1

Accountable Care Organizations

Answer 1

• help manage the health of populations served by the integrated systems

Question 2

Advocacy

Answer 2

activities for the purpose of protecting the rights of others while supporting the client’s responsibility for self-determination; involves informing, supporting, and affirming a client’s self-determination in health care decisions; pleads someone’s cause or act on someone’s behalf, with a focus on developing the capacity of the community, system, individual, or family to plead their own cause or act on their own behalf.

Question 3

Affirming

Answer 3

the point at which a tendency toward positive reaction or belief is observed by the therapist.

• advocate’s belief that a client’s decision is consistent
  with the client’s values and goals. The advocate validates
  that the client’s behavior is purposeful and consistent with the
  choice that was made. The advocate expresses a dedication to the
  client’s mission, and a purposeful exchange of new information
  may occur so that the client’s choice remains possible

Question 4

Allocation

Answer 4

staple of market competition. Nurses
perform allocation roles when they triage clients or perform the
gatekeeping and rationing functions. Nurses often reflect that
clinical judgments are influenced by their values and ethics as
well as organizational demands

Question 5

Amplifying

Answer 5

occurs between the
nurse and the client to assess the needs and demands that will
eventually frame the client’s decision.

Question 6

Assertiveness

Answer 6

Behavior directed toward claiming one’s rights without denying those of others.

• the ability to present one’s own needs.

Question 7

Autonomy

Answer 7

The quality of having the ability or tendency to function independently.

• the individual’s right to choose a provider, if a particular provider
  is not approved by the case management system. If a
  new provider must be found who can be approved for coverage,
  continuity of care may be disrupted.

Question 8

beneficence

Answer 8

Doing good or active promotion of doing good. One of the four principles of the ethical theory of deontology.

• ethical principle stating that one should do good and prevent or avoid doing harm

Question 9

brainstorming

Answer 9

to generate as many alternatives as possible without critical evaluation

Question 10

care coordination

Answer 10

Linking clients with services.

• one function of case management, is the deliberate organization
  of client care activities between two or more participants
  involved in a client’s care to facilitate the appropriate delivery of
  health care services…and involves the marshaling of personnel
  and resources to carry out all required patient care activities…
  managed by the exchange of information among participants for
  different aspects of care

Question 11

care management

Answer 11

Program or process that established systems and monitors the health status of individuals, families, and groups. The program or process develops planning and intervention activities, as well as targeted evaluation outcomes for the client and program.

• a health care delivery process that helps
  achieve better health outcomes by anticipating and linking
  populations with the services they need more quickly.

Question 12

care maps

Answer 12

Tool developed by Zander showing cause and effect and identifying expected client or family and staff behaviors against a timeline.

• a model for providing quality clinical care within an interprofessional
  practice. a tool that specifies activities providers may use in a timely sequence to achieve desired outcomes for care. The outcomes are measurable, and the pathway tools strive to reduce differences in client care.

Question 13

case management plans

Answer 13

A multidisciplinary model for documenting patient care that usually includes plans for problems, key inter-ventions, and expected outcomes for patients with a specific disease or condition.

• standards of client care, standards of nursing practice, standards of practice, and clinical guidelines using evidence-based practice as core foundations for managing a client’s care

Question 14

case manager

Answer 14

Nurse who works to enhance continuity and provide appropriate care for clients whose health problems are actually or potentially chronic and complex. School nurse who performs general activities concerning health problems of the children. Builds on the basic functions of the traditional role and adapts new competencies for managing the transition from one part of the system to another or to home.

Question 15

clarifying

Answer 15

a process in which the nurse and client strive
to understand meanings in a common way. Clarifying builds on
the breadth and depth of the exchange developed during amplifying
to determine whether the nurse and client understand
each other. During this process, misunderstandings and confusions
are examined. The goal of clarifying is to avoid confusion
between the nurse and the client.

Question 16

collaboration

Answer 16

Mutual sharing and working together to achieve common goals in such a way that all persons or groups are recognized and growth is enhanced.

• is achieved through a developmental
  process. Collaboration is a dynamic, highly interactive, and
  interdependent process in which people work together, sharing
  resources and even a vision for a goal.
  Androwich and Cary (1989) found that collaboration occurs in
  a sequence and is reciprocal and can be characterized by seven
  stages and activities

Question 17

cooperation

Answer 17

working together or associating with others for common benefit; a common effort

Question 18

coordinate

Answer 18

conscious activity of assembling and directing the work efforts of a group of health providers so that they can function harmoniously in the attainment of the objective of client care

Question 19

critical pathways

Answer 19

Tools used in managed care that incorporate the treatment interventions of caregivers from all disciplines who nor-mally care for a patient. Designed for a specific care type, a pathway is used to manage the care of a patient throughout a projected length of stay.

• tools that specify activities providers may use in a
  timely sequence to achieve desired outcomes for care. The
  outcomes are measurable, and the pathway tools strive to
  reduce variation in client care. Today, agencies are more
  likely to call these clinical paths, evidence-based practice
  protocols, clinical decision supports or guidelines, or case
  management plans of care.

Question 20

dashboard indicators

Answer 20

measure performance

Question 21

demand management

Answer 21

Program that provides to consumers, at the point at which they are deciding how to enter the health care system, information and support to access care.

• seeks to control use by providing
  clients with correct information and education strategies to
  make healthy choices, to use healthy and health-seeking
  behaviors to improve their health status, and to make fewer
  demands on the health care system

Question 22

disease management

Answer 22

Proactive treatment approach, focused on a specific diagnosis, that seeks to manage a chronic health condition and minimize acute episodes in a population.

• constitutes systematic activities to coordinate
  health care interventions and communications for
  populations with disease conditions in which client self-care
  efforts are significant. For example, diabetes,
  asthma, and depression are typically targeted by
  providers and insurers. These programs have evolved largely transitions among health care facilities, such as wellness and prevention, and interprofessional teams

Question 23

distributive outcomes

Answer 23

an outcome in which one person enlarges their share at another person’s expense

Question 24

fidelity

Answer 24

The agreement to keep a promise.

• faithfulness to the obligation of duty in this case to the client by keeping promises and remaining loyal within
  the nurse-client relationship.Duty to clients to secure
  benefits on their behalf and to limit unnecessary expenditures
  can create dilemmas when the goals are not uniform.

Question 25

information exchange process

Answer 25

• composed of interactions that reflect three subprocesses: amplifying,
  clarifying, and verifying

Question 26

informing

Answer 26

a communication process in which the nurse interprets facts and shares knowledge with clients

Question 27

integrative outcomes

Answer 27

an outcome in which mutual advantages override individual gains

Question 28

justice

Answer 28

1. equitable distribution of benefits and burdens of research.
2. The treatment of people in a nonprejudicial manner.

• an ethical principle for case managers considers
  equal distribution of health care with reasonable quality.
  Tiers of quality and expertise among provider groups can be
  created when quality providers refuse to accept reimbursement
  allowances from the managed system, leaving less
  experienced or lower quality providers as the caregiver of
  choice for clients being managed.

Question 29

life care planning

Answer 29

Customized, medically based document that provides assessment of all present and future needs (i.e., medical, financial, psychological, vocational, spiritual, physical, and social), including services, equipment, supplies, and living arrangements for a client (Llewellyn and Leonard, 2009).

• tool used in case management.
  A life care plan assesses the current and future needs of a client
  for catastrophic or chronic disease over a life span. The life care
  plan is a customized, medically based document that provides
  an organized plan to estimate reasonable and necessary current
  and future medical and nonmedical needs of clients with associated
  costs and frequencies of goods and services. Typically these
  needs incorporate medical, financial (income), psychological,
  vocational, built environment, and social costs during the
  remaining life of the client (Sambucini, 2013). Life care plans
  are typically used for clients experiencing catastrophic illness or
  adverse events resulting from professional malpractice or
  accidents/injuries or those who have sustained an injury when
  younger and subsequently have changes in requirements as they
  age. For example, conditions may include spinal cord injury,
  traumatic brain injury, chronic pain, amputation, cerebral palsy,
  and burns. Life care plans are also used to set financial rewards,
  which can be used to secure resources for care in the future and
  create a lifetime care plan. A systematic process like the nursing
  process is used and interprofessional input is required.

Question 30

Medical/ Health Home or Patient/ Client- Centered Medical home model

Answer 30

A facility that integrates primary care and behavioral health while emphasizing prevention and wellness. Care is provided by a diverse team, including advanced practice nurses, physicians, physician assistants, nurses, social workers, pharmacists, dieticians, care coordinators, and educators.

• provides accessible, continuous, coordinated, comprehensive care
  and is managed centrally by a physician/nurse practitioner with
  the active involvement of nonphysician practice staff. Care provided
  must be assessed, planned, implemented, adjusted, and
  evaluated on the basis of goals designed by many disciplines as
  well as goals of the client, the family, significant others, and community
  organizations. Although likely employed and located in
  one setting, the nurse as case manager will be influencing the
  selection, monitoring, and evaluation of care provided in other
  settings by formal and informal care providers.

Question 31

negotiating

Answer 31

Working with others in a formal way to achieve agreement on areas of conflict, using principles of communication, conflict resolution, and assertiveness.

• a strategic process used to move conflicting
  parties toward an outcome.

Question 32

nonmaleficence

Answer 32

The fundamental ethical agreement to do no harm. Closely related to the ethical standard of beneficence.

• is defined as doing no harm. When case
  managers incorporate outcomes measures, evidence-based
  practice, and monitoring processes in their plans of care, this principle is addressed.

Question 33

population management

Answer 33

includes wellness and health promotion, illness prevention,
acute and subacute care, chronic disease, rehabilitation,
end-of-life care, care coordination, and community engagement.

Question 34

problem-purpose- expansion method

Answer 34

Way to broaden limited thinking that involves restating the problem and expanding the problem statement so that different solutions can be generated.

• way to broaden limited thinking. It involves restating the problem
  and expanding the problem statement so that different solutions
  can be generated. If problem formulation yields to solution generation
  too early, important dimensions of the problem may go
  undetected and opportunities are missed. For example, if the
  problem statement is to convince the insurance company to
  approve a longer length of service, the nurse and client have narrowed
  their options. However, if the problem statement is to
  improve the client’s convalescence and safety, several solutions
  and options are available,

Question 35

problem solving

Answer 35

Methodical, systematic approach to explore conditions and develop solutions, including analysis of data, determi-nation of causative factors, and selection of appropriate actions to reverse or eliminate the problem.

• a systematic approach that includes understanding the values of each party and generating alternative solutions. The nursing process—assessment, diagnosis, planning, implementing,
  and evaluating—is an example

Question 36

risk- sharing

Answer 36

A process in which the third party payers and the provider share the risk of the costs of managing disease.

• a financial arrangement between an insurance payer and a health care provider. The payer and provider share in the extra cost of a client’s care when that cost is not expected.

Question 37

social mandate

Answer 37

a trust that society has placed in the government and health care system that the population’s health will be improved, for example, Healthy People 2020

Question 38

supporting

Answer 38

involves

upholding a client’s right to make a choice and to act on it.

Question 39

transitions of care

Answer 39

bridge the gaps among diverse services, providers, and settings through the systematic application of evidence-based interventions that improve communication and transfer of information within and across services, enhancing post–acute care follow-up, and decreasing gaps in care by the use of a single consistent provider

Question 40

utilization management

Answer 40

attempts to promote optimal use of services to redirect care and monitor the appropriate use
of provider care/treatment services for both acute and community/ambulatory services. Providers are offered multiple
options for care with different economic implications.
Through the use of utilization management, clients who have repetitive readmissions (i.e., they fail to respond to
care) are often referred to care management programs.

Question 41

veracity

Answer 41

Truth telling.

• truth telling, is absolutely necessary to the practice of advocacy and building a trusting relationship
  with clients. Clients particularly complain that in the changing health care system, payers do not seem to be
  able to provide comprehensive yet inexpensive options
  for care.

Question 42

verifying

Answer 42

the process used by the nurse advocate to establish

accuracy and reality in the informing process.