Chapter 22 Key Terms Flashcards
Accountable Care Organizations
- help manage the health of populations served by the integrated systems
Advocacy
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.
Affirming
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
Allocation
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
Amplifying
occurs between the
nurse and the client to assess the needs and demands that will
eventually frame the client’s decision.
Assertiveness
Behavior directed toward claiming one’s rights without denying those of others.
- the ability to present one’s own needs.
Autonomy
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.
beneficence
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
brainstorming
to generate as many alternatives as possible without critical evaluation
care coordination
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
care management
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.
care maps
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.
case management plans
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
case manager
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.
clarifying
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.
collaboration
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
cooperation
working together or associating with others for common benefit; a common effort
coordinate
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
critical pathways
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.
dashboard indicators
measure performance
demand management
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
disease management
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
distributive outcomes
an outcome in which one person enlarges their share at another person’s expense
fidelity
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.
information exchange process
- composed of interactions that reflect three subprocesses: amplifying,
clarifying, and verifying
informing
a communication process in which the nurse interprets facts and shares knowledge with clients
integrative outcomes
an outcome in which mutual advantages override individual gains
justice
- equitable distribution of benefits and burdens of research.
- 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.
life care planning
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.
Medical/ Health Home or Patient/ Client- Centered Medical home model
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.
negotiating
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.
nonmaleficence
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.
population management
includes wellness and health promotion, illness prevention,
acute and subacute care, chronic disease, rehabilitation,
end-of-life care, care coordination, and community engagement.
problem-purpose- expansion method
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,
problem solving
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
risk- sharing
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.
social mandate
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
supporting
involves
upholding a client’s right to make a choice and to act on it.
transitions of care
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
utilization management
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.
veracity
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.
verifying
the process used by the nurse advocate to establish
accuracy and reality in the informing process.
