Competencies 6-9

Question 1

Integrates nursing science, computer science, and information science to manage and communicate data, information & knowledge in nursing practice to support patients, nurses, and other providers in their decision-making

Answer 1

Nursing Informatics

Question 2

Senior-Friendly web design

Avoid auto-_____.

Use _____ language.

Avoid using ___, ___ & ___ in proximity to each other.

Use uppercase & lowercase print (not just ALL CAPS).

Avoid ___ backgrounds.

Use ___ icon buttons.

___-point font (such as Arial font)

___ body of the text.

___ navigation instructions.

Use ___ sparingly.

Answer 2

Avoid auto-scrolling.

Use simple language.

Avoid using yellow, blue & green in proximity to each other.

Use uppercase & lowercase print (not just ALL CAPS).

Avoid patterned backgrounds.

Use large icon buttons.

16-point font (such as Arial font)

Double space body of the text.

Simple navigation instructions.

Use pull-down or cascading menus sparingly.

Question 3

The Patient Protection and Affordable Care Act

1. Eliminate ___ for health insurance coverage for essential services
2. Eliminate the ability of insurance companies to ___
3. Free ___
4. Development of a prevention and public health ___.
5. Increase access to affordable care, including a provision for ___ (also expand Medicaid)
6. Quality improvement and ___ reduction

Answer 3

1. Eliminate lifetime limits for health insurance coverage for essential services
2. Eliminate the ability of insurance companies to rescind coverage
3. Free Preventative care
4. Development of a prevention and public health fund.
5. Increase access to affordable care, including a provision for pre-existing conditions (also expand Medicaid)
6. Quality improvement and risk reduction

Question 4

Who qualifies for Medicare?

Answer 4

Age 65 or over who have paid into the Social Security system, the railroad fund, or are diagnosed with end stage renal disease (on dialysis)

Question 5

What does Medicare Part A cover?

How many days?

Cost?

Answer 5

Inpatient hospital care, hospice, blood, home health services, skilled nursing facility care (up to 100 days)

*No cost for Part A but deductibles and copays apply

Question 6

What does Medicare Part B cover?

Cost? Extra charges?

Part B is _____

Answer 6

Outpatient care, doctor visits, medical equipment, mental health services, labs.

*Cost for Part B based on income and deductible & co-pays apply. Enrollment is Part B is optional.

Question 7

Medicare Part C (“Medicare ___”)

Replaces ___ & ___

Run by ___

Considered ___ ___ programs

Offers same benefits except ___

May include ___

Answer 7

Medicare Advantage. Replaces Parts A & B.

These plans are offered by private insurance companies (like Humana) and are considered managed care programs.

Includes all covered benefits for traditional Parts A & B, except hospice. May include additional benefits such as dental, vision, wellness programs

Question 8

Medicare Part D

Covers?

One plan or many?

Answer 8

Part D is optional: Covers prescription meds. (Remember “D” for Drugs) Multiple plans are offered which vary in prescriptions covered, deductibles, premiums, and co-payments.

Question 9

Preventive services covered by Medicare

Answer 9

• “Welcome to Medicare” physical
• Cholesterol screening
• PAP smear
• Colorectal cancer screening
• Diabetes screening and diabetes education
• Bone densitometry
• Mammogram
• Prostate cancer screening
• Smoking cessation
• Immunizations
• Obesity screening & counseling
• Depression Screening

Question 10

This “socialized medicine” model is currently found in Great Britain, Spain, and New Zealand

Answer 10

Beveridge Model of Healthcare

Designed by National Health Service creator Lord William Beveridge, the Beveridge model provides healthcare for all citizens and is financed by the government through tax payments. This “socialized medicine” model is currently found in Great Britain, Spain, and New Zealand

Question 11

Uses an insurance system and is usually financed jointly by employers and employees through payroll deduction. Non-profit, must include all citizens. Hospitals are _____.

Where?

Answer 11

The Bismarck model

Hospitals are private, but non-profit.

The Bismarck model uses an insurance system and is usually financed jointly by employers and employees through payroll deduction. Unlike the U.S. insurance industry, Bismarck-type health insurance plans do not make a profit and must include all citizens. Doctors and hospitals tend to be private in Bismarck countries.

This model is found in Germany, France, Belgium, the Netherlands, Switzerland, and Japan.

Question 12

National Health Insurance Model of Healthcare

Combines ___ and ___

Where?

Answer 12

The National Health Insurance model has elements of both the Beveridge and Bismarck models. It uses private-sector providers, but payment comes from a government-run insurance program that all citizens fund through a premium or tax. These universal insurance programs tend to be less expensive and have lower administrative costs than American for-profit insurance plans. National Health Insurance plans also control costs by limiting the medical services they pay for and/or requiring patients to wait to be treated. The classic National Health Insurance system can be found in Canada.

Question 13

Model of healthcare found in the majority of the world.

Answer 13

Out-of-Pocket Model of Healthcare

The out-of-pocket model is what is found in the majority of the world. It is used in countries that are challenged to provide any kind of national healthcare system. In these countries, those that have money and can pay for healthcare get it, while others may suffer a lack of care. In rural regions of Africa, India, China, and South America, hundreds of millions of people go their whole lives without ever seeing a doctor.

Question 14

Medicaid

Financed by?

Administered by?

Who determines eligibility guidelines?

3 main uses

Answer 14

• Financed jointly by state and federal governments
• Administered by states
• State will determine eligibility guidelines

1. Health insurance for low-income families and people with disabilities
2. Long-term care (LTC) for low-income older Americans and persons with disabilities
3. Supplemental coverage for low-income Medicare beneficiaries for services not covered by Medicare

** Low-income patients may have both Medicare & Medicaid

Question 15

Social Security

Based on ___

Eligible at ___ but will be ___

Full benefit age is ___

Answer 15

• Is “retirement income” based on work history.
• Can start receiving SS as early as age 62, but payments will be reduced.
• Age to receive full SS benefits has been slowing rising

Question 16

Triple Aims of healthcare reform

Developed by?

What are the 3 aims?

Answer 16

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

Question 17

Care Transitions Models

Primary focus is ___ because Medicare will not pay for ___ within ___

Question 18

BOOST

Answer 18

Better Outcomes for Older adults through Safe Transitions

Resource site provides tools to support nurses in improving care transitions

Question 19

Care Transitions Intervention (CTI)

Developed by ___

___-week program to improve care as ___

4 pillars

Uses a ___ coach who ___

Answer 19

Developed by Eric Coleman, this is a 4-week program to improve quality of care and contain costs for patients with complex care needs as they transition across care settings.

4 pillars:

1. Assistance with self-management of meds
2. Patient-centered medical record that is kept by the patient
3. Timely follow-up with primary physician or specialist
4. List of S&S that indicate worsening of the condition

Uses a Transitions Coach who follows the patient before & after discharge from hospital

Question 20

Transitional Care Model (TCM)

___-led model follows pt from ___ to ___

Visit within ___ of discharge

Accompany to ___

___ home visits and ___ support for ___ months

Answer 20

Nurse-led model that follows patient from hospital to home. Visits patient within 24 hours of discharge, accompanies to follow-up visits, makes weekly home visits, and ongoing telephone support for 2 months. Emphasis of TCM is care coordination and continuity of care. Specific research-based nursing protocols were developed to assist the nurse.

Question 21

Guided Care

Based in ___, care provided by nurse-physician teams. Patient receives __ services by Guided Care nurse, focusing on ___ management, ___ monitoring, nutritional & ___ interventions. Nurses work both in the clinic setting as well as ___.

Answer 21

Based in primary care offices, care provided by nurse-physician teams. Patient receives 8 services by Guided Care nurse, focusing on medication management, symptom monitoring, nutritional & activity interventions. Nurses work both in the clinic setting as well as the patient’s home.

Question 22

GRACE

Focus on which population?

Answer 22

Geriatric Resource for Assessment & Care of Elders

Focuses on improving the quality of care for low-income seniors. Uses a geriatric interdisciplinary team including NP, social worker, primary care provider & geriatrician. Uses care protocols to evaluate & follow common geriatric conditions. The team uses community-based care management programs.

Question 23

PACE

Provides an alternative to ___ loc for pt age ___ or older

Where?

Relation to Medicare/Medicaid

Answer 23

Programs of All-Inclusive Care for the Elderly

Provides an alternative to nursing-facility loc for pt age 55 or older

Where: Select states

Functions within Medicare and Medicaid - replaces other coverage

Provides an alternative to institutional care for patients age 55 or older who require nursing-facility level of care. The interdisciplinary PACE team manages all health, medical & social services. Care is provided in the home, community & PACE center. PACE functions within Medicare & Medicaid programs and replaces other coverage. Patients must live within the PACE service area. **Not available in all states. This option was part of the Balanced Budget Act of 1997

Question 24

Factors that lead to poor outcomes include:

1. Inadequate ___ to patients & family
2. Poor ___ between patients & providers
3. Inadequate ___ at point of care
4. ___ discrepancies
5. Lack of ___
6. Health ___ issues
7. Lack of ___ systems
8. ___ barriers

Answer 24

1. Inadequate education to patients & family
2. Poor communication between patients & providers
3. Inadequate assessment at point of care
4. Medication discrepancies
5. Lack of follow-up care
6. Health literacy issues
7. Lack of support systems
8. Cultural barriers

Question 25

AND

Answer 25

Allow Natural Death

Medical order which provides for comfort measures at end of an illness, allowing nature to take its course. It is seen as more positive and descriptive than a DNR order

Question 26

5 Wishes

Considered more specific than ___

Answer 26

Provides more specific instructions than living will:

1. Person chosen as durable power of attorney for healthcare
2. Kind of treatment the person wants
3. How comfortable they want to be
4. How they want to be treated by others
5. What they want their loved ones to know

Question 27

POLST

Answer 27

Physician’s Order for Life-Sustaining Treatment

Instructs emergency personnel on what actions to take while the person is still at home, before emergency treatment is given.

Question 28

Classifications of Pain (2)

Answer 28

• Neuropathic pain: Injury to peripheral nerves or central nervous system. May be described as shooting, stabbing, burning, or shock-like. May be constant or intermittent. Less responsive to opioids; responds best to anticonvulsants (like Neurontin) or tricyclic antidepressants.
• Nocioceptive pain: Peripheral pain receptors, from somatic or visceral injury. Somatic pain is sharp, well-localized. Visceral pain is diffuse, deep ache. Treated with NSAIDs, steroids, Tylenol, opioids

Question 29

WHO Step Approach to treating pain

Answer 29

• Step 1: Mild pain (1-3 on 0-10 rating scale): Tylenol or NSAIDs
• Step 2: Moderate pain (4-6 on 0-10 scale): Low-dose short-acting opioids in combination with Tylenol or NSAIDs. Adjuvants may also be used.
• Step 3: Severe pain (7 -10 on 0-10 scale): Opioids (not used in combination with Tylenol or NSAIDs so higher doses may be given). Adjuvants may also be used.

**Opioids are constipating so a concurrent bowel program is essential (usually a stimulant & stool softener combination)

Question 30

6 needs of mourning

Answer 30

1. Acknowledge/ accept the reality of the death
2. Embrace the pain of the loss
3. Remember the person who died
4. Develop a new self-identity
5. Search for meaning
6. Receive support from others

Question 31

Stages of Grief

** These are not ___

Answer 31

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

*These are not linear and retrogression may occur

Question 32

Risk factors for complicated mourning

1. ___ death
2. Overly ___ illness
3. Loss of a ___
4. Perception of the death as ___
5. Markedly angry, ambivalent or ___ relationship
6. Unaccommodated losses, stresses or ___ problems
7. Perception of lack of ___

Answer 32

1. Sudden, unexpected death (traumatic, violent, random)
2. Overly lengthy illness
3. Loss of a child, including adult children
4. Perception of the death as preventable
5. Markedly angry, ambivalent or dependent relationship
6. Unaccommodated losses, stresses or mental health problems
7. Perception of lack of social support

Question 33

Active euthanasia

Answer 33

When death is brought about by an act

(e.g., when a person is killed by being given an overdose of pain killers)

Question 34

Passive euthanasia

Answer 34

When death is brought about by an omission. This can be by withdrawing or withholding treatment:

• Withdrawing treatment (e.g., switching off a machine that is keeping a person alive, so that they die of their disease)
• Withholding treatment (e.g., not carrying out surgery that will extend life for a short time)

Question 35

Drugs used for euthanasia

Answer 35

• Phenobarbital (sedative/anti-epileptic)
• Secobarbital (sedative)
• Nembutal (sedative/anti-convulsive)

Question 36

ANA stance on assisted suicide (euthanasia)

Answer 36

It is a VIOLATION of Code of Ethics for Nurses

Nurses should focus on providing competent, comprehensive and compassionate end-of-life care