Exam 1 Flashcards
When was the Institute of medicine IOM established and by who?
1970 by the National Academies
What is the new name of the I OM
NAM national Academy of medicine
What is the mission of the NAM?
To improve health for all
By advancing science, accelerating health, equity in providing independent, authoritative, interested, advice, nationally and globally
What was in the I0M’s first report
It began the patient safety movement presented a strategy to improve healthcare quality over the following 10 years, and identified three domains of quality
What was the patient safety movement identifying
Medical errors as the leading cause of injury in the United States
What are the three domains of quality identified by IOM’s first report
Patient safety
Practice, consistent with current medical knowledge
Meeting customer, specific values and expectations 
 What are the key I OM outline six aims for healthcare improvement
Healthcare should be safe effective. Patient centered, timely, efficient, and equitable.
What are the four tiered approach to quality improvement that that IOM outlined?
Establish a national focus
Identifying and learning from errors
Racing performance, standards, and expectations for improvements and safety
Implementing safety systems in healthcare organizations
What are the six aims for healthcare in the 21st-century?
Safe
Effective
Patient centered
Timely
Efficient
Equitable
What does safe mean in the six aims for healthcare in the 21st-century
Avoiding injuries to patients from the care that is intended to help them
What does effective mean in the six aims for healthcare in the 21st-century
Providing services based on scientific knowledge to all who could benefit in refraining from providing services to those not likely to benefit, avoiding over, use underuse and miss use of care
Why did the IOM call for an overhaul by outlining six aims for healthcare improvement in the 21st-century
They needed major reconstructing in, addressing these performance characteristics, would leave to narrowing the quality gap
What is patient centered mean in the six aims for healthcare in the 21st-century
Providing care that is respectful of unresponsive to individual patients preferences needs and values in ensuring that patience values guide all decisions
What is timely mean in the six aims for healthcare in the 21st-century
Reducing weight and sometimes harmful delays for both those who receive in those who give care
What does efficient mean in the six aims for healthcare in the 21st-century
Avoiding waste in particular of equipment supplies ideas and energy
What does equitable mean in the six aims for healthcare in the 21st century
Providing care of that does not very good quality because of the personal characteristics, such as gender, ethnic city, geographic location, and socioeconomic status
Why did the IOM identify 10 rules to redesign and improve health care in the 21st-century
These rules are necessary to achieve significant improvement in quality. They are implemented to have an impact on healthcare, workforce and in turn require change in accountability standards of care and relationships between patients and healthcare professionals.
What is the goal of the QSEN core competencies?
To prepare future nurses with the knowledge, skills and attitudes, necessary to continuously, improve the quality and safety of healthcare
What are the five competencies of the QSEN core competencies
Provide patient centered care
Work in interdisciplinary teams
Employee evidence base practice
Apply quality improvement
Utilize informatics
Safety
What is important and patient centered care
Advocacy
Empowerment
Self-management
Health literacy
Cultural competence
Optimal healing environment
What is the strongest level of evidence in nursing research?
Evidence from a systematic review, or meta-analysis of randomized controlled trials
What is quality improvement in structure of care environment
Focusing on where nursing care is provided
What is quality improvement in the Kara process?
Focusing on how nursing care is provided
What is quality improvement in outcomes of care?
Focusing on the results of nursing care
What are the five principles of creating and maintaining a safety culture?
Providing leader ship
Respecting human limits in the design process
Promoting effective team functioning
Anticipating the unexpected
Creating a learning environment 
What is private healthcare?
Momentarily compensated health care provided to individual seeking care
Includes companies for profit and nonprofit, not associated directly with the government
Predominate form of healthcare for persons in United States
What is public health care?
Funded by tax dollars
Include state and county public health department in US government health agencies
Reduced payment options, or free care offered
What is government health care?
Refers to government provided health insurance such as Medicare or Medicaid
Not provided directly by the government
The VA
What is national or universal healthcare?
Healthcare or health insurance provider to citizens through their government without involvement of private health insurers
Not available in US
What does access to healthcare?
The ability to obtain health care services, when needed
US is low in comparison to other countries in regard to prevention and care of chronic condition
What is uninsured mean?
Those without healthcare insurance coverage
What is underinsured mean?
Those who have insurance coverage, but lack an adequate income to facilitate access to care
What is EMTALA?
Emergency medical treatment in labor act
What does the emergency medical treatment in labor act require?
All Medicare participating hospitals, with emergency departments providing stabilizing emergency care for a patient seeking help regardless, their insurance status, or ability to pay
What are the two avenues of healthcare?
Through a physician or care provider practice who not required to accept patient who cannot pay
Through Hospital emergency Department
What are barriers to access of care?
Living in an area with an adequate service
Lack of health insurance
Kos prohibitions
Why would a patient repeatedly comes to the ER for issues that could be treated at PMD
Lack of insurance
What is better quality of care and hospitals of the US acute or chronic
Acute
Strategies for cost containment
Restriction on expenditures
Press control
Utilization controls
Cost sharing
 What is Medicare?
Provides health insurance for disabled people over the age of 65 and disability
What is Medicaid?
Provide coverage to low income people primarily for children through chip non-disable adults and pregnant women
Who can a healthcare policy be developed by?
Citizen, action, local policies, proceedings, legislation, at the state or federal level, WHO
Our leadership and management interchangeable
No
What is leadership?
Process of influencing others through effective relationship skills
What does management?
A formal position with a specific function
What are the three behavioral theories characteristics of leaders
Autocratic democratic laissez-faire
What is an autocratic leader?
Makes decisions without input from team
Does not consider valuable suggestions from team members input
Potentially demoralizes team members
What is a democratic leader?
Expects team members to contribute to decision making process
Encourage team input
Enables individual growth and development
Analyzes and makes final decisions
Increase his participation in projects and creative solutions
Brings about higher production and satisfaction
What is a laissez-faire leader?
Provides advice support and timelines with low level involvement
Lex focus or time management resulting in high job satisfaction with risk of low productivity
Risks the potential of team members not having the knowledge to execute the tasks
May find intro theme, disagreements common, which may produce disharmony
What is the trait theory of leader ship?
Focused on traits of leaders and noted certain men were born leaders
Looked to be able to identify potential leaders more quickly
What is situational leadership theory?
Situational factors contribute to the leadership style, and the leader may be effective in certain situations and less effective in others
What is the contingency leadership theory?
A complex process of evaluating a leader style, the relationship with followers and the task to be completed
What is the contemporary theories of leadership?
4 leaders to be effective, the values and beliefs of the environment need to be considered
Relationship within the organization, need to be cultivated in order to promote a productive and healthy environment
What are the five relational leadership theories?
Quantum leader ship
Transactional leadership
Transformational leadership
Connective leader ship
Complexity, leadership
What is the attribution leadership theories?
Authentic leadership
Servant leadership 
What is a relational leader ship theory
Focus primarily on the relationship that occurs between the leader in team member
Put more emphasis on the leaders, relationship with others and less emphasis on the leader traits, situation, context or end result
What is quantum leadership?
Focuses on holistic and relational perspectives
Looks at system processes and relationship between workers and tasks to determine efficiency and job performance
What is transactional leadership?
Focuses on the goals of the orcas the nation with a directive style, establishing expectations for team members, and motivating with rewards
Has no shared vision between the leader and team member, but both gained some thing from interaction
Limits innovation focus on task completion in concrete rewards
What does the leader in team member focus on in a transactional leadership?
Leader focuses on getting job done while team member, motivated by reward
What is a transformational leader ship?
Involves active involvement of both the leader and team members they motivate each other
Affective type of leader ship to lead the change necessary to meet the demands of current health system
Everyone is involved
What is a connective leadership?
Focuses on caring
Incorporates the needs of diverse stakeholders within healthcare
Identifies and foster strength of team members by including them in the process of change within the organization
What is complexity, leader ship?
Focuses on learning creative, an adaptive capacity of complex system with the contacts of organizations
These leaders cultivate relationships, except feedback, Tolerate uncertain situation, seek diverse opinions, and listen to multiple points of views
Effective in fast pace world encourages flexibility
What is an attribution leadership theory?
Considers the characteristics or attributes of the leader, as the corner store in within the leader ship
Takes into consideration either the contacts or the intrrrelational aspects
What is an authentic leader?
Evidence by a strong commitment to truth, telling decreasing ambiguity in the system, and increasing efficiency and productivity
Embraces self-awareness and self regulation to enhance more leadership
Creates environment that is predictable, efficient and steadfast
What are five distinguishing characteristics of an authentic leadership?
Purpose, heart, self-discipline, relationships, and values
What is a servant leadership?
Ability to lead by desire to serve others
Creates a reassuring and kind workplace
What is emerging leadership theories?
Aspect of strategic agility in system leader ship
Moving away from individual leadership, ability to collective leader ship
What are some characteristics of a leader?
Character
Commitment
Connectedness
Compassion
Confidence
Emotional intelligence
What do you need in your fellowship when your leader?
Not passive participants need followers, who do not undermine the goal of the leader
What is a mentorship
Process in which two people engage in a relationship designed to support the growth and development of a less experience party
What must a mentor do?
Focus on the exchange of information to assist the mentee in advance in clinical competency’s research, skills or leadership ability
What must a mentee do?
Embrace, open minded dialogues with other nurses leaders in managers
What are the core concepts of nursing?
Person, culture care, health, healing environment, and nursing itself
What are ethics?
Actions people should take in a specific situation based on their own morals
Influenced by personal life and value systems
What are morals?
Ingrained in one’s consciousness
Provide people with establish rules of conduct
Reflect, and what’s right and wrong and good and bad
What is moral integrity?
Refers to quality of character and involves acting consistently with personal and professional values
How is moral integrity demonstrated
Honest and trustworthy
Consistent and doing the right thing
Stand up for what is right despite consequences
What is moral obligation?
A duty to provide care in nondiscriminatory manner
A primary commitment to the recipient of care
A nurse cannot abandon a patient wants a relationship has been established
What are values?
Personal beliefs, that influence behavior, and give meaning and direction to life
May change and grow
What is values clarification?
Process of reflecting on, and analyzing values to better understand what is important
Leads to self-awareness self reflection
Necessary to develop nonjudgmental approach
What is professionalism
Consistent demonstration of core values, evidenced by nurses working with other professionals
What are the five core professional value is critical to nursing?
Altruism
Autonomy
Human dignity
Integrity
Social justice
What is altruism?
Showing concern for the welfare and well-being of others
What is human dignity?
Respecting the inherent worth and uniqueness of an individuals in a population
What does integrity
Acting in accordance with inappropriate code of ethics and accepted standards of practice
What is social justice?
Acting in accordance with fair treatment, regardless of economic status, race ethnicity age, sexual orientation, disability
What do ethical theories offer for nurses?
A guide to clarify the personal values and beliefs
What is utilitarianism?
Acting morally , increase human happiness, and make the world a better place
Determined by consequences of actions to determine the greatest good
Overlooks the rights of an individual
When is utilitarianism used in nursing?
Staffing schedules
Time off request
What is deontology
The right Ness, or wrongness of an action often depends on the nature of the act rather than the consequences of the act
When can a nurse use deontology
Meaning to be objective when making hiring decisions
Steff assignments
Promotion
What is virtue ethics?
A person’s actions are based on the persons character in action is right if it is what the richest person would do
What is principalism?
Uses rule base criteria for conduct that stems from the identification of obligations and duties
Says one or more ethical principle should be used to dress ethical issues or dilemmas
What are ethical principles?
Basic moral truths that guide a persons actions
What is autonomy?
Refers to self governance in that an individual is free to make choices about what they can be done to his or her body
What is beneficence
Refers to an action intended to benefit another. In other words one’s action should always promote good.
What is non-malfeasance
Refers to the moral obligation to do no harm or injured to another person
What is justice?
Obligation to provide fair, equitable, inappropriate treatment, all patients based on their needs without prejudice
What is fidelity?
Refers to being faithful or loyal by keeping promises to others
What is veracity
Refers to the notion that patients have a right to truthful information
What is privacy?
Refers to a persons right to have control over an access to his or her personal information
What is confidentialities?
Refers to preventing disclosure of private information shared between a patient in healthcare’s team
What is the codes of ethics?
Reflect the values and beliefs, shared by members. Inform the public of standards of ethical conduct provides rules and principles surf self-regulation
What does advocacy
Nursing advocacy, encompasses, caring respect for the individuals autonomy an empowerment
What are ethical dilemmas
Occur when principles and rights values and beliefs are in conflict
Not always clear-cut, right or wrong solution
What is moral uncertainty
Results when a nurse senses there is moral problem, but he or she is not sure of the moral, correct action or what is moral principles apply
What is moral distress?
Results of a nurse knows the right action to take to solve a moral problem, but cannot follow his or her mobile believes because of an organizational constraints
What is moral courage?
Requires a study, fast commitment to fundamental moral principles, despite facing potential risk
What is moral resilience?
The capacity to sustain, restore or deep in one’s integrity, in response to Moral complexity, distress, or setbacks
How much do nurse identify an ethical decision making
Identify ethical problems and gather relevant facts
Consider all involved
Identify possible options
Implement decision
What are the three interrelated functions of an ethical committee?
Policy review and development
Ethics, education
Case consultation
What is conscientious objection?
An individual is motivated to do what is right because it is right
Occurs when the nurse refuses to participate, because they believe action would violate their moral values
What is lateral violence?
Negative acts that occur between nurses
What does incivility
Rude and discourteous action, including gossiping in spreading rumors
The nurse is commitment is always to the
Patient
When unsafe or a questionable practice occurs, nurse leaders are managers must
Confront a nurse in an effort to change the practice and take action of change is not made
 Support staff, who report unsafe practice
Report the nurse to state board of nursing if required
What are the three major functions of organizational finances.
Planning control decision
Chief nurse executive is responsible for what finances
Financial management at organizational level
Negotiate and establish amount of resources available held accountable for spending above or below plan budget
Mid-level managers, responsible financially
Area of the division of nursing that includes one or two units hope guideline managers through budget process
First line managers in finances responsible
Unit based financial management, and must answer to mid-level
Must understand budget process
The budgeting process has a direct effect on what
Quantity and quality of nursing care provided
What is the role of a nurse leader in manager and budgeting
Focus on the goal, taking high-quality value for every dollar spent
Monitor financial status of unit
Provide quality cost effective nursing care 
Nurse leaders in managers and cost containment and effectiveness must
Recognize they have control over unit activities that contribute to budget
Engage Steff in budget process and emphasize financial impact on unit
What is the budget process
A systemic plan that provides the best estimate of nursing expenses and revenues
It’s best stated in terms of attainable objectives
What is the average daily census?
Average number of patients on a unit of any given day over a period of time
What is the break even quantity?
The number of patients needed to break even
What is the cost per unit service?
Total cost divided by units of service
What is the full-time equivalent?
Equivalent of one full-time employee working for one year can become a nation of employees working part time
What is nursing hours per patient day?
Amount of productive, nursing care hours per patient on a 24 hour.
What does productivity
Measure of input required for the output
What does variance
Deviation from the projected budget
What are the steps of budgeting?
Assessment
Diagnosis
Planning
Implementation
Evaluation
What is the assessment aspect of budgeting?
Gather data and assess the needs for the upcoming fiscal year
Examine the present nursing activities, as well as those plan for the future
What is the diagnosis part of budgeting?
Determine the nursing productivity goal for the upcoming fiscal yea
Evaluate unit goals from the previous year to ensure they are in alignment with the organizations current mission
Revise or develop new goals for future year
What is the planning stage of budgeting?
Determine effective use of human in material resources
Consider the needs of the unit as well as the organization
Use budget worksheet and perform break even analysis
What is the implementation step for budgeting?
Keep the unit functioning with the budget plan
Engage all staff in the process and motivate them to work within constrains of budget
Meet with Steff to explain budget
Encourage input regarding any deviations
What is the evaluation step of budgeting?
Address any deviation
Perform variance analysis
Analyze the cause of variances, and determine strategies to avoid them in the future
Monitor trends in variances to assist in addressing work load issues
What is productivity and budgeting?
Ratio of output and input monitoring procedures, admission, and patient outcomes versus skill level and experience of staff, finding a balance between safe quality, patient care and cost containment
What is effectiveness and efficiency and budgeting?
Providing care based on evidence in avoiding under use in overuse of resources
What are necessary care activities?
Activities essential to delivery of patient care, but not directly benefit the patient
What is an example of a necessary care activity?
Transcribing orders and documenting medication administration
What is the value added care activity?
Direct care activities are typically performed by registered nurses
What is an example of a value added care activity?
Assessment taking vital signs, wound care, communication with patient, family and your team
What is a non-value added care activity
Activities performed by RNs that do not benefit the patient and are not necessary to delivering patient care
Can lead to increased cost
What is an example of a non-value AdaCare activity
Looking for equipment or people waiting for phone calls and waiting for patient transportation
What is the operating budget and what does it include?
Overall plan accounts for expenses in revenue is related to the day-to-day operation
All unit expenses
What is a fixed expense
Do not change over the budget. Regardless to volume or activity level.
What does variable expenses?
Fluctuate, depending on patient volume and acuity or an activity level
What is direct expenses?
Cost of providing patient care
What is indirect expenses?
Are necessary for daily operations of the organization, but do not affect patient care
What is the personnel budget?
Largest budget
Allocates expenses related to nursing personnel
Requires vigilant, monitoring to avoid over staffing or understaffing
What do you need to consider when setting the personal budget?
The staffing needs and staffing plan for the unit
What is the capital budget?
Includes equipment, furniture, technology, hardware, software, and building, renovations
What does the capital budget require?
Input from staff to identify items that me the cost limit they have
Requires an understanding of financial implications of leasing versus purchasing equipment, expected life of equipment in estimated cost of maintenance
What does incremental budgeting?
Involves multiplying the current year’s budget by a predetermined figure based on the cost of living consumer price index or inflation rate
What does performance budgeting?
Emphasizes outcomes in results, rather than activities and outputs
Helps determine amount of money needed to provide value, added nursing care, non-value added nursing care in quality nursing care
What is zero based budgeting
Starts from zero each year with goal to have zero friends left at the end of the fiscal year
Requires meticulous prioritize and justify or rear justify request funds
Forces priorities, avoid Waze using resources, efficiently
