Exam 3 Flashcards
What are the four nursing values central to advocacy?
Patients have the right to autonomy, right to hold personal values, access to information, the nurse must act on behalf of patients
What is the aim of Engaging Health Care Users: A Framework for Healthy Individuals and Communities and who created it?
American Health Association created it; aim: to increase the skills, knowledge and understanding of patients and families about what to expect when receiving care
Who created The Institute for Patient and Family Centered Care? What do they do?
Institute for Healthcare Improvement created it; makes it so the voice of the patient and family is represented at the organizational and policy levels
3 major goals of the Patients Bill of Rights?
To help patients feel more confident in the US healthcare system, to stress the importance of a strong relationship between patients and providers, and stress the key role patients play in staying healthy by laying out rights and responsibilities for all patients and healthcare providers
8 key areas of Patient’s Bill of Rights?
Info for patients (easily understood), choice of provider/plans, access to EMS, taking part in treatment, respect/non-discrimination, confidentiality of health info, complaints and appeals, and consumer responsibility
What has the Patient Protection and Affordable Care Act accomplished?
Greater access to healthcare, reimbursement based on quality of care, and reduced the number of uninsured
How does the Genetic Information Nondiscrimination Act work?
It prohibits genetic discrimination by employers and health insurance
What are the requirements for Physician Assisted Suicide?
18 years of age, within the capacity to make medical decisions, and have a terminal disease expected to result in death within 6 months
nurse ______ should advocate for other healthcare providers as well as patients when related to health and safety
administrators
Ways to promote subordinate advocacy?
Invite collaborative decision making, listen to staff needs, get to know staff personally, take time to understand challenges, face challenges and problem solve together, etc
Where does internal whistleblowing occur?
within an organization, reporting up the chain of command
Where does external whistleblowing occur?
Outside the organization such as the media and an elected official
Who must whistle blowing be reported to?
A state or national regulator; private groups such as the Joint Commission or National Committee for Quality Assurance do not provide protection
What must the patient advocate be able to differentiate between?
controlling patient choices (domination and dependence) and assisting patient choices (allowing freedom)
What is a managers role in workplace advocacy?
to see that the work environment is safe and conducive to professional and personal growth for subordinates
What is planned change?
the deliberate application of knowledge and skills to bring about a change
What is change by drift?
accidental change
What is a change agent?
A person skilled in the theory and implementation of planned change
What should be assessed by the change agent before change occurs?
The extent of and interest in change, the nature and depth of motivation and the environment in which change will occur
What are some barriers to change? (6)
Lack of leadership, resistance or skepticism from staff, hesitancy to invest time and money, shortage of internal resources, waning commitment, uncertain roles and lack of commitment
What are Lewen’s three stages through which change agents must proceed before change becomes part of a system?
Unfreezing (when change is needed)
Moving (when change is initiated)
Refreezing (when equilibrium is established)
What are Rogers five phases of planned change?
awareness, interest, evaluation, trial and adoption
How many phases of change are in Lipitt’s change theory?
7 phases
What is the unfreezing stage of Lewin’s Change Theory?
the change agent convinces members of the group to change or when guilt, anxiety or concern can be elicited (I.e people become discontent and aware of a need to change)
What are 4 steps to unfreezing?
- Gather data
- Accurately diagnose the problem
- Decide if the change is needed.
- Make others aware of the need for change
What is the movement stage of Lewin’s change theory?
the change agent identifies, plans and implements appropriate strategies, ensuring driving forces exceed restraining forces
What is the refreezing phase of Lewin’s change theory?
the change agent assists in stabilizing the system change so that it becomes integrated into the status quo
What are the three classic change strategies?
Rational-empirical strategies
Normative-reeducative strategies
Power-coercive strategies
What are covert tactics of resistance?
delaying tactics and passive aggressive behavior
What are overt tactics of resistance?
openly refusing to follow a direct command
Characteristics of a young organization?
High energy, movement, constant change and adaptation
Characteristics of aged organizations?
orderly and predictable fashion, focused on rules and regulations, have limited change
What is a managers responsibility in budgeting?
Vision for short/long term goals
Educating staff on factors affecting budget
Knowledge about political, social and economic factors
What is cost containment?
The effective and efficient delivery of services while generating revenues for operations (using resources wisely)
What are the steps in the budgetary process?
- assess what needs to be covered in the budget
- diagnosis of what needs to be accomplished
- develop a plan by creating a budgeting cycle
- implementation–ongoing monitoring and analysis
- evaluation (budget review and modification)
What are the 3 types of budgets?
personal budget, operating budget, capital budget
What is a personal budget?
a “workforce” budget; the largest budget of healthcare
What is an operating budget?
expenses that change in response to volume of services and items are ordered when needed and immediately before use
What is a capital budget?
Purchase of buildings or major equipment
What are the four budgeting methods?
Incremental, zero-based, flexible, performance
What is incremental budgeting?
takes last years budget and multiplies it by the inflation rate for next year’s
What is zero-based budgeting?
a style that forces managers to rejustify their program or needs every budgeting cycle
What is flexible budgeting?
flexes up and down over the year depending on volume
What is performance budgeting?
outcomes and results are emphasized instead of activities or outputs
What is Children’s Health Insurance Program?
coverage to children under 19 whose families make more than Medicaid limits but cant afford to purchase private health care
What does Children’s Health Insurance Program provide?
routine checkups, immunizations, dental and vision care, inpatient and outpatient hospital care, lab and xray services
Who can obtain Medicare?
65 and older
Individuals with catastrophic or chronic illness regardless of age
Who can obtain Medicaid?
low income children and adults
people with disabilities
low income seniors
What is covered under Medicare Part A?
inpatient hospital stays
What is covered under Medicare Part B?
voluntary outpatient, preventative services, durable medical equipment for the home
What is a benefit of Medicare Part C?
Allows pt to choose private insurers and other choices to manage care
What is covered under Medicare Part D?
Prescriptions
Disadvantages of Fee-For service hospitals?
incentives are given to physicians to provide more treatments because payment is dependent on quantity vs quality of care, leading to providers overspending
What is the Prospective Payment System?
regulations requiring organizations to justify need for services and monitor quality of services by using ICD to code diseases and requiring hospitals to submit budgets to justify costs to prohibit unnecessary spending
How does capitation work?
providers receive a fixed monthly payment; if the cost to provide care is less than capitated amt, provider profits; if more, the provider suffers a loss
What are the steps in developing health policies?
Formulation: collect and assess data that can be used to define scope, resources and need
Implementation: communication of adopted policies
Evaluation: additional data collection and analysis to determine effectiveness of a policy
Who regulates changes in health care policy?
The US Dept. of Health and Human Services
List examples when incident reports should be filed?
Med errors Procedure/tx errors equipment errors/injuries Needlestick injuries Falls/injuries Threats to staff Loss of property
When should incident reports be completed?
Within 24 hrs/ASAP
What should be included in an incident report?
Client name/hospital number
Location of incident
Factual description of incident and injuries
Names of witnesses
Corrective action taken
Name and dose of meds or ID number of equipment
What is a disaster?
an even that can cause serious damage, destruction, injuries or death that can be managed by a hospital and local resources
What is a mass casualty incident?
A catastrophic event that overwhelms local resources
What is an essential component of an emergency operating plan (EOP)?
The provision of training of all personnel regarding each component of the EOP
How often are facilities mandated by the JC mandated to test their EOP?
twice a year
What resources are included in an EOP?
local, state and federal resources
List examples of internal emergencies.
loss of electric power or water, severe damage or casualties because of a fire, weather, explosion or terrorist act
Readiness for internal emergencies includes what?
Safety and hazmat protocols, infection control policies and practices
List examples of external emergencies.
weather, volcano eruptions, earthquakes, pandemic flu, chemical plant explosions, industrial accidents, building collapses, major transport accidents, terrorist acts
List key roles of an emergency operating plan (EOP).
medical command physician, triage officer, community relations/public information officer
What are the four categories of triage during an MCI?
Emergent, Urgent, Nonurgent, Expectant
What color tag is an emergent patient and what does emergent status mean?
Red; highest priority; life threatening injuries with a high possibility of survival once stabilized
What color tag is an urgent patient and what does urgent status mean?
Yellow; Second-highest priority; injuries that are not yet life threatening and require treatment within 30 mins to 2 hrs
What color tag is a nonurgent patient and what does nonurgent status mean?
Green; minor injuries, can wait hours to days for treatment
What color tag is an expectant patient and what does expectant status mean?
Black; not expected to live and will die naturally; provide comfort measures
What criteria should nurses follow when discharging/relocating patients?
Discharge or relocate ambulatory clients
Make arrangements for continuation of care
Do not discharge or relocate clients who are unstable or require continuing nursing care and assessment
Steps to manage a biological incident?
recognize the occurrence, direct personnel on PPE, decon, isolation
Important information to gather in a chemical incident?
specific history of injury, name/concentration of chemical, duration of exposure, which facilities are open/closed to exposed/unexposed clients
What are some security measures in place in hospitals?
Employee ID’s
Electronic security systems in high risk areas
What is MNTrac?
a database used to track bed capacity, NDMS responses and pharmaceuticals and resources from all hospitals within the state to support surge capacity needs.
What are the five major emergency management functions?
Command Operations Planning Logistics Finance and Admin
Function of emergency command?
Sets incident objectives, strategies & priorities; overall responsibility for the incident
Function of emergency operations?
Conducts operations to reach incident objectives, establishes tactics & directs operational resources
Function of emergency planning?
Supports incident action planning process by tracking resources, collecting/analyzing info, maintaining documentation
Function of emergency logistics?
Arranges for resources and needed services to support achievement of incident objectives
Function of emergency finance and administration?
Monitors costs related to the incident, provides accounting, procurement, time recording and cost analyses
Who can function as the incident commander?
A nursing supervisor, director/administrator
What is the incident commander’s role?
has overall responisbility for establishing objectives, planning strategies and implements tactics
What is transfer of command?
the process of moving the responsibility for incident command from one commander to another
What should the oncoming incident commander be briefed on?
History, objectives, current plan, resource assignments, resources needed/ordered, facilities established, any limitations
What positions are a part of the command staff?
Public information officer, safety officer and liaison officer
Who is the safety officer responsible for?
Patients, staff, victim safety
What does a liaison officer do?
serves as primary contact with outside agencies
Who sets the staging area?
The operations section chief
Function of a operations section chief?
Organize, assign, supervise all tactical or response resources assigned to incident, set staging area
Function of the planning section chief?
Oversee the collection, evaluation and dissemination of operational information, prepare and disseminate incident action plan
What does a level 1 activation mean?
resources and supplies already present are adequate to handle the emergency
What does a level 2 activation mean?
Limited additional resources and supplies from the hospital or outside agencies need to be mobilized to manage emergency
What does a level 3 activation mean?
All available resources within the hospital and from outside will be needed to manage the emergency
Methods of communication during an emergency?
Handheld mobile satellite services, line of sight microwave transmission, High Frequency, Very High Frequency and Ultra High Frequency
What does the line of sight microwave transmission connect you to?
FEMA commercial networks
What does high frequency satellite communication connect you to?
Federal, state and local emergency centers
What does very high frequency and ultra high frequency satellite communication connect you to?
local radio communications
