Final Flashcards
Acute care
24-hour skilled care for short-term illnesses or injuries; generally given in hospitals and ambulatory surgical centers
Adult day care centers
provide a variety of health and social services to specific patient populations who live alone or with family in the community
Affordable care act
An expansion of medicaid, most of employers must provide health insurance, have insurance or face surtax, prevents rejection based on pre-existing condition. Also referred to as “Obamacare”, signed into law in 2010.
assisted Living
residences for people who do not need skilled, 24-hour care, but do require some help with daily care
Diagnosis related group (DRG)
classification of patients by major medical diagnosis for the purpose of standardizing health care costs
discharge planning
systematic process of preparing the patient to leave the health care facility and for maintaining continuity of care
extended care facility
a facility that provides health care and help with the activities of daily living to people who may be physically or mentally unable to care for themselves; this type of care may last from days to years
health care disparities
differences among populations in the availability, accessibility, and quality of health care services
health care equity
Expansion of programs to support the development of interdisciplinary community-based links that target underserved communities
home care
Care provided in a person’s home to assist him or her with activities of daily living.
Inpatient Prospective Payment System (IPPS)
system in which Medicare reimburses hospitals for inpatient hospital services according to a predetermined rate for each discharge.
medicaid
A federal and state assistance program that pays for health care services for people who cannot afford them.
medicare
A federal program of health insurance for persons 65 years of age and older
Minimum Data Set (MDS)
a detailed form with guidelines for assessing residents in long-term care facilities; also details what to do if resident problems are identified
Nursing-sensitive outcomes
Outcomes that are within the scope of nursing practice; consequences or effects of nursing interventions that result in changes in the patient’s symptoms, functional status, safety, psychological distress, or costs.
palliative care
Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.
primary health care
focuses on improved health outcomes for an entire population
rehabilitation
the process aimed at enabling people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels
respite care
planned short-term care, usually for the purpose of relieving a full-time informal caregiver
restorative care
Nursing care that is planned to promote residents health and regain as much of their independence as possible
secondary health care
includes the diagnosis and treatment of emergency, acute illness, or injury. examples include care given in hospital settings (inpatient and EDs), diagnostic centers, or emergent care centers
skilled nursing facility
SNF, nursing home
telehealth
Use of technology to deliver health-related services and information, including telemedicine
tertiary health care
involves the provision of specialized highly technical care. examples include oncology centers and burn centers
Nursing profession values are rooted in
helping people to regain, maintain, or improve their health, prevent illness, and find comfort and dignity at the end of life.
integrated health care delivery
(IHCD) a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and health status of the population served
Example of IHCD- integrated health care delivery
Accountable Care Organization (ACO)- health care reform
Secondary (Acute Care)
urgent care, hospital emergency care
acute medical-surgical care: ambulatory care, outpatient surgery, hospital
radiological procedures
tertiary care
highly complex care and therapy services from practitioners in a hospital or overnight facility, like neurology, cardiology, rheumatology
restorative care examples
-rehab programs
-sports medicine
-spinal cord injury programs
-home care
continuing care examples
• Long-term care: assisted living, nursing centers
• Psychiatric and older-adult day care
primary care examples
• Diagnosis and treatment of common illnesses
• Ongoing management of chronic health problems
• Prenatal care
• Well-baby care
• Family planning
• Patient-centered medical home care
preventative care examples
cancer screening, yearly check up, vaccine, diet
What does primary care do?
Focuses on improved health outcomes
Requires collaboration
secondary care
health services to which primary caregivers refer clients for consultation and additional testing
What is the most expensive health care delivery site?
ICU
Coleman’s “Care Transitions Program”
- med self-management
- patient-centered record
- follow up
- indicators of worsening medical conditions
Naylor’s Transitional Care Model
Emphasizes comprehensive discharge planning and follow-up for older adults who are chronically ill.
High-Intensity care model (GRACE model)
The interprofessional team is headed by both a nurse practitioner and a social worker. Other team members include a pharmacist, geriatric specialist, and mental health provider. This team works in tandem to support the primary care physician and, following best practice protocols, to fully address a patient’s health conditions. The focus is to help patients manage their health conditions, coordinate their health care, and achieve optimal health (Blue Cross Blue Shield of Michigan, n.d.; Center for Consumer Engagement in Health Innovation, 2018). This achieves a patient’s goal from the convenience and security of the patient’s own home (Counsell, 2015).
Magnet Recognition Program
The only national designation built on and evolving through nursing research that is designed to recognize nursing excellence of healthcare organizations through a self-nominating, appraisal process.
examples of social determinants of health
•Safe housing, transportation, and neighborhoods
•Racism, discrimination, and violence
•Education, job opportunities, and income
•Access to nutritious foods and physical activity opportunities
•Polluted air and water
•Language and literacy skills
Florence Nightingale
Established first nursing philosophy based on health maintenance and restoration
Organized first program for training nurses
First practicing epidemiologist
Improved sanitation in battlefield hospitals
Practices remain a basic part of nursing today
contemporary influences
Importance of nurses’ self-care
Health care reform and costs
Demographic changes
Medically underserve
Trends in Nursing
Evidence-based practice
Quality and Safety Education for Nurses (QSEN)
Impact of emerging technologies
Genomics
Public perception of nursing
Impact of nursing on politics and health policy
Professional Nursing Organizations
Address member concerns
Include specialty nursing organizations
Present educational programs
Publish journals
Student organizations include:
National Student Nurses Association (NSNA)
Canadian Student Nurses Association (CSNA)
Health Care Delivery Systems Factors
Four challenges facing nursing
Aging baby boomer generation
Shortage and uneven distribution of physicians
Rate of nurses’ retirements
Uncertainty of health care reform
traditional levels of health care
preventative, primary, secondary, tertiary, restorative, and continuing health care
issues in health care delivery
Health care costs and quality
Patient satisfaction
Nursing shortage
Competency
community based nursing center
function as the first level of contact between members of a community and the health care delivery system
community based nursing
the provision of acute care and care for chronic health problems to individuals and families in the community
community health nursing
nursing practice in the community, with the primary focus on the health care of individuals, families, and groups in a community. The goal is to preserve, protect, promote, or maintain health
Community-oriented nursing
nursing that has as its primary focus the health care of either the community or a population of individuals, families, and groups
incident rates
Rate of new cases of a disease in a specified population over a defined period of time.
Population
A group of individuals that belong to the same species and live in the same area
public health nursing
The practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences
vulnerable populations
Collection of individuals who are more likely to develop health problems as a result of excess risks, limits in access to health care services, or being dependent on others for care.
. Which activity performed by a nurse is related to maintaining competency in nursing practice?
- Asking another nurse about how to change the settings on a medication pump
- Regularly attending unit staff meetings
- Participating as a member of the professional nursing council
- Attending a review course in preparation for a certification examination
Attending a review course in preparation for a certification examination
Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.)
- Providing prenatal teaching on nutrition to a pregnant woman during the first trimester
- Assessing the nutritional status of older adults who come to the community center for lunch
- Working with patients in a cardiac rehabilitation program
- Providing home wound care to a patient
- Teaching a class to parents at the local elementary school about the importance of immunizations
1,2, and 5
Which of the following statements is true regarding Magnet® status recognition for a hospital?
- Nursing is run by a Magnet® manager who makes decisions for the nursing units.
- Nurses in Magnet® hospitals make all of the decisions on the clinical units.
- Magnet® is a term that is used to describe hospitals that are able to hire the nurses they need.
- Magnet® is a special designation for hospitals that achieve excellence in nursing practice.
4
The nurse is working in a tertiary care setting. Which activity does the nurse perform while providing tertiary care?
- Conducting blood pressure screenings at a local food bank
- Administering influenza vaccines for older adults at the local senior center 3. Inserting an indwelling catheter for a patient on a medical surgical unit
- Performing endotracheal suctioning for a patient on a ventilator in the medical ICU
4
A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is the most appropriate outcome for this patient’s restorative care?
- Patient will be able to walk 200 feet without shortness of breath.
- Wound will heal without signs of infection.
- Patient will express concerns related to return to home.
- Patient will identify strategies to improve sleep habits.
1
Which of the following describe characteristics of an integrated health care system? (Select all that apply.)
- The focus is holistic.
- Participating hospitals follow the same model of health care delivery.
- The system coordinates a continuum of services.
- The focus of health care providers is finding a cure for patients.
- Members of the health care team link electronically to use the EHR to share the patient’s health care record.
1,3, and 5
The school nurse has been following a 9-year-old student who has shown behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the student’s family to learn more about social determinants of health that might be affecting the student. Which of the following potential social determinants should the nurse assess? (Select all that apply.)
- The student’s seating placement in the classroom
- The level of support parents offer when the student completes homework 3. The level of violence in the family’s neighborhood
- The age at which the child first began having behavioral problems
- The cultural values about education held by the family
2, 3, and 5
A nurse is assigned to care for an 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehabilitation center closest to their home. The nurse learns that the patient will be discharged in 3 days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been addressed correctly?
- Patient and family involvement in referral
- Timing of referral
- Incorporation of referral discipline recommendations into plan of care
- Determination of discharge date
2
Which of the following are common barriers to effective discharge planning? (Select all that apply.)
- Ineffective communication among providers
- Lack of role clarity among health care team members
- Number of hospital beds to manage patient volume
- Patients’ long-term disabilities
- The patient’s cultural background
1 and 2
A nurse newly hired at a community hospital learns about intentional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? (Select all that apply.)
- Reduction in nurse staffing requirements
- Improved patient satisfaction
- Reduction in patient falls
- Increased costs
- Reduction in patient use of nurse call system
2, 3, and 5
The public health nurse is working with the local city/county health department during a pandemic that has created a crisis within the community. What are responsibilities of the public health nurse during the pandemic? (Select all that apply.)
- Educate the public on disease prevention
- Serve as liaison between patients and health care services and providers
- Investigate cases as they arise
- Monitor trends of the disease outbreak
- Assist with testing for identification of the disease
1,2,3,4,and 5
A community health nurse is working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic setting? (Select all that apply.)
- Decrease the incidence of asthma attacks in the community
- Increase patients’ ability to self-manage their asthma
- Treat acute asthma in the hospital
- Provide asthma education programs for the teachers in the local schools
- Provide scheduled immunizations to people who come to the clinic
1,2, and 4
The nurse caring for a refugee community identifies that the children are undervaccinated and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply.)
- Raising awareness about community resources for the children
- Teaching the community about health promotion and illness prevention
- Promoting autonomy in decision making about health practices
- Improving the health care of the community’s children
- Participating in professional development activities to maintain nursing competency
1,2, and 4
What factor results in vulnerable populations being more likely to develop health problems?
- The ability to use available resources to find housing
- Adequate transportation to the grocery store and community clinics
- Availability of others to help provide care
- Limited access to health care services
4
Many older homes in a neighborhood are undergoing a lot of restoration. Lead paint was used to paint the homes when they were built. The community clinic in the neighborhood is initiating a lead screening program. This activity is based on which social determinant of health?
physical environment
A community health nurse conducts a community assessment focused on adolescent health behaviors. The nurse determines that a large number of adolescents smoke. Designing a smoking-cessation program at the youth community center is an example of which nursing role?
- Epidemiologist
- Counselor
- Collaborator
- Case manager
2
A nurse in a community health clinic reviews screening results from students in a local high school during the most recent academic year. The nurse discovers a 10% increase in the number of positive tuberculosis (TB) skin tests when comparing these numbers to the previous year. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community nurse is acting in which nursing role(s)? (Select all that apply.) 1. Epidemiologist
- Counselor
- Collaborator
- Case manager
- Caregiver
1 and 3
A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. Which statement by the student indicates that the nursing professor needs to provide further teaching?
- “Many patients with mental illness do not have a permanent home.”
- “Unemployment is a common problem experienced by people with a mental illness.”
- “The majority of patients with mental illnesses live in longterm care settings.”
- “Patients with mental illnesses are often at a higher risk for abuse and assault.”
3
The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment.
- Structure or locale
- Social systems
- Population
1,3, then 2
The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2030. Most of the immigrant population do not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (Select all that apply.)
- Assess the health care resources within the community.
- Assess the existing health care programs offered by the county health department.
- Compare existing resources and programs with Healthy People 2030 goals. 4. Initiate new programs to meet Healthy People 2030 goals.
- Implement educational sessions in the schools to focus on nutritional needs of the children
1,2, and 3
