Final Exam Flashcards by Margaret Alleven

What is included in the Triple Aim?

Population Health
Experience of Care
Per Capita Cost

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What are the 5 aspects of social determinants of health?

education access and quality
economic stability
social and community context
healthcare access and quality
neighborhood and build environment

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What are the 4 main benefits of the EHR?

Safety
Access
Efficiency
Communication

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What are the five rights of CDS?

right info
right patient
right channels
right format
right points in workflow

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What is an example of a microsystem?

orthopedic surgery unit

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What is an example of a mesosytem?

surgical services

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How are healthcare systems different from other organizations?

Purpose, specialized workforce, public trust

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What values are usually in a HC system’s mission statement?

 Research
 Education
 Practice
 Community

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Effective access requires 3 things…

gaining entry
accessing services
trusting the provider

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What are 3 challenges of rural nursing?

lack of anonymity
role diffusion
informal vs formal roles

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What are the goals of the PPACA?

 Provide affordable insurance coverage to most Americans.
 Improve access to primary care.

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When states were given the option to expand medicaid, some didn’t, what happened?

created a gap of no coverage

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How has the individual mandate changed?

People are no longer required to pay tax penalties if they don’t have health insurance.

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What are the 3 attributes of healthcare economics?

price vs costs
efficiency vs equity
supply vs demand

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Health Maintenance Organizations (HMOs)

Coverage is limited to those providers within the organization.

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Preferred Provider Organizations (PPOs)

No referral needed to see any provider the patient would like.

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Point of Service (POS) Plans

Requires a referral to see a doctor out of network.

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With fee-for-service format, payment id dependent on:

quantity, not quality of service

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Goals of Managed Care Organizations

o Reduce costs.
o Promote preventative care.

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Capitation

A flat payment per covered member regardless of the amount of care provided.

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Diagnosis-Related Groups (DRGs)

Similar patients are categorized into groups that reflect the amount of care provided.

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What was a con of DRGs?

too early of discharge

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Who often funds pay-for-performance?

medicare

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What is a positive outcome of accountable care organizations?

receive part of any savings generated if quality is maintained

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What are 6 attributes of Quality Healthcare?

1. efficient 2. timely 3. effective 4. equitable 5. safe 6. patient-centered

What is Plan-Do-Study-Act?

a small test of change

What is the goal of an RCA?

Prevent future harm by eliminating active and latent errors.

When is RCA required?

mandated by TJC in sentinel event analysis

How is policy made?

1. agenda setting 2. policy formulation 3. policy adoption 4. policy implementation 5. policy evaluation

What act intended to promote advance directives?

Patient Self-Determination Act

What are 2 examples of advance directives?

 Durable Power of Attorney for Healthcare  Living Will

When a DPOA assigned?

when pt doesn't have the capacity

What is another name for Out-of-Hospital DNR orders?

Comfort One

What is an example of a legal document?

living will

What is an example of a medical document?

MOST/POLST form

What is the ethics committee's role in decision making?

Makes recommendations for a decision based on ethical frameworks.

What are the attributes of interprofessional collaboration?

1. values and ethics 2. communication 3. roles and responsibilities 4. teams and teamwork

What is the difference in covert and overt behaviors?

covert: covered overt: obvious

Why will there be an increased incidence of informal long-term caregiving over the next decade?

Improved chronic disease management Cost of formal caregivers Population is aging Overwhelmed formal health system.

“oh my gosh, cool!” Oh gosh, starting an IV.”

Environment Stimuli

“I will review the hospital policy and have the RN walk me through the supplies."

Coping: Problem-Focused:

“Oh no if I miss the RN might be mad. What if the patient asks if I’ve done this before?”

Primary Appraisal:

“I don’t know if I can do this, I’ve never used those IV supplies.”

Secondary Appraisal

“I need to take a deep breath and say a prayer. I can do this.”

Coping: Emotion-Focused:

“I did it!” I got the IV and it wasn’t so bad!”

Reappraisal:

What is the nurse's role in caregiver role strain?

identify the strain provide resources

When can palliative care be started?

at any point during an illness

What type of care may involve curative treatments?

palliative care

What tasks cannot be delegated?

Nursing judgment or activities that involve critical decision-making

What are the 5 rights of delegation?

1. right task 2. right circumstance 3. right person 4. right directions and communication 5. right supervision and evaluation

What can't LPNs do?

1. complete admission assessments 2. IV push meds 3. care for unstable client

An RN knows that when making the decision to delegate this legal document will guide her decision making

state nurse practice acts

5 steps of delegation?

1. decision to delegate 2. communication 3. supervision 4. evaluation 5. feedback

What is central to transformational leadership?

The notion that people require a sense of mission and purpose to be able to work effectively, which extends beyond receiving a thank you or a reward for effective performance.

4 elements of transformational leadership?

1. idealized influence 2. inspirational motivation 3. intellectual stimulation 4. individualized consideration

What is the role of the change agent?

Multifaceted: Requires mastery by the nurse manager in department and health care environment change and guiding and others in and through change.

What are the 6 different types of power?

1. coercive 2. legitimate 3. referent 4. reward 5. expert 6. informational

What is Lewin's Theory?

Unfreeze, Change, Refreeze stages

What is involved in the unfreeze stage?

Preparation

What is involved in the change stage?

Implement

What is involved in the refreeze stage?

Permanent change

What is Roger's Diffusion of Innovation?

Involves levels of participation (Innovators, Early Adopters, Early Majority, Late Majority, Laggards)

What is Lippitt's Change Theory?

emphasizes participation of key members and reflects the nursing process.

You, along with family and friends, talk to you friend and say, “nobody smokes anymore!” What type of change strategy?

normative-re-educative

You refuse to ride in the care with your friend when he is smoking. What type of change strategy?

power-coercive

You give your friend research on cancer and smoking. What type of change strategy?

empirical-rational