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Healtch Care Delivery Flashcards

1
Q

Health Resources and Services Administration (HRSA)

A

provides health related info; administers programs concerned with health care for the homeless, people with HIV and AIDS, organ transplants, rural health care and employee occupational health

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2
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Food and Drug Administration (FDA)

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Protect the public from unsafe drugs, foods and cosmetics

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3
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Centers for Disease Control and Prevention (CDC)

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Prevent the transmission of communicable diseases

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4
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National Institutes of Health (NIH)

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Conduct research and education related to specific illnesses

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5
Q

Substance Abuse and Mental Health Services Administration (SAMHSA)

A

Improve quality and availability of substance prevention, alcohol and drug addiction treatment, and mental health services

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6
Q

Agency for Toxic Substances and Disease Registry (ATSDR)

A

Maintain registry of certain diseases; provide information on toxic agents; conduct mortality and morbidity studies on defined population groups

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7
Q

Indian Health Service (IHS)

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Provide health care services to Native Americans, including health promotion, disease prevention, alcoholism prevention, substance abuse prevention, suicide prevention, nutrition, and maternal-child health care

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8
Q

Agency for Healthcare Research and Quality (AHRQ)

A

Primary source of federal support for research related to quality and safety of health care delivery

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9
Q

Nursing Roles- caregiver

A

traditional and most essential role; functions as nurturer; provides direct care; is supportive; demostrates clinical proficiency; promotes comfort of pt

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10
Q

Nursing Roles- teacher

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provides information; serves as a counselor; seeks to empower pt for self-care; encourages compliance with prescribed therapy; promotes healthy lifestyle; interprets information

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11
Q

Nursing Roles- advocate

A

protects the pt; provides explanations in pts language; acts as a change agent; supports pts decision

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12
Q

Nursing Roles- manager

A

makes decisions; coordinates activites of others; allocates resources; evaluates care and personnel; serves as a leader; takes initiative

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13
Q

Nursing Roles- expert

A

advanced practice clinician; conducts research; teaches in schools of nursing; develops theory; contributes to professional literature; provides testimony at government hearings and in court

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14
Q

Nursing Roles- case manager

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tracks pts progress through the health care system; coordinates care to ensure continuity

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15
Q

Nursing Roles- team member

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collaborates with others; possesses highly skilled communication methods; perfoms therapuetic measures to assist with respiration

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16
Q

Professional Roles- RN

A

procides care to individuals who are unable to care for themselves; with a holistic approach, nurses assist pts to cope with illness or disability; addresses the needs of the pt (individual, family, community); emphasizes health promotion

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17
Q

Professional Roles- APRN

A

diagnoses primamry health care problems; prescribes therapuetic modalities; promotes continuity of care; may specialize in a variety of areas

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18
Q

Professional Roles- MD

A

makes medical diagnosis and prescribes therapeutic modalities; performs medical procedures; may specialize in a variety of areas

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19
Q

Professional Roles- PA

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provides medical services under the supervision of a physician

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20
Q

Professional Roles- unlicensed assistive personnel

A

assists in provision of pt care activites under the direction of the RN; may include CNA, personal care assistant, nursing assistant, orderly or certified phlebotomist

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21
Q

Independent Practive

A

fee-for-service; consumer choice of provider; disease-oriented philosophy

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22
Q

Health Maintenance Organizations (HMO)

A

fee is preset and prepaid; provide services to a group of enrolled personls; service is provision limited

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23
Q

Preferred Provider Organizations (PPO)

A

fees are preset and prepaid; networks of providers that give discounts to sponsoring organization; members are not mandated to select a specific primary care provider but must use a provider in the network

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24
Q

Exlusive Provider Organizations (EPO)

A

plans pay no benefit if member is treated oustide the network; usually regulated by state insurance laws

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25
Medicare
established in 1965; individuals over 65; does not pay for all health care expenses (ie prescriptions); long term care and catastrophic illnesses are not covered; modivied in 1972 to include those with disabilites and end stage renal disease; run by federal government
26
Medicaid
shraed between federal and state; each state can modify who is elligible; reimburses NPs and CNMs if the state has authorized the APRN to provide services specified under the Centers for Medicaid Services (CMS)
27
State Children's Health Insurance Program (SCHIP)
established in 1997 as part of the Balanced Budgent Act; nurses play essential advocacy role to parents of economically disadvantaged children; each state makes decisions about it's financing
28
Levels of Care- Primary
promotes wellness and prevents illness or disability; society has begun to engage in health-promoting behaviors
29
Levels of Care- Secondary
acute treatment centers; most health care services are secondary; screening and diagnosis
30
Levels of Care- Tertiary
restoring an individual to the state that existed before the development of illness (optimal level of self-care)
31
Nursing Roles in- hospitals
caregiver, client educator, provides ongoing assessment, coordinates care and collaborates with other health care providers, maintains client safety, initiates discharge plans, variety of areas to specialize in
32
Nursing Roles in- extended care
caregiver, educator, advocate, provides care directed at meeting basic needs, provides teaching and counseling, pland and coordinates care, administers medications, treatments and other therapeutic modalities
33
Nursing roles in- home health
educator, caregiver, provides skilled nursing care, coordinates health promotion activities
34
Nursing roles in- hospice
caregiver, counselor, advocate, plans and coordinates care, promotes comfort measures, provides pain control, supports families
35
Nursing roles in- outpatient setting
check vital signs, assist with diagnostic tests, prepares client for examination, provides teaching and counseling, performs physical
36
Nursing roles in- schools
caregiver, educator, advocate, coordinates health promotion and disease prevention activities, treats minor illnesses, provides health education
37
Nursing roles in- industrial clinics
caregiver, educator, coordinates health promotion activities, provides educaiton for safety, proved urgent care as needed, maintains health records, conducts ongoing screenings, provides preventative services
38
Nursing roles in- managed care organizations
caregiver, educator, case manager, uses triage to determine the most appropriate intervention for clients
39
Nursing roles in- community nursing centers
caregiver, treats client's responsibilites to health problems, promotes health and wellness
40
Nursing roles in- rural primary care hospitals (RPCH)
caregiver, educator, advocate, performs assessments and provides emergency care
41
Quality Assurance
the traditional approach to quality management in which monitoring and evaluation focuses on individual performance, deviation from standards and problem solvine
42
Continuous Quality Improvement
approach to quality management in which scientific, data-driven approaches are used to study work processes that lead to long term system improvement
43
Total Quality Management
method of management and system operation used to achieve CQI. TQM promotes and organizational culture that supports customer need, empowers emplyees to work as a team, emphasizes self development, and requires a new leadership style in which emplyees are viewd as resources
44
Leadership
must create a people-oriented culture
45
Team/teamwork
a group who works together to achieve a common goal; demonstrates commitment, cooperation and communication
46
Tools to measure quality
audits, peer review, benchmarking (comparing to the competition), clinical pathways
47
The nurse is reviewing the nursing agenda for health care reform. Which is a basic premise of this agenda?
there must be plans to decrease the cost of health care
48
the nurse realized that which of the following factors will probably shape reform of the health care delivery system?
aging of the population
49
a client tells the nurse that he receieves health care services from the private sector. This sector of the health care delivery service includes....
independent providers who are reimbursed on a fee for the service basis
50
a client has a health insurance plan that has a capitated rate. Capitated rates in HMO's means....
a preset flat rate per member is paid to a provider whether the member uses the service or not
51
the nurse talks with every assigned client to ensure satisfaction with the care received. Which of the following could be a cause for client dissatisfaction?
delayed pain medication
52
A client is admitted to a rehab facility to recovery from surgery for hip fx. This facility is considered:
tertiary
53
A prescribing practitioner who is reimbursed directly by an insurance company for services provided is being reimbured by which method?
Fee for service
54
Which of the following is one reason why a nursing shortage is imminent?
Declining number of nursing faculty
55
Which group spurred the movement toward cost containment of health care?
the business sector
56
Which health sercive is promoted through primary care?
teaching
57
Which agency is responsible for administering the Medicare and Medicaid programs?
CMS
58
If a health care organization fails to adhere to quality standards for care, which of the following can occur?
denial of payment for services
59
Which factor places the quality of hospital care at risk when hospitals restructure?
Replacing RNs with UAPs
60
One dimension of an organizations cultrue is atmosphere. Which characteristic is an example of the atmosphere in a high performing organization?
open and nonthreatening
61
What is the percentage goal recommended by Healthy People 2010 for preschool children in this couintry to be immunized?
10%
62
In Nursing's Agenda for Health Care Reform, a cornerstone of this proposal is that...
all citizens must have access to health care services
63
What statement would be accurate about nurse practitioner versus prescribing practitioner care?
NP's can independently diagnose and treat common acute illnesses and injuries
64
Which action is the nurse manager's responsibility in quality improvement?
lead by example
65
A client has had a total hip replacement and is transferred to a facility for restorative care. This facility would be...
a long term extended care facility
66
According to the CMS, "never events" will not be reimbursed with payment to hospitals. Which occurence is an example of a never event?
A client falls out of bed and breaks her wrist
67
A client asks the nurse, "exactly what is an HMO?". The nurses response should incllude which of the following?
HMO's are groups of federally financed insurance companies; HMOs were established to control the costs of health care delivery; HMOs were intended to emphasize prevention rather than treatment of chronic conditions
68
WHen working with a person from a vulnerable population, it is important for the nurse to do which of the following?
learn about the person's specific cultural practices
69
The nurse who is working in a rehabilitation facility is providing which level of care?
tertiary
70
Which of the following nursing actions will adversely affect customer satisfaction of hospitalized clients?
implementing a routine schedule for every client

Nursing Fundamentals (10 decks)

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