health policy Flashcards
the influence of health policy on nursing practice
nurses can influence health policy by advocating for patient information, advocating for patients, work standards, and other issues that may affect a patient or their care or staffing.
- can impact nursing shortages, the scope of practice, advanced practice regulation, and reimbursement
the impact of health policy on health outcomes
- can help prevent disease and promote health
- individuals who have coverage are more likely to obtain a early diagnosis/proper one and early treatment which may ultimately contribute to improved health outcomes
the effect of health policy on health care needs of the client
can help prevent; human error, poor communication on all things especially around medical decisions.
- can help establish guidelines to benefit the patient, the healthcare organizations, and overall the healthcare system
what are the commission for nursing educations values
caring
diversity
integrity
excellence
why must a school follow accreditation standards
These standards ensure program effectiveness and excellence through the evaluation of governance, faculty, students, curriculum, and outcomes. After reviewing the applicant’s self-assessment, CNEA evaluators visit the nursing program to ensure standards are being met.
telehealth
the provision of both clinical and nonclinical aspects of health care delivery through the use of telecommunication devices such as the internet and telephone
endorsement
being granted single state licensure base don reciprocity for nurses who have passed the national council licensing exam (NCLEX)
nurse practice act
- they define the authority of the state board of nursing, identify the types of licenses and titles for nurses, prescribe requirements for licensure and nursing education in each state
American nurses association
a professional organization concerned with advancing the nursing profession by protecting the interests of nurses, promoting a safe and ethical environment, and advocating on health care issues that affect the government
advocacy
Speaking up for clients’ needs when the clients are unable to speak for themselves and supporting clients to make choices for their own health.
Defending the rights, interests, and safety of someone who is vulnerable.
The act of defending the interests, rights, and safety of those who cannot do it for themselves.
code of ethics in nursing establishes what
the ethical standard for the profession of nursing
nurse staffing
The process of determining the correct number and skill mix of nurses for the number and acuity of patients needing care. Affects the ability of nurses to deliver safe care.
nurse-to-patient ratio
The number of clients each nurse is assigned. The ratio is based on the service area and client acuity
acuity
the amount of time each client will need nursing care, based on personal needs and how ill the client is
professional nursing organizations
grouped by interest such as specialty area or nurse role
P&P manuals
policies and procedures that provide the standard of care that meets regulatory accreditation requirements and promotes safety
determinants of health
factors that impact health other than health care services, including location, environment, genetics, income, relationships, and gender
health in all policy
an approach to public policy making that systematically accounts for the health implications of all decisions
patient protection and affordable care act: essential health benefits
- Ambulatory (outpatient) patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavior health treatment
Prescription drugs - Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
underinsured
those with insurance who pay more than 10% of annual income, or 5% if below the poverty level, on health care costs out of pocket
uninsured
people without health insurance coverage. Correlated with poor access to care and lack of preventative care
health insurance portability and accountability act (HIPAA)
The Health Insurance Portability and Accountability Act of 1996, also known as the Privacy Act, legislation to protect insurance coverage and private information of clients. Its purpose is to protect client’s privacy and personal health information from security breaches, particularly electronic data. It was established by the federal government with the goal of making health care more efficient. Established in 1996 to reduce fraud and deter inappropriate use of client health care information.
Prior to disclosing any of Mr. Alvarez’s protected health information, the nurse should
identify any limitations the client has previously placed on the disclosure of health information to others, including friends or family. According to HIPAA guidelines, the nurse must maintain the client’s privacy, regardless of his level of alertness, which require that the caller’s identity as Mr. Alvarez’s primary care provider be confirmed and that the facility’s policies and procedures regarding identification and release of information be followed.
living wills
Legal document that allows individuals to decide what lifesaving measures they desire towards the end of life.
durable power of attorney for health care
Legal document that allows an individual to choose a designated person, a proxy, to make health care decisions on their behalf.
controlled substances schedules
1 = No accepted medical use
High potential for abuse
Not prescribed
2= High potential for abuse and severe physical or psychological dependence
3= Potential for abuse, but less than substances in Schedules I and II
Abuse may lead to moderate or low physical or high psychological dependence
4 = lower potential for abuse
5 = Low potential for abuse; consists of preparations with limited quantities of certain narcotics
diversion
when a health care professional replaces a controlled substance with another and takes the substance for personal use
mortality
the number of deaths due to a specific illness or injury
chemical restraints
the use of antipsychotic medications to control uncooperative behavior for a specific medical condition
uniform anatomical gift act does what
prohibits another person from revoking the consent of an organ donor after death
Americans with disabilities act
prohibits discrimination against individuals living with a physical or mental impairment that substantially hinders life activities
mental health parity and addiction equity act
ensures that individuals with mental illness receive coverage equal to those with medical illness or need for surgical intervention
- requires insurers and federal payers to reimburse for mental illness and substance use equally to medical intervention of surgical.
Dianne is the nurse caring for Jessica. Jessica recently had surgery to repair a ventral hernia and has been admitted to the surgical unit. She has type 1 diabetes mellitus and is dependent on insulin to control her blood glucose level. Jessica is a 30-year-old mother of two daughters, ages 8 and 4 years; she is single and unemployed. She and her daughters live with Jessica’s mother Carol, a 60-year-old widow in good health. Jessica has no insurance.
Which health policies may apply to Jessica’s hospitalization? (Match each option with the applicable category.)
Because Jessica was hospitalized, HIPAA applies to protect her personal health information. The Controlled Substances Act may apply depending on what medication was prescribed for pain management. The ACA likely applies because Jessica may have insurance; if she does not have insurance, hospital staff will help her understand her options to acquire coverage, such as Medicaid. The Patient Self-Determination Act applies because Jessica has the right to create a living will or durable power of attorney for health care. The Mental Health Parity and Addiction Equity Act ensures mental health services are reimbursed in the same manner as medical-surgical services, but Jessica was hospitalized for surgery so it does not apply. Although Jessica is a mother, the Newborns’ and Mothers’ Health Protection Act focuses on hospitalization in the immediate postnatal period.
health disparities
Preventable differences in incidence and prevalence of disease, injury, or violence among populations, based on race, ethnicity, gender, gender identity, LGBT, age, or socioeconomic status.
health inequity
Unjust, avoidable, uneven distribution of resources that impact health, stemming from systemic racism and discrimination of marginalized groups based on race, ethnicity, gender, gender identity, LGBT, and low socioeconomic status.
what is an issue raising concern in todays healthcare system
quality
- access to the right quality medical help. Death are increasing a rate of 300 clients globally
health equity
Valuing all individuals equally and removing obstacles to optimal health and health care across different populations.
deductibles
a fixed amount of money a client must pay before health insurance begins to cover, calculated anually
copays
an abbreviation of copayment, a copay is a fixed amount a consumer pays for health care typically at a time services are received
parts of medicare
Part A covers inpatient hospitalization and offers limited coverage for treatment at a skilled nursing facility and for home health services.
Part B pays for outpatient treatment, diagnostic services such as imaging studies, and therapies including physical therapy and occupational therapy.
Part C combines Parts A and B and is funded through private insurance companies and is also referred to as an Advantage Plan.
Part D covers prescription medications.
medicaid
individuals younger than 65 with a disability of those with socioeconomic hardship and no other insurance are covered by medicaid when they need healthcare
what are some mandatory benefits of medicaid
inpatient/outpatient hospital stays
lab services
imaging studies
home health services
children’s health insurance program
- insurance for children up to age 19 whose families may earn too much to qualify for medicaid but cannot afford private insurance
accountable care organizations consist of
networks of providers of health care services that join together to share costs and coordination of services for a population
Although Dianne addressed Jessica’s postoperative pain, Jessica was very upset about how she would pay for the hospitalization. Which health policy (federal, state, and local law) applies in this situation?
Jessica is worried about how to pay for her hospitalization and also has a chronic condition that can be expensive to manage. Even for individuals with insurance coverage, copays and deductibles can be expensive—and Jessica has no insurance. Since she has diabetes mellitus type 1, she is dependent on insulin. The Patient Protection and Affordable Care Act (ACA) provides more coverage options than were available prior to its enactment. Since Jessica is uninsured and has a chronic condition but is younger than age 65, she may be eligible for Medicaid. Particularly if Jessica resides in a state that has expanded its Medicaid eligibility, there may be coverage for her insulin and other supplies to manage her chronic condition. The nurse should contact personnel in the health care organization to help Jessica research options and apply for Medicaid.
culture of safety
- systems that approach to change that leads to safer procedures taking blame away from individual who make errors based on systems issues.
what is the administration on aging
the federal agency responsible for protecting the concerns and interests of older adults and the people who provide their care
what does the indian health service do
the mission is to raise the health of American Indians and Alaska Natives to the highest level
the mission of the National Institute of health is what
to obtain and apply knowledge about life, illness, and disability
what does the department of defense do for health
provides health care for all of the countries military personnel
what does the department of labor do for health
provides an oversight to protect consumers interests with regard to health insurance benefits and nurses interests and safety.
epidemiology
the incidence and prevalence of illness and injury
incidence
the number of individuals newly afflicted with an illness or injury, expressed as a percent of a larger population
prevalence
the number of individuals who have an illness or injury as a given point in time, expressed as a percent of a larger population
morbidity
- the number of individual affected by a specific illness of injury
A nurse is teaching a newly licensed nurse about an OSHA standard that is engineer controlled to minimize needlestick injuries. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
needleless IV tubing for IV infusions. Infusions is an example of an OSHA standard that is engineer controlled
A nurse in a provider’s office is completing an admission history for a client. Which of the following statements should the nurse make?
“The Affordable Care Act requires all insurance plans to offer preventive services such as mammogram screenings.”
A nurse has completed administering a controlled substance to a client. There is 1 mL of the medication left in the syringe. Which of the following actions should the nurse take to dispose of the unused medication?
Have a second nurse witness the disposal of the client’s unused medication.
A nurse is caring for a client whose neighbor works on another unit. The neighbor calls the unit and asks the client’s nurse, “What happened to the client?” Which of the following actions should the nurse take?
Tell the neighbor they cannot give them that information.
A newly licensed nurse is assigned to care for a client who has a newly inserted chest tube. The nurse has not previously cared for a client who has a chest tube. Which of the following actions should the nurse take?
Review the facility’s policy and procedure (P&P) manual.
A school nurse notifies the guardian of a school-age child who has failed the vision screening and recommends the child see an optometrist. The guardian reports that they cannot afford private health insurance. Which of the following programs should the nurse recommend the guardian contact?
Children’s Health Insurance Program (CHIP)
A nurse is caring for a young adult client who is deceased and has a valid organ donation card. The client’s parents have expressed a desire against having the client’s organs donated. Which of the following actions should the nurse take?
Inform the parents about the law that prohibits their ability to revoke the client’s wishes to donate.
A nurse who has a multi-state license receives a request from a facility in a neighboring state about providing care in their facility during an emergency disaster. Which of the following actions should the nurse take prior to responding to the request?
Contact the state board of nursing in the neighboring state.
A nurse is participating in a high school career day and is teaching about accreditation of nursing programs. Which of the following statements should the nurse make
“Nurses who graduate from accredited nursing programs will have more employment opportunities.”
A school nurse who works in a low-income school district is assisting with planning a community program to improve healthy eating habits of school-age students in the district. Which of the following organizations should the school nurse contact to provide funding?
Administration for Children and Families (ACF)
or
Children’s Health Insurance Program (CHIP)
A nurse is a member of the facility’s quality improvement committee. The committee is concerned with the increase in the number of catheter-associated urinary tract infections (CAUTI) at the facility. Which of the following agencies should the nurse use to find best-practice guidelines for the care of clients with indwelling urinary catheters?
Centers for Disease Control (CDC)
