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ANCC Boards Review > Issues, Trends, and Health Policy > Flashcards

Issues, Trends, and Health Policy Flashcards

1
Q

Therapeutic Relationship - What is involved in establishing rapport and professional therapeutic relationships (5)

A 
Non-judgemental approach
Mutual trust
Professional boundaries
Confidentiality
Cultural competency
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2
Q

Therapeutic Relationship - Cultural competency -

Asian - eye contact

A

Does not make eye contact out of respect

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3
Q

Therapeutic Relationship -
Cultural competency -

Native american - medicine man

A

Let them in

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4
Q

Therapeutic Relationship

Cultural competency - Do you offer to call the clergy?

A

Be careful not to assume

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5
Q

Therapeutic Relationship

Cultural competency - Jehova’s Witness?

A

They have a card that delineates that they do not want blood

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6
Q

Therapeutic Relationship - Therapeutic Communication

A 
Listen more than talk
"Tell me..."
Never ask "why"
Focus on feelings - mad, glad, sad
No euphemisms
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7
Q

No euphemisms (example)

A

Use solid words like - Dead/died versus “gone or passed”

Im concerned about alcohol abuse or alcoholism versus alcoholic.

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8
Q

Therapeutic Relationship -

Crisis Intervention

A

Ensure safety - set boundaries

    • Put distance between you
    • Call security - not police

Establish trust/rapport
– Offering self - reassuring patient “I AM HERE”

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9
Q

Therapeutic Relationship -

Crisis/Acute Grief Therapeutic Communication

A

Acknowledge feelings

    • Sad, or angry
    • DO NOT SAY “I UNDERSTAND”

Offering Self

  • -“I am here”
  • -“Is there something I can do for you?”
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10
Q

Medicare - who does medicare pay for

A

Elderly

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11
Q

Medicaid

A

Poor

Benefits vary from state to state

Medicaid payments are made after other insurance or third party payments have been made

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12
Q

Case Management

A

Comprehensive and systematic approach to quality care

Mobilize
Monitor
Control resources

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13
Q

What is QA/QI/CPI

A

Quality Assurance
Quality Improvement
Continuous Process Improvement

Management process to ensure quality

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14
Q

Process of QA/QI/CPI

4

A

Monitoring
Evaluating
Continuous Review
Improving

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15
Q

Components of QA/QI/CPI (6)

A 
Monitoring 
Care appropriateness
Effectiveness of care
Cost of care
Self-regulation
Peer review
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16
Q

Critical Path

A

Contains key patient care activities and time frames for those activities as needed

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17
Q

DRG

A

Diagnosis-related group

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18
Q

Care Map

A

a newer critical path

+ common problems

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19
Q

Who mandates scope of practice?

A

State board of nursing with state nurse practice acts

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20
Q

What are state practice Acts

A

Delineates what you can and cannot do

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21
Q

Where do we get our initials (AGACNP)

A

State board of nursing

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22
Q

Prescriptive authority

A

State board of nursing and specific state practice acts

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23
Q

Standards of advanced practice

A

ANA

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24
Q

DEA

A

allows numerification

but state practice acts dictate level of prescriptive authority

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25
Q

What are credentials

A

required education, license, and certification

minimal levels of acceptable performance

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26
Q

Licensure

A

Qualified -

from government agency - STATE BOARD OF NURSING

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27
Q

Certification

A

Mastery of information

from NON-governmental agency - ANCC/AANP/PNCB/NCC

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28
Q

Who said we could ADMIT patients

A

Joint commission in 1983

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29
Q

Credentialing

A

Process that we go through to obtain privileges

Committee is made up of Physicians

Can give partial credentials

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30
Q

Privileges

A

Hospital privileges

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31
Q

Medical abandonment

A

Termination without reasonable arrangements

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32
Q

E&M codes

A

Evaluation and Management

Identify the level of care provided

Match the level of service provided to the complexity of the presenting patient problem

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33
Q

Why are credentials necessary? (2)

A

Ensures safe health care

Comply with federal and state laws

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34
Q

Reimbursement levels, how many?

A

5 levels

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35
Q

Third party payers (5)

A 
Medicare
Medicaid
Commercial indemnity insurers
Commercial management organizations (HMOs)
Businesses or schools
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36
Q

Who sets the payment standards for DRG

A

Medicare

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37
Q

Physical Exam documentations levels of E/M services? (4)

A

Problem focused
Expanded problem focused
Detailed
Comprehensive

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38
Q

Physical Exam documentations levels of E/M services

Problem focused

A

Most simple

a limited examination of the affected body area or organ system

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39
Q

Physical Exam documentations levels of E/M services

Expanded problem focused

A

Limited examination of the affected body area or organ system
AND
any other symptomatic or related body areas or organ systems

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40
Q

Physical Exam documentations levels of E/M services

Detailed

A 
An extended examination of the affected body area or organ system and any other symptomatic
OR 
related body areas 
OR 
organ systems
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41
Q

Physical Exam documentations levels of E/M services

Comprehensive

A

A general multi-system examination
OR
Complete examination of a single organ system and other symptomatic or related body areas or organ systems

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42
Q

EXAMPLE: of Physical Exam documentations levels of E/M services

Cellulitis + lower extremity assessment

A

Expanded problem focused

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43
Q

EXAMPLE: of Physical Exam documentations levels of E/M services

Patient says SOB, no life changes, otherwise ok. What assessment would you do

A

Comprehensive

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44
Q

EXAMPLE: of Physical Exam documentations levels of E/M services

New patient with a complaint

A

Comprehensive

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45
Q

Advanced Directive

A

Written statement of intent of medical treatment

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46
Q

Patient self-determination ACT of 1990.

A

Patient has the right to have an advanced directive.

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47
Q

Patient Self-Determination ACT of 1990.

A

All patients entering a hospital should be advised that they have the right to have an advanced directive.

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48
Q

Healthcare directive

A

Type of advanced directive that may or may not include a living will and/or specifications regarding durable power of attorney in one or two separate documents

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49
Q

Living will

A

Specifies which life-prolonging measures one does and does not want to be taken

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50
Q

Difference between living will and advanced directive

A

advanced directive

    • do not tube me
    • do not CPR me

living will

    • specifies life prolonging measures
    • includes DPOA - proxy
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51
Q

DPOA

A

Durable power of attorney -

– articulate the wishes of advanced directive

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52
Q

Medicare A

A

Everyone > 65 years old

covers INPATIENT hospital services
and
Post hospital care (home health)

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53
Q

Medicare B

A

Supplemental - premium paid

Physician visits
– Physical exam
Outpatient diagnostics

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54
Q

How much do NPs get reimbursed by Medicare

A

85% of Physician fee schedule

80% for procedure

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55
Q

Medicare C

A

FREE ontop of A&B
Choice HMO, PPO

Medicare A+B = C

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56
Q

Medicare D

A

Premium

Drugs

Limited prescription coverage

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57
Q

Which type of medicare has to pay premium?

A

B & D

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58
Q

Services that DO NOT meet medicare’s definition of “Physician Services”

A

Regular physical exam

Health maintenance screenings

Counseling for well patients

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59
Q

Medicare Rules for NPs (3)

A

Hold state license
Certified by national body
Hold at least MSN

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60
Q

Incident-to Billing

A

NP sees patient and can bill under physician’s provider number to get 100%.

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61
Q

Incident-to Billing - OFFICE ONLY

A

NP sees patient and can bill under physician’s provider number to get 100%.
– Physician’s direct supervision (same building)

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62
Q

Doctor see’s patient - diagnoses HTN.

3 months later - comes for follow up. Can you bill incident-to billing

A

Bill incident-to billing for 100% reimbursement.

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63
Q

Is double billing allowed?

A

Cannot bill by 2 providers in same day.

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64
Q

Healthy People 2020 goals (2)

A

Increase quality and years of healthy life

Eliminate health disparities among Americans

65
Q

Reporting Statutes (5)

A

Criminal acts

Animal bites - animal control

Suspected or actual child/elder abuse

Domestic violence

Communicable diseases - Health Department

66
Q

Criminal Acts

A

Police can get generalized

67
Q

Health department reporting requirements in most states (5)

A 
Gonorrhea
Chlamydia - not all states 
Syphilis 
HIV
TB
68
Q

Are you legally responsible for reporting domestic violence?

A

NO

offer support
– social work

69
Q

Who works on our behalf in the hospital with suspected elder abuse?

A

Social services

70
Q

Collaborative practice

A

“true partnership”

Unique qualities that can be synergistic

Recognize and accept separate areas of responsibility and activity

71
Q

Navigating Health Care systems for patients (6)

A 
Social Services
Psychiatric services
Police
Security officers
Physical therapy
Occupational therapy
72
Q

Social services - What do they do

A 
"dig up the dirt"
Domestic violence 
Help with resources
--lack of money
--no insurance
73
Q

Psychiatric services -

A

Anyone who is in danger of harming themselves or others

74
Q

Police

A

Don’t call the police from the hospital

75
Q

Security

A

Escalating scene

76
Q

Physical Therapy

A

Joints

    • Range of motion
    • Walking
    • Strength training
77
Q

Occupational therapy

A

Fine motor
Psychomotor
Rehab into JOB
– Writing

78
Q

Issues regarding access to care

A

Home health
Hospice
Skilled Nursing Facilities
Private duty nursing

79
Q

How does home health nurse work?

A 
"flight attendant approach"
check vitals
wound care
incentive spirometry
how is pain, pain meds
are you able to get food
80
Q

Who qualifies for hospice?

A

Death diagnosis < 6 mo

ONLY comfort measures
– controversial IV antibiotics

81
Q

What is Skilled Nursing Facilities?

A

Multidisciplinary team there

Nursing home with physical therapy room

cost saving - early discharge from hospital

82
Q

What is the problem with private duty nursing

A

Very expensive

83
Q

Privacy and Confidentiality

HIPAA title I

A

Patient has a right to continue health care benefits for up to 18 months if no longer employed by practice

COBRA

33.4% $$

84
Q

Privacy and Confidentiality

HIPAA title II

A

Protecting records

85
Q

COBRA

A

Comprehensive Omnibus Reconciliation Act

86
Q

Who enforces HIPAA and protects privacy of health information?

A

The Office of Civil Rights

87
Q

What is covered under HIPAA

A

Health plans (HMO)
Most health care providers
Health care clearing houses

88
Q

Examples of protected information by HIPAA

A

Written information

Conversations by healthcare providers

Patient information stored in a health insurer’s computer system

Patient billing information stored at a clinic

Most all health-related information about a patient

89
Q

The Privacy Rule

A

Patient has a right to

    • see their chart
    • have corrections made
    • receive notice
    • decide whether or not they give permission
    • receive report of when/why did they share their information
    • file complaint if info not protected
90
Q

Examples of those NOT required to follow HIPAA

A 
Life insurers
Employers
Workers compensation carriers
Many schools and school districts
Many state agencies like CPS
Many law enforcements 
Many municipal offices
91
Q

Doctors notes - to keep privacy

A

“please excuse *** for these days due to medical reasons/care under this office”

92
Q

The Patient safety and Quality Improvement ACT (PSQIA) -

What is it

A

Voluntary reporting system to enhance data that can resolve patient safety and quality issues

93
Q

The Agency for Healthcare Research and Quality

A

Additional responsibility for listing patient safety organizations (PSO) which are external experts established by the patient safety act to collect and analyze patient safety information

94
Q

Confidentiality versus “Duty to Warn”

A

Reasonable right to know.

the Duty to warn supersedes the right to confidentiality if the patient’s condition may endanger others

95
Q

Patient is spurting blood around the ER, fix him and he is HIV +. refer to psych. Can you tell the Psych NP about HIV?

A

Yes,

He was endangering others.

96
Q

Invasion of privacy

A

Damaging one’s reputation as a result of information being shared without patient permission.

97
Q

Root cause analysis

A

Interdisciplinary experts
asking WHY WHY WHY at each level
Identify changes
A process that is as impartial as possible

“drilling down”
“cause and effect diagrams”

98
Q

Sentinel Events (4)

A

Unexpected occurrences

Death OR serious physical or psychological injury of risk thereof

NOT medical error

Needs to be a root cause analysis

99
Q

Risk management

A

A systematic effort to reduce risk

100
Q

What is the most common method of risk management documentation?

A

Incident reports

101
Q

Risk management:

Policies regarding incident reports should address: (6)

A

Persons authorized to complete a report

Persons responsible for review of a report

Immediate actions

Person’s responsible for follow-up

Plan for follow-up monitoring

Security/storage of reports

102
Q

A formal, written risk management plan includes: (5)

A

Goals

Program’s scope

Responsibility for implementation

Commitment by the board

Immunity from retaliation

103
Q

What are types of Risk management?

A

Incident reports
Satisfaction surveys
Complaints

104
Q

Risk Management -

Action taking initiatives (5)

A 
Prevention
Correction
Documentation 
Education
Departmental coordination
105
Q

Medical Futility

A

Interventions unlikely to produce any significant benefit

106
Q

Quantitative futility

A

The likelihood that an intervention will benefit the patient is extremely poor

107
Q

Qualitative futility

A

The quality of the benefit of an intervention is extremely poor

108
Q

To make Informed consent, the patient must be able to (4)

A 
ability to:
Understand
Reason
Differentiate good and bad
communicate
109
Q

Informed Consent

A

A state indicating that a patient has received adequate instructions or information regarding aspects of care to make a prudent, personal choice regarding treatment

110
Q

Does the patient have a right to refuse care?

A

yes, they can refuse
any of it
some of it
all of it

Patients must be informed on arrival that they have a right to refuse care

111
Q

Danforth Amendment, 1991

A

Patients must be informed on arrival that they have a right to refuse care (at a federally funded institution)

112
Q

Informed consent must include:

A

all benefits and risks to be truly informed

if the patient’s condition is life-threatening consent is assumed.

113
Q

Ethics is

A

The study of moral conduct and behavior which serves to govern conduct, thereby protecting the rights of the individual

114
Q

Nonmaleficience

A

The duty to do no harm

115
Q

Veracity

A

The duty to be Truthful

116
Q

Fidelity

A

The duty to be Faithful

117
Q

If a patient is hired to testify and asked to state that the NP only had “one” option of treatment, which 2 ethical principles are in conflict?

A

Fidelity and veracity

118
Q

A cancer patient wants to stop taking chemotherapy. Which to ethical principles are in conflict when making this decision?

A

autonomy versus beneficence

119
Q

What is often in conflict with Autonomy?

A

Beneficence

120
Q

What is often in conflict with fidelity?

A

Veracity

121
Q

Utilitarianism

A

The right act is the one that produces the greatest good for the greatest number

122
Q

Beneficence

A

The duty to prevent harm and promote good

123
Q

Justice

A

The duty to be FAIR

124
Q

Autonomy

A

The duty to respect an individuals thoughts and actions

125
Q

According to utilitarianism who should be helped first in a 911 situation? The people running down the street, the people below the burning building, or the people above the burning building

A
  1. People down the street
  2. People below
  3. Salvageable
126
Q

Can you dismiss someone from your practice? (3)

A

Yes:
Abuse
Refusal to pay for services
Persistant noncompliance

127
Q

What do you do when you close a practice? (3)

A
  1. Proper notification
  2. Keep all files for 5 years
  3. To avoid abandonment - give notice and resources for future care
128
Q

Steps for discharging a patient from a practice: (3)

A
  1. Certified letter - return receipt
    - -General content
  2. General healthcare coverage for 15-30 days post-termination deadline
  3. Obtain release of information to provide copies for subsequent provider
129
Q

History of the NP Role -

What area did the first NP roles begin?

A

Pediatrics

d/t physician shortages

130
Q

History of the NP Role -

How did the ACNP role movement begin? (3)

A

Results of managed care
Hospital restructuring
Decreases in medical residency programs

131
Q

History of the NP Role -

Who and when was the first NP program initiated

A

Loretta Ford and Henry Silver in 1964, pediatric NP program at University of Colorado Health Sciences Center

132
Q

History of the NP Role -

What are the 4 distinct roles for NP?

A
  1. Clinician
  2. Consultant/collaborator
  3. Researcher
  4. Educator/instructor
133
Q

EVIDENCE BASED PRACTICE and RESEARCH

Where does the AGACNP participate in the research process?

A

Any and all of them

134
Q

EVIDENCE BASED PRACTICE and RESEARCH

How many major steps in the research process?

A

11

135
Q

EVIDENCE BASED PRACTICE and RESEARCH

What are the types of research (broad)

A

Experimental
Non-experimental
Qualitative

136
Q

EVIDENCE BASED PRACTICE and RESEARCH

What are the subcategories of Non-experimental?

A

“No experiment”

Ex post facto/Correlational - “in the past”
- examines relationships among variables

Descriptive - aims to describe

137
Q

EVIDENCE BASED PRACTICE and RESEARCH

What are the Ex post facto types of research (3)

A

Ex post factos is non-experimental

Cross sectional

Cohort

Longitudinal

138
Q

EVIDENCE BASED PRACTICE and RESEARCH

What is cross sectional research?

A

examines a population with a very similar attribute, but differs in one specific variable - to find relationships between variables at a specific point in time

139
Q

EVIDENCE BASED PRACTICE and RESEARCH

What is an example of cross sectional research? like an onion

A

A SURVEY for asthma in children and adults

140
Q

EVIDENCE BASED PRACTICE and RESEARCH

What type of research is - pulling the surgeons records for the last 6 months to describe a situation?

A

Ex post factos

141
Q

EVIDENCE BASED PRACTICE and RESEARCH

What is a cohort studies

A

Study that compares a particular outcome

What is the outcome of your graduating class?

142
Q

EVIDENCE BASED PRACTICE and RESEARCH

Longitudinal

A

Over time - taking multiple measures of a group to find relationships
1 year, 5 year, 10 year follow up

143
Q

EVIDENCE BASED PRACTICE and RESEARCH

Experimental

A

Randomized control group trial

144
Q

EVIDENCE BASED PRACTICE and RESEARCH

What is a randomized control group trial?

A

Experimental

145
Q

EVIDENCE BASED PRACTICE and RESEARCH

Quasi-experimental

A

Manipulation of variables but lacks a comparison group or randomization

146
Q

EVIDENCE BASED PRACTICE and RESEARCH

What is Qualitative research?

A

Open-ended questions - “feelings”

Low sample sizes - question generalizability

Researcher bias is a potential problem

Produces rich data through no other means

147
Q

RESEARCH

Level of significance

A

p level

p <0.05 - significantly different

148
Q

EVIDENCE BASED PRACTICE and RESEARCH

Level of evidence hierarchy - list in order 1-6

A
  1. Meta-analysis of RCT
  2. RCT
  3. Quasi-experimental
  4. Qualitative cohort studies
  5. Case controlled studies
  6. Editorial/expert opinion
149
Q

RESEARCH

Confidence interval

A

An interval with limits at either end, with a specified probability of including the parameter being estimated

A small confidence interval implied a very precise range of values

150
Q

RESEARCH

Standard deviation

A

Indicates the average amount of deviation of values from the MEAN

68% of the sample within 1 standard dev
95% of the sample within 2 standard dev

151
Q

RESEARCH

Perfect correlation

A

Perfect positive correlation +1

Perfect negative correlation is -1

closer you get to 1 the better you are

152
Q

RESEARCH

t-test

A

statistical test to evaluate the difference between MEANS of 2 groups

153
Q

RESEARCH

Reliability

A

The consistency of a measurement

alpha - > 0.7 - the closer to 1 the higher the reliability

154
Q

RESEARCH

Validity

A

The degree to which a variable measures what it is intended to measure.

155
Q

What is the most important research term to focus on whether to change your practice after reading publication?

A

Level of significance - p value

p < 0.05

156
Q

RESEARCH

Terminal ill bone cancer patients in the final stage of illness have between 2.8 and 3.2 episodes of nausea every 24 hours. What are the numbers I am examining?

A

Confidence interval

157
Q

RESEARCH

normal distribution - Bell curve - the mean age in the room is 40 +/- 10, with a standard deviation of 5.

A

95% are between 30-50

5% are 25-55

158
Q

RESEARCH -

p-value

A

Level of significance

p <0.05

Usually don’t put in research if > 0.05 because there is no statistical significance in the research

159
Q

RESEARCH

2 ways to test reilability

A

Test/re-test - 2 administrations should yield same score

Internal consistency - estimates reliability by grouping questions

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