Issues, Trends, and Health Policy Part 1 Flashcards
Instructing patients in how to successfully manage their own conditions
Mentoring/ coaching
Instructing patient s with asthma on how to manage exacerbations this is a form of _____/ _____
Mentoring/ coaching
Instructing patients with diabetes mellitus on how to control blood glucose via diet and exercise form of _____/_____
Mentoring/ coaching
Instructing patient through examples of health care processes in action this is ____ ____
role modeling
______ ______ may be done through NP instructing patient in healthy behavior or through role modeling examples in other patients
Role modeling
Principles of Instruction include:
a) Mentoring/ coaching
b) Role modeling
c) __________
Counseling
Instructing patients in how to reponsibly mangage medications, conditions, and courses of treatment
Counseling
The degree to which health care professionals have the capacity to obtain, process, and understand basic health care information and servisces nessarey to make aprrorpirate health care decisions
Health Literacy
____ ____: considered to be the single best predictor of one’e health status
Health literacy
Average adult in America reads at an _____- grade level
eighth
Medical/ health information literature should be written at no higher of a grade level than ___ to ___ grade.
6th to 8th
Legislative and Regulatory Processes:
1) Accreditation guidelines
a) Often laid out by the ____ _____
Joint commision
Joint Commission also lays out ___ _____ ____ Goals and area of concern for health care profssionals in accredited instiutions
Natioanl Patient safety
_____ ___ _____
a) Rules laid out by the institution that may provide further qualifications and restrictions on the rule of healthcare staff (e.g. the duties responsibility, and privilegess of AGACNPs)
Institutional by laws
How consumers use health care resources and services
Resource Utilization
How patients interact with health care providers
Resource Utilization
Special concerns in acute care
a) length of stay
b) Top reasons for hsopitalization
c) Preventable hoospitalization
d) Long- term care
e) Emergency room and primary care clinic utilizations
Resource Utilization
Tem of multiple helath care professionals across various disciplnes, assembles to deal with emergency situations
Multidisciplinary Response Team (MRTs)
___ ____ ___: deals with rapid deteriations in health, such as respiratory distress or caridac arrest
a) Physician/ AGACNP
b) Nurse
c) Respiratory therapist
d) Others per institutional protocol
Rapid Response Team
____ ______: a mass casualty event wihich MRTs frequently train to intervene
a) Pandemic
b) Terrorist attack/ mass shooting
c) Natural disaster
d) Large chemical exposures
e) Large fires/ explosions
Institutional disaster
Utilizing healthcare technology and databases to optimize course of treatment
Integrating Health Information Technology
___ _____ ___ (__): Integrated database that allow NPs real time access to paitnet health information
Electronic Medical Record (EMR)
_____ ______ (___): Using EMR technology to
a) Improve quality, efficiency, and safety
b) Reduce healthcare disparities
c) Engage patient’s and family members in course of care
d) Improve care coordination
e) Maintain privacy and safety of patient health information
Meaningful Use (MU)
____ _____ _____ is a management process of monitoring, evaluating, continuously reviewing, and improving both the quality of health care deliver and the health status of target populations
Quality Improvment (QI) Principles
_____ and _____ _____ for Nurses (QSEN) Initiative
a) An initiative aimed at providing future nurses with the knowledge, skills, and attitude necessary to ensure continuous improvement in quality and safely of their respective healthcare systems
Quality and Safety Education
Quality and Safety Education for Nurses Initiative
b) Identifies, funds, and promotes education across six key competencies
i) Pateint- centered care
ii) Teamwork and collaboration
iii) Evidence- based practice (EBP)
iv) _____
iiv) Safety
iiiv) Informatics
QI
Evaluating Safety Initiatives
a) Uses multi cause variable systems such as ____ cause analysis
root
Evaluating Safety Initiatives
b) Effective systems of evaluation should answer the following questions:
i) Are we providing _____ care?
ii) How safe was this care in the past?
iii) How safe will we be in the future?
iv) Can our process and health system reliably deliver safer care?
iiv) How can we be sure that we are getting better?
safe
Standardizing Assessment Tools
a) General
i) Patient _____ Questionnaire
aa) Used in primary care to screen for behavioral health systoms
bb) Assesses symptoms of depression, anxiety, trauma, and alcohol use
Stress
Depression
Patient _____ _____ (PHQ-9)
1) Most common screening tool for depression
2) Patient self-ranks 9 signs and symptoms over the last 2 weeks on a scale of 0 to 3, with 3 indicating nearly every day.
Health Questionnaire
PHQ-9
____ to ___ = Moderately severe depression
15 to 19
PHQ-9
____ to ___ = Minimal depression
1 to 4
PHQ-9
____ to ___ = Moderate depression
10 to 14
PHQ-9
___ to ___ = Mild depression
5 to 9
PHQ-9
____ to ___ = Severe depression
20 to 27
Anxiety Disorders
Generalized ____ ____-7 (GAD-7)
1) Self-administered screening tool that identifies whether a complete assessment for anxiety is indicated
Anxiety Disorder
Anxiety Disorders
Generalized Anxiety Disorder-7 (GAD-7)
2) Patient ranks ___ signs and symptoms over the last 2 weeks on a scale of 0 to 3, with 3 indicating nearly every day
7
Anxiety Disorders
Generalized Anxiety Disorder-7 (GAD-7)
b. ____ to ___ = Moderate anxiety
10 to 14
Anxiety Disorders
Generalized Anxiety Disorder-7 (GAD-7)
a. ___ to ___ = Mild anxiety
5 to 9
Anxiety Disorders
Generalized Anxiety Disorder-7 (GAD-7)
c. ___ to ___ = Severe anxiety
15 to 21
Anxiety Disorders
Generalized Anxiety Disorder-7 (GAD-7)
d. A total score > ____ indicates a probable diagnosis of generalized anxiety disorder
10
Drug and Alcohol Use
CAGE-AID
1) Self-report questionnaire designed to quickly assess whether an alcohol or drug assessment is needed
2) Answering “yes” to two or more questions warrants a complete assessment
a. C: Have you ever felt that you ought to ___ ___ on
your drinking or drug use?
cut down
Drug and Alcohol Use
CAGE-AID
1) Self-report questionnaire designed to quickly assess whether an alcohol or drug assessment is needed
2) Answering “yes” to two or more questions warrants a complete assessment
b. A: Have people _____ you by criticizing your
drinking or drug use?
annoyed
Drug and Alcohol Use
CAGE-AID
1) Self-report questionnaire designed to quickly assess whether an alcohol or drug assessment is needed
2) Answering “yes” to two or more questions warrants a complete assessment
c. G: Have you ever felt bad or ____ about your drinking
or drug use?
guilty
Drug and Alcohol Use
CAGE-AID
1) Self-report questionnaire designed to quickly assess whether an alcohol or drug assessment is needed
2) Answering “yes” to two or more questions warrants a complete assessment
d. E: Have you ___ had a drink or used drugs first thing
in the morning to steady your nerves or to get rid
of a hangover? (e.g., eye opener)
ever
Pain
a. ____ _____FACES Pain Rating Scale
i) Self-assessment tool
ii) Patient rates pain by choosing among six faces,
ranging in expression from smiling to crying
Wong-Baker
Pain
b. ____ _____ Scale
i) Assesses conscious state of a patient
Ramsay Sedation
Pain
b. Ramsay Sedation Scale
i) Assesses conscious state of a patient
ii) If awake:
Ramsey ___: responsive to commands only
3
Pain
b. Ramsay Sedation Scale
i) Assesses conscious state of a patient
ii) If awake:
Ramsey ___: anxious, agitated, restless
1
Pain
b. Ramsay Sedation Scale
i) Assesses conscious state of a patient
ii) If awake:
Ramsey ___: cooperative, oriented, tranquil
2
If asleep:
Ramsey ___: No response to light glabellar tap or loud auditory stimulus
6
If asleep:
Ramsey ___: Sluggish respnse to light glabellar tap or loud auditory stimulus
5
If asleep:
Ramsey ___: response to light glavellar tap or loud auditory stimulus
4
Brief Pain Inventory (BPI) short form
i) Assesses severity of pain and impact of pain on ______functions by asking patient to fill out survey
ii) Through self- report or interview, patient rates severity of pain and impact of pin on dilay function, as well as location of pain, pind medication, and amount of pain relief
daily
Brief Pain Inventory (BPI) short form
ii) Through self- report or interview, patient rates _____ of pain and impact of pain on daily function, as well as location of pain, pain medication, and amount of pain relief
severity
Richmand Agitation Sedation Scale (RASS)
a) A ___-point scale to assess levels of anxiety, agitation, and sedation
10
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ combative
+4
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ agitated
+2
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ very agitated
+3
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ unarousable
-5
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ moderate sedation
-3
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
____ deep sedation
-4
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ restless
+1
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ alert and calm
0
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
___ light sedation
-2
Richmand Agitation Sedation Scale (RASS)
a) A 10-point scale to assess levels of anxiety, agitation, and sedation
b) Scoring based on observable behavior in the following categories
____ drowsy
-1
Sedtion Agitation Scale (SAS)
___ (Unarousable): Minimal or no response to noxious stimuli, does not communicate or follow commands
1
Sedtion Agitation Scale (SAS)
___ (Very Agitated): requiring restraint and frequency verbal reminding of limits, biting NP
6
Sedtion Agitation Scale (SAS)
___ (Agitated): anxious or physically agitated, calms to verbal instructions
5
Sedtion Agitation Scale (SAS)
___ (Calm and Cooperative): calm, easily arousable, follows commands
4
Sedtion Agitation Scale (SAS)
___ (Sedated): difficult to arouse to physical stimuli but does not communicate or follow commands, may move spontaneously
3
Sedtion Agitation Scale (SAS)
___ (Very Sedated): arouses to physical stimuli but does not communicate or follow commands, may move spontaneously
2
Sedtion Agitation Scale (SAS)
___ (Dangerous Agitation): Pulling at ET tube, trying to remove catheters, climbing over bedrail, striking at staff, thrashing side-to-side
7
Dementia mad Delirium
a. ____ ____State Examination (MMSE)–see
Neurological Disorders chapter
Mini-Mental
Dementia mad Delirium
b. _____drawing test
Clock
Dementia mad Delirium
b. Clock drawing test
1. Used to assess for cognitive ________
impairment
Dementia mad Delirium
b. Clock drawing test
2. Patient is asked to draw numbers in the circle to
make the circle look like the face of a clock and
then draw the hands of the clock to read “___ after
11”
10
Dementia mad Delirium
a. Mini-Mental State Examination (MMSE)–see
Neurological Disorders chapter
b. Clock drawing test
3. The clock is scored 1 to 6, with a score > ___
representing cognitive deficit
3
Depression
a. Geriatric Depression Scale
3. Consists of 15 yes/no questions; a score > ___
suggests depression
5
Depression
a. Geriatric Depression Scale
2. Can be used on cognitively intact individuals and
those with mild to moderate cognitive _______
impairments
Depression
a. Geriatric Depression Scale
1. Self-report questionnaire used to screen for
_______ in older adults
depression
- Gait and Immobility/Fall Risk
a. Get-up and Go Test
i) Short test that measures a patient’s risk of ____
falling
- Gait and Immobility/Fall Risk
a. Get-up and Go Test
ii) Patient is asked to rise from the _____, stand still
momentarily, walk a short distance, turn around,
walk back to the chair, turn around, and then sit
down in the chair
chair
Gait and Immobility/Fall Risk:
iii) Patient’s performance is rated 1 to 5, with a score > ___ indicating a risk of falling
3
Gait and Immobility/Fall Risk:
iii) Patient’s performance is rated 1 to 5, with a score > 3
indicating a risk of falling
___ = Normal
1
Gait and Immobility/Fall Risk:
iii) Patient’s performance is rated 1 to 5, with a score > 3
indicating a risk of falling
___ = Severely abnormal
5
Gait and Immobility/Fall Risk:
iii) Patient’s performance is rated 1 to 5, with a score > 3
indicating a risk of falling
___ = Mildly abnormal
3
Gait and Immobility/Fall Risk:
iii) Patient’s performance is rated 1 to 5, with a score > 3
indicating a risk of falling
___ = Moderately abnormal
4
Gait and Immobility/Fall Risk:
iii) Patient’s performance is rated 1 to 5, with a score > 3
indicating a risk of falling
___ = Very slightly normal
2
Pain Assessment in Advanced Dementia Scale
a) Tool used to measure pain in older patients with
dementia
b) Five behaviors of the patient are observed:
breathing, negative vocalization, facial expression,
___ ____, and consolability
body language
Pain Assessment in Advanced Dementia Scale
c) Each behavior is scored on a scale of 0 to 2, with 0
indicating no pain.
___ to ___ = Moderate pain
4 to 6
Pain Assessment in Advanced Dementia Scale
c) Each behavior is scored on a scale of 0 to 2, with 0
indicating no pain.
___ to ___= Mild pain
1 to 3
Pain Assessment in Advanced Dementia Scale
c) Each behavior is scored on a scale of 0 to 2, with 0
indicating no pain.
___ to __ = Severe pain
7 to 10
_____ ______ _____ (___)
a. Equipment and supplies ordered by a healthcare
provider for everyday or extended use
Durable Medical Equipment (DME)
Durable Medical Equipment (DME)
b. What makes medical equipment DME?
i) ______ (long-lasting)
Durable
Durable Medical Equipment (DME)
b. What makes medical equipment DME?
ii) Used for a ______ reason
medical
Durable Medical Equipment (DME)
b. What makes medical equipment DME?
iii) Not usually useful to someone who is not ___ or
injured
sick
Durable Medical Equipment (DME)
b. What makes medical equipment DME?
iv) Used in ______
home
Durable Medical Equipment (DME)
b. What makes medical equipment DME?
iiv) Has an expected lifetime of at least ___ years
3
Durable Medical Equipment (DME)
c. Examples of Medicare-covered DME
i) ____ (air-fluidized and hospital)
ii) Sleep apnea and CPAP devices
iii) Canes
iv) Crutches
v) Manual wheelchairs, power mobility devices
vi) Walkers
vii) Traction equipment
viii) Patient lifts
ix) Commode chairs
x) Continuous passive motion machine
xi) Nebulizers and nebulizer medications
xii) Oxygen equipment and accessories
xiii) Suction pumps
xiv) Blood glucose monitors and test strips
xv) Infusion pumps and supplies
Beds
____ _____
a. Devices whose primary purpose is to maintain or improve an individual’s functioning and independence
Assistive Devices
Assistive Devices
a. Devices whose primary purpose is to maintain or improve an individual's functioning and independence
b. Examples:
i) Wheelchairs
ii) \_\_\_\_\_\_\_\_
iii) Hearing aidsProstheses
Alternative/Complementary Therapies
1. \_\_\_\_\_\_ and \_\_\_\_\_\_ \_\_\_\_\_\_ (\_\_)
a. Term that refers to treatments that are used along
with, or in place of, conventional medicine
b. Focus is on the whole person
c. Includes physical, emotional, mental, and spiritual
health
d. Examples:
i) Natural products
1) Herbs
2) Vitamins and minerals
3) Probiotics
ii) Mind and body practices
1) Yoga
2) Chiropractic and osteopathic manipulation
3) Meditation
4) Massage therapy
5) Acupuncture
6) Relaxation techniques
7) Tai chi
8) Qi gong
9) Healing touch
10) Hypnotherapy
11) Movement therapies
12) Music
13) Light therapy
iii) Ayurvedic medicine
iv) Traditional Chinese medicine
v) Homeopathy
vi) NaturopathyComplementary and Alternative Medicine (CAM)
__________ Medicine
a) Bringing conventional and complementary
approaches together in a coordinated way
b) Examples
i) Chronic pain: incorporating mindfulness meditation
with pain management programs
ii) Symptom management acupuncture and deitation
to help mange symptoms and side effects of cancer
treatment
Integrative
a. AGACNP’s Role in Tests and Procedures
i) Facilitate the scheduling of ______
tests
a. AGACNP’s Role in Tests and Procedures
ii) ______ the patient on the test
Educate
a. AGACNP’s Role in Tests and Procedures
iii) Perform or _____ with procedures
assist
a. AGACNP’s Role in Tests and Procedures
iv) _____patients for adverse reactions to
procedures
Assess
a. AGACNP’s Role in Tests and Procedures
v) Preparing the Patient
1) Ensure patient _______ procedure
understands
a. AGACNP’s Role in Tests and Procedures
v) Preparing the Patient
2) Verify patient _______ with any pre-
procedural requirements
complied
a. AGACNP’s Role in Tests and Procedures
3) _______ any friends or family who
accompanied patient as to the length of
procedure
Notify
AGACNP’s Role in Tests and Procedures
During the Procedure
1) Evaluate the patient’s _____ level
anxiety
AGACNP’s Role in Tests and Procedures
During the Procedure
2) Help patient _____ (e.g., deep breathing, imagery)
relax
AGACNP’s Role in Tests and Procedures
During the Procedure
3) Evaluate patient’s level of _____ and comfort
safety
AGACNP’s Role in Tests and Procedures
After the Procedure
1) Help restore patient’s pre-diagnostic level of _______
functioning
AGACNP’s Role in Tests and Procedures
After the Procedure
2) Monitor patient for signs of _______ distress and
bleeding
respiratory
AGACNP’s Role in Tests and Procedures
After the Procedure
3) Discharge patient with ______ instructions
written
lnformatics and Technologies
- Goals of Technology in Nursing
a. ______ the tasks performed
Capture
lnformatics and Technologies
1. Goals of Technology in Nursing
b. ______ scope of practice and evidence-based
practice
Enhance
lnformatics and Technologies
- Goals of Technology in Nursing
c. Make practice ______-driven
knowledge
- _____ ___________
a. Specialty that integrates nursing science, computer science, and information science to manage and communicate data, information knowledge, and wisdom in nursing
Nursing Informatics
- Nursing Informatics
b. Through the use of information _______, information processes, and information technology, nursing informatics supports consumers, patients, and other providers in their decision-making in all roles and settings
structures
- Key nursing informatics organizations
a. Healthcare Information and ______ Systems
Society(HIMSS)
Management
- Key nursing informatics organizations
b. AmericanNursing ______ Association (ANIA)
Informatics
- Key nursing informatics organizations
c. American Medical _____ Association (AMIA)
Informatics
- Key nursing informatics organizations
d. _____ for Nursing Informatics
Alliance
Nursing informatics roles
a) Practice
b) _______
c) Government
d) Industry
Education
- Informatics Competencies
a. Beginning nurse
I) Computer literacy
1) Healthcare database and ________
applications
2) Presentation software
spreadsheet
- Informatics Competencies
a. Beginning nurse
II) Information management
1) Locate clinical data
2) Perfom a ________ retrievals using Internet
and librarybased resources
3) Evaluate clinical data
bibliographic
- Informatics Competencies
a. Beginning nurse
III) Know how to use nursing-specific software
IV) Ability to use patient care ________ (e.g.,
monitors, pumps, medication dispensing)
technologies
- Informatics Competencies
b. Experienced nurse
A) Skilled in information management and computer
technology related to specific areas of practice
1) Make _________ based on trends of data
2) Collaborate with informatics nurses in
development of nursing systems
judgments
- Informatics Competencies
c. Informatics nurse specialist
1) Advanced informatics preparation
2) Assists practicing nurse in meeting information
needs
3) Possesses ____ for conducting informatics
research along with theory development
skills
- _________
a) Definition: comparison and measurement of a healthcare organization s services against other national healthcare organizations
Benchmarking
Advanced Practice Ownership
b. Benefits
I) Helps leaders ______ how their organization
compares with similar organizations
II) Allows for the sharing of best practices and
evidence- based practice clinical research outcomes
understand
Advanced Practice Ownership
c. Four core principles I) Maintaining quality II) Improving customer \_\_\_\_\_\_\_ III) Improving patient safety IV) Continuous improvement
satisfaction
Advanced Practice Ownership
d. Examples of benchmarks
I) All patients who enter the hospital have a
______ reconciliation completed upon admission
II) Hospital readmission rates for acute-care hospitals
medication
Advanced Practice Ownership:
e. Meeting benchmarks
I) Management team must support goal
II) Compliance must be \_\_\_\_\_\_\_
III) Organization must allocate time and resources to
implementationmeasured
_____ ____
a) Definition: the process by which practicing registered nurses systematically access, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice (American Nurses Association)
Peer Review:
Peer Review:
b) Stimulates professionalism through increased ___________ and promotes self-regulation of the practice
c) A formalized, systematic peer-review nursing practice is required for Magnet recognition
accountability
d) Practice principles
I) A peer is someone of the _____rank
same
d) Practice principles
II) Peer review is ______-focused
practice
d) Practice principles
III) Feedback is timely, routine, and a _______
expectation
continuous
d) Practice principles
IV) Peer review fosters a ______ learning culture of
patient safety and best practices
continuous
d) Practice principles
V) Feedback is _____ anonymous
not
d) Practice principlee
VI) Feedback incorporates the nurse’s
______ stage
developmental
