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ACNP Certification > Issues, Trends & Health Policy > Flashcards

Issues, Trends & Health Policy Flashcards

1
Q

4 Malpractice examples

A
  1. Professional misconduct
  2. Unreasonable lack of skill
  3. Illegal/Immoral conduct
  4. Allegations resulting in harm to pt
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2
Q

Failure of a professional to render services with the degree of care, diligence, and precaution that another member of the same profession under similar circumstances would render to prevent injury to someone else

A

Malpractice

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3
Q

4 Components of Malpractice

A
  1. Duty to the patient
  2. Violate a standard of care
  3. That violation is the cause of damages
  4. Damages have to actually have occured
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4
Q

Name for the HIPAA Title II

A

Administrative Simplification provisions (AS)

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5
Q

Who enforces HIPAA?

A

Office for Civil Rights

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6
Q

3 main provisions of AS (HIPAA Title II)

A
  1. Privacy of identifiable pt info
  2. HIPPA security rule (electronic info)
  3. Patient Safety Rule (info used for safety events)
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7
Q

Covered Entities Required to follow HIPPA?

A

Health plans (HMO, Medicare, Medicaid)

Health care providers

Health care clearinghouses

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8
Q

Examples of HPI

A

Written info (chart)

Converstions

Electronic info

Billing infor

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9
Q

Written permission is required to disclose HPI for what 3 situations?

A

Disclosing to a pt’s employer

Using HPI for marketing

Private notes about pt’s healthcare

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10
Q

Who is NOT required to follow HIPPA?

A

Life insurers

Employers

Workman’s comp

Schools

State agencies

Law enforcement

Municipal offices

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11
Q

Privacy Rule: pt’s rights

A

See a copy of records

Corrections

A notice of how their HPI is used and shared

Give permission

File a complaint

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12
Q

Situations where HPI can be shared:

A

Coordination of care

payment

With others significant to pt unless they object

Quality

Public health

Police reports

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13
Q

HIPAA

A

Health insurance portability and accountability act

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14
Q

Title I HIPAA

A

provides COBRA for workers and families who lose or change jobs

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15
Q

PSQIA

A

Patient Safety and Quality Improvement Act

Voluntary reproting system for safety and quality of health care issues

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16
Q

PSQIA provides federal privilage and confidentiality protections called:

A

patient safety work product

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17
Q

Who lists patient safety organizations (PSO’s)?

A

Agency for Healthcare Quality and Research (AHRQ)

A list of external expertsestablished by the Patient Safety Act

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18
Q

Which is greater: the duty to warn or the right to confidentiality?

A

Duty to warn if a pt’s condition may harm others

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19
Q

Invasion of privacy is a result of what?

A

Damaging one’s reputation as a result of info being shared without permission of the patient

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20
Q

5 steps to establishing rapport and professional therapeutic relationships

A
  1. Non-judgemental
  2. Mutual trust
  3. Professional boundaries
  4. Confidentiality
  5. Cultural competency - respect and spiritual needs
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21
Q

Therapeutic communication strategies:

A

Listen more than talk

Tell me….

Never “Why”

Focus on feelings

No euphemisms

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22
Q

Who to protect first in a crisis?

A

Self then everyone else

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23
Q

Evil eye

A

Maldeojo

Middle eastern, Mexican, PR

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24
Q

Who is the decions maker in AA family?

A

Minister if family cannot agree

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25
Q

2 steps for crisis/grief communication

A

Offer self

Acknowledge feeling

“that’s awful, how can i help”?

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26
Q

Difference between advanced directive and living will?

A

AD is written statement regarding pt’s intent for medical treatment=wishes

LW specifies desires if incapacitated

-often includes granting POA or proxy who is responsible for articulating the pt’s AD

LW=wishes and POA

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27
Q

Which act requires that all pt’s be informed of their right to execute an AD?

A

Patient self-determination act of 1990

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28
Q

When initiating change, at what level do you begin?

A

Local then move up

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29
Q

Which is treated first, medical or psychosocial conditions?

A

Medical

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30
Q

What is the strongest method for evaluating teaching?

A

Return demonstration

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31
Q

Steps to determining if a patient needs higher level of care?

A
  1. assess pt
  2. stabilize
  3. assess capability of current facility
  4. Turf
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32
Q

What is the most powerful data collected from the pt?

A

Subjective data or observations of the NP

vs interp of family and friends

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33
Q

Goal of Healthy People 2020

A

Improve health and access to health care

  1. -Increase the quality and years of healthy life
  2. -Eliminate health disparities

contains health objectives, plan prevention programs, all levels are responsible for determining how to meet these goals

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34
Q

5 conditions to report

A
  1. Gonorhhea
  2. Chlamydia
  3. Syphillis
  4. HIV
  5. TB
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35
Q

Other things to report non-communicable?

A

Animal bites

Criminal acts and injury from dangerous weapon

Suspected child or elder abuse

(NOT DV)

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36
Q

What is collaborative practice?

A

True partnership with comon goalsk, share power and accept different areas of responsibility

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37
Q

Coding (E&M)

A

Matches the level of service to the complexity of the presenting problem

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38
Q

Who sets the standard for reimbursement and cutting costs?

A

Medicare

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39
Q

Levels of physical exam

A

Problem focused

Expanded problem focused

Detailed

Comprehensive

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40
Q

Which medicare covers hosptialization and SNF and hospice associated with the hosptialization?

A

Medicare A

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41
Q

Which Medicare covers physician services and labs/diagnostics/ DME/ HHN?

A

Medicare B

Requires premium

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42
Q

A+B=

A

C called Medicare Advantage

HMO/PPO

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43
Q

Medicare D

A

Copay and premiums

Penalty may apply if you don’t apply right away

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44
Q

Under Medicare, what percentage does Medicare pay of the physician’s services?

A

80%, pt pays 20%

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45
Q

How much does an NP receive of phsycian reimbursement for services provided in collaboration with a physician?

A

85%

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46
Q

Examples of things that do NOT meet physician services criteria?

A

regular phsycial exams- must be a “follow-up”

health screenings

counseling for well pts

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47
Q

To qualify for Medicare the NP must:

A

Hold a state licensce as NP

Be certified by national body

Hold at least an MSN

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48
Q

Procedure payment?

A

80% 0f the 85% phsyician fee rate

49
Q

Incident to billing

A

100% if provider is in the same office, out-pt setting only

Under direct supervision

otherwise, must bill under your own number

not allowed in the hospital

50
Q

Medicaid

A

Federally supported, state administered for low income persons and families

Benefits vary by state

Payments made AFTER other insurance or third party

51
Q

Purpose of case management

A

comprehensive and systematic approach to provide quality care

Mobilize and monitor and control resources while balancing quality and cost

52
Q

Who delineates the steps for Continuous Process Improvement? (CPI)

A

JCAHO

53
Q

Toyota Way in healthcare

A

CPI +

Structures

Processes of care

Outcomes

Used to assess, monitor and improve care

54
Q

Purpose of care map

A

multi-disciplinary tool for planning, managing and monitoring outcomes of care

55
Q

What is the purpose of a root-cause analysis?

A

Tool for identifying prevention strategies to ensure safety

Asks why, why, why?

56
Q

IS sentinel event and medicl error synomymous?

A

No

“or the risk thereof” is a significant phrase

57
Q

Who determines scope of practice?

A

State BON

58
Q

Which Act delineates scope of practice?

A

State Nurse Practice Act

59
Q

What are the key elements of the NP role?

A

Integration of care

EBP

clincial leadership

family assessment

discharge planning

60
Q

Who delineates the Standards of Advanced Practice?

A

ANA

Measures quality of practice, service, or education

61
Q

Who establishes authority to grant licensure?

A

Sate practice act of the BON

62
Q

What items does the State practice act describe?

A

Title

Scope

Prescriptive authority

Disciplinary grounds

63
Q

Who determines the ability and extent of a NP’s ability to prescribe?

A

State practice act

64
Q

Who registers the NP for narcotic prescribing and tracking?

A

DEA

65
Q

What is in a credential after your name?

A

Education, licensure, certification

66
Q

Why is credentialing necessary?

A

Ensure dsafe care

comply with state and federal regulations

Accoutnability

enforce professional standards

67
Q

What does licensure establish?

A

Person is qualified to perform in a role

68
Q

What does certification establish?

A

Establishes that person has met standards and minimum mastery

Granted by non-governmental agencies

69
Q

When were Np’s granted the permission to admit?

A

1983 by JCAHO

70
Q

Who gives privilages?

A

Hosptial credentialing board

71
Q

Examples of risk management strategies

A

Utilizes a formal, written plan

Satisfaction survey

Incident report

complaint

Action initiatives including documentation and education

72
Q

What constitutes abandonment?

A

Terminating pt-caregiver relatioinshiop without reasonable arrangements for ongoing care

73
Q

Interventions that are unlikely to produce any significant benefit to patient

A

MEdical Futility

Can be quantitative or qualitative

74
Q

4 Criteria for ability to give informed consent

i.e defintion of competence

A
  1. Understand
  2. reason
  3. differentiate between good and bad
  4. communicate
75
Q

Duty to do no harm

A

non-maleficence

76
Q

right act to produce the greatest good for the greatest number of people

A

utilitarianism

77
Q

duty to prevent harm and do good

A

beneficence

78
Q

duty to be fair

A

justice

79
Q

duty to be faithful

A

fidelity

80
Q

the duty to be truthful

A

veracity

81
Q

duty to respect an individual’s rights and thoughts

A

autonomy

82
Q

duties when terminating a pt from a practice

A
  • give notice by certified letter with return receipt
  • provide coverage for 15-30 days
  • provide copies of all records to subsequent provider
  • written and signed copy of rec care, appt cancelation etc can serve as reason for termination
83
Q

duties when closing practice

A
  • give adequate time
  • keep files 5 years
  • provide names of other providers and resources for future care
84
Q

Steps in research process

A
  1. formulate research problem
  2. review lit
  3. formulate hypothesis
  4. select research design
  5. identify population
  6. specify data collection methods
  7. design study
  8. conduct study
  9. analyze data
  10. interpret results
  11. communicate findings
85
Q

Research types: 3

A

non-experimental

experimental

qualitative

86
Q

2 types of non-experimental research designs

A
  • descriptive
  • ex-post facto/correlational

other types:

cross=sectional

cohort

longitudinal

87
Q

aims to describe situations, experiences,phenomena as they exist

A

descriptive/non-experimental

88
Q

examines relationships among variables

A

ex=post facto -non-experimental

89
Q

study that examines a population with a very similar attribute but vary in one specific variable

A

cross=sectional = non-experimental

90
Q

compares a particular outcome in a groups of individuals who are alike in many ways but differ by a certain characteristic

A

cohort=non-experimental

91
Q

study that involves taking multiple measures of a group population over an extended time period to find relationships

A

longitudinal=framingham

non-experitmental

92
Q

experimental research studies include what 2 things:

A

randomization

control group

93
Q

what is characteristic of quasi-experimental research?

A

manipulation of variables but lacks either a control group or randomization

94
Q

problems with qualitative research

A

researcher bias

lack of generalizability due to limited sample sz

95
Q

what size confidence interval indicates a very precise range of values?

A

small

ie: 2.8-3.2 episodes of nausea in cancer pts in 24 hrs

96
Q

how much of the population fits between 2 standard deviations from the mean?

1 SD?

A

2 SD’s=95%

1 SD= 68%

97
Q

the probablity that the results of statistical analyses are judged to indicate a statistically significant difference between groups

A

level of significance or p value

p<.05 => not due to chance

98
Q

a measure of interdependence of two random variables

A

correlation

-1 perfect negative correlation

0 asbence of correlation

+1 perfect postitive correlation

99
Q

evaluates the difference in means between two groups

A

t test

100
Q

the consistency over time of a measurement with the same subject

repeatability of a measurement

A

reliability

101
Q

two tests of reliability

A

test/retest

internal consistency

102
Q

does the test measure what it is supposed to test

A

validity

103
Q

what test is used to measure reliability

A

crohnbach’s alpha

>0.7 is greater reliability

104
Q

failure to meet the standard of care resulting in actual or potential harm

A

liability

105
Q

failure to o what a resaonable person would do, resulting in injury to the patient

A

negligence

106
Q

failure to render services with the degree of care, diligence and precaution that another member of the same profession under similar circumstances would render to prevent injury to a patient

A

malpractice

may involve

  • professional misconduct
  • lack of skill
  • illegal/immoral conduct
  • other allegation
107
Q

threat or apprehension of harm

A

assault

108
Q

willfull or negligent striking of a person

A

battery

can be commited on an unconscious pt

109
Q

communication that causes a damaged reputation

A

defamation

libel: written
slander: verbal

110
Q

duty to commit someone who is in danger of harming self or others

A

involuntary commitment

can be liable if pt is discharged before this is resolved

111
Q

documentation of restraints

A

need to document rationale

lack of documenation is responsiblity of np, otherwise can be held liable (failure to meet standard of care that results in actual or potential harm to pt)

112
Q

Concept of cultural competence

A
  1. social justice
  2. critical reflection
  3. transcultural nursing knowledge
  4. cross cultural practice
  5. healthcare systems and organizations
  6. pt advocacy and empowerment
  7. multicultural workforce
  8. education and training
  9. cross cultural communication
  10. cross cultural leadership
  11. policy developement
  12. EBP and research
113
Q

CLAS

A

culturally and linguistically appropriate services

  1. bilibnfual staff and interpreter at no cost at all times in a timesly manner
  2. preferred language services both verbal and written noticies of rights to receive language assistance
  3. don’t use family and friends for informed consent or translation
114
Q

What is the purpose of credentialing?

A

verifying education, licensure, and experience

115
Q

What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?

A

Balanced budget act

116
Q

When reading a systematic review, an adult-gerontology acute care nurse practitioner ensures that the review?

A

Describes the study inclusion criteria

117
Q

Four roles of the NP

A

Clinician

Consultant/collaborator

Educator

Researcher

118
Q
A

ACNP Certification (17 decks)

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