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Leadership > Leadership Exam 2 Blueprint > Flashcards

Leadership Exam 2 Blueprint Flashcards

1
Q

Ethics

A

system of principles that govern the actions of the nurse in relation to patients, families, other health care providers, policymakers, and society

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2
Q

Code of Ethics

A

Implicit standards and values for nursing

American Nurses Association Code of Ethics

International Council of Nurses Coder for Nurses

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3
Q

Bioethics

A

Interdisciplinary field within health care that addresses questions that arise as science and technology produce new ways of knowing

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4
Q

Dilemmas for health professionals examples

A

Life and death

Right to decide

Informed consent

Alternative tx issues

Stem cell research

Sexual reassignment

Therapeutic and reproductive cloning

In vitro fertilization; donor insemination

Surrogate motherhood

Organ transplantation

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5
Q

Dilemmas created by technology

A

Illnesses that once led to mortality are now manageable and are classified as chronic illnesses

Cost is a consequence of prolonging life with technology

Manipulation of DNA

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6
Q

Purpose of Ethical Principles

A

Establish consistent common ground for ethical discussions and decision making among all involved (nurse, patient, family, health care, society) on specific or related issues

Provides an analytical framework to evaluate moral problems

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7
Q

Autonomy

A

Principle of respect for the person: primary moral principle

People are free to form their own judgements and actions as long as they do not infringe on the autonomous actions of others

Concepts of freedom and informed consent are grounded in this principle

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8
Q

Beneficence

A

acting in the best interest of patients by promoting their well-being, preventing harm, and providing compassionate care.

Common bioethical conflict results from an imbalance bw the demands of beneficence and those of the health care delivery system

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9
Q

Nonmaleficence

A

Implies a duty not to inflict harm

removing harm to promote well being

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10
Q

Veracity

A

Principle of truth-telling to develop trust

Don’t withhold info bc you feel like it can cause harm or be uncomfortable

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11
Q

Justice

A

Nurses should treat all patients fairly and impartially, regardless of their background, race, gender, or social status

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12
Q

Fidelity

A

build trust by keeping promises, being reliable, and honoring commitments

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13
Q

Ethical Theory

A

a system of principles by which a person can determine what should and shouldnt be done

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14
Q

Utilitarianism

A

assumption that an action is right if it results in the greatest good or the least harm.

Strongest approach for bioethical decision making—Which action maximizes benefit and minimizes harm for all involved?

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15
Q

Deontology

A

Rooted in the assumption that human actions are guided by rational principles which compel people to do what is right.

Decisions should be made as if they could be universal laws

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16
Q

Purpose of Malpractice Insurance

A

to protect nurses from financial loss and legal consequences if they are accused of negligence or wrongdoing in their professional practice. It provides coverage for legal defense costs, settlements, and damages awarded in lawsuits related to patient care.

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17
Q

Reasons for Malpractice Insurance

A

More states recognize nurse malpractice claims.

RN and advanced practice roles are expanding.

Floating and cross-training mandates are increasing.

Nurses have more responsibility for supervising staff.

Some employers may fail to provide adequate defense for nurses.

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18
Q

Statutory Laws

A

Written laws that govern nursing practices and professional behavior, enacted by the federal or state legislature

Violations are criminal offenses and are punishable by fines or imprisonment

Licensing boards have the authority to hear and decide cases against nurses

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19
Q

Statutory Law: Penalties that may be imposed

A

formal reprimand

period of probation

fines

Limiting, suspending, or revoking the nurse’s license

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20
Q

Statutory Law: Emergency Medical Tx and Active Labor Law (EMTALA)

A

prohibits denying care to uninsured or poor patients in emergency departments

forbids transferring unstable patients, including women in labor, between facilities.

Applicable to nonemergency facilities (i.e. urgent care)

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21
Q

Statutory Law: Americans with Disabilities Act of 1990 (ADA):

A

ensures equal access and opportunities for individuals with disabilities by eliminating discriminatory barriers.

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22
Q

Statutory Law: Patient Self-Determination Act of 1990

A

requires healthcare providers to inform patients of their rights to make decisions about their care, including right to accept or refuse tx and advance directives for future medical preferences.

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23
Q

Statutory Law: Health Insurance Portability and Accountability Act of 1996 (HIPAA)

A

protects the privacy and security of health information, sets standards for handling personal data, and gives individuals control over their health records, including requesting corrections

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24
Q

Statutory Law: Patient Safety and Quality Improvement Act (PSQIA)

A

Promotes patient safety by encouraging error reporting without legal fear, offering federal protection for data shared with PSOs to foster a culture of safety and improvement.

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25
Q

Nurse/Patient ratio and mandatory overtime statues

A

California 1st to enact a law in Jan 1999 that mandates the establishment of minimum nurse/pt ratios in acute care facilities

Improved nurse/patient rations are associated w/ lower “failure-to-rescue” rates and lower inpatient mortality rates

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26
Q

Tort

A

A direct violation of a person’s legal rights

The plaintiff doesn’t need to prove a “special duty” or negligence, as it’s assumed nurses owe a duty of care; they only need to show the nurse’s actions fell below the standard of care.

Consequences include fines, punitive damages, or criminal acts

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27
Q

Torts include:

A

Assault and Battery

Defamation of character; libel/slander

False imprisonment; restraints

Intentional Infliction of emotional distress

Invasion of Privacy

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28
Q

Incident Reporting

A

The process of documenting and reporting any unusual events that occur during patient care, which may affect patient safety, quality of care, or the healthcare environment. This could include errors, accidents, injuries, near-misses, or adverse events.

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29
Q

Purpose of Incidence Reporting

A

helps prevent future occurrences and improves care quality.

uncovers patterns or systemic issues in care, equipment, or communication.

protects providers from liability by showing transparency and a commitment to improvement.

encourages open communication about mistakes without fear of punishment, fostering learning and safety.

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30
Q

Mandated reporting

A

Laws that mandate reporting of specific health problems and suspected or confirmed abuse

Most laws grant immunity from suit within the context of the mandatory reporting statue

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31
Q

Mandated circumstances that must be reported

A

Health Professionals must report the following under penalty of fine or imprisonment for failing to do so:

Infant and child abuse (Child Abuse Prevention and Treatment Act)

Dependent elder abuse

Specified communicable diseases

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32
Q

Ethical Decision Making: Answering Difficult Questions

A

What is safe care?

When staffing is inadequate, what care should be accepted or refused?

What does it mean to be ill or well?

What is the proper balance bw science/technology and the good of humans?

Where do we find balance when science will allow us to experiment with the basic origins of life?

What happens when tension exists bw personal beliefs and values and institutional policy or patient desires?

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33
Q

Ethical Decision-Making Model

A
  1. Situation assessment procedure
  2. Identify the ethical issues and problems
  3. Identify and analyze available alternatives for action
  4. Select one alternative
  5. Justify the selection
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34
Q

Situational Assessment Procedure: Usefulness & Application

A

Patient Provider Relationship
—Privacy, paternalism, fidelity. veracity

Encompassing questions for group (i.e. Institutional Ethics Committee)
—Provide ethics education, assistance with ethical policy development, and serve as consultative body to guide resolving ethical dilemmas

Policy making right and wrong choice that affect society

Daily practice of ethical decision-making

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35
Q

Bioethical Dilemmas

A

Dilemmas that involve choosing between confusing options in the delivery of healthcare due to unclear right or wrong answers.

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36
Q

Bioethical Dilemma: Life

A

abortion issue

When does life begin?

Reproduction issue: influenced by genetic screening, genetic engineering, and cloning

90% of the human genome identified in 2003 by Human genome Project

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37
Q

Bioethical Dilemma: Death

A

Quality of life and definition of death issues: w/ advances in health care, what is usual and what is heroic care has become unclear

Euthanasia and assisted suicide present new ethical questions

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38
Q

Bioethical Dilemma: Right to Healthcare

A

Health Care system more selective in the amount and type of tx offered as a result of managed care

Is each person entitled to the same health care package?

Does ability to pay affect a specific level of entitlement?

How ethical is gatekeeping in the new managed care system?

Access to health care and respect for human dignity are at the core of nursing practice

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39
Q

Bioethical Dilemma: Allocation of Scarce Resources

A

Should the recipient of scarce resources be selected on the basis of quality of life? Ability to pay? Best prognosis? First-come, first-served?

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40
Q

Moral development for a professional nurse

A

Moving toward moral maturity

The quality of healthcare decisions depends on the moral development of the nurse making them

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41
Q

Values essential for the professional nurse

A

altruism, autonomy, human dignity, social justice

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42
Q

Nurse value: Altruism

A

concern for the welfare of others

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43
Q

Nurse value: Autonomy

A

right to self-determination

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44
Q

Nurse value: Human Dignity

A

respect for inherent worth and uniqueness of individuals and populations

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45
Q

Nurse value: Social Justice

A

acting in accordance with fair tx regardless of background

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46
Q

Ethics acculturation

A

adopting the cultural norms and values of the healthcare environment they work in.

Values: Integrity, personal growth, practical wisdom, and effective problem solving

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47
Q

Rights of conscience:

A

the right to practice according to your ethical convictions (what you feel is right or wrong)

ex:debates over abortion and euthanasia, as part of civil rights in the U.S.

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48
Q

Ethical theory and ethical principles can provide a basis for

A

moving forward as a morally mature professional adult

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49
Q

Negligence

A

failure to act in a reasonable and prudent manner

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50
Q

Malpractice:

A

special type of negligence; the failure of a trained professional, to act in a reasonable and prudent manner

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51
Q

Elements essential to prove negligence or malpractice

A

A nurse owes a duty of care once a nurse-patient relationship is formed.

The nurse failed to meet that duty.

The patient experienced harm or damage.

The nurse’s actions directly caused the patient’s injury.

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52
Q

Most frequent allegations of nursing negligence

A

Failure to ensure patient safety.

Improper or negligent treatment

Failure to monitor and report key findings.

Medication errors.

Not following agency policies and procedures

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53
Q

Negligence and the doctrine of res ipsa loquitur

A
  1. Applies when the negligent act is obvious and within common knowledge to determine the standard of care—”the thing that speaks for itself.”
  2. An expert nurse witness is not needed to establish the standard of care.
  3. Example: Studies show about 5,000 foreign bodies (like instruments or sponges) are left inside patients after surgery each year.
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54
Q

Gross negligence

A

Reckless act that reflects a conscious disregard for the patient’s welfare

Court may award special damages meant to punish the nurse for the outrageous conduct; these are referred to as punitive damages

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55
Q

Criminal negligence

A

Constitutes a crime—the act is deemed so reckless that it results in serious injury or death to the patient

Malpractice insurance may not cover costs in all cases

98,000 patients die each year as a result of negligence and malpractice of health care providers

56
Q

Consequences in addition to criminal negligence charges include

A

Loss of job and livelihood

Suspension or revocation of license

Out-of-pocket fines levied by the nursing board

Significant attorney’s fees

57
Q

What can nurses not use as a defense against claims of negligence?

A

In no case may a nurse use the defense “following physician’s orders”

58
Q

Defenses against claims of negligence

A
  1. Emergency situations: Care in life-threatening emergencies may not meet the usual standard of care.
  2. Governmental immunity: Healthcare workers in federal or state facilities are protected from personal responsibility in malpractice cases.
    3
  3. Good Samaritan immunity: Nurses are shielded from malpractice when providing emergency help outside their job setting.
59
Q

ANA Code of Ethics and American Medical Association’s Code of Medical Ethics:

A

the central role of nurses is to prevent patient harm

60
Q

The law and patient rights

A

Advance directives

The right to refuse treatment

Leaving against medical advice (AMA)

The use of physical restraints

61
Q

Advance Directives

A

Statutes grant adults the right to refuse extraordinary medical tx when no hope of recovery

Patient’s wishes are made known through execution of a living will

62
Q

Medical and physician directives

A

Document that lists desires of patient in a particular scenario

63
Q

If properly executed, physical restraints provides physician with

A

immunity from claims of negligence in the patient’s death

64
Q

Do not resuscitate orders

A

Written by a physician based on directives by the patient

Nurses have absolute duty to respect patient’s DNR orders

65
Q

Durable power of attorney for health care:

A

document that authorizes patient to name the person who will make the day-to-day and end-of-life decisions when he or she becomes decisionally incompetent

66
Q

Informed Consent

A

Physician or NP has duty to disclose information so patient can make choices

Mandated by federal statute and state law

Provider cannot delegate this to RN

If nurse has reason to believe that pt has no given informed consent, the provider should be immediately notified

67
Q

Information that must be disclosed to patients

A

Nature of the therapy or procedure

Expected benefits and outcomes

Potential risks

Alternative therapies

Risks of not having the procedure

68
Q

Value

A

personal belief about worth that acts as a guide to behavior

69
Q

Value System

A

entire framework on which actions are based

70
Q

Diane Ustal

A

first nurse leader to describe the role of values clarification

71
Q

Ethics acculturations

A

a process of adapting one’s personal ethical values to the ethical standards and procedures of a professional organization

72
Q

Values Formation and Moral Development: Worldview

A

Provides a cohesive model for life

Encourages personal responsibility for living life

Prepares one for making ethical choices

73
Q

Learning Right and Wrong: Infants

A

Begin with no concept of right or wrong

If the need for basic trust is met, infants will develop the foundation for secure moral thought

74
Q

Learning Right and Wrong: Toddlers

A

Learn that good behavior is rewarded, and bad behavior is punished

Begin to make choices that are based on an understanding of good and bad

75
Q

Learning Right and Wrong: Adolescent

A

Questions existing moral values and his or her relevance to society

Becomes more aware of contradictions in adults’ value systems

76
Q

Learning Right and Wrong: Adult

A

Strives to make sense of the contradictions and learns to develop own set of morals and values

Begins to make choices that are based on an internalized set of principles

77
Q

Values clarification:

A

A process where people reflect on their values and how they fit into the bigger picture.

78
Q

Moral development

A

Developing a worldview and value system through an ongoing, evolving process.

79
Q

RNs cannot delegate:

A
  1. Initial and ongoing assessments requiring nursing knowledge and skill.
  2. Determining nursing diagnoses.
  3. Setting nursing care goals.
  4. Creating a nursing care plan.
  5. Evaluating patient progress.
  6. Education
  7. Activities needing specialized nursing knowledge and skill.
80
Q

UAP capabilities

A

no activity that requires nursing judgement. (i.e. assessing, teaching, evaluation, or administering meds)

Can collect, report, and document simple data

Can do simple, repeitive tasks (i.e. ADL’s, hygiene, feeding, and ambulation)

Can collect I/Os, specimen collection, & vital signs on stable patients

81
Q

LPN capabilities

A

Cannot initially assess, initially teach, or evaluate any client

Cannot delegate the care of an unstable client

Can reinforce client teaching

Can give some but not all medications

Can do Trach care, suctioning, insert urinary catheters, and administration of enteral feedings

82
Q

LPN can

A

data collect, monitor, observe

administer IVPB medication

Monitor transfusion of blood products

Administer topical, PO, or IM pain medications

Administer meds and nutrition via NG tube, G-tube or button, J-tube

Insert, maintain, & remove NG tubes and urinary catheters

Maintain & remove peripheral IV catheters

Calculate and monitor IV flow rate

83
Q

LPNs cant:

A

Administer IV push medication

Initiate transfusion of blood products

Administer IVP pain medications

Administer meds & nutrition via central line (no TPN)

84
Q

Safe delegation practices

A

Develop a foundation of knowledge (i.e., nurse practice act, policies, standards of care, competencies, etc…)

Know the patient

Know the staff member and his/her skills & competencies

Know the task

Explain tasks and expected outcomes

Expect responsible action

Assess and supervise

Evaluate and follow-up

85
Q

5 Rights of Delegation

A
  1. Right task: delegated tasks must conform to established guidelines
  2. Right circumstances: delegated tasks do not require independent nursing judgment
  3. Right person: one who is qualified and competent
  4. Right direction and communication: clear explanation about the task and outcomes and when the delegatee should report back to the RN
  5. Right supervision and evaluation: feedback to assess and improve the process; evaluate patient outcomes
86
Q

Assignment Considerations

A

Assigning groups of clients to various care providers, including AP and LPNs/LVNs is not appropriate

AP assignments include functions and tasks

LPNs/LVNs may be assigned specific clients for which to perform care, but RNs remain responsible for all nursing practice activities

87
Q

RN responsible for assignments made to nursing personnel should consider:

A

patient’s physiologic status and complexity of care

infection control or cross-contamination issues

level of supervision required

staff development opportunities such as assigning a less experienced nurse to a more complex patient with an increased level of supervision

88
Q

Nurse Practice Act

A

Will provide guidance for legal delegation

State board of nursing may offer guidance

RN should understand the legal scope of practice for an LPN/LVN

Practice by AP is generally governed by the health care organization’s standards

89
Q

Supervision

A

the active process of directing, guiding, and influencing the outcome of a worker’s performance

90
Q

On-site supervision

A

the nurse is physically present or is immediately available while the activity is being performed

91
Q

Off-site supervision

A

the nurse has the ability to provide direction through written, verbal, and electronic communication

92
Q

What situations can be unsupervised?

A

One RN works with another RN in a collegial relationship

Neither RN is in the position of supervising the other

Initial direction/periodic inspection

RN is supervising a licensed or unlicensed caregiver

Knows the individual’s training and competencies

Has developed a working relationship with the individual

93
Q

Continuous supervision

A

RN has determined that the delegatee will need very frequent to continual support and assistance

94
Q

Examples of Stable Clients

A

Post-op client being discharged with no family

Client with COPD, stable vitals, and uses O2

Diabetic with a wound, stable blood sugar, taking medications as ordered

Client with neurological problems, stable vital signs, no change in LOC/neuro checks

Client with dehydration, stable electrolytes, appropriate urine output, and improving hydration status

Client with chronic hypertension, history of angina controlled with meds & lives alone

Client with HIV+, medication compliance and works full time

Client with history of cancer in remission and young children in home

Client with history of stroke, paresthesias, and rehab equipment

95
Q

Examples of Unstable Clients

A

New admission

Neuro checks suddenly change

Diabetic with low blood sugar

Client returning from an invasive procedure

Client with acid-base imbalance and respiratory distress with unstable vital signs

Client with syncope and chest pain

Client with recent 2nd & 3rd degree burns

Client with infectious diseases - new onset

Client with multiple IV fluids & meds, plus lab & vital sign changes

96
Q

Prioritization Factors

A

Acute vs Chronic

ABC’s

Maslow’s Hierarchy of Needs

Urgent vs Nonurgent

Survival Potential

97
Q

Maslow’s Hierarchy of Needs

A

1.Physiological Needs: air, water, food, shelter, clothing, etc.

  1. Safety Needs: personal security, employment, resources, health, property
  2. Love and Belonging: friendship, intimacy, family, sense of connection
  3. Esteem: respect, self-esteem, status, recognition, strength, freedom
  4. Self actualization: desire to become the most that one can be; achieving one’s full potential including creative activites
98
Q

Triage Class: Emergent/ Immediate

A

Red; Highest priority is given to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized; tx w/in 1 hr

99
Q

Triage Class: Urgent/ Delayed

A

Yellow; Second highest priority is given to clients who have major injuries that are not yet life-threatening and can usually wait 30 minutes to 2 hours for tx

100
Q

Triage Class: Nonurgent/ Minimal

A

Green; 3rd priority is given to clients who have minor injuries that are not life-threatening and do not need immediate attention

101
Q

Triage Class: Expectant

A

Black; The lowest priority is given to clients who are not expected to live and are allowed to die naturally. Comfort measures can be provided, but restorative care is not

102
Q

Prioritizing Questions

A

Is the situation life-threatening or life-altering? If yes, this client is the highest priority.

*Is the situation unexpected for the disease process? If yes, then this client may be priority.

*Is the data presented abnormal? If yes, then this client may be priority?

*Is the situation expected for the disease process and not life threatening? If yes, then this client may be but probably is not priority.

*Is the situation/data normal? If yes, this client can be seen last

103
Q

Federal Policies That Shaped Nursing Practice

A

Nurse practice acts and registration of nurses (implemented in most states by 1910)

Sheppard-Towner Act (1921)

Hill-Burton Act (1950)

Medicare program (1965)

Renal disease program (1972)

Diagnosis-related groups (DRGs) (1983)

Patient Protection and Affordable Care Act (2010

104
Q

Nurse Practice Acts and Registration of Nurses

A

State laws regulate nursing practice, define its scope, set education and licensure requirements, and ensure nurses meet care standards, protecting the public by ensuring only qualified individuals practice.

105
Q

Sheppard-Towner Act (1921)

A

Federal law providing funds for maternal and infant health services to reduce mortality rates.

106
Q

Hill-Burton Act (1950)

A

Provided federal funding for hospital construction and modernization particularly in underserved areas and required free or reduced-cost care for the uninsured.

107
Q

Medicare program (1965)

A

A federal health insurance program for individuals aged 65 and older and disabled populations

provides funding for hospital care (Part A), medical services (Part B), and prescription drug coverage (Part D)

108
Q

Renal disease program (1972)

A

Medicare coverage for individuals with end-stage renal disease, including dialysis and transplants. .

109
Q

Diagnosis-related groups (DRGs) (1983)

A

Medicare system categorizing hospital cases to control costs by providing fixed payments per diagnosis.

110
Q

Patient Protection and Affordable Care Act (2010

A

Healthcare reform law expanding access, reducing costs, and improving care quality, with a focus on insurance coverage and preventive services.

111
Q

Examples of Local Health Policy

A

Free or reduced-rate immunizations

Tobacco-free public buildings

Safe drinking water

Provision of an emergency medical system

112
Q

Examples of State Health Policy

A

Governs nursing through nurse practice act

Ensures safe food storage and preparation in restaurants

Regulates healthcare facilities

Pays for healthcare services through Medicaid

113
Q

Examples of Federal Health Policy

A

Funds health-related research

Funds education for health professionals, including nurses and physicians

Pays for health care through Medicare, Medicaid, SCHIP, and the Veterans Administration health care system

Plays a monumental role in shaping nursing practice

Passage of the Patient Protection and Affordable Care Act (PPACA) (2010)

114
Q

Health Policy Purpose?

A

Set course of action taken by governments or health care organizations to obtain desired health outcome

115
Q

Private Health Policy

A

made by health care organizations such as hospitals and managed care organizations

116
Q

Public Health Policy

A

Refers to laws, regulations, and court rulings that govern healthcare practices at local, state, and federal levels.

117
Q

Health Policy Development; Who does it include?

A

Enactment of legislation and accompanying rules and regulations that carry the weight of law

Administrative decisions made by various governmental agencies

Judicial decisions that interpret the law

Involves numerous individuals and groups:

Elected officials & governmental agency officials

Experts in the related area

Stakeholders such as corporate representatives

Representatives from special interest groups

Other affected citizens

Involves all three branches of government

118
Q

Care Delivery Models

A

Describes how tasks, responsibilities, and authority are assigned to ensure effective patient care, matching caregiver roles to patient needs in a cost-effective way.

119
Q

Total Patient Care

A

Nurse is responsible for planning, organizing, and performing all patient care during the assigned shift

1.Background

2.. Oldest method of organizing patient care, sometimes referred to as case nursing

  1. Nursing student typically performs total patient care for assigned patients
120
Q

Functional Nursing

A

Staff members are assigned to complete certain tasks for a group of patients rather than care for specific patients

121
Q

Functional Nursing: Lines of Responsibility and Accountability

A

1.RN nurse manager assigns responsibility for completion of tasks to a group of health care workers

2.RN is responsible for planning care and supervising workers

3.RN retains accountability for the patient care provided

122
Q

Team Nursing

A

RN functions as a team leader and coordinates care for a small group of patients

123
Q

Team Nursing: Lines of Responsibility and Accountability

A

RN team leader is responsible for the following:

1.Planning care

2.Assigning duties

3.Directing, supervising, and assisting team members

4.Giving direct care

5.RN retains accountability for all patient care

6.RN team leader is responsible for encouraging a cooperative environment and maintaining clear communication

124
Q

Primary Nursing

A

RN “primary” nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care from admission through discharge

Provides total patient care while on duty

While off duty, care is provided by an associate nurse, who follows the care plan established by the primary nurse

125
Q

Modular Nursing

A

Modification of team nursing

1.Patient unit divided into modules; same team of caregivers assigned consistently to same geographic location

2.Each location or module has RN as team leader

3.Goal is to increase the involvement of the RN in planning and coordinating care

4.Designated modules should contain all the supplies needed by the staff to maximize efficiency

126
Q

Partnership Model (Co-primary nursing)

A

RN is partnered with an LPN/LVN or a nursing assistant; pair work together consistently

1.Modification of primary nursing designed to ensure more efficient use of RN

2.Lines of responsibility and accountability

3.RN responsible for planning care, assigning duties, coordinating care, and supervising the partner

4.RN is accountable for patient care for all assigned patients

127
Q

Purpose of Case Management

A

Collaborative approach to:

1.provide and coordinate health care services

2.identify and facilitate options and services for meeting health needs

3.decrease fragmentation and duplication of care

4.enhance quality, cost-effective clinical outcomes

5.Nurse case manager “manages” a “case load” of patients from preadmission (onset of illness) to discharge (resolution of illness)

128
Q

Case Management & Other Nursing Care Delivery Models

A

Supplemental form of nursing care that does not replace the nursing care delivery model already in place to provide direct patient care

RN case manager assumes a planning and evaluative role and usually is not responsible for direct care duties

Case management is generally reserved for the chronically ill; the seriously ill or injured; and long-term, high-cost cases

129
Q

Newer Models of Case Management

A

Newer models are emerging because of health care reform and the need to move patients to less costly home and community care settings

-Patient Navigators

-Transitional Care RN

130
Q

Patient Navigators

A

help people “navigate” the complex health care system (physicians, clinics, hospitals, outpatient centers, insurance and payment systems, patient-support organizations, etc.)

131
Q

Transitional Care RN

A

facilitate effective transitions for chronically ill patients to ensure good communication across settings and providers, appropriate follow-up, clear understanding of prescribed medications, assistance with referrals, and encouraging patients and families to take an active role in their health care

132
Q

Patient-Centered Care

A

Definition by IOM (2001) “Providing care that is respectful of & responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions”

health professionals ensure that health care decisions respect patients’ wants, needs, and preferences

Not a nursing care delivery model but a philosophy of care that is an essential component of any nursing care delivery model

133
Q

Methods to Engage patients, families, and significant others as partners in care

A

Include them in developing care plans and discharge plans

Include them in change-of-shift or handoff reports

Provide them with the information and education needed to make informed decisions

Establish “family advisory councils” to engage patients and families in decision making

134
Q

Patient Acuity

A

Indication of the severity of the patient’s illness and the amount and complexity of nursing care required; high acuity indicates a need for more intense, complex nursing care, and lower acuity indicates a need for moderate, less complex nursing care.

135
Q

Clinical Pathways

A

Delineates a predetermined written plan of care for a particular health problem

Specifies desired outcomes and the interdisciplinary intervention required within a specified period for a particular diagnosis or health problem

Written to address common medical diagnoses such as heart failure and pneumonia, common nursing care needs such as immobility, and medical complications such as weaning from mechanical ventilation

136
Q

Essential Components of Clinical Pathways

A

Physical assessment guidelines

Laboratory and diagnostic tests

Medications and procedures

Safety and self-care activities

Nutrition

Patient and family education needs

Discharge planning

May address triggers—potential or actual variations in the patient’s response to the planned interventions

Leadership (1 decks)

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