N471 Final Exam Flashcards
Reduced uninsured, increased access to care
Focus on VALUE vs VOLUME
Patient Protection and Affordable Care Act
Group of providers working together to take care of patient groups, goal of seamless, quality care, coordination of care
Accountable Care Organizations
Focus on efficient, effective, and quality services, equals out in revenue
Everyone is responsible, unit manager considers each unit’s budget
Cost Containment
A financial plan
Must be as accurate as possible
Value is directly related to its accuracy
Budget
Mortgages, salaries
Fixed expenses
Payroll of hourly employees, cost of supplies
Variable expenses
How many people work during a shift, number of personnel employed
Controlled expenses
Emergencies, needing more staff/time, specific supplies needed to care for patients
Uncontrolled expenses
Each of an organization’s revenues, expenses, assets, and liabilities are someone’s responsibility
Leader-manager at unit level is active participant in unit budgeting
Responsibility Accounting
Assess- what are the needs
Diagnosis- what needs are priority
Plan- set time/goals
Implementation- continue to assess for change
Evaluation- review, add, remove
Steps to Budgeting
Largest expenditure in a budget
Workforce
Personnel Budget
Expenses that change- electricity, repairs, maintenance, supplies
Operating Budget
Buildings, major equipment budget
NOT USED DAILY
MORE EXPENSIVE THAN OPERATING BUDGET
Capital Budget
Predetermined payment schedule based off specific pt conditions/diagnoses
Diagnosis Related Groups
Federally funded program for seniors over age 65 or disabled
Recipient pays into the insurance plan
Medicare (MC)
MC Hospital insurance plan
Medicare A
MC outpatient care and physician services coverage
Medicare B
MC managed care plan coverage
Medicare C
MC prescription drug coverage
Medicare D
Federal/state plan to assist indigent population, disabled, long-term care
Medicaid (MA)
Regulations as to what providers/healthcare agencies can charge based on a diagnosis rather than patient-specific
Prospective Payment System (PPS)
Health program that looks at efficiency, access, and cost, primary care provider as gatekeeper
Managed Care Organization (MCO)
Communication with patients, families, colleagues, leadership
Necessary for continuity and productivity
Interpersonal communication
More complex than interpersonal communication
More communication channels
More individuals
More information
New technology
Organizational Communication
Includes values, feelings, stress levels of both sender and receiver
Internal climate
Status, power, authority of sender and receiver, timing & organizational climate
External climate
Manager makes needs/wants known to a higher level
Upward communication
Manager communicates information to colleagues under them (subordinates)
Downward communication
Manager communicates with others on same hierarchical level
Horizontal communication
Manager interacts with other managers or physicians on different hierarchical levels
Diagonal communication
Information flows quickly and haphazardly among people at all levels
Grapevine communication
Used when documentation is needed, can be formal or informal, tone can be mistaken (e.g. never use caps lock in formal written communication)
Written communication
Can be formal or informal, depends on intent, sender/receiver needs, watch body language
Face to face communication
Rapid communication, can be formal or informal
Telephone/text communication
Facial expressions, body movement, gestures, tone, emotions
Non verbal communication
Direct honest, does not infringe on rights
Assertive verbal communication
Person remains silent about issue even though they have strong feelings; “suffer in silence”
Passive verbal communication
Direct, threatening, condescending, infringes on rights
Aggressive verbal communication
An aggressive message presented in a passive way (incongruent message)
Passive aggressive verbal communication
Interprofessional communication
Standardized professional communication to provide quality patient care and reduce errors
-Situation
-Background- admitting diagnosis
mentioned here
-Assessment- where you state the
patient’s problem(s)
-Recommendation
SBAR communication
Way of establishing behaviors in groups, who are the leaders and the dependents, what behaviors are among the group. Identify rules, tasks and responsibilities
Process of the group meeting each other and interpersonal relationships forming
Forming (group communication)
Resistance is normal when forming groups. See what influences come within the group, how they resolve or rebel. How are demands of tasks resolved
COMPETITION
Storming (group communication)
Group starts to develop more efficiently, conflict resolves, cooperation develops
Conflict and resistance are overcome!
Norming
Group completes tasks, members perform their roles, problems are resolved
The work gets done!
Performing (group communication)
-The force within the individual that influences or directs behavior
-The act of stimulating someone or oneself to get a desired course of action or to push the right button to get a reaction
-The process of inducing, inspiring, and energizing people to work willingly with zeal, initiative, confidence, and an integrated manner to achieve desired goals it is a morale boosting activity
Motivation
Comes from within a person, often influenced by upbringing, family structure, culture, values, beliefs are formed at a young age, these can develop and change over time
Intrinsic motivation
Comes from outside the person, what factors motivate a person- financial, emotional, self, personal, relational, these can develop and change over time
Enhanced by job environment or external rewards
Extrinsic motivation
The cooperative working together of two or more people or organizations when combined, their effect is greater than the sum of their individual efforts
Synergy
Employee’s emotional commitment to the organization and its goals
KEY TO RETENTION
Employee engagement
Validation of work effort
Be specific
Recognition of extra effort (can be key tool in retention)
Show trust in decisions
Let employees create at work
External rewards are not always positive
Give praise during huddles
Encourage one another
Hire for the fit, not just to fill a vacancy
Positive reinforcement
DO NOT MICROMANAGE
Being a role model
Taking self care seriously
Leaders can motivate by…
Giving employees the ability to make decisions and encouraging them to challenge the status quo
Employee empowerment
Goal: do the greatest good for the greatest number of people
Disaster triage goal
Situation in which medical resources are strained but NOT overwhelmed
The number of patients and the severity of their injuries do NOT exceed the capability of the facility to render care
Multi-casualty incident
Situation in which casualty numbers are large enough to disrupt healthcare services
The number of patients and the severity of their injuries DOES exceed the capability of the facility and staff
Patients with the greatest chance of survival are treated first
Demand for resources ALWAYS exceeds the supply in an MCE!!
Mass Casualty Event (MCE)
Your safety is of utmost importance
Practice body substance isolation precautions (gloves and mask at minimum)
Routinely assess your environment for safety concerns
DO NOT BECOME A PATIENT!!
Safety
Perceiving critical elements in the environment
Understanding the significance of available information
Projecting what could happen next
Situational awareness
IMMEDIATE priority
Breathing but unconscious
Respirations over 30
Perfusion capillary refill >2 or NO radial pulse
Mental status unable to follow commands
Patient with life-threatening problems including: severe altered mental status, airway compromise, severe difficulty breathing, cardiovascular problems, hemorrhage, major trauma, major wounds
Requires immediate evacuation and treatment
RED triage category
DELAYED
Patient with injuries requiring evaluation that are not immediately life-threatening such as extremity burns, isolated extremity injuries, spinal injuries, awake and alert head injury patients
Evaluation can be delayed
YELLOW triage category
MINOR
WALKING WOUNDED
Patients with non life-threatening injuries or medical conditions such as: small wounds, small burns, small abrasions, and exacerbated psychiatric conditions
ARE AMBULATORY
GREEN triage category
DECEASED
Dead patients
No respirations after head tilt
No pulse
BLACK triage category
EXPECTANT
some systems group this category into black
Patients who are mortally wounded and have non-survivable injuries (such as 100% third degree burns)
(Would be labeled red in non-disaster scenario)
GRAY triage category
Respirations
Pulse, perfusion
Mental status
BREATHING IS ALWAYS CHECKED FIRST
Patient Assessment Criteria (disaster triage)
Manually open airway (jaw thrust if trauma pt)
Clear the airway with a finger sweep
Insert nasal airway
Control major bleeding
Elevate the legs to prevent worsening shock
Patient Treatment (disaster triage)
Simple Triage and Rapid Treatment
Can be used to track patients
The four color system is the NATO international standard
CHECK PT AND SEE WHAT THEY’RE DOING FIRST
START Triage
Colored plastic tape
Labels, cards, tags, bandanas, etc.
Informal triage system
START but adds normal vital parameters for children, making it appropriate for use with pediatric population
JUMP START
Sort, Assess, Life-Saving Interventions, Treatment & Transport
Similar to START but sorts pts based on if pt can walk and respond to you
SALT Triage
Formalized, structured method whereby a group of rescue and response workers reviews the stressful experience of a disaster
MENTAL HEALTH PRIORITY
Critical Incident Stress Debriefing (CISD)
Emergency planning response and continued assessment
Improved coordination and cooperation with other communities
Developing and coordinating preparedness plans
Establishing warning systems
Stocking emergency supplies and equipment
Educating the public and training emergency personnel
Assessing the damage caused by the emergency
Recovering from the emergency and helping citizens return to normal life ASAP
Local Government Responsibilities
Reviewing plans and providing guidance
Protecting communities and citizens within the state
Financial assistance on a supplemental basis
Pivotal point between policy guidance and resources available
State Government Responsibilities
Assisting the states by reviewing plans, providing guidance, making plans and assessing their capability to provide protection from large-scale, nationwide disasters
FEMA acts in a coordinating role (mitigation, preparedness, response, and recovery activities)
Federal Government Responsibilities
American Red Cross
Led by volunteers, provides relief to victims of disasters
Provides food, shelter, first aid, clothing, bedding, medicines, and other services
Salvation Army, Catholic Charities, Mennonite Disaster Services
Voluntary agencies and organizations
Preventing future emergencies or minimizing their effects
Occurs BEFORE and AFTER emergencies
Ex: buying flood and fire insurance for your home
Prevention/Mitigation (emergency management cycle)
Preparing to handle and emergency
Plans or preparations made to save lives and help response and rescue operations
Takes place BEFORE an emergency
Ex: evacuation plans and stocking food & water
Preparedness (emergency management cycle)
Responding safely to an emergency
Takes place DURING an emergency
Ex: Seeking shelter from a tornado or turning off gas valves in an earthquake
Response (emergency management cycle)
Recovering from an emergency
Includes actions take to return to a normal or an even safer situation following an emergency
Takes place AFTER an emergency
Ex: getting financial assistance to help pay for repairs
Recovery/rehabilitation (emergency management cycle)
The best guideline for developing disaster plans is adherence to highest standards of medical practice
Developing disaster plans
An occurrence of a natural catastrophe, technological accident, or human-caused event that has resulted in severe property damage, deaths, and/or multiple injuries
FEMA Disaster Definition
Those caused by environmental forces. The WHO defines “natural disaster” as the “result of an ecological disruption or threat that exceeds the adjustment capacity of the affected community. Natural hazards are the consequence of the intersection of a natural hazard and human activity
Natural disaster
Man-made (human-generated). Those in which the principle direct causes are identifiable human actions, deliberate or otherwise
Anthropogenic disaster
Federal government to integrate all diff. agencies under one unit
Department of Homeland Security
Disaster medical assistance team; a group of professional and paraprofessional medical personnel designed to provide medical care during a disaster or other event. Each team responds rapidly to supplement local resources until other resources can be mobilized or the emergency ends
DMAT
A systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector work together seamlessly and manage incidents involving all hazards- regardless of cause, size, location, or complexity- in order to reduce loss of life, property, and harm to the environment
National Incident Management System (NIMS)
The ability of a hospital to expand care to manage the demand of a sudden dynamic influx of patients
Surge capacity
Hazard identification is used to determine which events are most likely to affect a community and to make decisions about whom or what to protect as the basis of establishing measures for prevention, mitigation, and response
Hazard identification and mapping
Vulnerability analysis is used to determine who is most likely to be affected, the property most likely to be damaged/destroyed, and the capacity of the community to death with the effects of the disaster
Hazard Vulnerability Assessment
Droughts, wildfire, avalanche, winter storm/blizzard, tsunami, hurricane, biological event (virus, pandemic), flood, earthquake
Natural events (type of hazard)
Economic failures, general strikes, terrorism, sabotage, bombs, hostage situation, arson, mass hysteria, etc.
Human events (type of hazard)
Hazardous material release, explosion/fire, transportation accident, building collapse, power or utility failure, extreme air pollution
Technological events (type of hazard)
Mass gatherings, concerts, sporting events, political gatherings, protests
Special events (type of hazard)
Climate change, sea level rise, deforestation, loss of natural resources, intensive urbanization, catastrophic earth changes, extra-terrestrial (e.g. impact, space weather)
Context hazards (type of hazard)
Community’s ability to resist, absorb, recover from, or adapt to an adverse occurrence
Resilience communities
Laws can create certain responsibilities for nurses such as laws that impose civil liability for the failure to provide professionally adequate care
Nurses ethical obligations to family and loved ones may supersede legal obligations depending on the degree of risk to the nurse’s family
Legal Issues in Disaster Response
All healthcare professionals, including nurses, are subject to civil liability for providing substandard healthcare
A nurse may be held liable for providing professional care that is below that standard followed by the profession
Professional Liability
Some states have enacted special legislation which may provide immunity from civil liability for persons when they render care in emergency situations
Good Samaritan Laws
Psychosocial effects can be variable, widespread, and may present differently among different individuals
No one who experiences a disaster is untouched by it
Disaster stress and grief reactions are “normal responses to an abnormal situation”
Psychosocial impacts of disaster
Getting work done through others or directing the performance of one or more people to accomplish organizational goals
Transfer of AUTHORITY and RESPONSIBILITY but retaining ACCOUNTABILITY for the task
NOT assignment- the distribution of work to qualified persons
What is Delegation
Focus on initiatives
Gain trust in staff performance
Earn respect from staff
Improves communication
Achieves goals
Balances workload and time
Decreases stress
Increases productivity
Personal benefits of delegation
Improves level of trust and communication
Achieves goals that require cooperative group effort
Personal and professional development
Increased job satisfaction
Know-how, experience
Increased productivity
Benefits of delegation for staff
Saves money
Increases productivity and efficiency
More motivated staff and improved retention
Organizational benefits of delegation
Determines the SCOPE OF PRACTICE for RNs in each state
RN must understand scope of practice of others on nursing team
Different rules apply in each state and organization for delegation to UAPs
Nurse Practice Act
Items that can/cannot be delegated
Description of professional nursing practice
Description of RN, LPN, and UAP scope of practice
Degree of supervision required to complete a task
Guidelines for lowering delegation risks
Warnings about inappropriate delegation
Essential Elements of Nurse Practice Act
Dependent Practitioners
Must work under the supervision of an RN
Performing tasks and responsibilities within the framework of case finding, health teaching, health counseling, and provision of supportive and restorative care
IN NY, LPNs CANNOT PERFORM ASSESSMENTS INDEPENDENTLY
CANNOT directly push IV meds or administer chemo
LPN Scope of Practice
NAs, CNAs, HHAs, PCTs, MOAs
Can perform in a limited manner some activities that fall within the nursing scope of practice
The supervising RN remains responsible for patient assessment, evaluation, and judgement –> these things cannot be done by UAPs
Non nursing functions: housekeeping, clerical, TRANSPORTATION, dietary
Health-related activities: tasks that do not require professional judgement, or critical thinking
Unlicensed Assistive Personnel
It is a crime to permit unauthorized practice
Class E felony
Delegation in NYS
RNs or LPNs
RNs can delegate to
Other LPNs
LPNs can delegate to
UAPs
RNs and LPNs cannot delegate to
Potential for harm
Condition/stability of the patient
Complexity of the task
Problem solving and innovation required
Unpredictability of outcome
Requires coordination of care (RN, NOT LPN)
Factors to Consider with Delegation
Define the task (complexity and components)
Decide on delegate (match task to individual)
Determine the task (clearly defining expectations)
Reach agreement (empower delegate)
Monitor performance and provide feedback (reward accomplishment)
Delegation Process
One that is delegable for a specific patient
Right task
rights of delegation
Appropriate patient setting, available resources, and other relevant factors considered
Right circumstances
rights of delegation
Right person is delegating right task to be performed on the right person
Right person
rights of delegation
Clear, concise description of the task, including its objective, limits, and expectations
Right direction/communication
rights of delegation
Appropriate monitoring, evaluation, intervention, as needed, and feedback
Right level of supervision
rights of delegation
Feeding (without swallowing precautions)
Drinking
Ambulating/turning
Grooming/dressing
Toileting
Collecting data such as vital signs, intake/output
TRANSPORTATION
Activities that CAN be assigned to UAPs
Assessing, evaluating, or problem solving
Determining a nursing diagnosis
Providing patient education or health counseling
Feeding through NG tube
Administering oxygen
Performing tracheal suctioning or respiratory care
Tasks that CANNOT be delegated to UAPs
Monitoring client findings (as input to RNs assessment)
Reinforcement of client teaching
Tracheostomy care and suctioning
Checking NG tube patency
Medication administration
Tasks that CAN be delegated to an LPN
Assess, evaluate, or problem solve
Administer chemo
Administer direct IV push meds
Administer fluid bolus for plasma volume expansion
Access central lines
Tasks that CANNOT be delegated to an LPN
Under Delegating
Over Delegating
Improper Delegating
Common Delegation Errors
Appraiser lets one or two positive aspects of the assessment of the employee unduly influence all other aspects of the employee’s performance
Halo Effect
Appraiser allows negative aspects of the assessment influence the assessment to the extent that other levels of the job performance are not accurately recorded
Horns Effect
Manager is hesitant to risk the assessment and therefore rates all employees as average
Central Tendency
Employees receive the same appraisal year after year. Those who did well will continue to do well and those who struggled will continue to struggle
Matthew Effect
