nur225 Flashcards
1
Q
how are health care agency classified
A
- length of stay
- according to ownership
- according to type of care
- mix of services
2
Q
classification by length of stay
A
-In and out stay: stay usually few hours or minutes
Ex: urgent care clinic, clinic visit, er treatment, therapy sessions
-Short stay: provides care to people with acute conditions who require less than 24hrs of care and monitoring
Ex: ambulatory care surgery
-Acute care-patients stay more than 24hrs but less than 30days for care and treatment of acute medical problem
- Longterm care- provides care from 30days to the rest of their lives.
ex. nursing home, rehab(30-90days), long term care nursing
3
Q
classification by ownership
A
-government-county,city,state,federal
ex: bergen pines(county hospital)
bellevue hospital center(city)
veterans(federal)
manhattan psych hosp(ny state)
- non-profit organization: run by all religious groups, philantropic and community organization
- proprietary corp- this is for profit, own by stockholders
- sole proprietorship-individual/family own
4
Q
classification by type of care
A
- acute care-immediate hospitalization,
goal: recovery from illness - long term care acute/long term acute hospital- care provided to stabilized illness but still needing highly skilled care. ex. vent support to care for major unhealed wounds
goal: move down to less extensive or skilled care - subacute care-usually provided in a separate unit of an acute hospital. care provided after initial recovery from the acute illness needing in patient care, but of less frequent and intense basis
- skilled nursing-needing in patient care after subacute care, also the type of care seen in nursing homes or nursing facility
- custodial- also called assisted living. adult home. care is needed because of functional deficit
- hospice care- care provided to terminally ill patients within the 6months period of expected death
goal: relief of symptoms while supporting the patient toward a peaceful death and the family and others in their morning process
ambulatory care:
home care: provided at home
5
Q
classification by mix of services
A
- general/community hospital: med sure/ maternity, all serve plus lab
- tertiary hospital: all of the above plus referral centers for patients with special needs such as level 1 trauma, burns, bone marrow transplant, etc.
- specialty hospital- offers only one type of services, maternity hosp, psych.
6
Q
acute care facilities
A
- hub healthcare
- center for healthcare
- care greater than 24hours but normally less than 30days
- inpatient services-patient admitted less than 30days
7
Q
long term care
A
- long term care facilities provide many types of care
- nursing home provides care for those without the ability to manage ADLs and who need ongoing care
- assisted-living centers provide supportive services to those who can manage most of their own activities of daily living.
- rehab centers assist the individual in returning to the maximum level of independence possible
8
Q
Ambulatory care
A
- healthcare providers offices
- walk in clinics
- provide care on an outpatient basis
- range form simple office cals for common illnesses and health promotion activities such as immunizations to the performance of ambulatory surgery
9
Q
community agencies
A
- public health agencies
- home care agencies
- hospice care
- community mental health centers
- adult day centers
- ambulatory care dialysis centers
10
Q
modern hospital
A
hub center of healthcare delivery system and the community health care, however the move now is towards community based care, and the emphasis is on avoiding or limiting hospitalization
11
Q
factors affecting the development of hospitals
A
- advances in medical sciences
- development of medical technology
- changes in medical education
- growth of health insurance industry
- greater involvement of the government
- emergence of professional nursing
12
Q
Who pays for health care?
A
- personal payment: from your own pocket
- charitable care: free care provided usually by charitable, religious group to people in need, unable to pay
- health insurance plan: usually with co-pay from individuals
- managed care/HMO-system for financing and organizing the delivery of healthcare in which cost are contained by controlling the provision of services
- comprehensive care thats cost effective
- the primary MD is the gatekeeper
- monitors and restricts the use of services by the client
- sees the client first and determines if referral or diagnostic services is needed
- pt needs a referral or prescription first before getting the services
- pt needs pre-authorization payment before care is provided
- based on set of predetermined protocols for treatment
13
Q
Managed care
A
- HMO- health maintenance organizations are the first managed care organizations
- HMO and managed care has built in incentives to emphasize prevent care and avoid costly hospitalization
14
Q
state administered health plans
A
- medicaid is adminsteed from the feds to the state thru CMS
- center for medicare services
- shared by the state and fed government
15
Q
federal administered health plans:
A
-medicare federally funded
PART A- (acute hospitalization)
-pays limited amount of rehab that may occur in nursing home
-it doesn’t pay any longterm or custodial care in nursing home
PART B-(physician and other out patient services
PART D- prescription and is subsidized by Medicare
Medigap- are supplemental insurances that pay to cover the part of the healthcare bill which medicare parts A and B do not
16
Q
Who pays for healthcare(cont.
A
- fee for fee services- each time a service is provided. it is billed for the care recipient(usually 80% insurance, 20% copay)
- PPS or prospective personal payment services- fixed reimbursement amount for all the care required for particular surgical procedure or illness
17
Q
types of prospective payment services
A
- fixed reinbursement amount for all the care required for particular surgical procedure or illness
- DRG and RUG
- DRG: diagnosis related groups
- RUG:resource utilization groups
18
Q
DRG: diagnosis related groups
A
- DRG: diagnosis related groups
- started in 1983
- determined the rates to be paid to medicare PPS by diagnosis
- cost determined by computerized analysis of cost that had been billed for hospitalized individuals in the past and a determination of an average length of stay.
- analysis led to the formation of categories of medical diagnosis that required similar treatment and for which costs are similar
- each DRG had specific length of stay,
- DRG is for acute stay reimbursement
- flat rate per hospitalization(entire hospital stay)
19
Q
RUG:resource utilization groups
A
- categories used to determine prospective payment for nursing home clients
- each RUG represent a group of residents who require similar amount of care and would have a similar cost of daily care
- fixed rate daily.
- daily rates include nursing care,all services,medications,treatments
-CMI- case mix index- the actual daily rate of reimbursement to the nursing home is average for the RUGs for all the residents
20
Q
MDS 3.0
A
- very structured assessment called comprehensive minimum data set
- basis for determining which RUGs a nursing home resident will be assigned for reimbursement purposes
- assessment is done at specific intervals-admission/initial, quarterly, annual
- assessment must be done time, accurately and is submitted electronically, if not done accurately and timely, will greatly affect reinbursement
21
Q
Factors causing health to rise
A
1) cost of tech. and new facilities
2) change patient profile
3) changing patient profile: population of USA as whole is growing older and statistically the elderly have an increased incidence of all chronic illnesses, require healthcare on regular basis, and may depend on medications, treatments and therapies, thus these will increase the budget for healthcare
4) uninsured individuals: all individuals who comes for treatment regardless of their ability to pay must be admitted or attended to
5) other cost: salary increasing of healthcare workers to catch up with inflation and maintenance of the standard of living
22
Q
cost control strategies
A
- limiting hop cost
- preferred provider contrast- use of 3rd party payers. ex supplemental insurance
- PPO- preferred provider org- group of org who are willing to negotiate more successfully with 3rd party payer regarding cost and coverage
- case management- like HMO
- using acuity to determine staffing
- controlling fraud and abuse
23
Q
case management
A
-a technique used to efficiently move an individual requiring major health care services thru the system resulting in more effective use of services and reduced cost, promoting quality cost-effective outcome
24
Q
case manager
A
RN or licensed SW with knowledge of available resources who oversees or a case to ensure that necessary care is instituted promptly and is provided in most cost-effective setting
25
evaluation and accreditation of healthcare agencies
- necessary in order ti maintain standard and quality of care
- meeting the standard of care a certification i is provided
- TJC- the joint commission
- CMS/DOH- medicare/medicaid certification
26
Outcome measures for evaluation
- outcome measures are also quality indicators which are specific measurable aspects of healthcare that shows the effectiveness of the system as a whole. it is use as peer review(comparing a hospital or nursing home to another, or to a national benchmark
- hospital healthcare outcomes(nosocomial infections)
- long term care quality
27
long term care quality measures
- used in long term care facilities as part of the regulatory process
- CMS has identified 14QMs for long term care facilities which serve as a focus for the DOH surveyors
- Quality Measures are data based on MDS 3.0 assessment data
28
quality
evaluated through peer review and the use of outcome measures, including key indicators and individual patient outcome standards
29
complimentary and alternative medicine
-a group of diverse medical and healthcare systems, practices, and products that are not generally considered to be part of conventional medicine.
-medical approaches used in place of conventional medicine.
-complementary is used along with conventional medicine
-cam is used more in women and people with high education
-most often used to treat musculoskeletal conditions or other conditions that involve chronic or recurring pain
-
30
conventional medicine
- allopathy
| - western, mainstream, orthodox, regular medicine, biomedicine
31
1Types of CAM(mind body medicine)
- relaxation exercies
- hypnosis
- meditation
- dance
- prayer
- visualization
- biofeedback
32
2Types of CAM(biologically based practices)
- herbal medicines
- special diets
- food supplements
- vitamin therapy
- biological substances such as bovine and shark cartilage
33
3Types of CAM(manipulative & body based practices)
- chiropractic
- massage therapy
- reflexology
34
4Types of CAM(energy medicine)
- BEM application to body
- radiofrequency hyperthermia
- radiofrequency diathermy
- magnets
- nerve stimulators
- biofields-reiki, therapeutic touch
35
assisting clients who choose alternative health care
- assess safety and effectiveness
- examine the expertise of the therapy practitioner
- investigate service delivery
- research the cost of therapy
- discuss the treatment with your regular healthcare provider
36
cultural competent
developing an awareness of ones own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds, demonstrating knowledge and understanding of the clients culture, accepting and respecting cultural differences, adapting care to be congruent with the client culture.
37
why do healthcare providers need to be cultural competent
- to be effective in establishing rapport with patients
- accurately assess
- develop and implement nursing interventions designed to meet patients needs
38
5 components of cultural competence
1) cultural awareness
2) cultural knowledge
3) cultural skill
4) cultual encounter
5) cultural desire
39
cultural awareness
- self examination and in-depth exploration of ones own professional background
- identification of biases
- possible prejudices when working with specific groups of clients
40
cultural knowledge
- process of seeking and obtain an information base on different cultural and ethnic groups as well as understanding the groups world views
- which will explain how members of a group interpret their illness and how being a member guide their thinking doing and being
41
cultural skill
- ability to collect relevant culture data about patients immediate problem and accurately perform culturally specific assessments
- involves how to perform cultural assessments and culturally based physical assessments
42
cultural encounter
- the process that encourages nurses to engage directly in cross cultural interactions with patient from cultural diverse backgrounds
- directly interacting with such patients will refine or modify existing beliefs about a cultural group and prevent possible stereotyping that may have occured
43
cultural desire
motivation to want to engage in the process of becoming culturally aware, knowledgeable, and skillful and to seek cultural encounters, as opposed to being required to seek such encounters, includes genuine passion to reopen to other, accept and respect differences and be willing to learn fro others as cultural informants
44
early image of nursing that had impeded the development of nursing(FOLK IMAGE)
- folk image
- responsible for nourishing and nuturing the children, caring for elderly, aging family member
- role is passed from generation to the next
- this where caring responsibilities in nursing begin
45
early image of nursing that had impeded the development of nursing(Religious image)
- nursing in this setting were expected to devote their lives to caring and to exhibit selfless commitment based upon their religious faith
- care for sick,poor,orphan,widows,aged,slaves,prisoners,
- various orders were formed
- first nursing military was formed
46
early image of nursing that had impeded the development of nursing(servant image)
- this image greatly influenced the development of nursing as a profession as many capable and desirable persons were unwilling to enter nursing while it had this image
- duties were those bearing children and caring for the home
- hospital care was relegated to uncommon women(prisoner, prostitutes and drunks)
- no status in society
- dark ages of nursing
47
during 17th century
- social reform began in europe
- serveral nursing groups were organized
- this groups gave money, time, and service to the sick and the poor
- visiting them in their homes and ministering to their needs.
- religious image was carried forward
- educational programs developed
- st vincent de paul
- sister of charity
48
florence nightingale era(19th century)
-changed course of nursing
-believed good food, proper sanitation, and clean water is essential for the healing of the wounded soldier
started first scientifically based nursing school
49
st. thomas hospital school of nursing
- first school of nursing based on florence theories and principles
- nurses would be trained in teaching hospitals associated with medical schools and organized for that purpose
- nurses would be selected carefully and would reside in nurses houses designed to encouraged discipline and form character
- the school matron would have final authority over the curriculum, living arrangements, and all other aspects of the school
- the curriculum would include both theoretic material and practical experiences
- the teachers would be paid for their instructions
- records would be kept on the students who would require to attend lectures, take quizzes ,write papers and keep diaries
50
characteristic of early nursing school
-21 single female
-first week of the month call probes
-spent time washing, scrubbing,polishing, stacking
-rules of conduct: rigid, possessed good conduct, good moral, honest, conscientious, obedient, respectful, loyal
-long working hours
-5:30am and ends with a nursing prayer at night
-no standardization of curriculum
no accreditation
-lecture given by MD at 8-9pm by superintendents and their assistants
-7 day work/week
-help needed in the hospital is priority
-lecture was cancelled if patient needed to be cared for
-student lived in nurse dorm- controlled by housemother
attrition was high
51
Florence nightingale
- envinronment/sanitation
- goal of nursing is to put the patient in the best condition for nature to act upon him, primarily by altering the environment
52
Dorothy Orem
- self-care
- nursing is concerned with individuals need for self care action, which is the practice of activities that individuals initiate and perform on their own behalf in maintaining health and well-being
53
Sister Callista Roy
- adaptation
- goal of nursing is the promotion of adaptive responses(those things that have positive influence on health) that are affected by the persons ability to respond to stimuli
- nursing involves manipulating stimuli to promote adaptive responses
54
Martha Roger
- unity human beings
| - look at patient as whole
55
Who approves and accredit nursing programs
NLNAC(National league of nurses accrediting committee)
56
Factors bringing about changes in Nursing Education
- the brown report
- development of national examination standards
- national accreditation of nursing programs
- changes in nursing service
- the report of the surgeons general consultant group on nursing
- the american nurses association position paper
57
Forces for change in nursing education
- incorporation of computer tech in nursing ed
- computer tech in classes
- computer in hospital environment
- establishment of programs that provide for educational mobility
- increase in community based practice experiences
- increase in emphasis on research
- education supporting evidence-based practice
58
ANA-political action committee
-actual lobbyist for the passage of or defeat of bills and supports candidates for public office
