practice issues Flashcards
a former pt of an NP is writing blog posts, sending emails and accusatory statements about NP practice - what form of defamation is this
libel
MRT
multidisciplinary response teams
rapid response
institutional disaster
CPOT
critical care pain observation tool
assessed pain in critical care
1. facial expression
2. body movements
3. muscle tension
4. compliance with vent OR vocalization
score 0-8
four features of CAM-ICU
confusion assessment method for ICU
1. acute onset of mental status changes
2. inattention
3. disorganized thinking
4. altered LOC
conducted daily at least
which alternative therapy my be used with Parkinsons
tai chi
goals of technology in nursing
enhance scope of practice & EVP , make practice knowledge-driven
benchmarking
comparison and measurement of a healthcare organizations services against other national healthcare organizations
four core principles of benchmarking
maintaining quality
improving customer satisfaction
improving patient safety
continuous improvement
what score indicates riks of falling with get up and go test
> 3 indicating risk of falling
5 components of establishing rapport
nonjudgmental approach
mutual trust
professional boundaries
confidentiality
culture competency
what makes up culture competency
respect
spiritual needs
a written statement of patients intent regarding medical treatment is what
advance directive
title I of HIPPAA
protects health insurance coverage when loose job (COBRA)
who enforces HIPPA
office of Civil Rights (OCR)
how do you start any change
begin at the most local level - begin at hospital then community then region then state then national
goals of healthy people 2030
increase quality and years of healthy life
eliminate health disparities among americans
reporting statues
criminal acts and injury from dangerous weapon (police)
Department of Health: gonorrhea, chlamydia, syphilis, HIV, TB, COVID
animal bites (animal control)
suspected or actual child/elder abuse (police via social service)
sets the standard for reimbursement and cutting costs
medicare
problem focused exam
limited exam of affected body area or organ system
expand problem focused
limited exam of affected body area/organ system and any other symptomatic or related body area/organ system
detailed exam
extended exam of affected body area/organ and another symptomatic or related body area/organ
comprehensive exam
general multi- system exam or compete exam of single organ system and other symptomatic or related body area
this portion of medicare covers inpatietn/hospitalization and related services with inpatient event
medicare A
medicare B
covers physician services, outpatient hospital services, lab/diagnostic procedures, medical equipment and home health
part bath pays NPs and clinical nurse specialists
NPs are reimbursed how by medicare
receive 85% of physician reimbursement
medicare C
A+B = C
pts with a and b are eligible to receive health acer through one of the provider organizations
this portion of medicare covers drugs
medicare D - monty premium required
to qualify to be a medicare provider NP must have what
hold state license
be certified by recognized national certifying body
hold at least MSN degree
these benefits vary from state to state
medicaid
a management process of monitoring, evaluating, continuous review, and improving the quality in providing health care
quality assurance (QA)/QI/continuous process improvement (CPI)
quality assurance
process for evaluating the care of patients using established standard of care to ensure quality
FIFE
model to use when interviewing pt about condition
Feelings - fears/concerns regarding condition
Ideas- pts understanding of nature/cause of condition
Functioning- how the quality of life is effected
Expectations - what the pt thinks/hopes might happen with course of treatment
QSEN initiative
quality and safety education for nurses initiative - providing future nurses with knowledge, skills and attitude necessary to ensure continuous improvement in quality and safety in respective healthcare systems
six key competencies of QSEN
patient centered care
teamwork and collaboration
EBP
QI
safety
informatics
pt is having diarrhea as side effect of tube feedings - how do you manage
decrease osmolality of tube feeding
strongest method to evaluate teaching is what
returned demonstration
what qualifies a pt for hospice
terminal dx with < 6 months to live and only receive comfort measures
pt needs helps with ADLS what needs to be consulted
SNF
case management
mobilize, monitor, and control resources that a pt uses during a course of an illness while balancing quality and cost
which two forms of medicare require pt to pay something
B and D
CQI
continuous process improvement
quality can be improved by continually monitoring structure, process and outcome standards
components of monitoring for CQI
care quality
care appropriateness
effectiveness of care
cost of care
self - regulation
peer review
6 key copentenczies of QSEN
patient centered care
teamwork and collaboration
EBP
QI
safety
informatics
a tool for identifying prevention strategies to ensure safety
root cause analysis
scope of practice
based on state
delineated by individual state nurse practice act of each state BON
varies state to state
state practice acts
authorize BON in each state to establish statutory authority for licensure of RN
credentials
encompass required education, licensure and certification tp practice as a nurse practitioner
minimal level of performance
what mandates accountability
credentials
credentialing is necessary to
ensure that safe health care is provided by qualified individuals
cosplay with federal and state laws relating to APN
established that a person is qualified to perform in professional role
licensure
granted by governmental regulatory body ie state BON
establishes that a person has met standards that signify mastery of knowledge/skills
certification
the most common method of documentation
incident reports
part of risk management
satisfaction surveys
important form for identifying problems before developing into actual incidents or claims ; important to track and analyze just like incident reports
part of risk management
two kinds of medical futility
quantitative
qualitative
quantitative futility
where the likelihood that intervention will benefit the patient is extremely poor
- the number
qualitative futility
where the quality of benefit an intervention will proceed is extremely poor
medical futility
refers to interventions that are unlikely to produce any significant benefit to patient
components of competence
ability to understand, reason, differentiate good and bad and communicate
nonmaleficence
duty to do no harm
utilitarianism
right act is the one that produces the greatest good for the greatest number - triage/mass casualty
beneficence
duty to prevent harm and promote good
justice
duty to be fair
fidelity
duty to be faithful
veracity
duty to be truthful
autonomy
duty to respect an individuals thoughts and actions
4 distinct roles of NP
clinician
consultant/collaborator
educator
researcher
types of nonexperiemental research
descriptive
ex post facto or correlational research
cross sectional
cohort
longitudinal
descriptive research
non experimental
aims to describe situations, experiences, and phenomena as they exist
ex post facto
correlational research
examines relationships between variables
- looks into past to obtain correlation between two things - such as a chart review to compare sepsis rates on surgeons
cross sectional
non experimental
observational study that examines a population with a very similar attribute but differs in one specific variable (such as age)
cohort
non experimental or observational study
retrospective or prospective
compares a particular outcome (such as lung cancer) in groups of people who are alike in many ways but different by a certain characteristic (eg. female nurses who smoke compared to those that don’t)
longitudinal
non experimental
taking multiple measures of a group/population over an extended period of time to find relationships between variables
experimental study
manipulation of variables utilizing randomization and a control group to test the effects of an intervention or experiment
quasi-experimental
involves manipulation of variable but lacks a comparison group or randomization
qualitative
case studies
open-ended questions
field studies
obersvation
ethnographic studies
used to explore phenomena through detailed descriptions of people, events, situations or observed behavior
what is a potential problem of quantitative research
researcher bias
PICOT
framework to answer a clinical-based question
P = patient
I = intervention
C= comparison
o=outcome
t= timing
type 1 error
“false postive”
incorrectly rejecting true null hypothesis
type 2 error
“false negative”
failing to reject null hypothesis which if false
difference between meta-analysis vs. meta synthesis
meta-analysis - quantitive study vs. meta synthesis qualitative
confidence interval
smaller is better
an interval (3.2-3.8) of probability
pts with cancer have 3.2-3.8 episodes of nauseas every 24 hours
standard deviation
average amount of deviation from the mean
68% of sample falls within one SD of mean
level of significance
probability of which the results of analyses are judged to be statistically significant difference between two groups
- the probability of false rejection of the null hypothesis in a statistical test
p< .05
experimental and control groups are considered to be significantly different
95% chance what you are seeing is not due to chance
t-test
statistical test to evaluate the difference in means
reliability
consistency of test to measure the same way over time
validity
degree to which a variable measures what it is intended to measures
-valid to ask
liability
legal responsibility for actions that fail to meet the standard of care resulting gin actual or potential harm
negligence
failure of person to do what a reasonable person would do - resulting in injury
malpractice
failure to render services as another member of same profession would render
-professional misconduct
-unreasonable lack of sill
-illegal/immoral conduct
-other allegations resulting in harm to patient
assult
threat of harm
ex: shaking first in the air
battery
actual harm to a patient
can be done on unconscious person, but assault cannot
defamation
communication that can someone to suffer a damaged reputation - libel or slander
libel
type of defamation that is written
slander
type of defamation that is spoken
sensitivity
true postive
a test identifies those that are positive have the disease
specificty
true negative
test identifies those that do not have disease test negative
incidence
frequency in which disease appears
prevalence
proportion of population that is affected by disease ( %)
primary prevention
prevents development of disease
es: immunizations/vacinations
primordial prevention
in childhood
healthy diet, regular exercise
secondary prevention
screening
early identification
- Pap smear screen, prostate cancer screen, cholesterol screen
tertiary prevention
rehab and restore health
cardiac rehab, PT after stroke
CLAS
culturally and linguistically appropriate services
eliminate racial/ethinic health disparities and improve health
standard 5 CLAS
must offer and provide language assistance services
standard 5 CLAS
must offer and provide language assistance services
standard 6 CLAS
must provide verbal offers and written notices (in their preferred language) informing them of their rights for language services
standard 7 CLAS
must assure competence of language assistance - family/friends should not be the interpreter (except upon request by pt)
