Practice Issues; Ethical and Legal Principles; Issues, Trends And Health Policy

Question 1

What are the 3 principles of instruction?

Answer 1

Mentoring/ coaching- instructing patients on disease management, medication management
Role modeling- NP instruct patient in healthy behavior or giving examples of other patient’s good behavior
Counseling
** mentoring/ coaching is similar to counseling

Question 2

What is health literacy? what is average reading level? what level should health information be written at?

Answer 2

the degree to which individuals have the capacity to obtain, process and understand basic health care information and services necessary to make appropriate health care decisions
**single best predictor of one’s health status
Average American adult- 8th grade reading level
Health information should be no higher than 6th-8th grade reading level, (preferably 5th grade reading level)

Question 3

What are goals in acute/ critical care laid out by the Joint Commission?

Answer 3

1. proper ID of patients and relevant health data (blood types)
2. proper staff communication
3. safe use of medications: labeling, proper care when treating patients on anticoagulants, proper knowledge and patient counseling on medication, maintain list of medications and check for possible interactions
4. ensure alarms are audible and responded to in a timely manner
5. Infection prevention: hand hygiene, treatment of resistant infections; using guidelines for prevention of CLABSI, CAUTI, surgical infection
6. prevention of mistakes in surgery- mark surgical area, timeout process every time.

Question 4

What are institutional bylaws?

Answer 4

rules laid out by institution that provide further qualifications, and restrictions on the role of healthcare staff- duties, responsibility and privileges of AGACNPs.

Question 5

Describe resource utilization or healthcare utilization- what are elements/ measures of healthcare utilization in acute care?

Answer 5

How consumers use health care resources and services.
How patients interact with healthcare providers
Length of stay, causes for readmission, causes for hospitalization, preventable hospitalizations, long-term care use, emergency room vs primary care clinic utilization

Question 6

What are elements of “Meaningful Use” with respect to EMR technology utilization?

Answer 6

NPs can use EMR data to….
Improve quality, efficiency, safety
reduce healthcare disparities
engage patients and family members in course of care- MyChart is great example of this
Improve care coordination
Maintain HIPAA- patient privacy and safety of PHI (personal health information)

Question 7

What are ways to establish rapport and professional therapeutic relationships? (5)

Answer 7

1. non-judgmental approach
2. mutual trust
3. professional boundaries
4. confidentiality
5. cultural competency- respect, spiritual needs.

Question 8

What legislation enforced that all patients should be informed of their right to execute an advanced directive?

Answer 8

Patient Self-Determination Act of 1990

Question 9

What does HIPAA stand for? what are the elements of title I and II of the HIPAA legislation?

Answer 9

Health Insurance Portability and Accountability Act
Title I: COBRA: protects health insurance coverage for workers and families when they change or lose their jobs– (comprehensive omnibus reconciliation act)
Title II: **HIPAA THAT WE’RE FAMILIAR WITH: Administration simplification provisions- requires establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers- Office for Civil Rights, under HIPAA, protects individual identifiable health information, sets standards for EMR security, and the Patient Safety Rule- protect identifiable information being used to analyze patient safety events

Question 10

Which types of businesses are required to follow HIPAA?

Answer 10

• “health plans” aka- health insurance companies, government insurance programs
• health care providers
• health care clearinghouses- process nonstandard health information data received from another entity

Question 11

What is included under The Privacy Rule: Patients’ Rights

Answer 11

A patient is allowed to…

• receive a copy of health records, view health records
• have corrections added to health information
• receive information on how their health information is being used or shared
• decide if they want to give permission for sharing PHI for external purposes, such as marketing
• file complaint if rights are being denied or violated

Question 12

What is the Patient Safety and Quality Improvement Act PSQIA?

Answer 12

federal privilege and confidentiality protections for PHI- encourages the reporting and analysis of medical errors

Question 13

Maxillofacial injuries:

What are the Severe Le Fort fractures of the skull- 1, 2, 3

Answer 13

Le Fort 1: Floating palate
Le Fort 2: Floating maxilla
Le Fort 3: Floating face

Question 14

what diseases require mandatory reporting?

Answer 14

STDs: chlamydia, syphilis, gonorrhea

HIV, TB

Question 15

what are other categories of mandatory reporting?

Answer 15

animal bites- contact animal control

child or elder abuse suspected

Question 16

is there mandatory reporting for domestic violence

Answer 16

no, state specific if mandatory reporting required

Question 17

what is Medicare A coverage?

Answer 17

inpatient/ hospitalization, SNFs, home health services, hospice

Question 18

what is Medicare B coverage?

Answer 18

physician services, outpatient hospital services, laboratory and diagnostic procedures, medical equipment, some home health services
supplemental medical insurance- have to pay premium
Medicare pays 80% of bill, patient pays 20%

Question 19

what is Medicare C

Answer 19

A+B= C
Medicare Advantage (prior Medicare+choice)
patients with A and B, are eligible to receive all of health care services through one of the provider organizations under part C: HMOs, PPOs

Question 20

what is Medicare D?

Answer 20

Limited prescription drug coverage: offered by insurance and other private companies; approved by Medicare
monthly premium, co-pay on each prescription
penalty may be applicable if not enrolled when first eligible

Question 21

is incident to billing applicable in hospital setting?

Answer 21

no, NP must bill under their NPI number

Question 22

what is SPO CQI

Answer 22

Continuous Quality Improvement
SPO: Structures- inputs into care such as resources, equipment, numbers and qualifications
Processes: assessments, planning, performing
Outcomes: complications, adverse events, short term results of treatments, long-term results of patient health and functioning

Question 23

what is QSEN? what are 6 key competencies

Answer 23

Quality and Safety Education for Nurses initiative- provide nurses with knowledge, skills and attitude

1. Patient centered care
2. teamwork and collaboration
3. EBP
4. QI
5. Safety
6. Informatics

Question 24

what are CQI steps, as outlined by Joint Commission?

Answer 24

1. Quality planning
2. Delineate scope of care
3. Establish thresholds for evaluation related to indicators
4. Collect and organize data
5. Evaluate care when thresholds are reached
6. Take action to improve care
7. Assess effectiveness of action and document improvement
8. Communicate relevant information