Professional Role Flashcards
(1)
The obligation to help the patient—to remove harm, prevent harm, and promote good (“do no harm”). Acting in the patient’s best interest. Compassionate patient care. The core principle in patient advocacy.
Beneficence
Examples:
- Educating patient with a new prescription about how to take the medication
- Encouraging a patient to stop smoking and enroll in smoking cessation program
- Calling the surgeon to get a prescription for stronger pain medications (a narcotic) for a postsurgical patient who complains of severe pain
(1)
The obligation to avoid harm. Protecting a patient from harm.
Nonmaleficence
Example: A middle-aged woman with osteoporosis wants to be treated with bisphosphonates. The nurse practitioner (NP) advises that the patient is not a good candidate for these drugs because of her past medical history of gastrointestinal (GI) bleeding and peptic ulcer disease (PUD). The NP decides not to prescribe bisphosphonates.
(1)
The obligation to act in a way that is useful to or benefits the majority. The outcome of the action is what matters. It also means to use a resource (e.g., tax money) for the benefit of most. It may resemble justice, but it is not the same concept.
Utilitarianism
Example: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is for only pregnant women and children, not other adults and elderly men. The reason may be that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (e.g., affects the brain growth).
(1)
The quality of being fair and acting with a lack of bias. The fair and equitable distribution of societal resources.
Justice
Example: A homeless alcoholic man without health insurance presents to the ED with abdominal pain. The patient is triaged and treated in the same manner as the other patients who have health insurance.
(1)
The quality or state of being worthy of ethical and respectful treatment. Respect for human dignity is an important aspect of medical ethics. A person’s religious, personal, and cultural beliefs can influence greatly what a person considers “dignified” treatment.
Dignity
Examples:
- Hospital gowns should be secured correctly so that when patients get up to walk, their backs are not visible.
- Foley catheter urine bags should not be visible to visitors so patients are not embarrassed. NPs should move urine bags to the opposite bed rail so that they are not visible to outsiders.
(1)
The obligation to maintain trust in relationships. Dedication and loyalty to one’s patients. Keeping one’s promise.
Fidelity
Example: The relationship between a patient and their healthcare team is important. The primary care NP should try their best to develop a trusting relationship with a patient.
(1)
The obligation to protect the patient’s identity, personal information, test results, medical records, conversations, and other health information. This “right” is also protected by the Health Insurance Portability and Accountability Act (HIPAA), which restricts release of patient information. Psychiatric and mental health medical records are protected information and require separate consent.
Confidentiality
Example: The HIPAA Privacy Rule protects most “individually identifiable health information” in any format (oral, paper, electronic). It is known as protected health information (PHI). The PHI includes demographic information (name, address, date of birth, Social Security number) as well as the individual’s past, present, or future physical/mental health and provision of care.
(1)
The obligation to ensure that mentally competent adult patients have the right to make their own health decisions and express treatment preferences. If the patient is mentally incapacitated (dementia, coma), the designated surrogate’s choices are respected. See later discussion on advance healthcare directives. A mentally competent patient can decline or refuse treatment even if their adult children disagree.
Autonomy
Example: An alert elderly woman who has breast cancer decides to have a lumpectomy after discussing the treatment options with her oncologist. The woman’s daughter tells the NP that she does not want her mother to have the surgery because she thinks her mother is too old. The NP has a duty to respect the patient’s decision. This case is also a good example of the NP acting as the patient advocate.
(1)
Healthcare providers are responsible for their own choices and actions and do not blame others for their mistakes.
Accountability
Example: An NP has an adult male patient with acute bronchitis who complains of acute onset of chest pain. He is diagnosed with pleurisy. The patient goes to the ED and is diagnosed with an acute myocardial infarction (MI). The NP made an error in diagnosis and is held accountable for the decision and actions in a court of law.
(1)
Describes situations in which one person interferes with or overrules the autonomy of another. In healthcare, it occurs when a provider or family member makes decisions for an elderly patient because they “believe” that it is in the patient’s best interest. The opinion (or desire) of the patient is minimized or ignored. The patient is “powerless.”
Paternalism
(1)
The obligation to present information honestly and truthfully. In order for patients to make an informed and rational decision about their healthcare, pertinent information (including “bad” news) should not be withheld or omitted.
Veracity
Example: The mammogram result of a 64-year-old female patient is highly indicative of breast cancer. The patient’s son does not want his mother to know about the results. The NP has a duty to discuss the mammogram results with the patient and refer her to a breast surgeon.
Exam Tip
Become familiar with some of the ethical concepts (e.g., beneficence, veracity, nonmaleficence, justice) and how they are applied (see examples provided in this chapter).
Become familiar with some of the ethical concepts (e.g., beneficence, veracity, nonmaleficence, justice) and how they are applied (see examples provided in this chapter).
(1)
“the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making.”
“is a nonnegotiable standard.”
For example, under Provision 4.4, “Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate selected interventions according to _____ nurse practice acts” (ANA, 2015)
The American Nurse Association ANA Code of Ethics for Nurses
For example, under Provision 4.4, “Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate selected interventions according to state nurse practice acts” (ANA, 2015)
(1)
Legal term: A person who acts as an intermediary (or as a liaison) between the patient and an organization (long-term care facilities or nursing homes, hospitals, governmental agencies, courts). Who investigates and mediates the complaint from both sides and attempts to reach a fair conclusion.
Ombudsman
(1)
An individual who is assigned by a court (and has the legal authority) to act in the best interest of the ward. The ward is usually a person who is a child or someone who is frail or vulnerable. Adults who are incompetent may be assigned a guardian ad litem by the court.
Guardian Ad Litem
(1)
Advance Directive that is a document that contains the patient’s instructions and preferences regarding healthcare if the patient becomes seriously ill or is dying. It contains the patient’s preferences (or not) for aggressive life-support measures. Healthcare providers should ensure that there is a copy of the document in the patient’s chart.
Living Will
(1)
Advanced Directive: The patient designates a person (family member or a close friend) who has the legal authority to make future healthcare decisions for the patient in the event that the patient becomes mentally incompetent or incapacitated (e.g., comatose). Also known as a “healthcare proxy,” “durable medical power of attorney,” or “healthcare surrogate.” Power is only for healthcare decisions (not financial assets).
When does this go into effect?
To be legal, must be signed in presence of?
Healthcare Power of Attorney
It goes into effect when the patient’s doctor has determined that they are physically or mentally unable to communicate in a willful manner.
To be legal, it must be signed in the presence of two adult witnesses who must also sign the document (the designated surrogate cannot act as a witness).
(1)
Advance Directive: A document whereby the patient designates a person (the “agent”) who has the legal authority to make all decisions for the incapacitated patient. The document should be signed and notarized. Also known as the “durable power of attorney.” This role is broader and encompasses not only healthcare decisions but also other areas of the patient’s life, such as those relating to financial affairs.
Power of Attorney
Health Insurance Portability and Accountability Act (HIPAA)
Also known as the “HIPAA _____ Rule” (or Public Law 104–191). The law was passed by the U.S. Congress and enacted in August 1996. The law provides protections for “the u___ and dis_____ of individuals’ health in______”—called “pr_____ health information” by organizations subject to the Privacy Rule, which are called “cov____ entities.”
Also known as the “HIPAA Privacy Rule” (or Public Law 104–191). The law was passed by the U.S. Congress and enacted in August 1996. The law provides protections for “the use and disclosure of individuals’ health information”—called “protected health information” by organizations subject to the Privacy Rule, which are called “covered entities.”
(1)
All healthcare providers, health insurance companies, healthcare plans, laboratories, hospitals, skilled nursing facilities (SNFs), and third-party administrators (TPAs) who electronically transmit health information must follow the HIPAA regulations.
Covered Entities
(1)
The organization that does the processing of claims and administrative work for another company (health insurer, health plan, retirement plan).
Third-Party Administrator (TPA)
HIPAA Requirements (Not Inclusive)
Health providers are required to provide each patient with a ____ of their office’s _____ policy (patient to sign the form).
The HIPAA form must be reviewed and signed _____ by the patient.
A mental health provider has the right to _____ patients’ requests to view their psychiatric and mental health records.
When patients request to review their medical records, the health provider has up to ____ days to comply.
Patients are allowed (under HIPAA) to _____ errors in their medical records.
Providers must keep _______ information (name, date of birth, address, Social Security number) and any diagnosis/disease or health concerns private except under certain conditions (see next flashcard)
Health providers are required to provide each patient with a copy of their office’s HIPAA policy (patient to sign the form).
The HIPAA form must be reviewed and signed annually by the patient.
A mental health provider has the right to refuse patients’ requests to view their psychiatric and mental health records.
When patients request to review their medical records, the health provider has up to 30 days to comply.
Patients are allowed (under HIPAA) to correct errors in their medical records.
Providers must keep identifying information (name, date of birth, address, Social Security number) and any diagnosis/disease or health concerns private except under certain conditions (see list that follows)
When Patient Consent Is Not Required
To contact the health plan/_______ company that is paying for the medical care
To contact a ______ party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor’s office hires to assist in payment of their services (e.g., medical billing services)
To perform certain healthcare operations (medical services review, sale of healthcare plan, audits)
To contact _______ agency for unpaid bills
To report ______/neglect or domestic ______
To con_____ with other healthcare providers
To contact the health plan/insurance company that is paying for the medical care
To contact a third party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor’s office hires to assist in payment of their services (e.g., medical billing services)
To perform certain healthcare operations (medical services review, sale of healthcare plan, audits)
To contact collection agency for unpaid bills
To report abuse/neglect or domestic violence
To consult with other healthcare providers
HIPAA Case Scenario
- If a staff member (who is not involved in the patient’s care) calls the attending NP and wants to discuss a patient’s progress, can the NP discuss it with this staff member?
- How to communicate results of lab tests or procedures?
- The NP cannot release information to the staff member.
- The Rule “does not prohibit us from leaving messages for patients on their answering machines,” however, we must “reasonably safeguard” their privacy. It is prudent to avoid leaving messages about lab results, medication names, or types of tests in the patient’s voicemail. Leave the clinic name (exceptions exist), your name, and phone number for the patient to contact you.
HIPAA and Patient Care Situations
- Putting patient charts on door box
- Having sign-in sheets on front desk
- Calling a patient in the waiting room to go inside the clinic exam room
- Leaving messages on voice mail
- Having a colleague who works in same clinic or hospital call, wanting information about a patient’s progress
-
Putting patient charts on door box
- Place the chart so that the front of the chart is facing the door (so that patient name is hidden)
- Limit access to certain areas; ensure area is supervised.
-
Having sign-in sheets on front desk
- This is allowed if it does not list patient’s diagnosis.
- Attendance list can show names, dates, and time
-
Calling a patient in the waiting room to go inside the clinic exam room
- Use only first name. If more than one person with same first name, use the first letter of last name.
- If you have two patients named Ann (e.g., Ann Lee and Ann Smith), use Ann L. and Ann S.
-
Leaving messages on voice mail
- When calling, first provide your name and contact information. Be concise. Limit to 60 seconds. Maximum of three calls per week.
- Information that can be given may include appointment reminders, notifications about prescriptions, and preoperative and postoperative instructions.
- Avoid leaving messages about lab results, diagnosis, or other sensitive information on the patient’s voicemail.
-
Having a colleague who works in same clinic or hospital call, wanting information about a patient’s progress
- If staff member is not part of the healthcare team, no patient information can be released to that person.
- HIPAA also does not allow such a person to access a friend’s or family member’s records without permission.
HIPAA and Patient Care Situations
What are special considerations in each of these scenarios?
- Having a family member call, wanting information about a patient’s progress
- Having inappropriate access of health information on the computer - ie family member in the hospital?
- Using personal devices (smartphones, laptops, tablets) at work
- Discussing a patient’s drugs and other instructions with a health aide who is with the patient
- Discussing patient’s treatment in front of a patient’s friend who is visiting
-
Having a family member call, wanting information about a patient’s progress
- Put on hold and tell patient about the call. If patient gives permission, you can speak with the family member.
- If patient does not consent, then advise the family member about the patient’s decision. Do not release patient information.
-
Having inappropriate access of health information on the computer
- Viewing the records of your relatives, friends, or coworkers is an HIPAA violation
- Do not allow someone to use your computer password.
-
Using personal devices (smartphones, laptops, tablets) at work
- Ideally, it is best to avoid using personal devices at work.
- Requirements: Secure Wi-Fi with passwords, regular encrypted backups, antivirus software, policies, etc
- If you want to use a personal device, discuss it with your manager and/or consult information technology. Best practice is to use the facility’s or clinic’s devices.
-
Discussing a patient’s drugs and other instructions with a health aide who is with the patient
- Discussing information is allowable.
- If patient has the capacity to make healthcare decisions, discussing information is allowable
-
Discussing patient’s treatment in front of a patient’s friend who is visiting
- Discussing treatment with the patient’s friend is allowable if the patient gives consent or requests that the friend come inside the treatment room
- Discussing patient information with others is allowable if patient agrees to it.
HIPPA, Psychotherapy, and Mental Health Records
Are psych records treated the same as other medical records?
What should you do with psych records?
A ______ consent form is needed to release psychotherapy records.
Exceptions include? (2)
Psychotherapy records made by a mental health professional are treated differently under HIPAA.
They should be separated from the patient’s other medical records.
A separate consent form is needed to release psychotherapy records.
The exceptions are mandatory reporting of abuse and “duty to warn” when the patient threatens serious and imminent harm to others. “In situations where the patient is given an opportunity and does not object, HIPAA allows the provider to share or discuss the patient’s mental health information with family members or other persons involved in the patient’s care or payment for care” (U.S. Department of Health and Human Services, 2017).
HIPAA and Minors
Can parents obtain medical records of minors without the minor’s consent?
If you need authorization to release the minor’s medical record, who must sign for that authorization? Exceptions include what type of minors?
The health records of a minor (by law, an individual younger than 18 years of age) can be released to parents or legal guardians without the minor’s consent.
If authorization is needed to release a minor’s medical record, the parent or legal guardian must sign for it (except for emancipated minors). Emancipated minors can sign their own legal documents.
Exam Tips
Become familiar with how HIPAA is applied in real life. Study the HIPAA case scenarios
Is it a HIPAA violation to leave any laboratory results on a patient’s voicemail?
Understand the role of an ombudsman, guardian ad litem, and others who act on behalf of a patient.
(1) the organization that does the processing of claims and administrative work for another company (health insurer, health plan, retirement plan).
Become familiar with how HIPAA is applied in real life. Study the HIPAA case scenarios
It is a HIPAA violation to leave any laboratory results on a patient’s voicemail.
Understand the role of an ombudsman, guardian ad litem, and others who act on behalf of a patient.
- Obudsman = liaison/intermediary between patient and organization ie hospital (mediates complaints from both sides)
- Guardian Ad Litem = guardian assigned by court (has legal authority) usually for incompetent adults/children/frail/vulnerable
A TPA (Third Party Administrator) is the organization that does the processing of claims and administrative work for another company (health insurer, health plan, retirement plan).
The Affordable Care Act (2010)
This national health insurance legislation, officially known as the Patient ______ and Affordable Care Act (ACA) and unofficially nicknamed Obamacare, was signed by President Obama in March 2010 (and upheld by the U.S. Supreme Court in 2012),
With the goal of expanding health insurance for the millions of Americans who were then ___insured.
It expanded health coverage through various provisions (e.g., allowing adult children younger than age ___to be insured under their parents’ healthcare insurance).
This comprehensive reform of U.S. health insurance law prohibits an insurance company from rejecting people with ___existing health conditions.
There is also a _____ for employers (and individuals) who choose not to participate in the national health plan.
Although increased numbers of Americans gained insurance as a result of the law’s passage, many millions more still ____ coverage.
This national health insurance legislation, officially known as the Patient Protection and Affordable Care Act (ACA) and unofficially nicknamed Obamacare, was signed by President Obama in March 2010 (and upheld by the U.S. Supreme Court in 2012),
With the goal of expanding health insurance for the millions of Americans who were then uninsured.
It expanded health coverage through various provisions (e.g., allowing adult children younger than age 26 to be insured under their parents’ healthcare insurance).
This comprehensive reform of U.S. health insurance law prohibits an insurance company from rejecting people with preexisting health conditions.
There is also a penalty for employers (and individuals) who choose not to participate in the national health plan.
Although increased numbers of Americans gained insurance as a result of the law’s passage, many millions more still lack coverage.
(1)
This act provides for the continuation of coverage of preexisting group health insurance (from the employer) for workers and their families who lose their coverage (between jobs, quit job, or are fired) for a fixed period of time.
How long does this coverage last?
“COBRA” Consolidated Omnibus Budget Reconciliation Act of 1985
COBRA coverage is generally offered for 18 months (up to 36 months in some cases)
Managed Care
(2)
“managed healthcare plans.”
HMOs health maintenance organizations
PPOs preferred provider organizations
Health Maintenance Organizations (HMOs)
Patients are assigned a (1), who is the “gatekeeper.” The patient has a set “_____” per visit, and the participating physician/health provider is paid a ____ fee (per patient) monthly. The physician receives a _____ check from the HMO.
- Specialist/consultant:* The PCP must first ____ the referral. The patient is l_____ to seeing the physicians/specialists who are enrolled in the HMO’s ___work.
- “____-of-network physicians” or ____ referred by the PCP:* The visit may not be covered, or it will be reimbursed at a lower rate.
Patients are assigned a primary care provider (PCP), who is the “gatekeeper.” The patient has a set “copay” per visit, and the participating physician/health provider is paid a set fee (per patient) monthly. The physician receives a monthly check from the HMO.
- Specialist/consultant:* The PCP must first approve the referral. The patient is limited to seeing the physicians/specialists who are enrolled in the HMO’s network.
- “Out-of-network physicians” or not referred by the PCP:* The visit may not be covered, or it will be reimbursed at a lower rate.
Preferred Provider Organization
The patient can visit any provider in the network _____ a referral.
____ assigned a PCP (as in HMOs).
The patient can ______ their own PCP.
____ referral is needed to see a specialist who is part of the PPO panel.
PPOs are usually ____ expensive than HMOs.
The patient can visit any provider in the network without a referral.
Not assigned a PCP (as in HMOs).
The patient can choose their own PCP.
No referral is needed to see a specialist who is part of the PPO panel.
PPOs are usually more expensive than HMOs.
Medicare and Medicaid
Both Medicare and Medicaid programs are under the aegis of the (1) (CMS). The CMS is one of the agencies under the U.S. (1) (DHHS).
Both Medicare and Medicaid programs are under the aegis of the Centers for Medicare & Medicaid Services (CMS). The CMS is one of the agencies under the U.S. Department of Health and Human Services (DHHS).
Medicare Part A (Inpatient Hospitalization)
“Automatic” at age ___ if the person paid the pr_____ (automatically deducted from paycheck by the employer).
If the person never paid the premiums (e.g., full-time housewife), the person is ___eligible for Medicare coverage.
Also covers persons with (1) diseases at any age.
Certain religious groups (e.g., Amish, Mennonites) do ____participate in Medicare.
“Automatic” at age 65 if the person paid the premiums (automatically deducted from paycheck by the employer).
If the person never paid the premiums (e.g., full-time housewife), the person is not eligible for Medicare coverage.
Also covers persons with end-stage renal diseases at any age.
Certain religious groups (e.g., Amish, Mennonites) do not participate in Medicare.
- Medicare Part A Covers*
- these “medically necessary” services*
(4)
Medicare Part A will not pay for ____ care ((2) homes).
“medically necessary” services
Inpatient hospitalization (including inpatient psychiatric hospitalization)
Hospice care
Home healthcare
SNF care
Medicare Part A will not pay for custodial care (nursing homes, retirement homes).
Medicare Part B (Outpatient Insurance)
Medicare Part B is a ____ program with ____ premiums. One must enroll during the “general ______ period.”
Medicare Part B is a voluntary program with monthly premiums. One must enroll during the “general enrollment period.”
- Medicare Part B Covers*
- Will pay for the following “medically necessary” services:*
- ___patient visits (including walk-in clinics, urgent care clinics, ED visits)
- L_____ and other types of tests (EKG, x-rays, CT scans)
- (1)*
- “______ opinions” with another physician (surgery)
- Kidney ______ (outpatient), self-dialysis equipment/supplies, organ transplants, and many others
- _______ service for emergency care or transportation to a hospital or SNF if transport in any other vehicle will endanger patient’s health
- Outpatient visits (including walk-in clinics, urgent care clinics, ED visits)
- Laboratory and other types of tests (EKG, x-rays, CT scans)
- Durable medical equipment*
- “Second opinions” with another physician (surgery)
- Kidney dialysis (outpatient), self-dialysis equipment/supplies, organ transplants, and many others
- Ambulance service for emergency care or transportation to a hospital or SNF if transport in any other vehicle will endanger patient’s health
Medicare Part B DOES NOT pay for:
- Most ___glasses and ____ exams (except following cataract surgery that implants an intraocular lens)
- ______ aids
- Most d_____ and d_____ care
- Cosmetic ______ surgery (unless it is medically necessary)
- (1) drugs and most (1) drugs*
- Most eyeglasses and eye exams (except following cataract surgery that implants an intraocular lens)
- Hearing aids
- Most dentures and dental care
- Cosmetic plastic surgery (unless it is medically necessary)
- Over-the-counter drugs and most prescription drugs
Medicare Part B does pay for some health prevention services:
- Abdominal aortic ______ screening
- I______ shots once a year and P_____ and P____ 13 (each once in a lifetime)
- Screening m______ (once every 12 months for women age 40+)
- Hepatitis __ vaccine series for individuals at medium or high risk
- Hepatitis ___ screening if high risk
- Screening c_______ or flexible sigmoidoscopy (age 50 years or older) every 10 years if low risk
- Routine P_____ smears (once every 2 years or once every 12 months for women at high risk)
- (1) screening (digital rectal exam [DRE] and prostate specific antigen [PSA] once a year after age 50)
- Abdominal aortic aneurysm screening
- Influenza shots once a year and Pneumovax and Prevnar 13 (each once in a lifetime)
- Screening mammogram (once every 12 months for women age 40+)
- Hepatitis B vaccine series for individuals at medium or high risk
- Hepatitis C screening if high risk
- Screening colonoscopy or flexible sigmoidoscopy (age 50 years or older) every 10 years if low risk
- Routine Pap smears (once every 2 years or once every 12 months for women at high risk)
- Prostate cancer screening (digital rectal exam [DRE] and prostate specific antigen [PSA] once a year after age 50)
Medicare Part B does pay for some health prevention services:
- (1) testing allowed once every 24 months if at risk for osteoporosis, taking prednisone, taking bisphosphonate therapy to monitor progress
- H____screening; ______ transmitted disease/infection screenings covered once every 12 months
- Ph_____ exams (once a year)
- ______-cessation counseling and treatment
- A_____misuse screening and counseling
- D_____ screening (twice yearly if at risk)
- C_______ disease screening
- Bone density testing allowed once every 24 months if at risk for osteoporosis, taking prednisone, taking bisphosphonate therapy to monitor progress
- HIV screening; sexually transmitted disease/infection screenings covered once every 12 months
- Physical exams (once a year)
- Smoking-cessation counseling and treatment
- Alcohol misuse screening and counseling
- Diabetes screening (twice yearly if at risk)
- Cardiovascular disease screening
Medicare Advantage (Medicare Part C)
Covers (2) and some (1)
Administered by what type of insurance?
Medicare Advantage Plans cover both inpatient care (Part A) and outpatient care (Part B), and some plans cover some prescription drugs.
They are administered by private health insurance companies approved by Medicare.
Medicare Part D
=
- Who is eligible for Medicare Part D?
- One type of Part D coverage is called the Medicare _____ (MA) plan.
- All prescription drug plans have a list of ______ drugs (the f______). If a (1) drug is used, it may not be covered, and the patient has to pay for it “____of pocket.”
Medicare prescription drug benefit
- Only individuals who are enrolled (or eligible) for Medicare Part A and/or Part B are eligible.
- One type of Part D coverage is called the Medicare Advantage (MA) plan.
- All prescription drug plans have a list of preferred drugs (the formulary). If a nonformulary drug is used, it may not be covered, and the patient has to pay for it “out of pocket.”
Medicaid
Authorized by Title XIX of the (1) Act. A federal and state matching program.
Provides health insurance coverage for (1) individuals and their families who meet the federal _____-level criteria.
Covers children, pregnant women, adults, seniors, and individuals with dis_____ (e.g., blindness).
Pays for (1) and (1).
Currently, Medicaid is the single largest payer for ____ health services in the United States. It covers care offered by _____ use disorder and ______ planning services (including contraception) as well as by maternal and infant health programs.
Authorized by Title XIX of the Social Security Act. A federal and state matching program.
Provides health insurance coverage for low-income individuals and their families who meet the federal poverty-level criteria.
Covers children, pregnant women, adults, seniors, and individuals with disabilities (e.g., blindness).
Pays for healthcare and prescription drugs.
Currently, Medicaid is the single largest payer for mental health services in the United States. It covers care offered by substance use disorder and family planning services (including contraception) as well as by maternal and infant health programs.
Children’s Health Insurance Programs
The Children’s Health Insurance Program (CHIP) and the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) covers who?
Cover uninsured children (infancy to adolescents) and pregnant women.
(1)
Usually experienced RNs who act as coordinators for the outpatient management of patients with certain diagnoses, usually chronic, resource-intensive diseases (e.g., asthma [children], chronic obstructive pulmonary disease [COPD], chronic heart failure, diabetes). The process is called (1). Mainly done by (1).
Case Managers
Usually experienced RNs who act as coordinators for the outpatient management of patients with certain diagnoses, usually chronic, resource-intensive diseases (e.g., asthma [children], chronic obstructive pulmonary disease [COPD], chronic heart failure, diabetes). The process is called case management. Case management is mainly done by telephone.
Patient-Centered Medical Home
Patient-centered medical home (PCMH) is a healthcare delivery model that is also known as the ____ care medical home. It is another way to deliver _____-centered primary care.
In PCMH, the p____ and f_____ are considered important members of the healthcare team. Most of the patient’s healthcare needs are taken care of in the _____ setting.
Other _____ members may include physicians, advanced practice nurses, physician assistants (PAs), nurses, pharmacists, nutritionists, social workers, educators, and care coordinators.
Patient-centered medical home (PCMH) is a healthcare delivery model that is also known as the primary care medical home. It is another way to deliver patient-centered primary care.
In PCMH, the patient and family are considered important members of the healthcare team. Most of the patient’s healthcare needs are taken care of in the home setting.
Other team members may include physicians, advanced practice nurses, physician assistants (PAs), nurses, pharmacists, nutritionists, social workers, educators, and care coordinators.
Patient-Centered Medical Home
Delivery of healthcare is coordinated to ensure smooth ______ between home and the h_____, home health agency, and community services.
The patient and/or family has _____ access to a member of the team by ______, video chat, or email.
Delivery of healthcare is coordinated to ensure smooth transition between home and the hospital, home health agency, and community services.
The patient and/or family has 24-7 access to a member of the team by phone, video chat, or email.
(1)
Program that involves monitoring, identifying problems, measuring outcomes, and establishing new parameters for improved performance.
The goal of these programs is to improve the _____ of care, decrease complications, decrease hospitalizations, lower patient m______, decrease s_____ errors, and increase patient s______.
Patient out______ are important indicators of a health system’s quality.
Quality-Improvement Programs
The goal of these programs is to improve the quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, and increase patient satisfaction.
Patient outcomes are important indicators of a health system’s quality.
Risk Management in Healthcare
Risk management is an important aspect of ______-improvement/quality-assurance programs in the healthcare setting.
It is the s______ organizational process used to identify _____ practices to minimize ______ patient outcomes and corporate l______.
For example, high-risk areas that are usually checked by risk managers are medication _____, _____-acquired infections, patient id______ problems, and f_____. Risk management promotes s____ and effective patient care practices.
Risk management is an important aspect of quality-improvement/quality-assurance programs in the healthcare setting.
It is the systematic organizational process used to identify risky practices to minimize adverse patient outcomes and corporate liability.
For example, high-risk areas that are usually checked by risk managers are medication errors, hospital-acquired infections, patient identification problems, and falls. Risk management promotes safe and effective patient care practices.
(1)
A voluntary process through which a nongovernmental association evaluates and certifies that an organization (e.g., hospital, clinic, nursing program) has met the requirements and excels in its class.
Accreditation
For example, the American Nurses Credentialing Center and the National League for Nursing Accrediting Commission are accreditation organizations.
(1)
An independent, not-for-profit organization that accredits healthcare organizations (hospitals, nursing homes, home care, laboratories) via inspection and evaluation of their facilities (charged a fee).
Achieving this certification means that a facility has met or surpassed the organization’s strict requirements. The purpose of the accreditation process is to enhance quality of care and patient safety.
The Joint Commission
(1)
A patient safety event (not primarily related to the natural course of the patient’s illness or condition) that results in any of the following: death, permanent harm, and/or severe temporary harm with intervention required to sustain life.
When an event like this occurs what is the healthcare organization expected to?
_______ organizations are strongly encouraged but are not required to report SEs to the (1).
Sentinel Event
When an SE occurs, the healthcare organization is expected to conduct a root cause analysis (RCA), make improvements to reduce risk, and monitor effectiveness of the improvements.
Accredited organizations are strongly encouraged but are not required to report SEs to the TJC.
Examples of Sentinel Events
S______ that occurs while receiving care in a staffed around-the-clock facility or within 72 hours of discharge
Unanticipated d_____ of an infant or discharge of infant to the _____ family
R____ or ass_____ of a staff member, visitor, or vendor
Invasive procedure on the _____ patient, the wrong procedure is done on a patient, or the procedure is done to the wrong l_____
Unintended retention of a ______ object
F____, flame, or unanticipated smoke or heat during an episode of patient care
- Suicide that occurs while receiving care in a staffed around-the-clock facility or within 72 hours of discharge
- Unanticipated death of an infant or discharge of infant to the wrong family
- Rape or assault of a staff member, visitor, or vendor
- Invasive procedure on the wrong patient, the wrong procedure is done on a patient, or the procedure is done to the wrong limb
- Unintended retention of a foreign object
- Fire, flame, or unanticipated smoke or heat during an episode of patient care
(1)
A structured, facilitated team process used in healthcare to identify the contributing factors that result in an error. The TJC has mandated the use of this to analyze (1). The gathered data are analyzed for the root causes (usually a combination of h____, en______, and s_____ factors). The goal is to identify the system breakdowns that resulted in an inadvertent mistake and to propose at least one c______ action to reduce or eliminate each root cause. The focus is on the ____ and not on _____ individuals.
Done for what?
Root Cause Analysis
A structured, facilitated team process used in healthcare to identify the contributing factors that result in an error. The TJC has mandated the use of this to analyze SEs. The gathered data are analyzed for the root causes (usually a combination of human, environmental, and system factors). The goal is to identify the system breakdowns that resulted in an inadvertent mistake and to propose at least one corrective action to reduce or eliminate each root cause. The focus is on the system and not on blaming individuals.
Sentinel Events
(1)
Refers to analysis and tracking of patient outcomes by using outcome measures such as surveys and questionnaires.
Outcomes Analysis
Hospice
The majority of hospice care in the United States takes place in patient’s ____ (59% die in their own homes).
The goal is p_____ care, not curative care.
Ensuring the patient’s _____ of life and c_____ are the ultimate goals of hospice care.
Hospice care is available for both pediatric and adult patients.
An inter_______ team provides hospice care. This team usually consists of the patient’s primary physician, hospice physician, RN, nursing assistants, therapists, social workers/grief counselor, and clergy.
Hospice staff are on call ____ hours a day.
They provide gr____-and-l____ counseling for patients and family members.
The majority of hospice care in the United States takes place in patient’s homes (59% die in their own homes).
The goal is palliative care, not curative care.
Ensuring the patient’s quality of life and comfort are the ultimate goals of hospice care.
Hospice care is available for both pediatric and adult patients.
An interdisciplinary team provides hospice care. This team usually consists of the patient’s primary physician, hospice physician, RN, nursing assistants, therapists, social workers/grief counselor, and clergy.
Hospice staff are on call 24 hours a day.
They provide grief-and-loss counseling for patients and family members.
Hospice
Hospice is covered under Medicare Part __, Medi_____, and most health insurance plans.
Are hospice patients allowed to have physical therapy (PT), occupational therapy (OT), and speech therapy?
Hospice is covered under Medicare Part A, Medicaid, and most health insurance plans.
Hospice patients are allowed to have physical therapy (PT), occupational therapy (OT), and speech therapy if prescribed
Eligibility Criteria for Hospice
=
Patient is rapidly de_____ or exhibits w_____ symptoms.
Patient needs ______ with two or more activities of (1)
Patient accepts p_______ care, not curative care. If they do not ____ to be in hospice (even if all criteria are met), then patient is not eligible.
Hospice physician and the patient’s physician certify that the patient is terminal and has 6 months (or less) to live. The hospice physician approves of admission.
Patient is rapidly declining or exhibits worsening symptoms.
Patient needs assistance with two or more activities of daily living (ADL).
Patient accepts palliative care, not curative care. If they do not want to be in hospice (even if all criteria are met), then patient is not eligible.
Examples of _____ Conditions
- Metastatic cancers (e.g., lung cancer, colon cancer)
- End-stage lung disease (e.g., COPD)
- End-stage heart disease (e.g., congestive heart failure [CHF] class III or IV)
- End-stage liver disease
- HIV/AIDS with comorbidities and refusal/discontinuation of antiretrovirals
- End-stage renal disease with plan to discontinue dialysis
- Amyotrophic lateral sclerosis, Parkinson’s disease, stroke, coma
- End-stage dementia (e.g., Alzheimer’s disease)
Examples of Terminal Conditions
- Metastatic cancers (e.g., lung cancer, colon cancer)
- End-stage lung disease (e.g., COPD)
- End-stage heart disease (e.g., congestive heart failure [CHF] class III or IV)
- End-stage liver disease
- HIV/AIDS with comorbidities and refusal/discontinuation of antiretrovirals
- End-stage renal disease with plan to discontinue dialysis
- Amyotrophic lateral sclerosis, Parkinson’s disease, stroke, coma
- End-stage dementia (e.g., Alzheimer’s disease)
(1)
Short-term care for the primary caregiver that is reimbursed by Medicare. This gives the primary caregiver a break, even if it is only a few hours. For example, gives the caregiver a chance to go see a movie and to “relax” and rest.
Respite Care
Human Genetic Symbols
The exam may include questions about genetic symbols,
Healthy male =
Disease/affected male =
Healthy female =
Disease/affected female =
Dead person =
Healthy male = empty square
Disease/affected male = filled square
Healthy female = empty circle
Disease/affected female = filled circle
Dead person = diagonal dash across symbol
Exam Tips
A patient may meet the criteria for hospice admission, but if the patient refuses hospice care, then the patient is ____ eligible.
If the patient meets the criteria for hospice care, Medicare Part ___ will reimburse hospice.
Medicare Part ___ will pay for an ambulance for emergency care. If transport in any other vehicle will endanger the patient’s health, transport by ambulance is allowed.
Does Medicare Part B reimburse for dentures, eyeglasses, or hearing aids?
(1) is a law that allows a person to continue group health insurance coverage from a job even if they have quit (the individual has to pay the insurance premiums).
Is separate consent required for entities that pay or process the patient’s health bills, such as health insurance companies, HMOs, medical billers, or collection agencies (or third-party contractors hired by the company to pay or to process claims)?
A patient may meet the criteria for hospice admission, but if the patient refuses hospice care, then the patient is not eligible.
If the patient meets the criteria for hospice care, Medicare Part A will reimburse hospice.
Medicare Part B will pay for an ambulance for emergency care. If transport in any other vehicle will endanger the patient’s health, transport by ambulance is allowed.
Medicare Part B does not reimburse for dentures, eyeglasses, or hearing aids.
COBRA is a law that allows a person to continue group health insurance coverage from a job even if they have quit (the individual has to pay the insurance premiums).
No separate consent is required for entities that pay or process the patient’s health bills, such as health insurance companies, HMOs, medical billers, or collection agencies (or third-party contractors hired by the company to pay or to process claims).
Exam Tips
The “(1)” is a method of primary healthcare delivery. Healthcare providers and therapists (physical, occupational, speech) deliver care in the patient’s home, with the family. These patients have chronic long-term illness. To communicate, technology is used, such as phone, video chat, or email.
Use common sense in answering questions on quality improvement and risk management. Keep in mind the goals of these processes: to improve the _____of care, decrease com______, decrease hos______, lower patient m______, decrease s_____errors, and increase patient s_______. Look for the answer that fits these goals.
Learn the human genetic symbol for a diseased (or affected) male and female =
The “medical home” is a method of primary healthcare delivery. Healthcare providers and therapists (physical, occupational, speech) deliver care in the patient’s home, with the family. These patients have chronic long-term illness. To communicate, technology is used, such as phone, video chat, or email.
Use common sense in answering questions on quality improvement and risk management. Keep in mind the goals of these processes: to improve the quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, and increase patient satisfaction. Look for the answer that fits these goals.
Learn the human genetic symbol for a diseased (or affected) male and female = filled in square (diseased male), filled in circle (diseased female)
The Nurse Practitioner Role
History
Loretta C. F____, PhD, RN, FAAN, and Henry K. S_____, MD, started the first nurse practitioner (NP) program at the University of ______in 19___. Initially, it was a certificate program and later became a m_____ program in the 1970s. The first NPs were p______ NPs who practiced in poor r_____ areas where there were no physicians (because of a severe shortage of primary care physicians).
Loretta C. Ford, PhD, RN, FAAN, and Henry K. Silver, MD, started the first nurse practitioner (NP) program at the University of Colorado in 1965. Initially, it was a certificate program and later became a master’s program in the 1970s. The first NPs were pediatric NPs who practiced in poor rural areas where there were no physicians (because of a severe shortage of primary care physicians).
Educational Requirements
An NP must meet the minimal educational requirements that are mandated by the nurse _____ act of the _____ (where they plan to practice).
An NP must meet the minimal educational requirements that are mandated by the nurse practice act of the state (where they plan to practice).
State Nurse Practice Act
The nurse practice act is enacted into law by the ____ legislature. Therefore, the NP’s ____ right to practice is derived from the state legislature.
Each state has its own nurse practice act that contains regulations that dictate the ed_____ requirements, responsibilities, and s____ of practice for NPs and other nurses (e.g., RNs, licensed practical nurses, midwives) who practice in the state.
NP practice is ____ regulated by the federal government, the American Medical Association (AMA), or the U.S. Department of Health and Human Services (DHHS).
The nurse practice act is enacted into law by the state legislature. Therefore, the NP’s legal right to practice is derived from the state legislature.
Each state has its own nurse practice act that contains regulations that dictate the educational requirements, responsibilities, and scope of practice for NPs and other nurses (e.g., RNs, licensed practical nurses, midwives) who practice in the state.
NP practice is not regulated by the federal government, the American Medical Association (AMA), or the U.S. Department of Health and Human Services (DHHS).
State Board of Nursing
The state board of nursing (SBON) is responsible for enforcing the (1)
The SBON is a formal g_______ agency that has the statutory authority to reg_____ nursing practice.
The SBON has the legal authority to l_____, monitor, and discipline nurses.
The SBON is also authorized to _____ a nurse’s license (after formal hearings).
The state board of nursing (SBON) is responsible for enforcing the state’s nurse practice act.
The SBON is a formal governmental agency that has the statutory authority to regulate nursing practice.
The SBON has the legal authority to license, monitor, and discipline nurses.
The SBON is also authorized to revoke a nurse’s license (after formal hearings).
(1)
Professional designations, such as RN, NP, or APRN, are protected by law. It is _____ for any person to use these titles without a valid license. It is under mandate by a state’s nurse practice act. It protects the public from un_____ “nurses.”
Title Protection
Professional designations, such as RN, NP, or APRN, are protected by law. It is illegal for any person to use these titles without a valid license. Title protection is under mandate by a state’s nurse practice act. Title protection protects the public from unlicensed “nurses.”
Licensure
=
Obtained through a _____ entity, the (1)
The NP must meet the minimal _____ and _____ requirements in order to become licensed.
The legal requirement to practice as an NP
It is obtained through a governmental entity, the SBON.
The NP must meet the minimal educational and clinical requirements in order to become licensed.
- Certification*
- =*
. The majority of states in the United States now ____ board certification (or certification) as a condition to obtain licensure.
A “voluntary” process and is done through a nongovernmental entity such as a professional nursing association or specialty organization.
. The majority of states in the United States now mandate board certification (or certification) as a condition to obtain licensure.
Standards of Professional Nursing Practice
Standards are auth______ statements of the _____ that all RNs, regardless of role, population, or specialty, are expected to perform.
According to the (1), these include both the Standards of Practice and the Standards of Professional Per_____
They are developed by professional societies (1) as well as specialty organizations; for example, the(1) publishes Standards of Practice for Nurse Practitioners (AANP, 2019).
Standards are authoritative statements of the duties that all RNs, regardless of role, population, or specialty, are expected to perform.
According to the American Nurses Association (ANA), these include both the Standards of Practice and the Standards of Professional Performance.
They are developed by professional societies (e.g., ANA) as well as specialty organizations; for example, the American Association of Nurse Practitioners (AANP) publishes Standards of Practice for Nurse Practitioners (AANP, 2019).
(1)
A written agreement between a physician and NP outlining the NP’s role and responsibility to the clinical practice.
A _____ of the collaborative practice agreement must be kept at the NP’s practice setting and mailed to the S_ _ _.
Most states require an ______ review of the agreement that contains signatures of the individuals involved and dates.
The state practice environment differs for each specific state. Some states allow f____ practice under the exclusive authority of the SBON, some states allow reduced practice, and some have restricted practice.
In these states, the NP must be under the super_____ or delegation of an outside health discipline such as the Board of ______.
Collaborative Practice Agreements
A copy of the collaborative practice agreement must be kept at the NP’s practice setting and mailed to the SBON.
Most states require an annual review of the agreement that contains signatures of the individuals involved and dates.
The state practice environment differs for each specific state. Some states allow full practice under the exclusive authority of the SBON, some states allow reduced practice, and some have restricted practice.
In these states, the NP must be under the supervision or delegation of an outside health discipline such as the Board of Medicine.
Agreements With Physicians and Dentists
NPs can sign collaborative practice agreements with (3)
(1) (DCs) and (1) (NDs) are not considered physicians under nurse practice acts.
In most states, physicians are the only practitioners who can legally sign a d_____ certificate.
NPs can sign collaborative practice agreements with physicians (MDs), osteopaths (DOs), and dentists/dental surgeons (DMDs/DDSs).
Chiropractors (DCs) and naturopaths (NDs) are not considered physicians under nurse practice acts.
In most states, physicians are the only practitioners who can legally sign a death certificate.
Prescription Privileges
The majority of states require NPs to have a written practice protocol with a (1) in order to prescribe drugs.
The protocol usually contains the ____ of drugs (by name, class, or condition) that an NP is allowed to prescribe.
In the United States, all 50 states grant prescriptive authority to NPs, including the right to prescribe _______ substances (varies by state).
The majority of states require NPs to have a written practice protocol with a supervising physician in order to prescribe drugs.
The protocol usually contains the list of drugs (by name, class, or condition) that an NP is allowed to prescribe.
In the United States, all 50 states grant prescriptive authority to NPs, including the right to prescribe controlled substances (varies by state).
Prescription Pads
The NP’s prescription pad should contain the following:
- NP’s name, des_____, and _____ number
- Cl____ name, ad_____ , and phone number; if the practice has several clinics, the other clinics where the NP practices should also be listed on the pad.
- To reduce fraud, it is best if the _____ number is not listed (only for controlled substance prescriptions).
- NP’s name, designation, and license number
- Clinic’s name, address, and phone number; if the practice has several clinics, the other clinics where the NP practices should also be listed on the pad.
- To reduce fraud, it is best if the DEA number is not listed (only for controlled substance prescriptions).
Generation Types
Match each generation to their description
(1) Born from 1946 to 1964. Hard workers. Like to achieve. More susceptible to burnout and stress-related illness.
(1) Born from 1981 to 2000. Multitaskers who seek learning and career development but also value free time to socialize.
(1) Born from 1925 to 1945. Disciplined and loyal. Traditional work ethic. More action oriented. The youngest nurses from this generation are now in their 70s, and most have retired.
(1) Born from 1965 to 1980. Question authority, expect immediate results. They are loyal to peers over the company.
Baby Boomers Born from 1946 to 1964. Hard workers. Like to achieve. More susceptible to burnout and stress-related illness.
Generation Y (Millennials) Born from 1981 to 2000. Multitaskers who seek learning and career development but also value free time to socialize.
“Silent Generation” Born from 1925 to 1945. Disciplined and loyal. Traditional work ethic. More action oriented. The youngest nurses from this generation are now in their 70s, and most have retired.
Generation X (Gen Xers) Born from 1965 to 1980. Question authority, expect immediate results. They are loyal to peers over the company.
Claims-Based Policy
What if a claim is made in the future when the employee does not have the same insurance company?
What can the employee do to address this issue?
The claim will not be covered (in the future) if they do not have the same insurance company as when the lawsuit was filed. - NEEDS INSURANCE AT TIME OF CLAIM
“Tail Coverage”
Buying “tail coverage” can help address this issue.
Tail coverage insurance will cover the NP for malpractice claims that may be filed against them in the future. When an NP with claims-based malpractice insurance retires or changes jobs, it is advisable to buy tail coverage insurance.
What Are E&M Codes?
Evaluation and Management Service (E&M) codes are used to bill for patient visits and are part of the ____.
If a bill is missing an E&M code, the healthcare provider will not be reimbursed for the time they spent with the patient.
E&M codes are based on the h____, ex_____, and medical decision-making (_______) that take place.
The provider must document that these three components have been met (or exceeded). The com____ and t____ spent with the patient are assigned codes by the CPT system.
Evaluation and Management Service (E&M) codes are used to bill for patient visits and are part of the CPT.
If a bill is missing an E&M code, the healthcare provider will not be reimbursed for the time they spent with the patient.
E&M codes are based on the history, examination, and medical decision-making (complexity) that take place.
The provider must document that these three components have been met (or exceeded). The complexity and time spent with the patient are assigned codes by the CPT system.
Exam Tips
NPs receive their “right to practice” from the ______ legislature.
Identify a ______-focused visit (see example in “What Are E&M Service Codes?”).
There are various types of nursing leadership.
Claims-based malpractice insurance will cover claims only if?
Occurrence-type malpractice insurance will cover a lawsuit in the future even if?
NPs receive their “right to practice” from the state legislature.
Identify a problem-focused visit (see example in “What Are E&M Service Codes?”) = just needs chief complaint and HPI, does not need ROS, past, family, or social history
There are various types of nursing leadership.
Claims-based malpractice insurance will cover claims only if the NP is still enrolled with the same insurance company at the time the claim is filed in court.
Occurrence-type malpractice insurance will cover a lawsuit in the future even if the NP no longer carries the policy, as long as the NP had an active policy during the alleged incident.
Individualistic and Collectivistic Societies
Cultures are often categorized as ______istic or _____istic.
_______ societies value the individual above the family, organization, or group.
In contrast, ______ societies consider the rights, needs, and wishes of the family or group over those of individuals.
Cultures are often categorized as individualistic or collectivistic.
Individualist societies value the individual above the family, organization, or group.
In contrast, collectivist societies consider the rights, needs, and wishes of the family or group over those of individuals.
Qualitative vs. Quantitative Studies
Hierarchy of Research Evidence
(1)
This is a statistical method that combines data from multiple studies (systematic review), resulting in higher statistical power and a single conclusion. This method is considered the gold standard for evaluating research evidence for EBM.
Meta-Analysis
(1)
In a nutshell, involves random subject selection, one placebo or control group, and one or more intervention group(s). An RCT is a type of this study.
Experimental Study
(1)
Can be biased and may not be based on solid evidence. They are the weakest form of evidence.
Opinions and Editorials
(1)
Cohort studies are a type of research that is used to investigate risk factors for diseases, risk factors for death, and other conditions. The research subjects are observed for a long period. There is no intervention done (not an experiment). The goal is to identify risk factors and associations (not causation) of a disease(s). For example, the Nurses’ Health Study is a large cohort study of female RNs age 30 to 63 years who reside in the state of Massachusetts. Can be a type of prospective study (present to future).
Cohort Study
(1)
A type of literature review that identifies, selects, and analyzes multiple research articles concerning a health condition, disease, or other health-related practice. Follows specific methodology to identify all the relevant studies on a specific topic. Studies to be included must meet explicit criteria. Studies are ranked from grade A (best evidence) to grade D (poor evidence). After it is done, the acceptable studies are pooled together, and statistical testing of the data (meta-analysis) is performed.
Systematic Review
(1)
A detailed report of one patient with a disease or an unusual condition that includes demographics, signs and symptoms, diagnosis, response to treatment, and so forth.
(1)
A series of case reports that involves a series of individuals who are given similar treatment.
Case Report
Case Series
(1)
Subjects are randomly assigned to either the control group or the treatment group(s). The intervention may be a drug, procedure, or device. Some use a double-blind design (the intervention is hidden from the patient, clinician, and/or researchers). Are experimental studies.
Randomized Controlled Trial
Practice Drag and Drop EBP Questions
1 =
2 =
3 =
1 = A
2 = C
3 = B
Practice Drag and Drop EBP Questions
1 =
2 =
3 =
1 = B
2 = A
3 = C
