random 2 Flashcards
When is a balloon pump contraindicated
aortic valve insufficiency
What is integrative medicine
Brings conventional and complementary approaches together in a coordinated way
3 goals of technology in nursing
capture tasks performed, enhance scope of practice and EBP, make practice knowledge driven
4 nursing informatics roles
practice, education, government, industry
what is nursing informatics
manage and communicate data, information, and wisdom
Benchmarking
compares/measures services against other healthcare national organizations
four core principles of benchmarking
maintain quality, improve customer satisfaction, improve safety, continuous improvement
What is peer review? and why do you want to do it?
Formalized review required for magnet recognition
5 components of establishing rapport/professional therapeutic relationships
nonjudgement approach, mutual trust, professional boundaries, confidentiality, cultural competency
2 components of cultural competency
respect, spiritual needs
Advanced directive
patient’s intent regarding medical treatment
healthcare directive may include what?
living will or durable power of attorney
What is a living will, what can it include
written compilation of statements that specifies which life prolonging measures
what is a durable power of attorney; another name? when is it honored?
“proxy/agent/attorney-in-fact” usually significant other or someone else in charge of articulating advanced directive; must be in writing before it is honored
Title 1 of HIPAA
health insurance coverage when they change or lose jobs
title 2 of HIPAA; known as?
“administrative simplification provisions”; establishes national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
who enforces HIPAA
Office of civil rights
HIPAA security rule
national standards for security of electronic protected health information
Patient safety rule
confidentiality provisions which protect identifiable info being used to analyze patient safety events and improve patient safety
What are healthcare clearing houses
process nonstandard health information data received from another entity into a standard (like standard electronic formats)
What are covered entities that are required to follow HIPAA regulations
health plans, government programs that pay for healthcare (medicare, medicaid), most health care providers, health clearing houses
PSQIA
Confidential voluntary reporting system regarding patient safety issues
strongest method to evaluate teaching
return demonstration
le fort fracture of skull; 3
1: floating palate; 2: floating maxilla; 3: floating face
2 goals of healthy people 2030
increase quality and years of healthy life; eliminating health disparities
Common reporting statutes
criminal acts/injury; STDs (G/C/S); HIV; TB; animal bites; suspected child/elder abuse
key elements of palliative care
early identification, impeccable assessment, treatment of pain and other problems (psychosocial/spiritual)
Who sets standard for reimbursement and cutting costs
medicare
third party payers
medicare, medicaid, commercial indemnity insurers, commercial management organizations (hmos), business/schools wanting health services for employees/students
How much does medicare reimburse
80%
5 levels of physical exam documentation to determine levels of E/M services
problem focused, expanded problem focused, detailed, comprehensive
Medicare A - what services
INPATIENT; every gets at 65 years - hospitalization/inpatient, SNF, home health and/or hospice associated with inpatient event
Medicare B - what services and cost
OUTPATIENT; physician services, outpatient, labs/diagnostics, medical equipment, some home health; premium that is paid monthly
How much of physician reimbursement does the NP get for services provided in collaboration with physician
85%
How much does Medicare reimburse for physician services, how much does patient pay
80%; patient pays for 20%
Medicare C
A+B=C; can receive all healthcare services through provider organizations under part C (like hmos, PPOs)
Medicare D
limited prescription DRUG coverage; requires monthly premium and copay with each prescription
Medicare requirements for NPs (3)
state license, certification by national certifying body, MS degree
How much of the physician fee does an NP get reimbursed for procedures?
80% of the 85% physician fee schedule rate
incident to billing rate requirements
Services billed under physician provider number gets 100%; physician initiates plan, NP can continue, physician must be available in the suite; not allowed inpatient
Do NPs need physician order to bill for NP home visits under medicare A?
No, NPs can bill under their own NP provider number
When do NPs need a physician order to bill under NP provider number for home visits?
if NP is providing nursing services only
Medicaid benefits state to state
vary, and made after other insurance/third party payments have been made
QA/QI/Continuous process improvement (CPI)
Management process of monitoring, evaluating, continuous review, and improving the quality in providing health care
What is quality assurance
evaluating patient care using established standards of care to ensure quality
QSEN initiative
part of quality assurance; aimed at providing future nurses with knowledge/skills/attitude to ensure CQI
6 key competencies in QSEN
patient centered care, teamwork and collaboration, EBP, QI, safety, informatics
critical path
key patient care activities and time frames for activities needed for specific diagnosis related groups (drg)
critical map
newer version of critical path that is a blueprint for planning and managing care by all disciplines
root cause analysis
tool for identifying prevention strategies to ensure safety; builds culture of safety, move beyond culture of blame
sentinel events
unexpected occurrences of death, injury, risk; requires need for immediate investigation/response; root cause analysis must be conducted in response to sentinel event
How does scope of practice vary
varies by state
state practice act
authorize boards to establish license authority, prescriptive authority, disciplinary grounds
prescriptive authority
depends on state nurse practice acts
credentials
encompasses required education, license, and certification; minimal levels of acceptable performance
why are credentials necessary
ensure safe care is provided, comply with federal/state laws
what does licensure establish
person is qualified to perform in particular professional role; granted by state board
what does certification establish
establishes certain standards which signify MASTERY of specialized knowledge/skills; granted by nongovernmental agencies
When were nonphysician providers granted hospital staff membership and by who?
1983, joint commission
most common method documentation for risk management
incident reports
why are satisfaction surveys important
helps identify problems before developing into actual incidents/claims
6 action taking initiatives for risk management
prevention, correction, documentation, education, departmental coordination
two kinds of medical futility
quantitative and qualitative
quantitative futility is
likelihood an intervention will benefit the patient is extremely poor (number of interventions will not make a difference)
qualitative futility
quality of benefit an intervention will produce is extremely poor
7 Ethical principles
nonmaleficence (do no harm); utilitarianism (greatest good for greatest number); beneficence (prevent harm, promote good); justice (be fair); fidelity (faithful); veracity (truthful); autonomy (respect right to choose)
who were the first NPs
pediatric NPs
When did NPs move to inpatient?
managed care, hospital restructuring, and decreases in medical residency programs
4 distinct roles for the nurse practitioner
clinician, consultant/collaborator, educator, researcher
11 major steps in research process
formulate problem, review literature, formulate hypothesis, select study design, identify population, specify methods of data collection, design study, conduct study, analyze data, interpret results, communicate findings
3 kinds of research
non experimental, experimental, qualitative
2 categories of nonexperimental study designs
descriptive and ex post facto
descriptive study design aims
describe situations, experiences, phenomena as they exist
ex post facto (in the past) or correlation research aims and examples
examine relationships among variables (cross sectional (surveys of relationship between variables), cohort (compares outcomes in similar groups with certain different characteristics), longitudinal (multiple measures over time to find relationships between variables)
experimental/quasi experimental aims
manipulates variables using randomization and a control group to test effects of intervention; quasi does the same but lacks comparison (control) or randomization
qualitative study types and aims
case studies, field studies, observation; explore phenomena or behaviors
potential problems in qualitative studies
researcher bias, generalizability of findings,
Type 1 error
false positive; incorrectly rejecting true null hypothesis
type 2 error
false negative; failing to reject null hypothesis which is false
meta analysis vs meta synthesis
analysis: test hypotheses using numerous QUANTITATIVE studies to systematically assess results of previous research; synthesis: analyze data across QUALITATIVE studies to build new theories
PICOT
framework to answer clinical based question: patient (population), intervention, comparison, outcome, timing
Levels of evidence hierarchy
1a: systematic review RTCs; 1b: systematic review of non randomized; IIa: single RTC; IIb: single non randomized; III systematic review of correlational/observational; IV: single correlational/observational study; V: systematic review of qualitative study (animals, lab studies); VI: single qualitative; VII: opinions
Confidence interval
interval with specified probability including the parameter being estimated ; small interval implies precise range of values
standard deviation; % of sample within one SD, % within two SD
average amount of deviation of values from the mean; 68% within one SD, 95% of population within 2 SD
level of significance
probability level of which results indicate statistically significant difference between groups; probability of false rejection of the null hypothesis in a statistical test
perfect correlation
measure of interdependence of two random variables ranging from -1 to +1
correlation of -1
perfect negative correlation
correlation 0
absence of correlation
correlation +1
perfect positive correlation
T test
evaluates differences in means between two groups
reliability
consistency of measurement over time with same subject; reflects estimated repeatability
how does internal consistent estimate reliability?
groups questions in a questionnaire that measures the same concept, do those two groups of questions reliably measure the concept when tested for correlation?
Cronbach’s alpha
measures correlation among questions on instruments, closer to one = higher reliability; (optimal is equal to or greater than .70
difference between test/retest and internal consistency
test retests involves two administrations of measurement instrument, internal consistency involves only one
reliability vs validity
reliability is consistency of measurement, validity is degree to which the variable measures what it is intended to measure
liability terms
legal responsibility when NP fails to meet standard of care
negligence
failure of individual to do what a reasonable person would do
malpractice
failure to render services in way that causes harm
assault
threat of bodily harm with ability to cause harm
battery
illegal, angry, violent, physical harm
defamation
communication that causes damage to reputation
involuntary committment
duty to commit someone when they are in danger of hurting himself or others; NPs liable if patient is discharged while still in danger
Use of restraints
Must document exact reason, liable if excessive restraints employed or no document of reason, or safety checks not charted
Good Samaritan statues
protects NPs from lawsuits who aid scene of accident and render care within scope of practice
Incidence
frequency of disease at a given time, rate of new cases during specific time
prevalence
proportion of population affected by disease during particular time
primordial prevention
in childhood, to prevent development of risk factors
primary prevention
modifying risk factors to prevent development of disease
secondary prevention
screening, early identification and treatment of existing problems
tertiary
rehab, restoration of health
culturally and linguistically appropriate services, 3 of 14 CLAS standards
5: offer and provide language assistance at no cost; 6: provide written/verbal notices in preferred language; 7: assure competence of language assistance provided - don’t use family
