T2 Lesson Blackboard Flashcards
We need to speak up when errors are about to be made or when situations are unsafe. We should make suggestions to provide better, more consistent care to our clients. Consider these issues of patient advocacy:
What are the nurses’ roles in these complex situations? How do their work places affect those roles? Keep in mind:
Decisions regarding end of life care, protection of patient privacy, informed consent.
- The nurse supports clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care. -ANA code of ethics
- Nurses must act as advocates even when they disagree with clients’ decisions.-ANA
- Nurses must advocate for clients when the health care system is not acting in their best interests.
Health care organizations and economics and policy
Healthcare organizations are groups of individuals brought together in a designated environment to achieve one of two goals:
Provide illness care or provide wellness care
Institutional providers may be the hospitals, long term care and skilled nursing facilities, and rehabilitation centers.
Most hospitals are considered acute care facilities and provide short-term, episodic or emergency care, with stays lasting fewer than 30 days. These services are usually described as ?
primary care (first-access care), secondary care (disease-restorative care), and tertiary care (rehabilitative or long-term care).
There are three forms of health care organization ownership in the U.S.
Public institutions: These provide health services to individuals under the support and/or direction of a government agency. These organizations answer to the sponsoring government agency. An example of this is the Veteran’s Administration.
Private non-profit (or not-for-profit): Run by voluntary boards or trustees and provide care to both paying and non-paying patients, these facilities place any excess revenue over expenses back into the organization for maintenance and growth rather than returned as dividends to stock-holders (Yoder-Wise, 2011). These organizations are required to serve people regardless of their ability to pay. These organizations often serve primarily impoverished individuals, creating a great burden in uncompensated care. These facilities may be run by churches, industries, and special interest groups such as the Shriners.
For-profit organizations: These are proprietary or investor-owned organizations. These organizations operate with the purpose of earning a profit by providing healthcare services to individuals who can afford to pay. Owners may be individuals, partnerships, corporations, or multi-systems
Community health nurses are found where?
most rural communities and schools, typically funded by the local health departments.
?? Nurses, funded by churches, serve as health educators, case managers, and advocates.
Visiting nurse associations provide nursing services for families in need and are usually voluntary organizations. Historically, these organizations’ purpose has been to control infectious diseases. Today, most of their work is aimed at ??.
Parish nurses
Today, most of their work is aimed at education and prevention
Healthcare organizations commonly seek accreditation by either The
?? accredits approximately 80% of acute care hospitals in the United States
American Osteopathic Association (AOA) or The Joint Commission (formally known as the Joint Commission on Accreditation of Healthcare Organizations or JCAHO).
The Joint Commission accredits approximately 80% of acute care hospitals in the United States
Organizations such as private or public insurers who provide healthcare insurance coverage are known as ??
??? is the U.S.’s largest health insurance program; it provides coverage to more than 40 million Americans
Medicare is not just for senior citizens; it also covers disabled persons.
An example of a private insurer is Blue Cross/Blue Shield.
?? financing organizations have a major effect on our health care, as they identify which procedures, tests, services or medications will be covered.
third-party payers.
Medicare
Third party payers
??, sometimes referred to as “Obama-care,” is an attempt to insure more Americans who beforehand could not obtain adequate health insurance.
Another goal is to prevent the powerful insurance companies from controlling individual patient care.
The Health Care Reform Act
Positive changes, stemming from the Affordable Care Act include:
Negative changes include:
- Ending the insurance companies’ ability to drop coverage for someone when he or she gets sick.
- Care for all children by eliminating the preexisting conditions restrictions found in most policies.
- Access to high-risk pools for all uninsured, even adults with preexisting conditions.
- Increasing the age to 26 years for young adults to be covered on their parents’ plans.
- Eliminating higher insurance premiums based on a person’s gender or health status.
- Expanding Medicare payment to health-care facilities that have a small number of Medicare clients.
Negative changes include:
• An anticipated gradual increase in premiums, up to 13%. However, most individuals and families will qualify for subsidies.
• A requirement that Americans buy health insurance or pay a penalty starting in 2014
Advanced practice nurses need to be developing ways in which they can practice in a preventive, wellness model, rather than in our previous medical, disease-focused model.
True
As advocates, nurses must ensure that clients are informed of their ??? and have the correct ?? on which to base health care decisions.
rights
Information
Each state has its own Nurse Practice Act, and it is every nurse’s responsibility to become familiar with it.
The State Board of Nursing will have links to the Practice Act; these Boards have the authority to issue and revoke a nursing license based upon ???? of the Nurse Practice Acts.
compliance or violation
Standards of care are developed by the ?? and other professional organizations, and they direct the level of care given by nurses.
Nurses should refuse to practice beyond the scope of their practice or outside of their area of competence.
ANA
But how did the Nurse Practice Act come into existence?
How does any law become a law?
The three branches of the United States government are the judicial, legislative, and executive branches.
These 3 branches exist at the local, state, and federal levels.
- Judicial branch: This is our court system, whose primary role is to interpret laws.
- Legislative branch: This consists of our House of Representatives and Senate, whose roles are to represent the people in the forming of laws.
- Executive branch: This is where we find the President, vice president, cabinet, and various executive administrative bodies (Governors, County Commissioners, Mayors). Their role is to enforce the laws.
Laws may begin with any elected official, lobbyist, consumer group, advocate, public interest group, or governmental agency.
Most nurses avoid becoming involved in politics, or government issues, but they need to realize that their professional survival may depend upon it!
Why?
Because politics and health care laws are related to almost every aspect of life.
Politics Influence:
Where (and when) children go to school
Quality of food and water
Medications, prescriptions, over the counter drugs
Where nurses work
What nurses do
Ability to organize professionally
Professional status through licensure and certification
How can you, a novice nurse, become more involved?
Become Active in a Professional Organization
The easiest way is to join and be active in a professional organization, such as the ANA, the NLN, or any other nursing organization.
Develop a Political Relationship with a Local Legislator
try to develop a political relationship with a legislator in your area. Letter writing, letters to the Editor of your local newspaper, emails, and telephone calls to the office are very successful methods of communicating with your elected official. For best results, schedule a meeting.
Politically involved nurses have the following credentials:
They have self-confidence, motivation, creativity, a capacity to change, and persistence.
In short, all nurses have the ability and skills to be more involved!
Nurses are skilled patient advocates and are well qualified to advocate or lobby for health care legislation.
What Is Clinical Judgment?
The concept of clinical judgment basically refers to interpretations and inferences that influence actions in the clinical setting
To use judgment, one needs to form an opinion (an inference, interpretation or discernment) and apply it to the current clinical picture.
???is the thinking process by which a nurse reaches a clinical judgment. It is defined as a way of noticing, interpreting, and responding to the patient and how the patient responds to treatments and interactions
clinical reasoning,
There are two approaches to clinical judgment in nursing.
???? approach puts the nurse and the needs of the patient outside the caregiving situation, rather than situating the specific patient issue in a context of care. Decision making from this perspective involves selection from options of mutually exclusive possibilities, implying that there is one right decision. This approach often involves use of maps, decision trees, and policy and procedure manuals
??? Approach
The Interpretivist approach originates from the belief that life experiences are culturally bound, that individual patients will interpret these experiences on the basis of their culture, and that one set approach is often not right for all patients
Standards-based Approach
Interpretivist Approach
Which approaches bring the nurse to the sphere of the patient centered care, and account for what the nurse personally contributes to the caring encounter, including previous experiences, values, and emotions ?
Interpretivist approach
?? approach is more likely to be successful in problem solving
team based and patient centered
