T2 Lesson Blackboard

Question 1

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:

Answer 1

Decisions regarding end of life care, protection of patient privacy, informed consent.

1. 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
2. Nurses must act as advocates even when they disagree with clients’ decisions.-ANA
3. Nurses must advocate for clients when the health care system is not acting in their best interests.
   Health care organizations and economics and policy

Question 2

Healthcare organizations are groups of individuals brought together in a designated environment to achieve one of two goals:

Answer 2

Provide illness care or provide wellness care

Question 3

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 ?

Answer 3

primary care (first-access care), secondary care (disease-restorative care), and tertiary care (rehabilitative or long-term care).

Question 4

There are three forms of health care organization ownership in the U.S.

Answer 4

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

Question 5

Community health nurses are found where?

Answer 5

most rural communities and schools, typically funded by the local health departments.

Question 6

?? 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 ??.

Answer 6

Parish nurses

Today, most of their work is aimed at education and prevention

Question 7

Healthcare organizations commonly seek accreditation by either The

?? accredits approximately 80% of acute care hospitals in the United States

Answer 7

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

Question 8

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.

Answer 8

third-party payers.

Medicare

Third party payers

Question 9

??, 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.

Answer 9

The Health Care Reform Act

Question 10

Positive changes, stemming from the Affordable Care Act include:

Negative changes include:

Answer 10

• 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

Question 11

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.

Answer 11

True

Question 12

As advocates, nurses must ensure that clients are informed of their ??? and have the correct ?? on which to base health care decisions.

Answer 12

rights

Information

Question 13

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.

Answer 13

compliance or violation

Question 14

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.

Answer 14

ANA

Question 15

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.

Answer 15

• 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.

Question 16

Most nurses avoid becoming involved in politics, or government issues, but they need to realize that their professional survival may depend upon it!
Why?

Answer 16

Because politics and health care laws are related to almost every aspect of life.

Question 17

Politics Influence:

Answer 17

 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

Question 18

How can you, a novice nurse, become more involved?

Answer 18

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.

Question 19

Politically involved nurses have the following credentials:

Answer 19

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.

Question 20

What Is Clinical Judgment?

Answer 20

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.

Question 21

???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

Answer 21

clinical reasoning,

Question 22

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

Answer 22

Standards-based Approach

Interpretivist Approach

Question 23

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 ?

Answer 23

Interpretivist approach

Question 24

?? approach is more likely to be successful in problem solving

Answer 24

team based and patient centered

Question 25

Three Attributes of Clinical Judgment

Answer 25

1. Holistic view of the patient situation: This is a willingness to consider all factors involved in patient care, including certain characteristics of the patient (as well as the nurse).
2. Process orientation: This requires an understanding of the individual patient situation and a nurse’s own personal background, experience, and values.
3. Reasoning and interpretation: At least 3 types of reasoning are required, and they are analytic, intuitive, and narrative. In unfamiliar situations, the nurse tends to rely on analytic reasoning processes, consider the options, and come to a solution. The expert nurse may recognize a situation immediately and act intuitively and tacitly, but the novice nurse typically relies on analytic reasoning

Question 26

Problem Solving
Several models of problem solving exist.

A traditional approach is outlined and requires the nurse to Know ??

Answer 26

1) know the facts,
2) separate the facts from interpretation,
3) be objective and descriptive, and
4) determine the scope of the problem.

Question 27

Steps to problem solving

Answer 27

• Assess the problem: Collect and record data to provide the information needed.
• Diagnose and Identify Outcomes: Clarify realistic outcomes and identify problems, risks, or issues.
• Plan: Make certain that there is a realistic, attainable, measurable patient-centered goal.
• Implementation (Interventions): Put the plan into action.
• Evaluation: Where does the patient stand? Has the goal been achieved? Does it need revision?

Question 28

One can define patient centered care as a focus on the patient and the individual’s particular health care needs.

But the goal of patient centered care is not quite so simplistic; it requires the empowerment of patients to????

Answer 28

become more active in their plans of care.

Question 29

Care which was once directed by the physician must now be rendered ?? the patient rather than to the patient,

According to the ????, Health care has been evolving away from a “disease-centered model” and toward a patient-centered model

patients become active participants in their own care and receive services designed to focus on their individual needs and preferences, in addition to advice and counsel from health professionals.

Answer 29

With

Agency for Healthcare Research and Quality (AHRQ)

Question 30

When the Institute of Medicine (IOM) published Crossing the Quality Chasm in 2001, it established six aims for health care improvement, three of which was that patient care must be ??

That report went on to acknowledge things that nurses commonly value, such as the idea of a ?? (think Florence Nightingale), ???

It also stated that all health care professionals should be ???

Answer 30

safe, effective, and patient-centered.

healing environment

individualized care, autonomy of the patient in making decisions, evidence-based decision making, and the need for transparency

educated to deliver patient centered care and provided the impetus for payment methods being based on quality outcomes

Question 31

By establishing a connection with the patient and his or her family, we can help foster patient centered care.

How?

Keeping an awareness of the patient’s individual life experiences, his responses to previous health care situations, and his age, gender, spirituality, etc., make the nurse more effective in promoting patient centered care.

Answer 31

Understanding the culture and diversity of each individual client can help us develop plans of care which are truly client-focused.

Question 32

Still, sometimes the ideal of patient-centered care collides with the reality of cost effective treatment.

Answer 32

True

Question 33

What Is Evidence-Based Practice and Why Is It Important?

Answer 33

Evidence-based practice (EBP) is an organized method for clinical decision making to provide the most effective care to patients. EBP uses current research findings that define best practices, clinical knowledge, proficiency and expertise, and values to optimize patient outcomes as well as their quality of life (Research is typically defined as generation of new knowledge; EBP is a priority for all health care providers in order to ensure patient safety.
EBP promotes the use of effective strategies to help patients be well. It also helps nurses prevent harm to their patients, to themselves, or to the global community.

Question 34

Who directs that the nurse participates in advancement of the profession through contributions to practice, education, administration and knowledge development. Because of this, all nurses need to be aware of how to conduct and use research.

Answer 34

The ANA Code of Ethics for Nurses

Question 35

The desire to achieve low-cost, high-quality and safe care generates the need for ??

Answer 35

evidence-based practice (EBP

Question 36

The IOM’s recommendation is that all health care professionals be able to do the following:

Answer 36

• Know where and how to find the best possible sources of evidence
• Formulate clear clinical questions
• Search for relevant answers to those questions from the best possible sources
• Determine when and how to integrate those findings into practice

Question 37

Nurses need to be aware of several critical steps in evidence reports when attempting to integrate EBP into their care.

The first part of the report should include a??

The second part should comprise a lengthy and detailed ??

The third, and important, is the ??

After gathering that information, the nurse must now ask the following:
??

Answer 37

1. structured summary statement of the problem, practice, or disease that describes what is in the evidence report.
2. analysis of the published and unpublished data, including reviews of articles and reports, the populations included in the studies, and the nature of the nursing actions investigated.
3. ranking of such evidence.

After gathering that information, the nurse must now ask the following:

1. Is this the best available evidence? Look for sources that are peer-reviewed and no more than 5 years old.
2. Will the recommendations work for my practice given the client population and problems? If the study population is of the elderly and the nurse’s primary work is with children, the information may not be applicable.
3. Do the recommendations fit well with the preferences, needs, and values of the clients I serve? I

Question 38

How Can You Conduct and Use Research to Improve Nursing Care?

Answer 38

Attending conferences and poster presentations in which clinical research findings and ideas for practice are presented is an excellent way to quickly view the findings and network with the researchers.

Other strategies proposed include conducting research via textbooks and procedure manuals, connecting research use to a facility’s goals, developing committees between colleges and hospitals, and inviting nurses to present during routine meetings and conferences.

Question 39

?? makes the location of and the spreading of the research possible and necessary.

Answer 39

Technology

Question 40

The goals of EBP include?

It requires the utilization of collaboration and teamwork across the professional spectrum, and clinical recommendations

Answer 40

cost-effective practice based on the data produced by research,

the Spreading of data,

and the implementation of best practice interventions into the nurse’s practice.

Question 41

??? nurses are expected to be able to demonstrate an awareness of the value of research by becoming knowledgeable consumers of current information and by helping identify problems within their scope of nursing practice that may warrant exploration.

Answer 41

Associate Degree (A.D.N.s)