UNIT L Flashcards
How does managed care affect the economics of health care delivery?
a.
Provides incentives for smaller private or individual hospitals
b.
Increases the tax base for the community
c.
Uses corporate economics to achieve a profit
d.
Care is paid for at a prearranged rate
ANS: D
Under a managed care system, care is paid for at a prearranged rate, rather that at the billed rate. This was the start of efforts to reduce health care costs. Managed care does not increase the community tax base because the costs are paid by the patients and their insurance. Managed care is more of an incentive for larger hospitals and corporations. The focus is to reduce duplication of services and not to use corporate economics to achieve a profit.
Which statement regarding characteristics of clinical pathways shows the nurse’s lack of understanding?
a.
“Clinical pathways focus on patient outcomes.”
b.
“Clinical pathways use a timeline with sequenced interventions.”
c.
“Clinical pathways collaborate efforts by health care professionals.”
d.
“Clinical pathways involve nurse-centered orientation.”
ANS: D
Clinical pathways help reduce expensive variations in care. Clinical pathways are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for patients with a particular diagnosis, procedure, or symptom. Clinical pathways are not a nurse-centered orientation.
Which statement shows the nurse’s understanding of patient-focused care?
a.
“Patient-focused care is a nursing care delivery system.”
b.
“Patient-focused care is a model for a health care organization.”
c.
“Patient-focused care is a clinical pathway within an institution.”
d.
“Patient-focused care is an institutional value and philosophy.”
ANS: A
Patient-focused care is another type of delivery system. The level of productivity is increased through centralization of functions (e.g., phlebotomy, diet instruction, respiratory therapy) on the unit under the direction of the nurse and cross training ancillary workers to do more than one function. The patient comes into contact with fewer people under this organizational framework.
Which statement by the nurse manager is inaccurate regarding the forces of magnetism? “Forces of magnetism include a. professional models of care.” b. consultation and resources.” c. cost reduction and sound budgets.” d. nurses as teachers.”
ANS: C
The forces of magnetism include professional models of care, consultation and resources, and nurses as teachers among several others. Budgets are not included.
A nurse manager is training a new hire. Which statement shows an understanding of functional nursing? a. “Functional nursing is organized around tasks.” b. “Functional nursing is patient led.” c. “Functional nursing is physician led.” d. “Functional nursing is unorganized.”
ANS: A
Functional nursing is where nursing care is broke into a series of tasks performed by many people, which results in a fragmented, impersonal kind of care. Fragmentation of care caused patient problems to be overlooked because they did not fit into a defined assignment. Aides, vocational nurses, and licensed practical nurses are allowed to perform functions such as administration of medication and treatments. None of the other statements is correct.
Which of the following statements shows the nurse’s understanding of primary nursing?
a.
“One nurse plans and directs patient care over 24 hours.”
b.
“Involves care for 48 hours or more”
c.
“Includes only one nurse planning care for the patient”
d.
“Is the only method of care used today”
ANS: C
In primary nursing, the fragmentation between shifts and nurses is eliminated because one nurse is accountable for planning the care of the patient around the clock. In primary nursing, an associate nurse takes over when then primary is not working. There are many models of nursing care delivery systems in use today.
Which statement is true about case management?
a.
It helps clients achieve goals effectively and efficiently.
b.
It is used to reduce resource utilization only.
c.
To be effective, it requires case managers to provide direct patient care.
d.
It eliminates the need for other caregivers (LPNs, LVNs, nursing assistants).
ANS: A
Case management is one of the strategies to reduce costs while ensuring coordination of care. Its main purpose is to help clients achieve goals, but also it is a cost control strategy. The case manager does not always provide direct care. Many other members of the health care team are involved in case management.
A nurse is interested in case management. Which statement indicates an understanding of the primary work environment of case managers?
a.
“They work most often in acute care institutions.”
b.
“Their work is focused on community activities and is based within the community.”
c.
“They typically work for insurance companies, providing coordination of care.”
d.
“All types of health care organizations, as well as organizations with health-related functions, hire case managers.”
ANS: D
Nurses who are case managers work in all types of health care institutions. They may also work for insurance or utilization review companies or in health-related areas of various types of large businesses. Registered nurses, social workers, and therapists may all be case managers, but how they perform their role depends on the scope of practice of their discipline. All case managers must be skilled at communication, critical thinking, negotiation, and collaboration. They must be knowledgeable about resources available to patients. The case manager not only deals with individual patients but also with family and other support systems of the patient; however, a case manager’s work is not focused on just the community.
Which statement is true about patient classification systems?
a.
They measure all the needs of patients.
b.
They provide an absolute formula for unit staffing.
c.
They should not be used to make patient-care assignments because acuity systems are more accurate.
d.
They have been used to determine the number of nurses needed on a unit at any one time.
ANS: D
A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. This system does not measure the needs of all patients, is not used an as absolute formula for unit staffing, and is not used to make patient assignments. Patient acuity is the measure of categorizing patients based on their nursing care requirements.
Which of the following best describes the concept of evidence-based practice?
a.
It is a method of improving nursing care and effectively maintaining cost containment.
b.
Insurance companies review the evidence of the health care practice for reimbursement.
c.
It achieves large-scale economics while providing cost-effective care.
d.
It provides for the use of recent research in current nursing practice.
ANS: D
The IOM reported that it took 17 years for research to be reflected into daily practice. Evidence-based practice is the use of the current best evidence to provide care and make decisions regarding patient care. Evidence-based practice is not a method of improving nursing care and maintaining cost containment. Insurance companies do not review the evidence of health care practice for reimbursement. Evidence-based practice does not achieve large-scale economics while providing cost-effective care.
A female patient is admitted to the labor and delivery unit, where she is assigned a registered nurse who will manage her care for the duration of her hospitalization. What type of nursing care delivery model is represented in this nursing unit? a. Functional care b. Primary care c. Patient-focused care d. Case management
ANS: B
This is an example of primary care nursing, in which the nurse is the principal or primary person to manage and coordinate the patient’s care around the clock. Patient-focused care is an interdisciplinary approach to patient care. Functional care is the provision of care by nursing and nursing ancillary staff rather than by an all-nursing staff as seen in primary care nursing. Case management is a model of care delivery in which a nurse case manager coordinates and collaborates with other health services when a patient has complicated health care needs, but the case manager may not be involved in the daily care activities of the patient.
The nurse is reviewing upcoming discharges. Which patient would a case manager be assigned to?
a.
A 55-year-old woman post hysterectomy, who has adequate support from family
b.
A 42-year-old man post appendectomy, who is able to change his own dressing
c.
A 60-year-old man post sepsis, in need of nursing home placement
d.
A 38-year-old woman, post shoulder repair, who needs to follow up with the orthopedic surgeon
ANS: C
Case managers become involved when patients with complicated health care needs are receiving care that is expensive or are receiving care from multiple providers. The patient who is post sepsis is likely to be seeing a team of doctors and will need that care transferred over to the nursing home setting. The case manager can bridge that care so that the transition is smooth for the patient. The other patients need minimal support and therefore would not qualify for case management.
A chief nursing officer wants to create a healthy work environment. What action by the CNO would be best to accomplish this goal?
a.
Use a nursing theory to support the environment and nursing care.
b.
Send unit managers to frequent leadership development workshops.
c.
Be a nursing advocate and make most nursing decisions him/herself.
d.
Offer bonuses for high-performing nurses and ancillary staff.
ANS: A
Development of and “living” a patient-centered culture in which values are known, subscribed to, and transmitted to newcomers is one way to create a healthy work environment. Using a single nursing theorist, the hospital would have values that are known to all who work there. Sending unit managers to workshops on leadership will help create good managers. Bonuses can help with retention, but the broadest option is to use a nursing theorist to undergird the nursing division. Managers and nursing staff need the autonomy and trust to make most decisions that affect their daily work
Which of the following statements about evidence-based practice shows that the nurse has an adequate understanding?
a.
“Evidence-based practice is the hospital’s protocol for providing care.”
b.
“Evidence-based practice is based on community need.”
c.
“Evidence-based practice is a set of guidelines determined by each hospital unit.”
d.
“Evidence-based practice is the use of current best evidence in making decisions about patient care.”
ANS: D
The statement “Evidence-based practice is the use of current best evidence in making decision about patient care” shows that the nurse has an adequate understanding. The other statements about evidence-based practice are false.
A new nurse is determining which hospital to apply for. The nurse has heard a lot about magnet hospitals from friends who are nurses and knows that working for a magnet hospital would mean
a.
the nurse would likely experience high job satisfaction.
b.
the nurse would likely experience poor job satisfaction.
c.
the nurse would have to have a BSN before being able to apply.
d.
the nurse would be hired after having a year of nursing experience.
ANS: A
Magnet hospitals are known for attracting and retaining nurses because of their high satisfaction rates among nurses. These hospitals have low job turnover and low nurse vacancy even when the hospital is in an area experiencing a nursing shortage.
A nurse is covering for a coworker who is on a lunch break. While administering medications, the nurse notices a bag of antibiotic hanging with another patient’s name on it. The nurse immediately stops the infusion. What should the next step be?
a.
Say nothing about the error because the patient is fine.
b.
Speak with the coworker about the error and document the error.
c.
Tell the other coworkers about the error.
d.
Tell the patient about the error.
ANS: B
The next step that the nurse should take is to speak to the coworker about the error and then fill out paperwork for documentation. The nurse needs to have a “crucial conversation” with this coworker to alert him/her about the error. This allows for a decrease in the number of errors and a safer health care environment.
The nurse assesses the quality of patient care to be higher in the Total Patient Care model because:
a.
patients are able to perform the majority of their own care.
b.
nurses are required to perform less care.
c.
nurses are able to focus all of their care on one patient.
d.
nurses are hired to care for two patients.
ANS: C
The quality of care is higher in the Total Patient Care model because nurses are able to focus all of their care on one patient instead of juggling the care of two or more.
A nurse has been assigned as team leader for the day and is working with two LPNs and two unlicensed personnel. What should the nurse do to ensure success in caring for patients?
a.
Give the assignments for the day out to the team, and plan to meet right before the end of shift.
b.
Continuously communicate with the members of the team throughout the entire day.
c.
Report changes in a patient’s condition to the health care provider only.
d.
Revise each patient’s plan of care once a shift.
ANS: B
To ensure success for the day, the nurse should continuously communicate with the members of the team throughout the entire day. The nurse should be sure to update all members of the team on any change in patient status. The LPN can also report changes in a patient’s condition to a health care provider because it doesn’t have to be the team leader. Revisions of each patient’s plan of care should be done continuously as changes arise and not just once a shift.
The nurse has an adequate understanding of patient-focused care when stating which of the following?
a.
“Patient-focused care includes the physician, who supervises care.”
b.
“Patient-focused care decreases productivity.”
c.
“In patient-focused care, the nurse supervises delivery of care.”
d.
“The patient is not an active participant in patient-focused care.”
ANS: C
In patient-focused care, the nurse (not a physician) supervises delivery of care. This system increases productivity and encourages the patient to be an active member of the health care team. Patients are encouraged to be active participants in the planning of their care.
Which type of nursing delivery models would be appropriate in a rural area that would require fewer numbers of registered nurses? (Select all that apply.) a. Functional nursing b. Team nursing c. Primary care nursing d. Patient-focused care e. Transitional care
ANS: A, B, D
When you have a limited number of nurses, then functional nursing, team nursing, and patient-focused care are useful because you can deliver quality care by using more ancillary staff. Primary care is usually 24-hour nurse coverage, and transitional care is when advanced practice nurses (APRNs) conduct assessments and—with physicians—design and coordinate patient care and discharge plans.
The nurse understands cost containment when stating which of the following? Major elements of the law that support cost containment include (Select all that apply.)
a.
“increased governmental regulation of insurers.”
b.
“less use of technology.”
c.
“increasing incentives for coordination of care.”
d.
“emphasis on physician-centered care.”
e.
“decreasing consumer out-of-pocket costs.”
ANS: A, C
Major elements of the law that supports cost containment include increased governmental regulation of insurers, increased use of technology, increasing incentives for coordination of care, emphasis on patient-centered care, and increased consumer out-of-pocket costs. These measures are in an effort to reduce the overall cost of health care.
Which actions can the hospital administrator take to reduce health care costs? (Select all that apply.)
a.
Hire case managers to see all patients who have extensive medical needs.
b.
Reduce the number of patients the hospital can accommodate.
c.
Ensure that appropriate staff is available.
d.
Encourage the use of evidence-based practice.
e.
Accept only patients with health insurance.
ANS: A, C, D
To reduce health care costs, the hospital administrator can take different actions. The hospital administrator can hire case managers to see all patients with extensive medical needs, ensure that appropriate staff is available, and encourage the use of evidence-based practice. It is not realistic for the hospital administrator to reduce the number of patients that the hospital can accommodate. It is illegal to turn away patients without health insurance.
Which statements by the nurse indicate understanding of the case manager’s role? The case manager (Select all that apply.)
a.
“guides patients through the health care delivery process.”
b.
“ensures quicker discharge for patients without insurance.”
c.
“coordinates care for the patient.”
d.
“assists patients in achieving goals effectively and efficiently.”
e.
“collaborates with the health care team.”
ANS: A, C, D, E
The role of the nurse case manager includes guiding patients through the health care delivery process, coordinating care for the patient, assisting patients in achieving goals effectively and efficiently, and collaborating with the health care team. Patients without insurance do not necessarily have a quicker discharge process.
The nurse judges that the disease management program has been successful when the patient (Select all that apply.)
a.
assumes responsibility for his/her own health.
b.
learns how to maintain good health.
c.
can state how to manage his/her chronic condition.
d.
relies on the health care team for maintenance of health.
e.
can state how to avoid worsening of health
ANS: A, B, C, E
The disease management program has been successful when the patient assumes responsibility for his/her own health, learns how to maintain good health, can state how to manage his/her chronic condition, and can state how to avoid worsening of health.