Week 1: Synergy Model, Professional Issues & Trends, & Care of the Hospitalized Patient

Question 1

What is the synergy model?

Answer 1

• describes nursing practice based on the needs and characteristics of patients
• when the competencies of both the patient and the nurse are matched and are “synergized”, the outcomes for the patient are optimized
• each characteristic or competency exists on a continuum from low (level 1) to high (level 5)

Question 2

Patient characteristics of the synergy model

Answer 2

Resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability

Question 3

Synergy model: resiliency

Answer 3

The capacity to return to a restorative level of functioning compensatory or coping mechanisms, their ability to “bounce back”

Question 4

Synergy model: vulnerability

Answer 4

How likely a patient is to cave to stressors or adverse effects, susceptibility to stressors or adverse effects

Question 5

Synergy model: stability

Answer 5

Ability to maintain status quo

Question 6

Synergy model: complexity

Answer 6

Entanglement of two or more systems (doesn’t always have to be body systems)

Question 7

Synergy model: resource availability

Answer 7

The extent of resources

Question 8

Synergy model: participation in care

Answer 8

The extent to which a patient or family engages in care

Question 9

Synergy model: participation in decision making

Answer 9

The extent to which the patient or family engages in decision making

Question 10

Synergy model: predictability

Answer 10

A characteristic that allows one to expect a certain course of events or course of illness

Question 11

Synergy model call nurse competencies include…

Answer 11

Clinical judgment, advocacy and moral agency, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, and facilitator of learning

Question 12

Synergy model: clinical inquiry

Answer 12

Ongoing process of questioning and evaluating practice and providing informed practice

Question 13

Synergy model: clinical judgment

Answer 13

Clinical reasoning, which includes clinical decision making, critical thinking, and a global grasp of the situation

Question 14

Synergy model: facilitation of learning

Answer 14

The ability to facilitate learning for patients and/or families, nursing staff, other members of healthcare, and community

Question 15

Synergy model: collaboration

Answer 15

Working with others in a way that promotes or encourages each person’s contribution

Question 16

Synergy model: systems thinking

Answer 16

There is a body of knowledge or tools that allows the nurse to manage environmental or system and resources exist for the patient and/or family

Question 17

Synergy model: advocacy and moral agency

Answer 17

Working on another’s behalf and presenting the concerns of the patient and/or family

Question 18

Synergy model: caring practices

Answer 18

Constellation of nursing activities that create a compassionate, supportive, and therapeutic environment for patients and staff

Question 19

Synergy model: response to diversity

Answer 19

Ability to recognize, appreciate, and incorporate differences into the provision of care

Question 20

Synergy model outcomes include…

Answer 20

Satisfaction of patients and their families, rate of adverse incidents, complication rate, adherence to the discharge plan, mortality rate, and each patient length of stay

Question 21

Fundamentals of AIDET

Answer 21

A - acknowledge
I - introduce
D - duration 
E - explanation
T - thank you

Question 22

What is a living will?

Answer 22

States types of interventions of patient would want in a critical illness (artificial nutrition/hydration, life-support and intubation, names surrogate decision maker)

Question 23

What is a guardianship?

Answer 23

A legal process used to protect individuals who are unable to care for their own well-being due to infancy, incapacity, or disability

Question 24

Emancipation

Answer 24

• A minor who is emancipated do not need parents permission to sign a legally binding contract, get medical care, enroll in vocational school, or engage in other activities that otherwise require a parent permission
• also includes minors who are married or in the military

Question 25

Strategies for resolution: collaboration

Answer 25

Step one: understand the cognitive and emotional perspective; listen, mutual respect, no power and balances, set ground rules Step two: engage all parties Step three: make decision and make a plan

Question 26

Strategies for resolution: compromise

Answer 26

- compromise is used when parties in conflict are committed to maintaining the relationship - parties each possess high moral certainty about opposing courses of action - each party relinquishes some control

Question 27

Strategies for resolution: accommodation

Answer 27

- used when the issue is seen as minimally important - only one party is committed to preserving the relationship - May not preserve integrity for all parties

Question 28

Strategies for resolution: coercion

Answer 28

- reflects a strong commitment to a particular position | - generally encourages a power imbalance

Question 29

Strategies for resolution: avoidance

Answer 29

- used when a moral issue is seen as unimportant or the situation is highly emotionally charged - The conflict is not addressed or discussed

Question 30

What is negligence?

Answer 30

The failure to exercise the care that a reasonably prudent person would exercise in the same situation

Question 31

What is medical malpractice?

Answer 31

When a hospital, doctor, or other healthcare professional, through a negligent act or omission, causes an injury to a patient

Question 32

What four factors must be present for a malpractice suit to exist?

Answer 32

1. Duty of care must be owed 2. Breech - The excepted standard of care is breached 3. Patient must have sustained an injury 4. Causation - injury caused by your actions

Question 33

What is claims made liability insurance?

Answer 33

In order to be covered, the claim has to be made during the time of that the insurance was active for you to be covered

Question 34

What is tail coverage insurance?

Answer 34

Extended reporting period endorsement, offered by a provider’s current malpractice insurance carrier, which allows an insured provider the option to extend coverage after the cancellation or termination of a claims made policy

Question 35

What are the components of decision making capacity?

Answer 35

- The ability to understand the options - The ability to understand the consequences of choosing each of the options - The ability to evaluate the personal costs and benefits of each of the consequences and relate them to your own instead of values and priorities

Question 36

What are informed consent components?

Answer 36

- nature of treatment - consequences of treatment - risks and hazards - known side effects and complications - alternative treatments available

Question 37

What is the Stark Law?

Answer 37

Prohibits physicians from referring patients to certain services in which they have a “financial relationship”

Question 38

What is the anti-kickback statute?

Answer 38

Cannot get kickbacks or money for referrals

Question 39

What is the National Practitioner Data Bank (NPDA)?

Answer 39

- A web-based repository of reports containing information on medical malpractice payments related to healthcare practitioners, providers, and suppliers - prevents practitioners from living state to state without disclosure or discovery previous damaging performance - Mission is to improve healthcare quality, protect the public, and reduce healthcare fraud and abuse in the US - Not visible to the public

Question 40

What is defense medicine?

Answer 40

- often the reason why providers order too many tests | - A way providers protect themselves against lawsuits

Question 41

Characteristics of the synergy model

Answer 41

- when the competencies of both patient and nurse are matched they are synced, the outcomes for the patient are optimized - each characteristic or competency exists on a continuum from low (level 1) to high (level 5)

Question 42

Components of a therapeutic relationship

Answer 42

- Mutual trust: depend on each other to reach a common goal, don’t plan for but with the patient - professional boundaries: maintain patient/provider relationship - confidentiality: patient feels vulnerable especially when they are an inpatient - cultural respect: know yourself and your biases, don’t stereotype

Question 43

Ethical principles: autonomy, nonmaleficence, beneficent, formal justice, veracity, Fidelity, confidentiality, and privacy

Answer 43

- autonomy: ability to make own decisions - Nonmaleficence: do no harm - beneficence: do good - formal justice: have equality - veracity: to tell the truth - Fidelity: do what you say you’re going to do

Question 44

What is credentialing?

Answer 44

Represents the verification of a persons education, training, and experiences; as in “to verify a persons credentials“

Question 45

What is privileging?

Answer 45

Permission to provide medical and other patient care services in the granting institution based on the individuals education, professional license, experience, competence, ability, health, and judgment

Question 46

Medicare

Answer 46

- An insurance program that primarily serves people 65 and older, regardless of income - medicare is a federal program - can also get Medicare if a younger person has disabilities and/or certain diseases, including end-stage renal disease, Lou Gehrig’s disease, etc.

Question 47

Medicaid

Answer 47

- available in every state to those with income below the poverty line - Federal government makes the guidelines, but the program is administered by states so eligibility requirements vary

Question 48

Licensure

Answer 48

A formal recognition by a regulation agency that someone has proficient on a scale to practice in an area, often a state

Question 49

Ordering diagnostics

Answer 49

- don’t just order because you can - Think about risk versus benefit - is the diagnostic going to change your treatment plan - what do you ultimately want to find out

Question 50

Medical futility

Answer 50

Interventions that are unlikely to have significant benefit to the patient