Ambulatory Exam 1

What are the defining features of ambulatory care nursing when compared with in-patient nursing?

—outside of in patient setting

-perspective

-locus of control

-type of technology (Telehealth / virtual care)

-depth of care coordination

What’s the difference between ambulatory and acute

-treatment management is more in patient control. Family support/ involvement is essential

-medical interventions occurs same day but general encounters occur over time

-ambulatory incorporates all elements that impacts a person

-payment affect treatment options more

Who created the organization that evolved into the Visiting Nurse Service?

Lilian Wald 1893 (Henry street settlement)

What are the different functions for the different roles in ambulatory care?

RN- license professional who does assessment, patient education, and more under scope of practice depending on state

LPN- license to work under the supervision of a RN. Can’t perform all nurse duties like education, assessment, and some drug administration.

MA: most ubiquitous role, just assist professionals in whatever capacity allowed

Provider- practices medicine by diagnosis conditions, care for conditions through medication,

What is primordial prevention and a example

focus on social and economic conditions

Ex.) policy

What is primary prevention and example of it

focus on individual to prevent disease

Ex.) immunizations

What is secondary prevention and an example of it ?

focus on identifying subclinical disease - screening

Ex.) Pap smears, STI testing

What is tertiary prevention an example of it ?

focus on mitigating disease severity and effects

Ex.) physical and occupational therapy

What are principles of appropriate screening?

The condition should be an important health problem

There should be a treatment for the condition

Facilities for diagnosis and treatment should be available

There should be a latent stage of the disease

There should be a test or examination for the condition

The test should be acceptable to the population

The natural history of the disease should be adequately understood

There should be an agreed policy on whom to treat

The cost of finding in a case should be balanced in relation to overall medical expenditure

What makes something an effective screening tool?

1.) increases the average life expectancy for a population

2.) The number of subjects screen to prevent disease or death in one individual

3.) the absolute and relative impact of screening on disease incidence or mortality

What might be disadvantages of simply screening for every possible issue?

1.) false positive test

2.) adverse effects from preventative medication

3.) over diagnosis of disease

4.) screening anxiety and discomfort

What is specificity and sensitivity?

Sensitivity: the ability of a test to detect any possibility of a disease → decreases false negatives.

Specificity: the ability of a test to identify the specific disease in question →decreases false positives.

What would be ideal for a really good Screening test?

High sensitivity; This ensures that most

people who actually have the disease are detected and not missed (minimal false

negatives)

What does level A mean in the USPSTF website

The USPSTF recommends the service. There is high certainty

that the net benefit is substantial.

What does level d mean on the USPST website

The USPSTF recommends against the service. There is moderate

or high certainty that the service has no net benefit or that the

harms outweigh the benefits.

What does level I mean on the USPSTF website

The USPSTF concludes that the current

evidence is insufficient to assess the balance

of benefits and harms of the service.

Describe the positive impacts of Covid on Telehealth

Convience

Continuity of care for patient unable to do face to face

Effective for screening

Reduces workplace burnout

Describe the negative impact of Covid on Telehealth

-fraud

-digital device issues (access and technology literacy)

-privacy concerns

Patient care consideration for Telehealth RN’s

-shift to technology focus and less patient care and nursing standards

-interdisciplinary collaboration

-further complicates disparities for vulnerable populations

Legal considerations for Telehealth RN’s

Data breeches

-Hippa

-scope of practice laws state by state

Understand the principles of triage and prioritization.

1.) Timely consultations that assess for urgency and severity

2.) treatment or referral: treatment must include follow up and referrals should be appropriate and practical

What are the benefits and limitations of protocols?

Benefits: safety, credibility, security

Limitations: unnecessary control, less helpful in complex care with co-morbidities,

age, gender, social & structural DOH not always addressed

What are key elements of primary care

What is ask me 3 ?

A guide line of questions that help patients become more active members of their health care team

What are the questions of ask me 3

What is my main problem?

What do I need to do?

Why is it important for me to do this

Key elements of primary care

Location and specialty

What are challenges in primary care?

Administrative and clinical responsibilities

Need clear protocols and supportive education

Lack of understanding by administrative and clinical leaders

Clarity of responsibilities

Initiative within nursing leadership to support expanded roles

What are the facilitators of primary care

Change in national attitude

Cost of acute care

Renewed interest in team-based care

Increased availability/use of NPs, PAs

What activities does RN perform in an annual wellness visit?

General assessment, Preventive care review, and care plan

What activities does a RN do in a flipped or CO visit

Gather SBAR information, report it to the provider, provides education and care plan goals,

What are challenges in school nursing

Managing acute, chronic, and mental illness of multiple student with only one RN over various school, & not a lot schools have school nurses due to access barriers

How has occupational health change over time and how has that affect nursing?

The labor workforce is decreasing over time resulting in not a need for occupational nurses

What are defining principles for the chronic care model?

It is a framework that improves chronic illness management and outcomes in primary care setting with patient centered management and goal through different channels and interactions: health care organization, community, and patient

What are the defining principles of the transitional care model through a multidisciplinary approach

Framework of time limited care that ensure health continuity and prevent poor outcome when at-risk populations transition settings

What are defining principles for the health belief model

Framework that focuses on cognitive constructs that influence behavior around fear and anxiety around disease prevention:

What’s are the 6 dimensions apart of the health belief model

Perceived susceptibility: probability of acquiring an illness or encountering an

undesirable outcome

Perceived severity: understanding the severity of the illness, condition, or

unfavorable outcome and what could happen if no additional action is taken

Perceived benefits: how the effectiveness of various available actions to

reduce the risk of illness are perceived

Perceived barriers: obstacles to performing a recommended health action

that may stop one from doing what is recommended

Self-efficiency: An individual’s belief in their capacity to perform a specific

behavior or task effectively

Cues to actions: whether from one’s surrounding or subjective experiences