Nursing 100 Quiz 3

Chapters 19, 7, 10, 24, 17, 20

Relaying information using words, letters, symbols, or body language is referred to as \_______.

communication

Anyone who wishes to convey an idea or concept to others is referred to as a \_______.

sender

What is the most important concept to remember when using both verbal and nonverbal communication?

Nonverbal messages are accepted as true more often than verbal ones

The primary goals of good relationship building and client care are best achieved when all members of the interprofessional care team have achieved what?

Have developed a trusting nurse-client relationship

When a client expresses doubt whether a complicated procedure will actually help his condition, the nurse best avoids blocking the communication by providing what response?

"What makes you doubt that your condition will benefit from having the procedure done?

What observations made by the nurse manager indicate that a nurse demonstrated positive conflict management interventions when a patient's family member angrily accuses the nurse of neglecting the patient's need to be ambulated more frequently?

- Kept refocusing the discussion to the patient's needs associated with ambulation
- Moved the discussion to the privacy of the patient's room
- Kept culturally appropriate eye contact with the family member while discussing the issues

What is the most likely reason a 9-year-old child cries and refuses to cooperate with an injection?

The child's past experiences with injections

Nursing's primary concern related to the appropriate use of social media is to preserve what?

Confidentiality

active listening

the process of hearing what others are saying with a sense of seriousness and discrimination

Conflict

an experience in which there is simultaneous arousal of 2 or more incompatible motives

Filtration

unconscious exclusion of extraneous stimuli

information

the data that are meaningful and alter the receiver's understanding

interpretation

receiver's understanding of the meaning of the communication

negative communication

behaviors that block or impair effective communication

perception

the manner in which one sees reality

positive communication

behaviors that enhance effective communication

Information regarding a patient's health status may not be released to non-health care team members because

Legal and ethical obligations require health care providers to keep information strictly confidential.

Conciseness

- State necessary information clearly and briefly
- Determine what facts are pertinent to enable reader to understand the true message
- When in doubt and if appropriate, ask another party to read message and provide feedback
- Be as judicious in handling written material as in handling any other form of communication

Confidentiality

Nurses are legally and ethically obligated to keep all patient information confidential.

Nurses are responsible for protecting records from all unauthorized readers.

HIPAA requires that disclosure or requests regarding health information are limited to the minimum necessary.

Thoroughness

- Provide complete information to help avoid communication breakdown
- Anticipate and answer relevant questions before they are asked

- Electronic health records are normally more thorough rather than written records
- EHR's always allow for nurses notes also

Attention to Detail

■Written documents should be descriptive
■Information should be quantified whenever possible
■Descriptive categories for physical conditions
-Measurement, color, position
-Location, drainage, or condition
■Descriptive categories to document meetings, conferences, evaluations, or other interchanges
-Time, setting, people present
-Issues or goals discussed
-Direct quotes

It is not enough to say "the IV looks fine"

We would want to include a lot of detail: measurements of wound (this helps us to tell if the wound is healing), color of the wound, where it is located

If you didn't document it, it is assumed you did not do it

accuracy

- Absolute accuracy is paramount when one is recording in the legal document (medical record)
- Every effort should be made to report concisely and truthfully

- Accuracy is a paramount importance
- Your documentation could be called to court
- What you put on paper is going to help in court of law, so it is important that it is very accurate

Standards

■Current documentation standards require that each patient have an assessment:
-Physical, psychosocial, environmental, self-care, patient education, knowledge level, and discharge planning needs
■Nursing documentation standards are set by federal and state regulations, state statutes, standards of care, and accreditation agencies.

Interdisciplinary Communication Within the Health Care Team

■Interdisciplinary communication is essential within the health care team.

purpose of records

Communication
Legal documentation
Reimbursement
Education
Research
Auditing/monitoring

Legal Guidelines for Recording

- Correct all errors promptly, using the correct method.
- Record all facts; do not enter personal opinions.
- Do not leave blank spaces in nurses' notes.
- Write legibly in permanent black ink.
- If an order was questioned, record that clarification was sought.
- Chart only for yourself, not for others.
- Avoid generalizations.
- Begin each entry with the date/time and end with your signature and title.
- Keep your computer password secure.

Guidelines for Quality Documentation and Reporting

■Factual
■Accurate
■Complete
■Current
■Organized

Methods of Recording

■Paper record
-Episode-oriented
-Key information may be lost from one episode of care to the next.
■Electronic health record (EHR)
-A digital version of a patient's medical record
-Integrates all of a patient's information in one record
-Improves continuity of care

Records or chart

Confidential permanent legal document

Reports

Oral, written, or audiotaped exchange of information (could be given to other doctors, nurses, or units)

Conferences

Team members communicating in a group

Consultations

A professional caregiver giving formal advice to another caregiver

Referrals

Arrangement for services by another care provider

what are the 4 main requirements for nursing documentation?

1. accuracy
2. detailed
3. thorough
4. concise

Workforce Advocacy is?

how a nurse reacts to challenges within the workplace and continues to advocate to improve patient care is a necessary focus for the profession

what are some issues in the workplace?

•Nursing shortage •Appropriate staffing and mandatory overtime •Patient advocacy and safety •Workplace safety

History of nursing shortages have been documented since when?

World War II

what is one of the most critical challenges of this century pertaining to nursing shortage?

Planning for an adequate nursing workforce

what will job opening result from in nursing?

•Need to replace experienced nurses who leave the occupation •Technological advances in patient care •Increasing emphasis on preventive care •Rapid growth in the older population

retention depends on?

creating an environment conducive to professional autonomy that supports decision making and effective nurse-physician relationships

Magnent hospitals

successful retention program; promotes standards for professional nursing practice and recognizes quality, excellence, and service

Nurses in Magnet hospitals have higher levels of

\-autonomy, greater control over the practice setting, and better relationships with physicians

Increased satisfaction in retention is predicted by:

•Organizations who emphasized the quality of patient care •Management that recognized the importance of nurses' personal and family lives •Satisfaction with salary and benefits •High job security •Positive relationships with other nurses and with management

Decreased satisfaction in retention is predicted by:

•Feeling stressed to the point of burnout •Feeling burdened by too many non-nursing tasks •Experiencing an increase in the number of patients assigned Having a general, negative overall view of the health care system

Nurses older than __________ years represent nearly 1/3 of the workforce

50

•Strategies for retaining the older, expert nurse are

•Provide greater flexibility in scheduling •Provide better ergonomics and health care design to decrease physical demands •Allow for greater participation in decision making

what are the most common reasons for turnover?

•Insufficient supply of qualified managers and experienced staff •Other career prospects •Workload and inappropriate staffing

what are the 9 elements of a healthy work environment?

•Collaborative practice culture •Communication-rich culture •Culture of accountability •Presence of adequate numbers of qualified nurses •Presence of expert, competent, credible, visible leadership •Shared decision making at all levels •Encouragement of professional practice and continued growth/development •Recognition of the value of nursing's contribution •Recognition of nurses for their contribution to practice

What are the factors contributing to nursing dissatisfaction within the workplace?

•Inappropriate staffing levels •Increased requirement for mandatory overtime

__________________ has reinforced the importance of appropriate nurse staffing to affect nurse satisfaction and positive patient outcomes

Research

Mandatory overtime and adequate staffing levels have become _________ and ____________ legislative issues

federal, state

The first state (and only state) to pass legislation addressing nurse staffing levels through fixed minimum ratios was _________________ in 1999

California

The 2012 ANA _____________ for _____________ ____________ identify the major elements needed to achieve optimal staffing, which enhances the delivery of safe, quality care. These principles and the supporting material in this publication will guide nurses and other decision-makers in identifying and developing the processes and policies needed to improve nurse staffing at every practice level and in any practice setting

Principles for Nurse Staffing

Shared Governance

•Gives nurses an active role in decision making •Provides maximal participation and accountability for nursing practice •Attributes include independence, accountability, and autonomy over nursing practice •Results in increased job satisfaction and better patient outcomes •Questions should be asked about shared governance or participatory management models (Box 13-7)

Patient _____________ is the cornerstone of nursing

advocacy

Whistle-Blower Protection

Protects nurses who speak out about unsafe situations from being fired or subjected to other disciplinary actions by their employers

Categories of health hazards in the health care workplace are?

•Biologic •Ergonomic •Chemical •Psychological •Physical

Blood-Borne Pathogens

•Health care professionals at risk for exposure to hepatitis B and C, and HIV/AIDS •Use of needlestick devices reduces worker injuries

Needlestick Safety and Prevention Act signed into law in _________

2000

what does the Needlestick Safety and Prevention Act require?

Requires the use of safer devices to protect from sharps injuries -Requires employers to maintain a sharps injury log

Ergonomic issues

•Nursing is ranked second after industrial work for physical workload intensity •ANA's lifting initiative—Handle With Care—seeks to prevent back and other musculoskeletal injuries through education and increased use of assistive equipment and patient-handling devices

what is a major societal issues?

workplace violence

Starting in the 1960s, the rapid introduction of technically advanced health care diagnostics and treatment procedures contributed negatively to what aspect of health care?

Cost of services

The 2010 Patient Protection and Affordable Care Act (PPACA) projects that within the next 10 years what health care related situation will be a realization?

All Americans will have health care insurance available to them.

When hospitals receive payment for services based on the pay-for-performance model, what is the nurses' role?

Providing client care that helps ensure positive health outcomes

An example of nursing's influence on outcome management through consumer empowerment would include what intervention?

Providing a post surgical client with education regarding the early signs of incisional infection

When an unemployed, blind adult requires medical treatment but cannot afford the services, the nurse suggests that the client is possibly eligible for what form of payment assistance?

Medicaid

Place the following events associated with healthcare finance in the appropriate chronological order.

\- Blue Cross/Blue Shield originates at Baylor Hospital

* Individual disability and illness insurance policies become available
* Medicare and Medicaid are created
* Managed care emerges

Which statement is true when considering characteristics of a preferred provider organization (PPO)?

\- Includes deductible and copayment

* Member may select their primary health care provider.
* Members pay less for care at facilities on the plan's preferred list.
* Member pays a premium for a fixed percentage of expense covered.

What component is included in the Hospital Consumer Assessment of Health Care Providers and Systems survey?

\- Discharge information

* Responsiveness of hospital staff
* Communication with nurses
* Cleanliness and quietness of hospital environment

What area of professional nursing is directly affected by changes in financing of health care services?

\- The general perception of the worth and values of health care services

* The public's willingness to seek services for various health care providers
* Rate of reimbursement for nurse practitioners
* Job opportunities for salaried health care providers

Centers for Medicare and Medicaid Services (CMS)

The federal government agency that administers Medicare and Medicaid

DRGs (diagnosis-related groups)

A common method of reimbursement for health care services based on a predetermined fixed price-per- diagnosis

Effectiveness

Production of a desired outcome; taking the right action to achieve the expected result

efficiency

The extent to which resources, such as energy, time, and money, are used to produce the intended result

GDP (Gross Domestic Product)

The measure of the total value of goods and services produced within a country; the most comprehensive overall measure of economic output; provides key insight to the driving forces of the economy

health insurance exchange

Also known as the "Health Insurance Marketplace," an online marketplace for individuals to shop for and purchase health insurance at affordable rates and to identify whether they qualify for cost assistance subsidies to help pay the cost of the insurance; states established health insurance exchanges as a component of the Patient Protection and Affordable Care Act to provide access to affordable health insurance options for American citizens and legal residents.

marginal

an economic term that refers to a small or insignificant change in some variable (e.g., the number of medical tests performed)

medicaid

A jointly sponsored state and federal program that pays for medical services for persons who are elderly, poor, blind, or disabled and for certain families with dependent children who meet specified income guidelines

medicare

a federally funded health insurance program for disabled, persons with end-stage renal disease, and persons 65 years of age and older qualify for social security benefits

Patient Protection and Affordable Care Act (PPACA)

A federal statute enacted in 2010 that requires U.S. citizens and legal residents to have health insurance through comprehensive health care reform; expands health care coverage access to millions of people who were previously uninsured

Private Health Insurance

A method for individuals to maintain insurance coverage for health care costs through a contract with a health insurance company that agrees to pay all or a portion of the cost of a set of defined health care services such as routine, preventive, and emergency health care; hospitalizations; medical procedures; and/or prescription drugs. Typically the private insurance is provided through an individual's employer with a portion of the cost paid by the employer and a portion paid by the employee. Private insurance policies can also be purchased by individuals but are generally much more expensive than when provided through an employer's group plan.

Prospective Payment System

A method of reimbursing health care providers (i.e., physicians, hospitals) in which the total amount of payment for care is predetermined based on the patient's diagnosis; provides for a "set price per diagnosis" payment system in contrast to the retrospective or "fee-for-service" system; encourages increased efficiency in the use of health care services because providers are reimbursed at a set level regardless of how many services are rendered or procedures performed to treat a particular diagnostic category; the most common method of payment in today's health care system.

provider

A licensed health care professional (such as a physician or nurse practitioner) or an organization (such as a hospital) that receives reimbursement for providing health care services

Retrospective payment system

A method of reimbursing health care providers (i.e., physicians, hospitals) in which professional services are rendered and charges are billed based on each individual service provided; also known as the "fee-for-service" payment system. This system may encourage overuse of health care services because the more services rendered or procedures performed, the more revenue received by providers.

single-payer system

A method of reimbursement in which one payer, usually the government, pays all health care expenses for citizens, funded by taxes. Decisions about covered treatments, drugs, and services are made by the government. Though the terms universal health care and single payer system are sometimes used interchangeably, universal health care could be administered by many different payer groups; both offer all citizens health insurance coverage.

Third-party payer

an organization other than the patient and the provider, such as an insurance company, that assumes responsibility for payment of health care charges. An individual's health insurance plan provided by his or her employer is considered a third-party payer

cultural humility

incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-clinician dynamic and to developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations

Cultural Sensitivity

experienced when neutral language, both verbal and nonverbal, is used in a way that reflects sensitivity and appreciation for the diversity of another

culture

shared values, beliefs, and practices of a particular group of people that are transmitted from one generation to the next and are identified as patterns that guide thinking and action

Ethnicity

affiliation resulting from a shared linguistic, racial, or cultural background

ethonocentric

believing that one's own ethnic group, culture or nation is best

minority

an ethnic group smaller than the majority group

prejudice

preconceived, deeply held, usually negative, judgement formed about other groups

stereotyping

assigning certain beliefs and behaviors to groups without recognizing individuality

transcultural

being grounded in one's own culture, but having the skills to be able to work in a multicultural environment

The belief that one's own culture is superior to all other cultures is called __.

ethnocentrism

Acceptance of others regardless of their cultural background is referred to using what term?

Tolerance

How is cultural humility best achieved?

Through regular self-evaluation of biases

A nursing school best demonstrates an understanding of strategies that support recruitment of minority nursing students when engaging in what behavior?

Providing same-culture mentors from among faculty and student populations