Teamwork,Collaboration,Health Policy

Fee-For-Service

physicians are paid for each service they provide

Capitation

set monthly allowance provided by insurance company

Private Health Insurance

Group: protects ppl from bills of unexpected illnesses

Individual: offered to only individuals not part of a group

Veterans Health Administration

health care to all vets

DRG (Diagnosis-related-groups)

diagnosis determines hospital flat fee for certain diagnosis based on data

Premium insurance

the price paid to an insurance company for coverage

Deductible

the annual amount you pay for covered healthcare services before your health insurance plan starts to pay its share

Co-pay

a fixed amount you pay for a covered health service, usually at the time you receive the service

Co-insurance

the splitting or spreading of risk among multiple parties.

Healthcare provider

any person, group, or organization that offers medical or health services

Primary Care Physician (PCP)

the gatekeeper for access to medical services

Libel

False written statements about another that are made public with the intent to harm

Assault

To purposely threaten physical harm to an individual

Battery

To touch an individual without consent

Slander

Damage to someone’s reputation by verbalizing untrue or confidential information

General (implied) consent

treatment is implied upon admission EMERGENCY ONLY

Informed consent

invasive procedure (surgery, diagnostic) PATIENT MUST BE FULLY INFORMED AND AWARE

Patient-Centered Care

Compassion, culturally sensitive, including patient in decision-making process.

Evidence-Based Practice

Current knowledge of research to base client care

What is the LVN’s role on the healthcare team?

Dependent/interdependent; assists with nursing process, reinforces teaching, manages basic care, can be charge nurse in LTC, reports to RN/physician

What is intradisciplinary collaboration?

nurse-to-nurse teamwork

What is interdisciplinary collaboration?

Two or more professions working together to improve patient outcomes (nurses, physicians, PT, RT, etc.

Why is “seeking clarification” important?

Prevents miscommunication; SBAR & closed-loop communication ensure safety and accuracy.

Examples of healthcare worker strengths? (2)

communication and reliability

Examples of healthcare worker weaknesses? (2)

cant accept criticism and poor organization

What does HIPAA protect?

Patient privacy and confidentiality of health information (written, verbal, electronic).

What does HIPAA stand for?

Health Insurance Portability and Accountability Act

What is mandated reporting?

Nurses are legally required to report abuse, neglect, communicable diseases, or criminal acts.

What is Medicare?

Federal health insurance for adults 65+, disabled, or ESRD.

What is Medicaid?

State and federal program for low-income individuals; eligibility varies by income/need

What does Social Security provide?

Retirement and disability income benefits funded through payroll taxes.

What is SNAP?

Supplemental Nutrition Assistance Program (food stamps), income-based.

PPO vs HMO – what’s the difference?

:PPO = flexible, out-of-network covered but costly.

HMO = cheaper, must use in-network providers, PCP referral required for specialists.

What is acute care?

Short-term hospital care for sudden illness/injury.

What is LTAC (Long-Term Acute Care)?

Extended hospital care (20–30 days) for patients with complex medical needs (ventilator, severe wounds).

What is a rehab hospital?

Focuses on recovery and regaining independence through therapy.

What is a psych hospital?

What is hospice care?

Comfort-focused care for terminal illness (<6 months life expectancy).

What is home healthcare?

Skilled nursing and therapy provided in the patient’s home.

What is assisted living?

Residential setting for adults needing some help with ADLs but still mostly independent.

What is adult daycare?

Supervision and activities during daytime; patients return home at night.

What is memory care?

Specialized residential care for dementia/Alzheimer’s in secure settings.

What is a SNF (skilled nursing facility)?

24/7 medical and therapy care under RN supervision.

What are the 6 QSEN competencies?

Patient-Centered Care, Teamwork/Collaboration, Evidence-Based Practice, Quality Improvement, Safety, Informatics.

What is the National Academy of Medicine (NAM)?

Private nonprofit providing research-based advice to improve health equity and policy.

What does The Joint Commission (TJC) do?

Accredits hospitals, sets patient safety standards, conducts unannounced surveys.

What is a sentinel event?

Unexpected safety event causing death, permanent harm, or requiring life-sustaining intervention.

What are the top causes of sentinel events?

Falls, wrong surgery, suicide, delayed treatment, retained foreign objects.

What is the nurse’s role in sentinel events?

Report immediately, ensure patient safety, participate in root cause analysis.