nursing 228 exam 2

what lead to the growth of hospitals in the US?

1. advances in medical science
2. development of medical technology
3. changes in medical education
4. growth of the health insurance industry
5. greater involvement of the gov't
6. emergence of professional nursing

what is the other name for the Hospital Survey and Construction Act of 1946?

Hill-Burton Act

Hill-Burton Act

resulted in construction of many hospitals

Patient protection & Affordable Care Act of 2010

provides affordable health insurance, requires US citizens/legal residents to have a qualifying health insurance

long term care facilities

nursing homes, assisted-living centers, rehabilitation centers

nursing homes

- functional dependence
- provides care for those w/o the ability to manage ADLs (activities of daily living)
- provides skilled care in nursing; physical therapy & speech therapy is termed a skilled nursing facility (SNF)

admission to a nursing home is __

functional

assisted-living centers

- independent
- provide supportive services
- they can manage most of their ADLs
- shared decision model

rehabilitation centers

- assist individual in returning to maximum level of independence
- Sister Callista Roy's adaptation model

skilled nursing facility (SNF)

speech therapy and physical therapy

history of nursing home

- harsh beginning
- person who was housed in a county poorhouse often had no financial resources and no family to care and assistance and endured a certain social stigma
- nursing homes emerged as a result of the social security act
- in the postwar period, the Hill-Burton Act was expanded to include voluntary (nonprofit) nursing homes, and some states developed grant programs
- since 1950, gov't funding for nursing home care has increased steadily

Madeleine Leininger

founder of the theory of transactional nursing, her theory has now developed as a discipline in nursing, theoretical framework is depicted in her Sunset model

Betty Neuman

- systems approach
- based on personal relationship to stress
- focuses on the response of the client system to actual or potential environmental stressors and the use of several levels of nursing prevention interventions for attaining, retaining, and maintaining optimal client system wellness
- nursing responds to individuals, groups, and communities who are in constant interaction with environmental stressors that can create disequilibrium

Sister Callista Roy

- adaptation model
- holistic
- promotion of adaptive responses
- assistance w/ the adaptations to stress to facilitate the integration process of the client
- nurse will be that change agent in assisting an individual w/ adaptation
- promotion of adaptive responses that are affected by the person's ability to respond to stimuli
- 4 models of adaptation: physiologic, self concept, role function, interdependence

ambulatory care settings

- provide care on an outpatient basis (ex: doctors office/walk in clinic)
- care may range from simple office of performance of ambulatory surgery
- goals are focused on treating a health problem and returning the person to an independent living situation

medicare

largest health insurance program in the US; entitlement program based on age or disability

part A of medicare

provide payment for hospitalization

part B of medicare

purchased insurance to meet physicians fees & outpatient costs/monthly premium to cover whatever part A can't

medicaid

covers disabled persons, low income households w/ children, & those in nursing homes

when was medicare and medicaid established?

1965

case management

a nursing care pattern; a case manager (an RN) coordinates a person's care from admission through discharge and into the home setting

preferred provider organization (PPO)

group of healthcare providers that provide services to a specific group, often at a reduced rate

joint commision

provides accreditation for wide variety of healthcare facilities including home care, ambulatory care, and assisted living

quality improvement organization (QIO)

a group of health quality experts, clinicians, & consumers organized to improve quality of care delivered to people w/ medicare

how is quality evaluated?

through peer review and use of outcome measures

agency for healthcare research and quality (AHRQ)

a federal agency established to improve the quality, safety, efficiency, and effectiveness of health care for americans; identified set of items for indicators of quality of care

3 groups of QI's

1. prevention QIs
2. inpatient QIs
3. patient safety QIs

clinical pathways

- standardized hospitals tool to monitor outcomes
- describes the optimum progress through system
- care can be modified to address the problem

statutory law

includes all written laws and government codes

regulatory law

rules and regulations established by administrative bodies within gov't

example of regulatory law

center for medicare and medicaid services writes regulations governing the payment of medicare and medicaid funds that are authorized by legislation

common law

judicial law and common usage or custom (less clear)

common usage in nursing practice

safe medication practice illustrates how common usage applies to nursing

HIPAA

health insurance portability and accountability act; individually identifiable data about a person's health or healthcare

healthcare agencies and health plans are required to provide training for all employees (T/F)

true

institutional policies provide guidance

- proper actions to be take in specific situations
- identify the individuals responsible for taking action
- establish specific timelines for action

criminal law

addresses the general welfare of the public; misdemeanor & felony

civil law

encompasses those laws regulating private conduct between individuals

criminal law and nursing

- performance outside the nurse practice act
- administering medication w/o an order
- inappropriate care and distribution of controlled substances
- committing crimes while in the role of caregiver: gross negligence & reckless endangerment

criminal action could result in

the loss of a job and a license to practice nursing even when not prosecuted in court

felonies

major criminal offenses

common offenses (felonies)

drug trafficking; fraud in billing services for medicare patients; theft, rape, murder

civil law and nursing

nurses may be involved in cases related to intentional torts, negligence, or malpractice

torts

a wrongful act

negligence

a failure to exercise that degree of care

malpractice

a term used to identify professional negligence

advanced directive (living will)

details the conditions under which life support measures should be used

advanced directive (power of attorney)

used to give another person the authority to make healthcare decisions

assualt

something to male a person genuinely afraid that they will be touched w/o consent

battery

touching a person when that individual has not consented to the action

guidelines to testifying

- listen carefully to the entire question before answering and pause to let your attorney object if appropriate

- answer only the questions asked and frame your answer in your mind before beginning to speak

- do not volunteer additional information

- admit if you do not remember

- refer to your written documentation to support your answers

- be brief and direct

- do not use medical or technical terminology unless essential—then explain your terms

- explain when a simple yes or no would be misleading

- note differences between hypothetical cases presented and the one under consideration

beneficence

doing or producing good

nonmaleficence

the prevention of intentional harm

autonomy

involves the right of self-determination or choice

justice

referred to as fairness, refers to the quality of being just of fair

fidelity

obligation to be faithful to the agreements

fidelity is a foundation of the concept of __

accountability

veracity

refers to telling the truth or not intentionally deceiving clients

utilitarianism

rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences

strongest approach for bioethical decision making

utilitarianism

deontology

rooted in the assumption that humans a re rational and act out of principles that are consistent, objective, and compel them to do what is right

natural law

theory in ethics that says that human beings possess intrinsic values that govern our reasoning and behavior

social equity

pursuing fairness in public services in terms of access; outcomes; quality; and processes

steps of ethical decision making

1. identify and clarifying the problem
2. gathering data
3. identifying options
4. making a decision
5. acting and assessing

ehtical issues related to nursing

- nurses have ethical obligations to the client and to the employer

- commitment to personal excellence and to the profession of nursing

- self evaluation is a way to protect against poor nursing care

- serious situations: when using the chain of command does not invoke response to voiced concerns, one might use whistleblowing;
this should be used as a last resort because of the possible ramifications

self evaluation plan

- assessment of client
- planning for client care
- intervention
- evaluation
- personal growth and relationships

chemically impaired nurse

concern to the profession and danger to clients

nurses have an obligation to report those who demonstrate chemical impairment and to assist impaired colleagues in finding treatment & rehabilitation (T/F)

true

factors that can lead to chemical dependency

stress, frequent shift changes, staffing shortages, injuries, pain

boundary violations

situation in which the nurse moves beyond a professional relationship and becomes involved with clients and their families

why are boundary violations a concern

represents a violation of the trust relationship

examples of boundary violations

sexual misconduct & overidentyfying with members of family

institute of medicine (IOM)

released a ground breaking report about preventable medical errors in hospitals; reported that hospital acquired infections can be prevented

hospital acquired infection

HAIs

joint commission

has taken steps to encourage hospitals to reduce the incidence of errors

sentinel events

an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof

example of sentinel event

surgery on the wrong body part

no reimbursement to hospitals for the costs associated with six serious hospital acquired complications (T/F)

true

6 serious hospital acquired complications

- pressure ulcers

2 HAIs:
- catheter associated urinary tract infections
- resistant staphylococcus aureus (MRSA)

3 never events:
- air embolism
- blood incompatibility
- foreign object left behind in a surgical client

culture of saftey

trust and mutual respect encourage healthcare providers report errors, near misses, and other adverse events without fear of distribution

root cause analysis

type of analysis that starts with a result and then works backward to identify fundamental cause

handoff

information about the client or resident communicated from one healthcare provider to another

handoffs typically occur at...

each change of shift

universal protocol

- pre produced verification
- marking surgical sites
- performing time out

time out

- involves immediate members
- all members of the team actively communicate during the time out and agree, that the client. identity, site, and procedure is correct

what contributes to medication errors

- calculation errors
- look alike sound alike/similar similar packaging
- catheter and tubing misconnections
- interruptions and distractions during time of administration
- illegible written medication errors
- unclear verbal orders
- failure to check the client's name with MAR
- overly tired nurses
- inadequate staffing and high nurse client ratios

community based nursing

emphasizes advocating for clients, promoting self care, focusing on health promotion & disease prevention, and recognizing the importance of family, culture, and the community based nursing

examples of community based nursing

public health, home health, ambulatory care, occupational health, school nursing

primary prevention (disease management)

focuses on preventing disease

secondary prevention (disease management)

screening and preventing complications

tertiary prevention (disease management)

preventing long term disability and restoring functional capacity

healthy people 2020

includes overall goals, priority areas, and leading indicators to measure progress in developing healthier communities

healthy people 2020 vision

a society in which all people live long, healthy lives

healthy people 2020 mission

to improve health through strengthening policy and practice

healthy people 2020 goals

1) eliminate preventable disease, disability, injury, and premature death
2) achieve health equity, eliminate disparities, and improve the health of all groups
3) create social and physical environments that promote good health for all
4) promote healthy development and healthy behaviors across every stage of life

complementary and alternative medicine

- mind body medicine
- biologically based practices
- manipulative and body based practices
- energy medicine as well as alternative whole medical systems

unconventional western systems

homeopathy and naturopathy

homeopathy

exposure to extremely small quantities of substance causing an illness or related substance will stimulate a cure

homeopathy is the basis for __ and __

immunization; allergy desensitization

naturopathy

natural agents used in treating disease