Patient Care Organization Terms | Nursing Chapter 14 Study Set

Which statement best describes functional nursing care delivery?

A) Nursing care is holistic and patient centered

B) The nurse must be a licensed person

C) Emphasis is on getting work done through tasks

D) It is also known as total patient care

Answer: C

Functional nursing is task focused. None of the other options identify that connection.

The nurse is assigned to administer medications to all patients throughout the shift. What is this an example of?

A) Team nursing

B) Case method nursing

C) Primary care delivery

D) Functional nursing care

Ans: D

Feedback: Being assigned a specific task to do is part of functional nursing. None of the other options identify that connection.

A nurse has accepted a position as a staff nurse and will practice primary care nursing. The nurse will be the only RN on the team. What is an appropriate role expectation for role fulfillment?

A) Planning nursing care independently of others

B) Assigning work according to the expertise of group members

C) Being responsible for care planning 24 hours a day

D) Carrying out the majority of personal care for your patients

Ans: B

Feedback:

In primary nursing, the sole RN would not plan the care without others' input or be responsible for care planning for 24 hours. Neither would the RN carry out the majority of personal care.

With modular nursing, who checks the completion of tasks assigned to a team member?

A) The charge nurse

B) The area manager

C) The team leader

D) Another team member

Ans: C

Feedback:

The team leader should check the work of team members. None of the other options identify the role correctly.

Which statement is correct concerning primary nursing care?

A) Requires minimal RN staffing

B) Is easy to implement

C) Provides challenging work

D) Has proved to be a failure

Ans: C

Feedback:

Primary care provides challenging work for nurses; however, it is not easy to implement and requires an all-RN staff. None of the other options accurately describes the concept of primary nursing care.

What is the goal of case management?

A) Containing health-care costs

B) Providing challenging work

C) Enhancing professionalism

D) Decreasing length of hospital stays

Ans: A

Feedback:

The ANA maintains that case management is designed to contain health-care costs. None of the other options identify a goal of casement.

What is the most important component in being well organized and increasing productivity on the unit?

A) Adequate resources

B) A well-trained staff

C) A well-thought-out plan

D) Time to carry out your duties

Ans: C

Feedback:

Unless the plan is well thought out, patient care has the potential to be disorganized. None of the other options identify that connection.

Which statement best describes case management?

A) Clinical outcomes should occur within a prescribed time frame

B) Case managers do not provide direct patient care

C) Managed care practice is a unit-based model of care

D) The goal is outcome management for every patient

Ans: A

Feedback:

In case management, clinical outcomes need to occur within prescribed time frames. Case managers do not provide care; neither is managed care unit based. The goal is outcome management for specific patients, but not every patient needs case management.

What is necessary when implementing care multidisciplinary action plans (MAPs)?

A) Caregivers alter the plan as they deem necessary

B) Variances be indicated for patient deviations

C) Time frames for implementation be left open

D) Critical paths not be considered in care planning

Ans: B

Feedback:

In care MAPs, it is necessary to provide variances when there are patient deviations, because this is a major component to case management. None of the other options identify that connection.

Which is a true statement about the patterns of patient care management?

A) Functional nursing is organized according to the desires of the worker

B) Primary nursing and total patient care are synonymous

C) Team leading includes the concept of patient care conferences

D) Case load nursing provides little autonomy for nurses

Ans: C

Feedback:

Team leading includes the need for patient care conferences. None of the other options identify that need.

Where did critical pathways originate from?

A) Case management

B) Functional nursing

C) Team nursing

D) Primary care nursing

Ans: A

Feedback:

Critical pathways were developed as a result of the case management system. None of the other options identify that original connection.

What nursing model provides the foundation for matching patient needs with nursing competencies?

A) Primary nursing practice

B) Differentiated nursing practice

C) Modular nursing

D) Case management

Ans: B

Feedback:

To facilitate the effective use of nursing resources, patient needs and nursing competencies should be matched. None of the other options identify that connection.

What is one of the most important differences between case management and disease management?

A) Disease management referrals begin in the hospital inpatient setting

B) Disease management is a collaborative process to meet patient needs

C) High-cost population groups are targeted in disease management

D) Disease management treatment is episodic

Ans: C

Feedback:

Although there are many similarities between disease management and case management, the primary goal of disease management is to target high-cost disease populations.

What is the oldest form of organizing patient care that is still widely used today?

A) Total patient care

B) Functional nursing

C) Team or modular nursing

D) Primary care nursing

Ans: A

Feedback:

Total patient care, utilizing the case method of assignment, is the oldest form of patient care organization and is still widely used today.

What type of nursing uses mini teams, typically an RN and unlicensed health-care workers, to provide care to a small group of patients who are centralized

geographically?

A) Total patient care

B) Functional nursing

C) Modular nursing

D) Primary care nursing

Ans: C

Feedback:

Modular nursing and model RN line use mini teams, typically an RN and unlicensed health-care worker(s), to provide care to a small group of patients, centralized geographically. None of the other options provide that staffing format.

Primary care nursing is organized so that the patient is at the center of the structure. How many nurses have 24-hour responsibility for care planning and coordination?

A) One

B) Two

C) Three

D) Four

Ans: A

Feedback:

Primary care nursing is organized so that the patient is at the center of the structure. One nurse has 24-hour responsibility for care planning and coordination.

What was the focus historically for case management?

A) Individual patient

B) Care for populations

C) Group of patients with same chronic illness

D) Group of patients with same acute need for surgery

Ans: A

Feedback:

While the focus historically for case management has been the individual patient, the case manager employed in a disease management program plans the care for populations or groups of patients with the same chronic illness.

What is included in an MAP?

1. Critical path

2. Nursing care plan

3. Indication of times when nursing interventions occur

4. Nurses follow the care plan to facilitate expected outcomes

A) 1, 2, 3

B) 1, 2, 4

C) 1, 3, 4

D) 2, 3, 4

Ans: A

Feedback:

The care MAP is a combination of a critical path and a nursing care plan, except that it shows times when nursing interventions should occur as well as variances. All health-care providers follow the care MAP to facilitate expected outcomes.

When work is redesigned, it frequently has consequences for employees that must be considered. What consequences must be considered?

1. Professional interactions

2. Degree of autonomy

3. Employee evaluation

4. Communication patterns

A) 1, 2, 3

B) 1, 2, 4

C) 1, 3, 4

D) 2, 3, 4

Ans: D

Feedback:

When work is redesigned, it frequently has personal consequences for employees that must be considered. Social interactions, the degree of autonomy, the abilities and skills necessary, employee evaluation, and communication patterns are often affected by work redesign.

What is the positive patient outcome during a single shift of case method nursing? Select all that apply.

A) Clear lines of responsibility

B) Nursing autonomy

C) Holistic patient care

D) Unfragmented care

Ans: A, B, C, D

Feedback:

This method of assignment is still widely used in hospitals and home health agencies. This organizational structure provides nurses with high autonomy and responsibility. Assigning patients is simple and direct and does not require the planning that other methods of patient care delivery require. The lines of responsibility and accountability are clear. The patient theoretically receives holistic and unfragmented care during the nurse's time on duty. To maintain quality care, this method requires highly skilled personnel and thus may cost more than some other forms of patient care.

What is the primary outcome resulting from the implementation of the functional nursing care delivery system?

A) A cost-effective method of care delivery

B) Another permanent care delivery option

C) Ancillary staff with varying levels of training and education

D) A care delivery system addressing the needs of the baby boom patient

Ans: C

Feedback:

The employment of personnel with various levels of skill and education proliferated as new categories of health-care workers were created. Currently, most health-care organizations continue to employ health-care workers of many educational backgrounds and skill levels. None of the other options represent a primary outcome of resulting from the implementation of functional nursing.

Which statement demonstrates an intervention focused on the primary disadvantage of team nursing?

A) "We are working with 1 fewer team members today."

B) "The team will be meeting for a care report update in 5 minutes."

C) "Our patient assignment is comprised of both males and females"

D) "We will be having a member of the float pool on our team today."

Ans: B

Feedback:

Disadvantages to team nursing are associated primarily with improper implementation rather than with the philosophy itself. Frequently, insufficient time is allowed for team care planning and communication. This can lead to blurred lines of responsibility, errors, and fragmented patient care. None of the other options address a known disadvantage of team nursing.

Which statement demonstrates an understanding of the factors that are considered when a change in the care delivery system is being proposed? Select all that apply.

A) “We have determined that our level of care would improve if we provided it differently.”

B) “It's questionable whether our current nursing staff is large enough to support the proposed change.”

C) “We will discuss our proposed change with the multidisciplinary team members.”

D) “Administration has been supportive of the planned change in our care delivery system.”

Ans: A, B, C, D

Feedback:

If evaluation of the present system reveals deficiencies, the manager needs to examine available resources and compare those with resources needed for the change. There must be a commitment on the part of top-level administration and a majority of the nursing staff for a change to be successful. Because health care is multidisciplinary, the care delivery system used will have a heavy impact on many others outside the nursing unit; therefore, those affected by a system change must be involved in its planning. The philosophy of the nursing services division must support the delivery model selected. Changing the philosophy is not appropriate.

Which concept should a care delivery system support? Select all that apply.

A) Organization

B) Nursing process

C) Cost effectiveness

D) Patient satisfaction

Ans: A, B, C, D

Feedback:

Each unit's care delivery structure should facilitate meeting the goals of the organization, be cost-effective, satisfy the patient, provide role satisfaction to nurses, allow implementation of the nursing process, and provide for adequate communication among health-care providers. While important, nursing research is not a concept that is considered when selecting a care delivery system.

Which aspect of care at a long-term care facility most clearly suggests that a functional model of care delivery is being used?

a. One nurse is assigned to provide all of a resident's care during a shift.

b. Unlicensed assistive personnels (UAPs) coordinate each resident's care and

occasionally delegate to practical nurses.

c. Registered nurses perform all assessments while UAPs provide all feeding and hygiene.

d. A pairing of one registered nurse and one practical nurse provides all the care for a designated pool of residents.

ANS: C

Feedback: Functional nursing is task focused with specific tasks assigned to specific members of the care team. Having one nurse provide all of a resident's care is indicative of total patient care. No model of care ascribes a coordination role for UAP. Pairings suggest team or modular nursing.

The nurse is assigned to administer medications to all patients throughout the shift. What is this an example of?

a. Team nursing

b. Case method nursing

c. Primary care delivery

d. Functional nursing care

ANS: D

Feedback: Being assigned a specific task to do is part of functional nursing. None of the other options identify that connection.

A nurse has accepted a position as a staff nurse and will practice primary care nursing. The nurse will be the only RN on the team. What is an appropriate role expectation for role fulfillment?

a. Planning nursing care independently of others

b. Assigning work according to the expertise of group members

c. Being responsible for care planning only during the shift when he or she works

d. Carrying out the majority of personal care for assigned patients

ANS: B

Feedback: In the primary nursing, during work hours, the primary nurse provides total direct care for that client. When the primary nurse is not on duty, associate nurses, who follow the care plan established by the primary nurse, provide care. In primary nursing, the sole RN would not plan the care without others' input. The nurse is responsible for care planning for 24 hours per day. The RN leads the planning of care but may not carry out the majority of personal care.

A registered nurse is providing care in a setting that uses modular nursing. What task should the nurse perform during a shift?

a. Providing every aspect of care to one half to one third of the mini-team's assigned patients

b. Collaborating with another registered nurse to plan the care of all the mini-team's assigned patients

c. Confirming that each member of the mini-team is completing his or her assigned tasks

d. Providing total patient care to the most acutely ill patients that the mini-team is assigned

ANS: C.

Feedback: The modular team leader should check the work of team members. Care is divided among the mini-team members, so the RN does not provide every aspect of care to some of the patients, even those who are acutely ill. Modular nursing does not usually involve collaboration between two RNs; it is more common for each team to have only one RN.

A nurse-manager is advocating for a switch from team nursing to primary nursing care. What characteristic of primary nursing care should the manager describe to decision makers?

a. It requires minimal RN staffing.

b. It is comparatively easy to implement.

c. Many nurses find it stimulating and challenging.

d. It eliminates the need for UAP or practical nurses.

ANS: C

Feedback: Primary care provides challenging work for nurses; however, it is not easy to implement and it can succeed with a diverse skills mix (i.e., not all RNs). It requires a comparatively large cohort of RNs.

A nurse-manager has recently learned that the health-care facility will be moving toward a case management approach. What factor is most likely driving this change?

a. The need to address cost-effective options for care

b. The need to provide challenging work for nurses and other members of the care team

c. The need to enhance professionalism throughout the organization

d. The need to obtain magnet designation

ANS: A

Feedback: Case management addresses each client individually, identifying the most cost-effective providers, treatments, and care settings possible. It is not an explicit requirement of magnet designation and it is not primarily motivated by a need to stimulate nurses or increase professionalism.

A change in the patient care delivery system has been mandated on a hospital unit. The manager can best ensure the successful introduction of a new delivery system by:

a. assigning a senior registered nurse to lead the implementation.

b. explaining the implications of the proposed change to patients and families.

c. carefully studying the best method for implementing the planned change.

d. hiring nurses who have experience in providing the new delivery system.

ANS: C

Feedback: Thorough preparation is essential to the successful implementation of a new patient care delivery system. This does not necessarily require hiring new nurses who have experience with the new system; existing staff can be adequately prepared if there are sufficient time and resources. The manager should collaborate with staff but it would be an inappropriate delegation if the manager assigned a nurse to lead the transition. Explaining internal changes to patients and families is not normally necessary and would not significantly increase the chances of success.

What is the primary focus of case management in prioritizing client care?

a. Assessing each client's needs individually

b. Minimizing costs to the organization

c. Minimizing costs to the patient

d. Applying the principles of team nursing

ANS: A

Feedback: Case management is largely dependent on individualized assessments of each patient's specific needs. The patient's needs supersede costs, even though cost containment is an important consideration. Case nursing does not necessarily entail a team nursing care delivery model.

A nurse is practicing in a case management context and a patient has been following a multidisciplinary action plan (MAP). In the last 24 hours, it has become clear that the patient's health status is not improving as quickly as expected and the patient is deviating from the MAP. What is the nurse's best action?

a. Cancel the patient's current MAP and call a meeting to select a new one.

b. Document the presence of a variance in the MAP.

c. Collaborate with the care team to arrange a transfer to a new setting.

d. Cancel the current MAP and adopt customized, rather than standardized care.

ANS: B

Feedback: In care MAPs, it is necessary to provide variances when there are patient deviations, because this is a major component to case management. Deviations do not warrant a wholesale rejection of the existing MAP or case management principles. A transfer to another site may or may not be necessary, and this does not address the need to change the patient's MAP.

The nurse is providing care in a setting that uses a team nursing approach. What should be integrated into the routines in the health-care facility?

a. Inclusion of the patient and family as members of the team

b. Opportunities for UAP and practical nurses to increase their education level

c. Frequent communication between team members

d. Use of multidisciplinary action plans (MAPs)

ANS: C

Feedback: Team nursing is wholly dependent on close, frequent communication between the team members. Through extensive team communication, comprehensive care can be provided for clients despite a relatively high proportion of ancillary staff. The client's and family's input is vital, and frequently sought, but they are not formal members of the care team. MAPs are associated with case management, which may or may not utilize team nursing. Educational opportunities for practical nurses or UAPs are not the drivers behind team nursing.

The majority of patients whose care is organized by case management have contact with the health-care system in what acute care setting?

a. Emergency department

b. Ambulatory clinics

c. Primary care provider offices

d. Perioperative settings

ANS: A

Feedback: Because 50% to 80% of admissions in most hospitals enter via the emergency department, case management often begins there in the acute care setting.

Which patient would be most likely to benefit from a disease management approach within the context of case management?

a. A client who is being treated for a ruptured tympanic membrane

b. A client who has chronic obstructive pulmonary disease (COPD)

c. A client who has been diagnosed with a postpartum hemorrhage (PPH)

d. A client being treated for a transfusion reaction after receiving packed red blood cells

ANS: B

Feedback: Disease management is most often focused on the management of long-term, chronic diseases rather than acute health problems.

What is one of the most important differences between case management and disease management?

a. Disease management referrals begin in the hospital inpatient setting.

b. Disease management is a collaborative process to meet patient needs.

c. High-cost population groups are specifically targeted in disease management.

d. Disease management treatment is episodic.

ANS: C

Feedback: Although there are many similarities between disease management and case management, the primary goal of disease management is to target high-cost disease populations. Disease management referrals may originate in the community rather than from inpatient settings. Both models are collaborative. Disease management is designed to be ongoing rather than episodic.

A large health-care organization is reconsidering the model of patient care delivery. What factor should be prioritized in this decision?

a. Patient needs

b. Staff expertise

c. Cost

d. Physical layout of the facility

ANS: A

Feedback: Many factors need to be considered when a change in care delivery is being selected. Central among these, however, is the interests of patients. Costs, staffing, and facilities must be considered, but the needs of patients are paramount.

A registered nurse is paired with a practical nurse and the two nurses are working together to provide all the needs for a group of patients. What type of nursing care delivery are these nurses demonstrating?

a. Total patient care

b. Functional nursing

c. Modular nursing

d. Primary care nursing

ANS: C

Feedback: Modular nursing uses mini-teams, typically an RN and unlicensed health-care worker(s), to provide care to a small group of patients, centralized geographically. None of the other options provide this particular staffing format.

Primary care nursing is organized so that the patient is at the center of the structure. How many nurses have 24-hour responsibility for care planning and coordination for the patient?

a. One

b. Two

c. Three

d. Four

ANS: A

Feedback: Primary care nursing is organized so that the patient is at the center of the structure. One nurse has 24-hour responsibility for care planning and coordination.

A nurse can directly address one of the Institute of Medicine's recommendations to improve practice environment by:

a. facilitating open communication and shared decision making.

b. advocating for caps on the maximum allowable nurse-patient ratio.

c. adopting a functional nursing model whenever the setting allows.

d. becoming a nurse navigator who is centered on patients' needs.

ANS: A

Feedback: Interdisciplinary teamwork is accomplished through interdependent collaboration, open communication, and shared decision making. The Institutes of Medicine future of nursing has expand opportunities for nurses to lead and diffuse collaborative improvement efforts with physicians and other members of the health-care team to improve practice environments.

A nurse is following a multidisciplinary action plan (MAP) when caring for a new patient. The nurse should identify what components within the MAP? Select all that apply.

a. Cost analysis of major interventions

b. Identity of the nurse navigator

c. Critical path

d. Nursing care plan

e. Indication of times when nursing interventions occur

ANS: C, D, E

Feedback: The care MAP is a combination of a critical path and a nursing care plan that shows times when nursing interventions should occur as well as variances. All health-care providers follow the care MAP to facilitate expected outcomes. It does not include cost analysis and does not necessarily involve a role for a nurse navigator.

A patient who has just been diagnosed with lung cancer has been assigned a nurse navigator. What task should the nurse prioritize in this role?

a. Providing evidence-based guidance on treatment options and treatment decisions

b. Providing clinical leadership and ensuring quality for the patient's care

c. Guiding the patient in an effort to provide high-quality managed care

d. Guiding the patient and family through their various interactions with the

health-care system

ANS: D

Feedback: The primary role of a nurse navigator is to help the patient and the family navigate the complex health-care system by providing information and support. The navigator would not provide direct guidance on choosing treatment options, which are normally beyond the nurse's scope of practice. Clinical leadership is the role of the clinical nurse-leader. The role of the nurse navigator is not synonymous with managed care.

An experienced registered nurse has begun a position as a clinical nurse-leader (CNL). In this role, what tasks should the nurse perform? Select all that apply.

a. Collaborating with the interdisciplinary team

b. Guiding patients and families through the health-care system at various sites

c. Coaching nurses to provide evidence-based care

d. Introducing quality improvement initiatives

e. Preceptoring senior nursing students

ANS: A, C, D

Feedback: The CNL role involves close collaboration with the interdisciplinary care team, leading nurses on the unit to ensure high-quality care and introducing quality improvement measures. Guiding patients and families through the health-care system at various sites is more congruent with a nurse navigator role. A CNL focuses on high-level leadership at the clinical site and would be less likely to be a preceptor because that role focuses on direct patient care.

A clinical site has a diverse skill mix that includes registered nurses, practical nurses, and UAPs. Senior management is proposing a shift from team nursing to primary nursing. What effect will the skills mix have on this transition?

a. Implementation of primary nursing will likely require hiring more UAPs and

laying off some RNs.

b. Implementation of primary nursing will likely require hiring more RNs, and laying off some UAPs.

c. With adequate resources, primary nursing can be successfully implemented with the existing skills mix.

d. Primary nursing is most successful if every member of the team providing direct patient care is an RN.

ANS: B

Feedback: Shifting from a team approach to a primary care nursing approach would typically necessitate an increased number of licensed RNs and a reduction in UAP.

Which statement demonstrates an intervention focused on the primary disadvantage of team nursing?

a. "We are working with one fewer team member today."

b. "The team will be meeting for a care report update in 5 minutes."

c. "Our patient assignment is comprised of both males and females."

d. "We will be having a member of the float pool on our team today."

ANS: B

Feedback: Disadvantages to team nursing are associated primarily with improper implementation rather than with the philosophy itself. Frequently, insufficient time is allowed for team care planning and communication. This can lead to blurred lines of responsibility, errors, and fragmented patient care. None of the other options address a known disadvantage of team nursing.

Which statements demonstrate an understanding of the factors that should be considered when a change in the care delivery system is being proposed? Select all that apply.

a. “We have determined that our level of care would improve if we provided it

differently.”

b. “It’s questionable whether our current nursing staff is large enough to support the proposed change.”

c. “We will discuss our proposed change with the multidisciplinary team members.”

d. “Administration has been supportive of the planned change in our care delivery system.”

e. “We’re going to make our decision based on which option is newest in the

literature.”

ANS: A, B, C, D

Feedback: If evaluation of the present system reveals deficiencies, leaders and managers need to examine available resources and compare those with resources needed for the change. Therefore, openness to change and a willingness to examine available resources are necessary. Interdisciplinary collaboration is essential and support from high-level administration is needed as well. Decisions should not be based simply on which model is newest or most innovative.

Which historical event is known that have had a major effect on the delivery model of nursing care?

a. Emergence of antibiotic-resistant microorganisms in the 1990s

b. Increases in patient empowerment during the 1970s and 1980s

c. High rates of infection, death, and disability during the Civil War

d. Shifts from home-based care to hospital-based care during the 1930s

ANS: D

Feedback: Major shifts in the location of care from the home to the hospital underlie many of the shifts in care delivery in the early decades of the 20th century. Patient empowerment, antibiotic resistance and the Civil War are not identified as having such sweeping effects on the delivery of nursing care.

A nurse-manager is part of a committee that has been commissioned to change the care delivery model at a health-care facility. When planning this change, the nurse and the other committee members should be aware that this process will:

a. be difficult to implement without hiring staff who have experience with the new model.

b. affect social relationships and group functioning in the workforce.

c. require equal input from every staff member during the planning stage.

d. be best conducted by objective consultants from outside the organization.

ANS: B

Feedback: The nurse-leader-manager needs to be aware that redesigning work that disrupts group cohesiveness may result in increased levels of job dissatisfaction. Reorganizing care does not necessarily require individuals from outside the organization. Often, the existing staff and skills mix can be used to implement a change; hiring may not be necessary. Input from staff and other stakeholders should be sought, but it is unrealistic to expect equal input from everyone.

The emergency room nurse is assessing a patient who has presented with an exacerbation of recently diagnosed irritable bowel syndrome. The patient states that he is "overwhelmed" and "bewildered" by the mix of diagnostic tests, appointments, and consultations since he was diagnosed. What is the nurse's best action?

a. Acknowledge the difficulty of the patient's circumstances and arrange for a nurse navigator.

b. Validate the patient's concerns and liaise with the clinical nurse-leader (CNL).

c. Offer to mediate between the patient and the case manager.

d. Offer to accompany the patient to any upcoming appointments.

ANS: A

Feedback: Nurse navigators help patients and families navigate the complex health-care system by providing information and support. It would not be possible for the ED nurse to perform this role on an ad hoc basis. A CNL focuses on quality of care in a specific setting and less on helping patients navigate the larger health-care system. Offering to mediate between the patient and the case manager does not address the patient's expressed concern.

An experienced nurse is applying for a position as a clinical nurse-leader (CNL). In addition to the nurse's clinical experience, what characteristic best qualifies the nurse for this position?

a. The nurse currently sits on the hospital's ethics board.

b. The nurse has consistently adhered to the standards of practice.

c. Specialty certification in a specific area of practice.

d. The nurse has a master of science in nursing degree.

ANS: D

Feedback: The CNL, as an advanced generalist with a master's degree in nursing, is expected to provide clinical leadership at the point of care. CNLs have advanced knowledge and education in general practice as opposed to specialization in one primary discipline, like clinical nurse specialists. Adherence to standards of practice is a minimum requirement for nursing practice, not a specific qualifier for a CNL role. Similarly, sitting on an ethics board is a useful aspect of experience but not a specific qualifier for a CNL role.

A nurse-manager sits on the hospital's board of directors and there has been repeated discussion about the possibility of changing the care delivery model. What action should be performed first?

a. Elicit support from internal and external stakeholders.

b. Perform a cost-benefit analysis of the major alternatives for care delivery.

c. Assess the strengths and weaknesses of the current delivery model.

d. Plan a pilot project where the delivery model will be changed on one subacute unit.

ANS: C

Feedback: Assessment of the current delivery system must precede any decision to change the delivery model. Consequently, it would be premature to start building support from stakeholders, introducing a pilot project or doing cost benefit analysis of alternatives.

A primary health-care teams (PHCT) has been established to coordinate the care of a patient with complex health-care needs. What should be the nurse's primary role in this team?

a. Communicate the wishes of the patient to the other team members.

b. Weigh the benefits of suggested interventions with their costs.

c. Provide the patient's direct bedside care, whenever possible.

d. Emphasize improved quality of life and patient-centered care

ANS: D

Feedback: The nurse can perform several tasks in the context of a PHCT, but advocating for the patient and promoting patient-centered care is a priority role that encompasses many smaller tasks (such as communicating the patient's wishes, when necessary). The nurse does not focus on financial concerns in this setting, and it is not necessary for the nurse on the PHCT to be the one to provide the majority of the patient's actual care.