Untitled Flashcards Set

HIPAA 

• Define HIPAA (intention and purpose of HIPPA) 

  • HIPAA: signed by law in 1996 is the Health Insurance Portability and Accountability Act 

  • Purpose of HIPAA: curtail healthcare fraud and abuse, enforce standards for health information, guarantee the security and privacy of health information and assure health insurance portability for employed persons. 

    • Essentially a protection of healthcare coverage for employees who change jobs by allowing them to carry existing plans with them 

• Discuss protected health information (types of PHI, when information can be disclosed) 

  • Protected health information includes: electronic records, paper records, fax documents, oral communication (between nurse/doctor and patient) 

  • Types of information that is confidential: ( name, address, phone, fax, SSN,), persons reason for sickness, treatment that the patient received, information about past health conditions, any information that could identify the patient reasonable bias to believe that information can be used to identify the client 

  • The 18 PHI’s : names, geographic information “info smaller than state”, all dates except the year, phone/fax number, email, SSN, medical record #, health insurance #, account #, license #, VIN and plate #, device ID/ serial #, IP address, biometric ID’s, photographs 

  • Information can be disclosed when: under certain circumstances without the clients (or personal representatives) permission as specified by law “ treatment, payment and healthcare operations as defined by HIPAA. 

  • Law requires the disclosure of confidential information including: 

    • HIPAA cover entities must verify the identity of the individual demanding the information and their authority to obtain the information

    • Chief medical examiner or county medical examiner when death is under investigation

    •  diagnosis of cancer to the central cancer registry. 

    • Known or suspected child abuse/neglect or child deaths to DSS

    • Suspected abuse of elderly or disabled adults to DSS 

    • “Clear danger to public health” or other health hazards reported to HHS

    • Outbreaks of reportable communicable diseases and medical records pertaining to the diagnosis, treatment or prevention to state health directors 

    • Criminal violence wounds or injuries to law enforcement 

    • Immunizations to specific providers and schools 

    • Occupation injuries on farms and occupational diseases and illnesses to DHHS 

    • Persons in charge or laboratories that provide diagnostic services must report occupational disease and illnesses to DHHS 

    • Anything pertaining to bioterrorist incident 

    • State and federal auditors of medicaid 

• Examine the impact HIPAA has on healthcare consumers and healthcare professionals (preventing confidentiality breaches/ responsibility of students and nurses) 

  • ANA code of ethics: the nurse has the duty to maintain confidentiality of all patient information and to do less jeopardized the patients welfare and destroys trust in the nurse/patient relationship which jeopardizes the nurses ability to practice 

  • If you don't follow HIPAA it can result in: termination, lawsuit and dismissal form shadowing 

Healthcare Delivery 

• Identify the recipients of nursing (know principles of patient and family centered care in care coordination) 

  • Care coordination: link patients with resources in the community to enhance their well being, improve information exchange, reduce fragmentation and duplication of services 

• Compare the types of health care settings and the types of care delivered in each (know various healthcare setting and identify best care setting based on patient scenario)

  • Hospitals: acute inpatient services, outpatient and ambulatory care, emergency department, hospice care 

  • Subacute care: variation of inpatient care, technically complex treatments 

  • Ambulatory care: diagnostic treatment facilities, minor surgery ( out patient care center typically MRI, CT, Biopsy, X-ray ) 

  • Occupational health clinics: run by companies for employees, health promotion activities ( flu shot clinics, screening for BMI and TB) 

  • Extended care facilities (nursing homes): for chronically ill and need help taking care of themselves, includes independent living, assisted skilled, extended care facilities, custodial care 

  • Retirement and assisted living centers: for clients unable to stay at home but do not require a hospital or nursing home 

  • Crisis centers: emergency services for life crises, counseling and support 

  • Mutual support or self help groups: health problems life crises 

  • Rehabilitation centers: restore or recuperate health (falls) , drug and alcohol abuse (long term care) 

  • Home health care agencies: education to clients and families, care to acute, chronic or terminally ill ( IV antibiotics, dressing changes ) 

  • Day care centers: infants or children, adults that cannot be left at home 

  • Hospital services: care for dying in the home or facility, improve or maintain quality of life until death. ( focus on family and quality of life until die care) 

  • Traditional acute care: less than 30 hours 

  • Skilled care facilities: 24 hour nursing care and provides speech therapy, IV therapy, occupational therapy, patient meds. , respiratory care, wound care, long term antibiotics, pain control 

  • Independent living extended care facility: laundry, cleaning and cooking done for patient 

  • Palliative care: terminally ill patients 

• Discuss the factors affecting health care delivery (know factors impacting healthcare and nurse’s role in healthcare reform)

  • The factors affecting health care include: increasing number of elderly population, advances in technology, economics, women's health issues, uneven distribution of services, access to health insurance, homeless and the poor, HIPAA. 

  • Nurses role in health care reform: 

    • Changes taking place in health care give nurses the opportunity to help shape health care for the future

    • Nurses are becoming a stronger voice in addressing health related problems in our nation and proposing solutions 

    • Nurses in greater numbers are increasing their education and becoming APRNs, DNPs, and PhDs 

    • The focus of nursing care provided by all nurses is holistic care essential to promoting health and preventing illness 

• Examine the contemporary frameworks for care (differentiate between primary, secondary, and tertiary prevention)

  • Primary prevention: address adequate and proper nutrition, weight control and exercise and stress reduction. This emphasis the important role clients play in maintaining their own health and encourage to aminting the highest level of wellness a client can achieve 

    • Example of primary prevention: exercise programs, nutrition, seat belt laws, smoke free environment laws, immunizations and flu clinics, stress management, weight lifting techniques, well baby care

  • Secondary prevention: already have the illness; includes hospitals ( emergency care, intensive care, around the clock care), and health promotion services ( early detection, routine screening )

    • Examples of secondary prevention: monitoring blood glucose levels on a diabetic, monitoring blood pressure, yearly mammograms, prostate exams, pap smears, STI testing, dental exams, bone density cholesterol screening 

  • Tertiary prevention: help to move patients back to their previous level of health, rehabilitation to function adequately in the physical, mental, social, ecomonic, and vocational areas of their lives 

    • Tertiary prevention examples: “fall baby back home” post mother who just gave birth to a child with down syndrome, post stroke or car accident, teaching client how to care for themselves are betterness, referrals to therapy, rehabilitation to walk again  

• Identify the models for the delivery of nursing (distinguish between respite care, preventative care, restorative care, palliative care, and hospice care)

  • Respite care: temporary relief for primary caregivers who are caring for individuals with chronic illnesses, disabilities, or other care needs. It gives family members and other caregivers a break, allowing them time to rest or attend to other responsibilities.

    • Nursing role of respite care: Nurses provide temporary care for the patient, ensuring their basic needs are met while their regular caregiver takes a break. 

  • Preventative care: focuses on measures to prevent the onset of disease or illness, as well as early detection of potential health problems before they become severe.

    • Nursing role of preventative care: educate patients on healthy lifestyle choices, such as nutrition, exercise, and stress management, and provide screenings for conditions like high blood pressure, diabetes, and cancer. encourage vaccinations and routine health check-ups

  • Restorative care: aims to help patients recover and regain function following an illness, injury, or surgery. The focus is on restoring health and functional abilities to the highest possible level.

    • Nursing role in restorative care: help patients improve their strength, mobility, and independence through rehabilitation activities such as physical therapy, occupational therapy, and speech therapy. As well as recording patient progress. 

  • Palliative care: providing relief from the symptoms, pain, and stress of serious illness, regardless of the stage or prognosis. It aims to improve the quality of life for both the patient and their family

    • Nursing role in palliative care: manage symptoms such as pain, nausea, and fatigue. They provide emotional support, assist with end-of-life discussions, and coordinate care with other specialists. Nurses work to ensure comfort and dignity for the patient.

  • Hospice care: form of palliative care focused specifically on end-of-life care. It is provided to patients who are terminally ill and have a prognosis of six months or less to live. The focus is on comfort and support for both the patient and their family.

    • Nursing role in hospice care: manage pain and other symptoms, offer emotional and spiritual support, help patients and families navigate the dying process, and provide bereavement care after death

• Determine how health care economics have affected the quality of care (know managed care; CMS prospective payment system (DRGs); clients served as well types of governmental insurance)

  • Prospective payment system: lump sum of money is given ahead of time based on the patient's diagnosis

  • DRG ( diagnosis related group): focuses on how much it would cost to treat someone, CMS gives money for treatment ( medicare reimbursement) 

  • Medicare: federal insurance for adults over 65 and could provide hospitalization, home care, hospice, partial outpatient and physician services, prescription plan, but dies not cover dental, eyeglasses, hearing aids 

  • Medicaid: insurance for low income families, financial assistance (paid out of taxes) each state is distinct 

  • Managed care organization: health maintained focus to specific group of voluntary enrolled people strives to minimize cost ( insurance companies utilizing programs) 

  • PPO: services at discount for companies under contract with them ( private insurance) 

• Discuss concept of community-based nursing (types of community health settings; focus of community health nurse)

  • Community based health care: provided to people who live within a defined geographic area 

    • Community health nurse: provide continuity of care when patient moves from one level of care to another or from one setting to another, provide interventions to promote health and manage acute or chronic illnesses and promote self care

    • Qualities of a community based nurse: knowledgeable and skilled, independent in making decisions and accountable

• Identify competencies required for community-based care (know concepts of discharge planning and care coordination in community settings)

  • Components of discharge planning: assess strengths and limitation of the patient, family or support system, assess the environment, implement and coordinate the care plan, consider resources and evaluate effectiveness of care

  • Key elements necessary for collaboration for discharge: effective communication skills, mutual respect, trust and decision making process 

Other important things to note:

• Vulnerable population: racial and ethnic minority groups, uninsured, underinsured, low income children, frail older adults, mentally disabled, homeless, physically disabled, rural americans, immigrants, farm workers, people with HIV or AIDS 

• Health care group plans: provide blanket medical services in exchange for monthly payment 

  • Health maintenance organization: require referral ( typically cheaper for the patient) 

  • Preferred provider organization: discounted rate for using them 

  • Preferred provider arrangements: will not pay out if patient uses someone that is not preferred  

Historical Perspectives 

•  Discuss the historical background of nursing (important people and their contributions to nursing)

  • Florence nighting gale: also referred to as the lady and the lamp, considered the founder of modern nursing and was the first practicing epidemiologitst. She improved sanitation in the battlefield hospitals 

  • Mary mahoney: first african american nurse 

  • Clara bartron: founder of the american red cross 

  • Harriet tubman: known for her work in the underground railroad, during the civil war she nursed the sick and suffering of her own race 

  • Dorothea Dix: was the unions superintendent of female nurses during the civil war 

  • Lillian Wald: typically associated with mary bruster and founded the henry street settlement, she is considered the founder of public health nursing 

  • Mary adelaide nutting: first nursing professor at columbia teachers collage ( formal nursing education) 

  • Mother bickerdyke: known for development of ambulance services 

• Discuss the societal influences on Nursing (discuss greatest challenges in the 21st century)

  • Changes in society that lead to changes in nursing: changes in curriculum, advances in technology and informatics, new programs address current health concerns, leadership role in developing standards and policies 

  • Changes in the 21st century: affordable health care act, rising health care cost, demographic changes, medically underserved 

• Discuss the scope of nursing (role and regulation of Nurse Practice Acts and licensure) 

  • Nurse practice acts: overseen by state boards of nursing and regulate scope of nursing practice, protect public health, safety and welfare 

  • Licensure: the NCLEX Rn examination 

  • Certification: requirements vary 

• Relate the characteristics of a profession to nursing as a profession (professional roles and characteristics of nurses)

  • Nursing as a profession: administer quality care, be responsible and accountable 

  • Quality and safety education for nurses: patient centered care, teamwork and collaboration, quality improvement, safety, evidence based practice, informatics. 

• Caregiver: A role that refers to the provision of care that combines the art and science of nursing in meeting physical, emotional, intellectual, sociocultural, and spiritual needs.

• Leader: The assertive, self-confident practice of nursing when providing care, affecting change, and functioning with groups

• Client advocate: Nursing role of pleading the cause of a client. It protects legal and human rights of the client.

• Communicator: An individual that is skilled in communication and conveying concepts. Uses effective interpersonal and therapeutic communication.

• Continuing education: Refers to formalized experiences designed to enhance a knowledge or skills of practicing professionals

• Counselor: Process of helping a client to recognize and cope with stressful psychological or social problems and make appropriate referrals.

• Researcher: Participating in or conducting research to increase the body of nursing knowledge.

• health : Degree of wellness or well-being that the client experiences

• Professionalism: Refers to professional character, spirit, or methods; a set of attributes a way of life that implies responsibility and commitment

• teacher : Role the nurses asumess to help clients learn about their health and healthcare procedures they need to perform to restore or maintain health

• Describe existing professional organizations that facilitate the progress of nursing (ANA, health care advocacy groups) 

  • American nurses association: To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice

  • Robert wood johnson foundation: campaign for action of future nurses

  • Institute of medicine: publication on the future of nursing 

  • International nursing organization: promotion of health, prevention of illness, advocacy, promotion of a safe environment, research, participation in shaping health policy and education 

• Describe the different types of educational programs for nurses (distinguish between different types of nursing education and nursing careers)

  • Clinical nurse specialist: Provides direct care to patients with complex health issues, using advanced assessment and clinical decision-making skills

  • Certified nurse practitioner: advanced practice nurse with the ability to diagnose, treat, and manage various healthcare conditions

  • Certified nurse midwife: specializes in providing maternity care, including labor and delivery, prenatal care, and postpartum care

  • Certified registered nurse anesthetist: specializes in administering anesthesia and providing anesthesia care to patients undergoing surgeries or procedures

• Identify conceptual frameworks that have contributed to nursing

Essential skills to prevent burn out: time management, therapeutic communication, compassionate implementation of bedside skills, self care, resilience. 

Six standards of practice: assessment, diagnosis, outcomes identification, planning, implementation, evaluation 

Code of ethics: philosophical ideals of right and wrong that define principled used to provide care 

EBP and Theory

• Explain the relationship between research and evidence-based nursing practice (distinguish between validity and reliability in research instruments; Distinguish between qualitative and quantitative research) 

  • Research: uses formal and systematic process to address a problem or answer a question 

  • Evidence based research: when the nurse combines best current evidence with clinical expertise 

  • Reliability: measure is consistent 

  • Validity: accuracy of measure 

  • Statistical significance: result are significant due to the study/ data collection and analysis not just by random chance

  • Qualitative: collection of thematics/ narrative data subjective/ meaning/ understanding/ words “how does the sky color affect mood?”

  • Quantitative: collection of numerical data, statistical information/tables/graphs/objective measurement “does AIC increase with one soda per day?” 

• Identify the ways the nurse can participate in research activities/research roles (identifying components of PICO) 

  • P: Population ( who is it affecting) 

  • I: Intervention ( what do you want to change or do ) 

  • C: comparison of intervention or treatment ( did it make a difference) 

  • O: outcome 

• Discuss ways to protect the rights of human subjects of research (purpose of IRB; participant rights in a research study)

  • IRB: a committee that reviews all potential studies and ensures safety of participants 

  • Elements for informed consent by IBS: right not to be harmed, right to full disclosure, right to self determination, right to privacy 

• Discuss the steps of the research process (steps of research process)

  • Identify problem areas, review current literature, find population available, design data collection instrument, secure population consent, collect/monitor data, analyze data and see if implementation or significance

• Explain how theory has shaped nursing practice (nursing theorists and the major components of nursing theory)

  • Conceptual framework: group of related ideas/statements/concepts “freud’s”

  • Midrange theory: nursing research most often informed by this theory (benner)

  • Grand theory: broad range of significantly related concepts within a discipline (henderson) 

  • Paradigm: pattern of shared understandings and assumptions about reality and the world.  

  • Metaparadigm: combines the four concepts of person/health/environment/nursing

  • Henderson's Theory: focuses on the nurse’s role in assisting individuals in achieving health and wellness by fulfilling basic human needs.

  • Neuman's theory: views the individual as an open system influenced by internal and external stressors, with nursing interventions aimed at maintaining stability and wellness.

  • Roy’s theory: sees individuals as adaptive systems that respond to stimuli from the environment. These systems are composed of biological, psychological, and social components, and each person is constantly responding to internal and external stimuli to maintain balance.

  • Orem’s theory: Centers on the idea that individuals can care for themselves, but when they cannot, a self-care deficit occurs, and nurses must intervene

  • Peplau’s theory: Emphasizes the nurse-patient relationship as the foundation of nursing practice.

  • Watson: focuses on the human aspect of nursing and the importance of caring in the therapeutic relationship.

Dosage Calculations

Bettey Neuman's theory: humans are in constant relationship with stressors in the environment

Role of a nurse: is to maintain a patients stability by assessing environmental stressors and enduring the patients' adjustment well. Patents are seen as open systems interaction with the environment and the main goal is to reduce the stress 

( primary prevention, secondary prevention, tertiary, normal line of defense, flexible line of defense, lines of resistance) 

• Flexible line of defense: surrounds and protects the normal line of defense from stressors

• Normal line of defense: normal level of health for each patient 

• Lines of resistance: when stressors penetrate the normal line of defense “symptomatology”