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Foundations of Nursi

Foundations of Nursing - Basic Nursing - Chapt 3 & 4

QuestionAnswer
What changes in the Health Care Delivery System in 1960's Physician practice were authority, preogative autonomy, free choice, solo practice, fee for service (FFS)
What was the Health Care Delivery System made up of primarily in the 1960s Independent, not for profit hospitals.Small private practices of office based physicians.Neighborhood & medical supply stores
Utilization Review (UR) State regulation of hospitals construction - State must say if a hospital needs more room.
Diagnosis Related Groups (DRG) Medicare to limit hospital length of stay - Daily records of what to do, must be discharged when told.
What changed the in Health Care Delivery System in 1989? Hospitals were having decreased profits & decreased hospital length of stay.Acutely ill utilized home care & ambulatory.Cost sky rocketed.Ill were sent home
Were changes in the Health Care Delivery System in 1990s 95% of all insured were enrolled in some from of managed care, including fee for service (FFS), prefered provider organizations (PPO), Health maintenance organizaitions (HMO).RN's & LPN's being replaced by unlicensed assistive personnel (UAP's)
PPO Preferred Provider Organizations
HMO Helth Maintenance Organizations
What are managed Care Plans Critical PathwaysCare MapsClinical PathwayStandard Nursing Care PlansState desired outcomes (goals) within timelines. They must be followed to receive the maximum cost reimbursement for service- Do not fit every - What we want to happen.
Holistic Healthcare Comprehensive & total care of a personEmphasized wellness - Sbsence of disease, meet basic needs, avoidance of hazardous situations, ability to cope with stress.Old trend being revisited.
Herbalist Use herbs & botanicals
Acupuncture & Acupressure Based on Qi (chee)Pain #1 reason for use
Therapeutic Relaxation Deep breathing can lower blood pressure
Therepeutic Touch Do not actually touch - restores electromagnetic field
Client No longer known as a PatientCustomer is buying a service.
Hospitals - Acute Care Facilities (ACF) Ambulatory - Dietary - Emergency Care - ICU - Chemo - Surgical - Home Health - Hospice
Hospitals - Specialized Developmental or Mental Disable - VA - Burn - Rehab Centers - Psychiatric - Pediatric
ACF Acute Care Facilities
Community Health Services Outpatient Services - Walk-In Care - School - Industry - Telehealth
Outpatient Services PT, OT, Wound Care, Chemo, etc.
Walk-In Care Minor Med
Industry Workman Comp - Prevention - Education
Extended Care Facility (ECF) Nursing Home, Rehab Centers, Mental Health Center
ECF Extended Care Facility
Skilled Nursing Facilities (SNF) Certified for a certain number of beds (RN doing care)
SNF Skilled Nursing Facilites
Intermediate Care Facilities (ICF) 24 Hour services of nursing assistans under supervision of an LPN, with a RN on staff.
ICF Intermediate Care Facilities
Components of Quality Care Focus on deliver of careOutcome based careNursing AccountabilityConsumer needs
Client Resresentatives Patient representativeAdvocateLiaisonOmbudsmanSocial services
Hospital Administration has a Chain of Command
Hospital Ownership - Profit oriented - Proprietary IndividualPartnershipCorporation
Hospital Ownership - Nonprofit - Voluntary Church associated - Baptist, MethodistPrivate school - VanderbiltFoundation associated - Shriner's
Hospital Ownership - Nonprofit - Governmental Federal - VAState - UniversityCountyCity - The Med
Proprietary, inverstor owned, or for profit hospital Very few, many nursing homes
Not for profit Hospital Majority of all hospital
Standars of Quality Established by individual health care facilities to guide the nurses in client care - Do not overrule Board of Nursing (BON)
BON Board of Nursing
Hospital Accrediation Organization Joint Commission for Accrediation of Healthcare Organizations, (JCAHO)
Joint Commission for Accrediation of Healthcare Organization (JCAHO) Can not close hospital but can stop funding.
JCAHO Joint Commission for Accrediations of Healthcare Organizations
Methods of Payment Fee for Service (FFS)Third-party payment-Private-Group-HMO-PPO-Medicare-Medicaid
Private Insurance High CostCompany often refuses to insure anyone who is considered a health risk
Group (family) or individual insurance Cost is highDon't usually insure people with health risks
Group Insurance Company insurancePremium is fairly lowPeople usually insured without physicals
Health Maintenance Organization (HMO) Fixed monthly chargeGroup practice (several MD’s & specialist)Person pays a certain amount per month to stay well (Capitation fee)Pay a small added cost when see MD (Co-pay)Prevention–main goaldisorders & diseases are treated as they occur
PPO’s (Preferred Provider Organizations) “Managed” systemGroups of Healthcare practitioners who contract to provide servicesServices within groupOutside of group is higher
POS (Point of Service Plans) Contacts with physicians and healthcare providers“Managed” by a primary care doctor with groupCan see outside of group but has to pay higher premiums
Social security System Federal system to provide health, old age, survivor, and disability insuranceEnacted by RooseveltFederal
Medicare Promoted by the government to aid people 65 or olderDivision of the department of health & human services Organized to set up programs to aid handicapped & disabled individualsAvailable to recipients of Social Security Disability Insurance (SSDI)
(SSDI) Social Security Disability Insurance
Medicaid Joint effort between Federal and State governmentsDiffer from state to statePeople over the age of 65BlindDisabledReceiving Aid to Families with Dependent ChildrenMust qualify - Not all get
PPS – Prospective Payment System RUG’s (Resource Utilization Group)DRG’s (Diagnosis Related Groups)
RUG’s (Resource Utilization Group) Used in nursing homes for payment
PPS – Prospective Payment System
RUG’s (Resource Utilization Group)
Ethics Conduct appropriate for all members of a group
Ethical Problems Organ TransplantClinical DeathQuality of LifeTreatment IssuesEuthanasia - Legal in Oregan
Morality Behavior in accordance with customs or tradition; usually reflects personal or religious beliefs
Laws Nurses are governed by civil and criminal law in roles as providers of services, employees of institutions, and private citizensProfessional nurses are held responsible (liable) for harm resulting from their negligent acts, or omissions to act
Felony Offenses as falsification of medical records, insurance fraud, theft of narcotics or practicing without a license
Tort Injury that occurred because of another person’s intentional or unintentional actions or failure to act
Nonmaleficence Do no harm - No evil
Beneficence Doing good - Remove harm - Paternalism is an undesirable outcome of beneficence, where health care provider decides what is best for the client & attemps to encourage the client to act against his/her own choice.
Justice Providing fair and equitable treatment to all clients
Veracity The obligation to tell the truth
Fidelity The duty to do what one has promised
Ethical Codes Not legally binding-Most Boards of Nursing (BON) has authority to reprimand nurses for unprofessional conduct
Advocate A person who speaks up for or acts on the behalf of the client, protects the client’s right to make own decisions, and upholds the principle of fidelity
Nurse Practice Act Defines what nursing is, is not, & under what circumstancesAll nurses are responsible for knowing provisions of the act for the state No MD, RN, or agency can give the licensed practical/vocational nurse the right to do more than can be performed
Tennessee Nurse Practice Act Rules and regulations of individual stateAdministered by Board of NursingThe board’s mission is to safeguard the health, safety and welfare of Tennesseans (the public)
Standards of Care Guidelines by which the nurse should practiceGuidelines for determining whether nurses performed duties in an appropriate mannerBased on what an ordinary prudent nurse with similar education and experience would do in similar circumstances
Employee Guidelines Respondent SuperiorEmployer will be held liable for any negligent acts of an employee if the alleged negligent act occurred during the employment relationship and was within the scope of the employee’s responsibilities
Hospital Staffing Nurses should not walk out when staffing is inadequate because charges of abandonment can be madeNurses in short staffing situations are obligated to notify the nursing supervisor
Floating Nurses who float should inform the supervisor of any lack of experience in caring for the type of clients on the new nursing unit
Disciplinary Action Boards of nursing may deny, revoke, or suspend any license to practice as a practical/vocational nurse in accordance with their statutory authority
Causes for Disciplinary Action Knowingly delegating nursing care to unlicensed personnel that places the client at risk for injury
Negligence And Malpractice If a nurse gives care that does not meet appropriate standardsMalpractice is determined if the nurse owed a duty to the client & did not carry out the duty & the client was injured because the nurse failed to perform the duty
AMA Against Medical Advice
Experimentation Stringent regulations govern research on humansNuremberg laws
Professional Liability Insurance Nurses need their own liability insurance for protection against malpractice lawsuits
Good Samaritan Laws Immunity from suit applies only when all of the conditions of the state law are met, such as the caregiver receives no compensation for the care provided and the care given is not intentionally negligent
Assault Occurs when a person puts another person in fear of a harmful or an offensive contactThe victim fears and believes harm will result as a result of the threat
Battery An intentional touching of another's body without the other’s consent
Invasion of Privacy Includes violating confidentiality, intruding on private client or family matters, and sharing client information with unauthorized persons
False Imprisonment Occurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the clientOccurs when restraining devices are used without an appropriate clinical needA client can sign an Against Medical Advice form
Defamation Occurs when information is communicated to a third party that causes damage to someone’s reputation, either in writing (libel) or verbally (slander)
Fraud Results from a deliberate deception intended to produce unlawful gains
Patient’s Bill Of Rights Key elements of a client's rights with which nurses should be familiar include informed consent and confidentiality
Confidentiality A special relationship exists between two people in which information discussed will not be shared with a third party who is not directly involved in the client’s careInformation release may be mandatory when ordered by a court
Informed Consent Consent must be obtained by the physician, surgeon, or other medical practitioner performing the treatment or procedureMinors who are married or emancipated from parents & those seeking treatment for STD can sign an informed consent form
Libel Written statement or photograph that is false or damaging.
Slander Term given to malicious verbal statements that are false or injurious
Created by: 1028210410
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