ANCC AGPCNP Non-Clinical Terms, Accurate definitions. Rated A

ANCC AGPCNP Non-Clinical Terms, Accurate definitions. Rated A Level of Evidence Hierarchy: - 1. Meta-analysis 2. Systemic review 3. Randomized Controlled Trial (RCT) 4. Experiment 5. Cohort Study 6. Case Reports/Series 7. Expert Opinions/Editorials Types of Research - • Meta-analysis • Systemic review • Randomized Controlled Trial (RCT) • Experiment (Classic Research) • Cross-Section • Longitudinal Design • Case Study (Report/ series) • Field study or Naturalistic study • Survey study • Cohort research Statute of Limitations: - • The time limit when a lawsuit can be filed or action against a nursing licensee for alleged violation can occur. Most states are 2-3 years. • A period of limitation for the bringing of certain kinds of legal action. Standards of Practice - • Authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty are expected to perform • It is developed by professional societies (ANA) and specialty organizations (AANP) Emancipated Minor - • Can sign own legal documents • Legally married or divorce • Active duty in the armed forces • These are people under the age of 18 y/o but do not require an adult for consent. • Legal court document HITECH - • Heath Information Technology or Economic and Clinical Health Act • Promotes adoption and meaningful use of health information technology • ACT approved in 2009 for the use of electronic health information. • Protection of PHI enacted in 2009. PHI must be encrypted prior to sending. • Patients must be informed if their PHI has been disclosed inappropriately even if the disclosure was accidental. • Providers will be offered financial incentives for demonstrating meaningful use of EHR until 2015 then penalties. • HITECH- signed by President Obama to transition to electronic health records. No more paper charting. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law with the explicit intention of accelerating the adoption and promoting the "meaningful use (MU)" of electronic health records (EHRs) by US physicians. Patient in EOL (end of life) stage ask of hospice: - • The patient is already end stage so beneficence is not correct unless you are educating about smoking cessation or vaccination. This is to promote good. Utilitarianism is the greater good for a population of patients. Justice is to be fair. Which leaves us to autonomy. This is allowing the patient to make his own choice after giving him all the information to make a good informed decision. • AFTT (adult failure to thrive). This is a secondary diagnosis for hospice eligibility. So when you consult hospice for weight loss and not eating with no other major diagnoses, this is not a good referral. Hospice is no longer able to use this as a primary diagnosis. Prescriptive Authority - • The majority of states require NPs to have a collaborative agreement with a physician in order to prescribe. • All states now allow NPs to prescribe certain controlled drugs, but with limitations DEA - • Drug Enforcement Administration • NP must obtain prescriptive authority before getting a DEA number to prescribed controlled substances. • Allows advanced practice nurses to obtain registration numbers for prescribing controlled medication • Though DEA is federal, prescriptive authority is managed by the state board Certification - • Generally a "voluntary" process and is done through a nongovernmental entity such as professional nursing association or specialty organization. • Many states mandate certification as a condition to obtain licensure Licensure - • Legal requirement to practice as an NP • Obtained through a governmental entity, the SBON • Must meet minimal educational and clinical requirements in order to become licensed Incidence - • Conveys information about the risk of contracting a disease • Measure of disease that allows us to determine a person's probability of being diagnosed with a disease during a given period of time. • Rate of new cases of the disease Prevalence - • How widespread the disease is • Measure of disease that allows us to determine a person's likelihood of having a disease, number of alive cases with the disease What are the 4 ethical principles? (and define) - • Beneficence (promoting well-being for pt. and society) • Nonmaleficence - "above all, do no harm" • Autonomy (person acts intentionally after being given informed consent) • Justice (equitable distribution of social benefits) Beneficence - • To do good. The obligation to help the patient; to remove harm, prevent harm, and promote good • Acting in the patient's best interest • Compassionate patient care • The core principle in patient advocacy. • Encourage a patient to stop drinking and enroll in AA program. • Education on a new prescription about how to take the medication, health promotion, education, smoking cessation Nonmaleficence - • Obligation to do no harm; protecting a patient from harm • Your patient has asthma. She brown bags her medication on this visit and you notice a beta-blocker. You educate her that she is not a good candidate for these drugs • Example: Discussing risks vs. benefits of a treatment; working within SOP (standard operating procedures). Utilitarianism - • The outcome of the action is what matters with utilitarianism. It also means to use a resource for the benefit of most (e.g., tax money). It may resemble justice, but it is not the same concept • The Women, Infants, and Children food (WIC) program is only for pregnant women and children. • Outcome of the action is what matter with utilitarianism. • It also means to use a resource for the benefit of most. • It may resemble justice, but it is not the same concept. • Example: WIC program is only for pregnant women and children. It is not open to adults and elderly males. The reason maybe that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (affects the brain growth). • Obligation to act in a way that is useful to or benefits the majority Justice - • The quality of being fair and acting with a lack of bias • The fair and equitable distribution of societal resources • Example: Low income individuals do not pay some types of taxes to the government but still have equal access to the public services supported by taxes. Informed consent - • Research subjects must be informed that they have the right to withdraw at any time without consequences or penalty • All information must be presented on what to expect, risks, benefits, alternatives, compensation, and confidentiality • Permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Durable Power of Attorney - • A legal document that gives someone you choose the power to act in you place. Advance Directive - • A written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should be the person be unable to communicate them to a doctor. Living Will - • A written statement detailing a person's desire regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. CPOE - • Computerized Provider Order Entry- electronic entry of medical practitioner instructions for the treatment of patients under his or her care EHR - • Electronic health record; digital version of patient's chart; makes information available instantly and securely to authorized users Electronic Medical Record - • Electronic version of the patient's chart; should remain confidential as the paper chart; providers should log out of patient identifying screens when away from the computer. ICD 10 - • International Classification of Diseases • Used to indicate the diagnosis, including family history disorders. • Each disease is assigned an ICD-10 code. • Global health information standard for mortality and morbidity statistics. • Increasingly used in clinical care and research to define disease and study disease patterns, as well as manage health care, monitor outcomes and allocate resources. CPT - • Current Procedural Terminology • List of descriptive identifying codes that are used to identify procedures and medical services. • It owned by the AMA. • Medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies, and accreditation organizations. CMS - • Centers for Medicare and Medicaid Services • Agency under the U.S. Department of Health and Human Services Claims Based Policy - • Policy that provides coverage when a claim is made against the policy, regardless of when the claim event took place. • A claims-made policy is most likely to be purchased when there is a delay between when claims are filed when they occur. • ONLY beneficial if a claim is made while your policy active. • You are covered when you have the policy for that period of time... ie.... you have the policy from . • If a claim is made while you have the policy you are good, but if a claim is made in 2019 and you do not have tail coverage then you're up the creek. Even if the incident occurred in . • Type of malpractice insurance that will cover claims only if the incident occurred when the NP paid the premium and only if the NP is still enrolled with the same insurance company at the time the claim is filed in court. Occurrence Based Policy - • This includes tail coverage so it is more expensive. It will cover you even if you no longer have the policy. As long as you had the policy, if the claim is filed in the future.. ie... your insured from then you retire. A patient makes a claim in 2018 for something that happened in 2016. This means you are covered. • Type of malpractice policy is not affected by job changes or retirement. If a claim is filed against the NP in the future, it is covered at the time the incident occurred Tail Coverage - • When you are retired and had claims based coverage. It will protect you if you have retired or changed providers against any claim made NPI - • A number used to identify healthcare providers and is used for billing purposes. The Joint Commission - • Has developed practice standards for which to measure quality. • Establishes performance standards for hospitals to follow for accreditation • Holds organizations accountable for sentinel events • Implements the Core Measures program The Centers for Medicare and Medicaid Services (CMS) - • Responsible for administering several key federal health programs, such as Medicare and Medicaid. Third Party Payers - • Medicare • Medicaid • Commercial Indemnity Insurers • Commercial management organizations (HMO) • Businesses or schools wanting health services for employees or students. Issues regarding Access to Care - • Home health - Nurse/Therapy/HHA/MSW in the home - Cheaper Model than Hospital • Hospice - death diagnosis of the patient with 6 month survival with no additional treatment • Skilled nursing facilities - Nursing home with therapy room. Decrease of cost. • Private duty Nursing - $$$$$ - Nurse, Expensive Medicare - • Federal health insurance program for people who are 65 and older, certain younger people with disabilities, and people with end stage renal disease. • Sets the standard of reimbursement and controlling cost • ie- aarp, blue cross Reimbursement rate for NP w/o incidence to - • 85% of physician reimbursement for services provided in collaboration with a physician Medicare Part A - • Medicare plan that you receive if you are 65 or older no matter the income, severely disabled, or have ESRD. • "Automatic" at 65 if person paid premiums • Covers persons with ESRD at any age • Will pay for certain "medically necessary" services: a. Inpatient hospitalization(including IP psych) b. Hospice associated with inpatient care c. Home health d. Skilled nursing facility • Will not pay for custodial care (nursing home, retirement home) Medicare Part B - • Outpatient insurance • Supplemental medical insurance requiring recipients to pay a premium • Voluntary program with monthly premiums; must enroll during general enrollment period • Will pay for a. OP doctor visits b. Labs, EKG, Xray, CT c. Durable medical equipment - wheel chairs, walkers, etc d. 2nd opinions e. OP dialysis, self-dialysis equipment, organ transplant, surgeries f. Some health prevention services • Will not pay for: eyeglasses/exams, hearing aids, dentures/dental care, cosmetic surgery, OTC and most RX drugs Medicare Part C - • Medicare Advantage • Cover IP (A) and OP (B) and some plans cover RX drugs • Administered by private health insurance companies approved by Medicare • "Choice" plan that includes for additional services: vision, dental. • Can keep Medicare Part A and pay for Medicare Part B. • Entitled to A, enrolled in B are eligible to receive all their health care services through one of the provider organizations (HMO,PPO) Medicare Part D - • Prescription drug benefit; only those who are enrolled/eligible for A and B are eligible • Formulary for preferred drugs • D=Drug • Limited prescription drug coverage • Monthly premium required • Co-pay on each prescription is required Medicaid - • Authorized by social security act • Federal and state matching program • Provides health insurance coverage for low-income individuals and their families who meet the federal poverty level criteria • Covers children, pregnant women, adults, seniors, and individuals with disabilities • Pays for health care and RX drugs • Health care program that assists low-income families or individuals in paying for long-term medical and custodial care costs. • Joint program, funded primarily by the federal government and run at the state level, where coverage may vary. HIPAA - • Health Insurance Portability and Accountability Act • Provides protections for the "use and disclosure of individuals' health information"--called "protected health information" by organizations subject to the Privacy Rule, which are called "covered entities" • Health Insurance Portability and Accountability Act that was passed by Congress in 1996. • Must keep all information confidential, do NOT need consent for consultation with other providers. • Only healthcare providers that are active in the patients care can review any medical information. "Covered Entities" - • All health care providers, health insurance companies, health care plans, laboratories, hospitals, SNFs, and 3rd party administrators who electronically transmit health information must follow HIPAA regulations HIPAA Requirements - • Health providers are required to provide each pt a copy of their office's HIPAA policy (pt sign) • HIPAA form must be reviewed and signed annually • pt. has right to review medical files • Mental health provider has the right to refuse pts' requests to view their psychiatric and MH records • When pt. request to review records, health provider has up to 30 days to comply • Pts are allowed to correct errors in their medical records • Provider must keep identifying info (name, DOB, address, SS#) and any Dx/Dz or health concerns private except under certain conditions Balanced Budget Act - • Broadened Medicare coverage of NP and clinical nurse specialist services • HIPAA required providers to have NPI to bill Medicare and Medicaid • NPs can be reimbursed directly by Medicare Part B, Medicaid, Tricare, and some health insurance plans • Medicare will reimburse NPs at 85% of the Medicare Physician Fee Schedule "Incident to" Billing - • Way to bill Medicare for OP services rendered by a non-physician health provider and receive 100% physician fee • During 1st visit, the physician must evaluate the pt. (and write care plan); follow up visits with the NP can be billed as "incident to" so long as the same health care problems are being addressed • The physician's NPI number issued to bill for the service • The "incident to" billing is reimbursed at 100% of the physician rate Malpractice - • Improper, illegal, or negligent professional activity or treatment Negligence - • Failure to use reasonable care, resulting in damage or injury to another Veracity - • Truth • Example: Patient recently diagnosed with advanced pancreatic cancer. Patient thinks that she has a very good chance of being cured. The oncologist explains to the patient her poor prognosis. The oncologist is being truthful and honest to the patient about her prognosis. Fidelity - • Dedication and loyalty to one's patients. Keeping one's promise. • A woman with terminal breast cancer does not want the NP to reveal her poor prognosis to her mother. • The obligation to maintain trust in a relationship. • Dedication and loyalty to one's patients. Keeping one's promise. • Example: A woman with terminal breast cancer does not want the NP to reveal her poor prognosis to her mother. The patient explains to the NP that her mother is very anxious and she wants to wait until the next week before she tells her mother news. If the NP keeps the prognosis is confidence from the patient's mother, she is exercising the concept of fidelity. Autonomy - • The obligation to ensure that mentally competent adult patients have the right to make their own health decisions and express treatment preferences. • Examples: An alert elderly female with periods of forgetfulness and who has breast cancer decides to have a mastectomy after discussing the treatment options with her oncologist. The woman's daughter tells the NP that she does not want her mother to have a mastectomy because she thinks her mother is too old and confused. The NP has the duty to respect the patient's decisions. This case is also a good example of the NP acting as the patient advocate. Paternalism - • Making decisions for patient (or for others) because you "believe" that it is for their best interest. • The opinion (or desires) of the patient is minimized or ignored. • Patient is "powerless". • Example: 92-year-old male does not want to be on a ventilator if he codes. The son agrees and quietly tells the NP and physician that he wants this father to be aggressively treated with life support, if it is necessary. Tail insurance coverage - • When an NP with claims-based malpractice insurance retires or changes to a new job, it is advisable to buy "tail" coverage insurance. The tail coverage insurance will cover the NP for malpractice claims that may be filed against him or her in the future. Health Risk Management - • A systematic organizational process to identify risky practices to minimize adverse patient outcomes and corporate liability. • HAI (health care associated infection) Accountability - • Being held responsible for your actions. Dignity - • To treat with respect. • Example: Hospital gowns should be secured correctly so when patients get up to walk, their backs are not visible. Confidentiality - • Ethical principle or legal right that a physician or other health professional will keep information private. Control group - • Subjects in group that did not receive treatment Hypothesis - • The proposed explanation for (or prediction of) a phenomenon. Median - • The numerical value separating the higher half from the lower half. The middle value in a list of numbers. The numbers are sorted from the lowest to the highest value. Mode - • Most common value in a list of numbers N - • Symbol indicate total size of group n - • Number of subjects in group Significance Level - • Also known as the "α" or a "p-value." It is the probability that the study results are due to chance. The p-value is usually set at either p . 05 or p . 01. Null Hypothesis - • There is no significant relation between the variables of the study. If the null hypothesis is rejected, it means that the results of the study are not due to chance. Budget Reconciliation Act of 1989 (HR - • The first law allowing NPs to be reimbursed directly by Medicare. Only certified pediatric and family nurse practitioners were allowed as primary providers as long as they practiced in designated "rural" areas. Modifiable risk factors - • Smoking • Blood pressure • Diabetes • Physical inactivity • Overweight • High cholesterol Non-modifiable risk factors - • Age • Ethnic background • Family history • Gender Primary prevention (Vaccine and Education) - • Prevent disease/injury • Nutritious diet, exercise, seatbelt, helmet • Gun safety • Immunizations, OSHA, EPA • Youth center, shelter • ASA prophylaxis for primary prevention of CVD and colon CA in adults age 50 to 59 yrs with 10% risk or higher Secondary Prevention (Blood and Touch {Screen}) - • Early detection of a disease to minimize bodily damage • Screening tests (pap, mammo, CBC for anemia) • Screening for depression • Screening for STI • Screening for alcohol abuse • Testing for Hep C in person with risk factors Tertiary Prevention (Treat) - • Prevention of disease progression, rehabilitation, support groups, education on equipment • AA, breast CA support group, HIV support group • Education for pts with preexisting dz (diabetes, HTN) • Cardiac rehab, PT, OT • Tx of person with Hep C • Tertiary prevention generally consists of the prevention of disease progression and attendant suffering after it is clinically obvious and a diagnosis established. This activity also includes the rehabilitation of disabling conditions. Examples include eliminating offending allergens from asthmatic patients; routine screening for and management of early renal, eye, and foot problems among diabetics; and preventing reoccurrence of heart attack with anticlotting medications and physical modalities to regain function among stroke patients Levels of Prevention: - • P (Pupil), S (Screen), T (Treat) • Primary prevention (Vaccine and Education) • Secondary Prevention (Blood and Touch {Screen}) • Tertiary Prevention (Treatment and Post-Treatment {Rehab}) Reportable Communicable Diseases - • Anthrax, botulism, west nile, encephalitis, chlamydia, chickenpox, diphtheria, gonorrhea, H.flu, Hep A, B, C, flu related infant deaths, Lyme disease, malaria, measles, meningitis, mumps, pertussis, polio, rabies, rocky mountain spotted fever, rubella, smallpox, syphilis, tetanus, TB, and more Relative Risk - • Ratio of the probability of event occurring in exposed group to the probability of the of the event occurring in a non-exposed group Relative Risk Reduction - • Measure of how much risk is reduced in the experimental group compared with the control group Therapeutic communication - • Face-to-face process of interacting that focusses on advancing the physical and emotional well-being of a patient Root Cause Analysis - • Process used in health care to identify the contributing factors that result in an error • "Structured facilitated team process to identify root causes of an event that resulted in an undesired outcome and develop corrective actions" • The gathered data are analyzed for root causes; the goal is to identify the system breakdowns that resulted in an inadvertent mistake and to propose at least one corrective action to reduce or eliminate each root cause • An approach designed to breakdown and analyze the cause of an adverse event. Consultation - • To request another's opinion; could be specialist or colleague Collaboration - • To work jointly Morbidity - • Refers to illness or any departure from physical and/or mental health Welcome to Medicare visits - The four components required for an assessment of functional ability and level of safety in the visit include the evaluation of hearing impairment, activities of daily living, fall risk and home safety Sentinel Events - • An accident that results in death. • Sentinel Event (SE) • Patient safety event that results in any of the following: death, permanent harm, severe temporary harm with interventions required to sustain life. • Must perform RCA and improve. Transcultural Nursing Theory - • Leininger -involves knowing and understanding different cultures with respect to nursing and health-illness caring practices, beliefs, and values with the goal to provide meaningful and efficacious nursing care services to people Family Systems Theory - • Murray Bowen - suggests that individuals cannot be understood in isolation from one another, but rather as part of their family, as the family is an emotional unit • All parts of a system are interrelated and dependent on each other. If one part of the system is damaged or dysfunctional, the rest of the system is also affected. Health Belief Model - • The psychological model that attempts to explain and predict health behaviors • Done by focusing on the attitudes and beliefs of individuals • A model that attempts to explain why people engage in health behavior( s). According to the HBM, a person is more likely to engage in healthier behavior if he or she feels threatened by the condition (perceived susceptibility), and believes that he or she can overcome the barriers (perceived barriers), will benefit, and can successfully perform the action (self-efficacy) (Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal) Transitional Care Model - • Designed to prevent health complications and re-hospitalizations of chronically ill, elderly hospital patients by providing them with comprehensive discharge planning and home follow up Stages of Change - 1. Pre-contemplation- no intention on changing behavior 2. Contemplation- aware a problem exists but with no commitment to action 3. Preparation- intent on takin action to address the problem 4. Action- active modification of behavior 5. Maintenance- sustained change; new behavior replaces old 6. Relapse- fall back into old patterns of behavior Cultural Awareness - • Foundation of communication and it involves the ability of standing back from ourselves and becoming aware of our cultural values, beliefs, and perceptions. Cultural Beliefs - • Religion, culture, beliefs, and ethical customs can influence how patients understand health concepts, how they take care of their health, etc. Cultural Competence - • Ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. Hispanics - • Strong matriarchal element • May consult folk healers (AKA - Santero, brujo, curandero, shaman, Babalawo) • "Susto" is a cultural illness (fright) • Mal ojo- the "evil eye"- folk illness usually of child/baby caused by an adult who stares with envy at the child; hex can be broken if the person staring at the child touches the child or to pass an egg over the child with prayers and then place the egg under the bed overnight • Families enjoy public affection • Extended family are treated like immediate family • Multi-generational may live in the same households are common • Some display distrust in physicians • Public affection is noted African American - • This is a matriarchal (female is the head of household) and some patients may feel that their illness is caused by lack of faith or by sin. • Religious persons are important sources of emotional and tangible support. • Distrust in medical workers, especially doctors Native American - • View illness as punishment by the spirits for wrongful actions • Healing is done by "shamans" using prayers, dance, fasting, smudging, and sometimes ingesting hallucinogenic plants • Native American medicine is used to treat Native American problems such as pain, disturbed family relationships, alcoholism and mental illness. While "White man" medicine is used to treat the "White Man" diseases such as DM, Cancer and cholelithiasis. • 50 yrs. of age and older qualifies an "elder".