nur601 test 3 with best solution

What are the determinants of health? 3 1. Access to quality health care 2. Policies and Interventions 3. Individual - behavior, biology, physical environment, social environment p. 350 Describe Leininger's work in transcultural practice Sunrise Model - helps caregivers give culturally congruent care by revealing cultural factors and professional systems - p.356 00:03 01:33 Define Health Literacy. Why is it important for APNs to embrace and for their patients "The degree to which a person can obtain, process, and understand basic health information and services needed to make appropriate health decisions." - Healthy People 2010, USDHHS, 2000 Describe patient navigator programs 1. Patient navigator assists with completion of forms and scheduling, organizes and coordinates transportation, and explains the procedure(s) in the patient's native language 2. Measurable improvement in outcomes What does communication encompass? learning by asking patients to share their views related to culture What is population based risk assessment? (esp as related to new health promotion programs) examining a particular population cohort - prof is Irish and her family has difficulty with alcohol and drug abuse. Look at needs of particular populations Describe primary barriers to providing quality care to diverse populations ethnocentrism others? Discuss barriers to care for special populations (e.g. migrant workers) Need access No insurance move around a lot What is healthy disparity? Access to care...others? Discuss APRN reimbursement Varies by region and type of APRN. As more become DNPs, salary may go up. Mostly controlled at state level. Data that links APRNs to improved pt outcomes and lower costs can be used to provide compensation for APRNs Describe the type of impact APNs will have on patient care and overall health care ... List some changes and challenges in healthcare (see book) ... 00:02 01:33 Upgrade to remove ads Only $35.99/year Why should future considerations be evaluated (e.g. skills vs knowledge, advancing the discipline) ... Describe marketing principles (Product, Price, Place, Promotion, Public Relations) Product- service or material good that satisfies a need Price - cost to the consumer Place - where to secure goods or services Promotion - communication by seller to consumer regarding the goods or services Public Relations - promoting a favorable relationship with the consumer What is a marketing plan? How can you promote yourself as an NP? (Review cost effective PPT) The APN plans to offer a service The APN wants to ensure financial success from the sales of this service The APN researches and surveys the public The APN tailors product design and pricing of the service to fit the needs and preferences of the public The APN uses advertising, networking, and promotion strategies to convince the public to purchase the service The public becomes aware of a need or preference for the service and purchases it APN makes profit from sale of service to public The APN regularly evaluates the service and strategies to maintain and increase profits LIst rationales for NPs as a "good value for the public" ... Describe what is meant by the "Ultimate selling point." What need you can fill for the lowest cost? Cultural diversity is often associated with what? 1. poverty 2. unemployment 3. educational deficits 4. poor health Leininger Cultural Care Theory 1. Care is the central, unifying focus of nursing 2. Acknowledges both universal and culture-specific care patterns 3. Formulated from an anthropological perspective 4. Questions nursing's reliance on the concepts of person, health, and the environment Leininger's Cultural Care Principles 1. Cultural care preservation and maintenance 2. Cultural care accommodation and negotiation 3. Cultural care repatterning or restructuring Each principle is underscored by the attributes of respect, advocacy, and partnership (core competencies) What is needed to achieve cultural competence? 1. Value both diversity and similarities 2. Understand and effectively respond to cultural differences 3. Engage in cultural self-assessment at the individual and organizational levels 4. Make adaptations to the delivery of services 5. Institutionalize cultural knowledge Why is health literacy important for APNs to embrace and for their patients ... Components of our Multicultural Environment 1. Exponential growth in patients from a wide variety of cultures 2. Health literacy is not only about English 3.Communication with health providers is by interpersonal dynamics and the lens of culture 4. Aim for transcreation: development of all forms of information within a cultural context Ethnocentrism 1. Belief in the relative superiority of one's own cultural group 2. Often operates at an unconscious level 3. Do no harm; look to the patient to be the teacher about his or her culture Questions to elicit beliefs and treatment expectations What do you think caused your problem? Why do you think it started when it did? What do you think your sickness does to you? How does it work? How severe is your sickness? Will it have a short or long course? What kind of treatment should you receive? What are the results you hope to achieve? What problems has your sickness caused you? What do you fear most about your sickness? Note that all of the questions are framed from the perspective of the patient. What are some Ethical, Professional, and Legal considerations for multiculturalism? 1. Cultural and linguistic factors must be accommodated. 2. Failure to document culturally appropriate care may serve as an ethical and legal indictment of your practice. 3. Culturally and linguistically appropriate care is an ethical, accreditation, and legal standard. Foundations for Service Statement of Philosophy The mission statement Goals, objectives, and tasks What is the "statement of philosophy?" 1. Declaration of the practice's approach to health-care services 2. Based on values, those aspects of the human experience the APN deems the most worthy, desirable, and important attributes 3. A foundation for creating vision 4. Time to address differences and strengthen commonalities in multipartner practices What is "The mission statement?" (For an APN business) How, what, and to whom APN intends to offer services The assignment to be carried out How does an APN "disrupt the established order?" 1. Identifying the conventions, the established approaches, that have worked in the past 2. Introduce a novel and unexpected idea What is the goal of Market research? To answer 3 questions 1. What is needed (the product or service)? 2. Who needs it (the target market)? 3. Where should it be located (the place)? REALM Rapid Esimate of Adult Literacy in Medicine - Health Literacy Assessment tool TOFHLA Test of Functional Health Literacy in Adults - Health Literacy Assessment tool What do non western cultures look at as primary social institutions? Family What create barriers, especially for immigrant populations? 1. Cultural beliefs 2. Cultural practices 3. Limited education 4. Poverty 5. Lack of English proficiency 6. Dependence on publicly funded, over burdened health facilities Patient Navigator Outread Act of congress that gave funding to hospitals to reduce barriers to care and improve health outcomes Cultural Competence A set of values, behaviors, attitudes, and practices? What nurses need to do to be culturally competent 1. Value diversity 2. Effectively respond to cultural differences 3. Engage in cultural self assessment (individual and organizational) 4. Make adaptations to the delivery of services 5. Institutionalize cultural knowledge What replaced patient bill of rights? Patient Care Partnership The ethical principle of autonomy is what core component? Participatory Decision Making Key Component of Muslim Culture 1. Women cover up 2. Females not allowed to be alone with males who are not family members 3. If female is seen by male health care worker, a male family member must be present 4. No pork Key component of asian culture 1. Listening quietly without questioning is a sign of respect 2. High respect for education (Doctors) 3. Elderly are held in high esteem Key components of Vietnamese culture 1. Save half used prescriptions 2. Think blood loss throws body out of balance What is NPI? National Provider Identifier. Number that providers use for financial transactions What is ICD? V code - The reason for the visit What is the "Ultimate Selling Point?" APNs selling point to the middle class - Identifies for patients what the most important benefit your practice or service would meet in the critical mass. (What is it?) Describe advantages to independent practice 1. Can focus practice on your interests 2. Time management becomes flexible 3. Quality is your responsibility 4. Multiple sources for reimbursement 5. New opportunities and requests for services offer challenges to expand 6. You can staff who you want 7. Problem solving skills and self esteem Barriers to independent practice 1. The need for direct reimbursement from 3rd party payers 2. Statutory limitations to the APN's scope of practice 3. Inconsistent and restrictive prescriptive authority 4. The inability to obtain hospital privileges (also everything having to do with money) Key business decisions 1. Clear strategy 2. Determine a need 3. Develop timeline for business startup 4. Determine licensing, tax, and insurance requirements 5. Select consultants 6. Decide on appropriate business structure 7 etc...(Plan, location, financing, billing, personnel, marketing How should you start off if you want to eventually have your own business 1. Start as a generalist and gradually move into a niche or specialized practice. 2. Make sure you have exhaustive knowledge of any specialized area you choose. 3. Determine and comply with licensing, tax, and insurance requirements. How do you determine need for your service? ... How do you go about determining licensing, tax, and insurance requirements? (She lists a lot of licences you need like NPI, state tax ID, etc.) Analyze best decisions for your appropriate business structure. Sole proprietorship Partnership Corp Limited Liability Corp (LLC) Describe how a sole proprietorship differs from a professional association Prof says, "Sole proprietorship is more business oriented, about product and profit." What is sole proprietorship When the business and the business owner are one and the same What is a partnership co owners of a business to make a profit What is a corporation An individual legal entity not tied to the individual business owner. Taxed as a business and taxed as things are distributed. What is an LLC? Limited liability Corp - a mix of partnership and corporation but the best of them both tax wise. Not recognized in all states. What comprises policy and procedure development? Details about how to handle medical emergencies, confidentiality, equipment maintenance, how to handle patient complaints, termination of the professional relationship, etc. What are best practices for maketing? Repetition, Internet and social media, web site, educate staff on what services are offered What are the differences between being and an employee vs independent contractor? - Employee: the entity for whom the APN performs services controls what the APN does and when and how he or she does it - Independent Contractor: the entity oversees only the result of the APN's work and not the manner or method in which the work is done - Though not absolute, employees have a level of protection that is unavailable to APNs who function as independent contractors - The independent contractor is responsible for paying his or her income and self-employment taxes. The organization is not required to withhold any taxes or make any Social Security or Medicare payments - Employees receive paychecks that have monies withheld, and employers often provide additional benefits to their employees Describe contract issues for NP employees vs independents (types, terms) 1. Contractors are not entitled to benefits that the organization provides to its employees 2. An APN who is not an employee at a hospital, but has privileges there, would be individually responsible for his or her negligent acts 3.Contracts are promises or sets of promises that outline the rights and responsibilities of the parties; they are legally binding 4. When one or more parties fails to perform in accordance with articulated rights and responsibilities, that failure is termed a breach Why are written agreements important especially from a legal perspectice? 1. Contracts are promises or sets of promises that outline the rights and responsibilities of the parties; they are legally binding 2. When one or more parties fails to perform in accordance with articulated rights and responsibilities, that failure is termed a breach Doctor of NP focuses on what? Administrative leadership, clinical practice, clinical education What consultants will you need for a practice? 1. Attorney 2. Accountant 3. Medical biller 4. Practice manager What are factors to determine status of APN in an organization? 1. The degree of control asserted by the organization versus the degree of independence maintained by the worker 2. What instructions does the organization give to the APN? 3. Does the organization educate the APN to perform services according to certain policies and procedures, or does the APN have his or her own protocols for providing services? 4. Does the APN advertise, and are services available to more than one organization? 5. How is the APN paid? APN "At will" employee 1. Can be terminated "at will" 2. in 1970 exceptions were made 3. exceptions include public polic concerns, antdiscrimination laws, whistleblower statutes 4. A terminated at-will employee may pursue a wrongful termination claim against the employer in situations in which the employee believes he or she was terminated in violation of one of these exceptions What are common contractual terms included in written agreements - Scope of the contract - Effective date - Relationship and responsibilities of the parties - Confidentiality - Conflict of interest - Compensation - Indemnification and subrogation - Dispute resolution - others p 473 PPOs vs HMOs HMO - gatekeeper What is CMS under Department of Health and Human services (DHHS) Medicare part A 1. Inpatient Hospitalization 2. Hospice Home Care 3. SNF (Not ALCs) Medicare part B 1. Out patient visits 2. Labs 3. Durable medical equipment 4. Dialysis 5. Transplants 6. Preventative services (flu shots) Medicare Part D Prescription Drugs Medicaid facts Authorized by title xix of SS act Federal and state matching program - insurance for low income individuals and those with disabilities First NP program Loretta Ford and Dr. Silva - 1978 for kids in rural areas NP regulations State, Professional Organizations, BON Education requirements for NPs Masters degree (state mandated) Where is our right to practice derived from? Nurse Practice Act Nurse Practice Act contains what? 1. Educational requirements 2. Responsibilities 3. Scope of practice State board of nursing does what? Enforces state practice act NP license is through what? State board of nursing What does the board of nursing do? Licenses, disciplines, and something else The title NP is a what protected by what Professional designation, Nurse practice act What is required to obtain licensure in FL Certification NPs standards of practice are develped by what? Professional organizations What goes on prescriptions Name, title, license #, DEA number, Clinics name, address and phone #, everywhere you practice What to remember in telemarketing have licensure in any state you call What are 2 major marketing areas for healthcare practice (you can market yourself better if you help an organization with these 2 things) Quality outcomes and cost effectiveness What to look for in contracts with doctors Broad based, timeframe, protocols you are going to be using, physician backup Ultimate selling point Making yourself attractive to the masses, the most important benefit of your service to the pt Practice Function anyone in practice should always be assigned the highest level of capability in that practice What florida organizations enlighten you on legislation? FNA, FNPN What should you always start a program with? A needs assessment What to look for in a doctor to practice with A collaborative mentality Personable Educated on NPs Supportive of interdisciplinary practice Nation Provider number A unique ID for NPs and PAs - I think you need this for reimbursement These people are helpful in starting a practice Medical Biller, Laywer, CNA (accountant), practice manager, RN, Patient Care Tech How to track value in nurse practice Outcome measures, Performance improvement processes Legal Risks of Advanced Practice 1. Judgments or settlements from a civil lawsuit 2. Licensure or certification actions by the relevant state agencies or private associations 3. Civil or criminal sanctions and exclusion from participation in the federal health-care programs for fraud or abuse Civil Lawsuits 1. Failure to follow the appropriate standard of care results in harm to the patient and financial exposure to compensate the patient or the patient's family 2. Typical risk that most malpractice insurance policies cover What may cause Licensure or state certification exposure 1. Breaking state or federal laws or regulations that control advanced practice nursing and direct reimbursement 2. Examples: false claims, overpayment, substance abuse, fraud, unprofessional conduct, or failure to have a written collaborative agreement with a physician (if required) 3. May or may not be covered by a professional liability insurance policy Federal Health Program Exclusion (what can happen if you are non compliant with federal health care program laws and regulations) 1. Noncompliance with laws and regulations of the federal health-care programs 2. Penalties can be both criminal and civil 3. Conviction referred to the state board of nursing for action with respect to the license 4. The most severe civil penalty is exclusion from federal health-care programs National Practitioner Data Bank (NPDB) 1. Implemented, maintained by U.S. Department of Health and Human Services (DHHS) 2. Information on disposition of all cases and malpractice payments 3. Adverse licensure, clinical privilege, and professional society actions are mandatory to report for all physicians and dentists; actions against APNs may be voluntarily reported Trends in malpractice claims 1. Among APNs, the greatest experience is among CRNAs and CNMs 2. The highest number of claims were reported in New Jersey and Texas, the lowest in Delaware and Vermont Response to the malpractice crisis 1. Early retirement 2. Closure of high-risk practices such as OB 3. Relocation to a state where the claims experience is more reasonable and insurance is available 4. Self-insure through professional association 5. Risk management Insurance Selection Criteria 1. Policy coverage limits 2. How legal costs are treated in the policy 3. Forms of coverage: occurrence and claims-made 4. Occurrence: the policy that was in effect at the time the adverse event occurred applies 5. Claims-made: Adverse events must have occurred and claim made during policy period "Tail-funding" necessary for claims-made Defensive actions to minimize malpractice risk 1. Maintain current professional skills 2. Know and consistently practice within the applicable standard of care 3. Deliver quality care 4. Documents those actions Managing Risk Through Positive Relationships 1. Patients; family and friends; staff; physicians 2. Open and full communications, as permitted 3. Truthfulness, honesty, respect Incorporation in decision making as appropriate 4. Explanations in understandable terms American Nurses Association stance on code of ethics We have an obligation to adhere to it Ombudsman A liaison between patient and an organization - works in best interest of pt Guardian Ad Litem Court appointed representative of "ward" (child, frail, vulnerable person) Health Care power of attorney makes decisions for patient in regards to health care Power of attorney makes healthcare decisions and financial ones Claims based malpractice insurance only covered if you are still with the company Occurrence based malpractice insurance you are covered for the time the incident occurred, even if you no longer have the inurance Scope of practice for APNs 1. Interview 2. Obtain and record health histories 3. physical and developmental assessments 4. order tests 5. diagnose health problems 6. manage clients 7. teach, counsel, and make referrals 8. maintain health records Why give NPs narc priveleges? Outcomes barrier to providers Quality Cost effectiveness What should drive your decision to work at a practice? 1. NPs working there already 2. Working relationship with MD 3. Pt population 4. Expectations of you 5. Salary - hourly or salary...benefits, liability, vacation What to require when working with a supervision doctor 1. back up MD 2. ability for open communication 3. APN knowledge of this MDs integrity How long do you have to submit protocol supervisory agreement once you start a practice in FL? 30 days Plaintiff must prove what occurred to make a lawsuit go forward 1. Duty was owed (established relationship) 2. Duty was breached (failure to do what is reasonable and prudent) 3. Breach caused an injury (Medical expense, pain/suffering, lost wages) 4. Damage Occurred (direct cause between incident and injury) What is the most common lawsuit in healthcare? Failure to diagnose...mostly cancer, particularly breast cancer. Standard malpractice coverage is how much? 1 million per event and 3 million max. what are sources of law legislation, regulations, court decision Statutes Legislation passed in Congress or in State What is policy? guidelines that ensure the smooth functioning of a practice What is telehealth? What is its legal uniqueness? Have to have a licence in the state(s) you are calling What, if poster on social media, would have a potential negative effect on your APN licence? If it could be shown that any of the following occurred then disciplinary action could be the result - 1. Violation of patient confidentiality 2. Photos of alcohol use, illicit drug use, or unethical behaviors 3. Use of sexually suggestive language 4. Negative comments about colleagues, their practice, or another institution What is a tail policy On claims based policies - for coverage after the policy is cancelled Rationale for HIPPA regluations ... What is decent process for purchasing liability insurance? (pp 512-513) 1. Identify a carrier 2. Select type of coverage 3. Select level of coverage 4. Understand the coverage limits 5. Determine policy settlement provisions 6. Understand costs of malpractice insurance 7. Know contractual obligations What happens when a lawsuit is filed? (pp 513-515) 1. APN gets copy of suit with summons 2. Notify insurance 3. Specifics of claim noted 4. copies of summons to insurance and employer 5. Anecdotal documentation prepared 6. Notify risk manager (if employed) 7. Don't discuss case 8. Don't pay without the insurance consent (Insurer's response - provides a rep) (Legal Counsel - Lawyer interviews APN) Don't agree on a settlement until your opinions have been seriously considered. ADR Alternate Dispute Resolution ---------Sophisticated body of literature - Formal research - Best practices commentary - Compelling case histories - Evocative emerging theories What are the common conflict strategies that most nurses use? Why may these styles require reframing? - Avoiding and compromising most common - Next preference was accommodation - Avoiding and accommodating lead to outcomes where one disadvantages oneself - Compromising runs a weak second, because in this strategy, all parties are equally disadvantaged - Using these strategies allows conflict to generate negative feelings What are conflict management styles that may best serve APN? Best one is truth telling without any underlying attitudes Others...? What are key components to ADR? 1. Emphasis on relationship building 2. collaboration 3. authenticity 4. self management What is practice based bioethics? Why is context important? Why is this important for the APN to master? 1. A bioethical approach deriving from professional responsibility is symphonologic 2. Symphonology is intended to be appropriate to the self-determination of a patient, the purposes of a health-care setting, and the role of a health-care professional 3. It further recognizes that the context guides what is possible and desirable in the nurse/patient agreement 4. Ethical reasoning and clinical judgment share a common process, and both serve to teach and inform the other 5.Ethical and professional aspects of practice are interwoven 6. There is no such thing as being competent without being competent in ethical analysis Autonomy uniqueness and independence Freedom right to direct course of one's life Objectivity ability to deal with the reality of one's situation Self-Assertion right to control one's time and effort beneficence Obligation to help the patient. Remove harm, prevent harm, promote good. Acting in the patient's best interest fidelity faithfulness to the terms of an agreement non-maleficence The obligation to avoid harm justice Lack of bias...a right to a fair and equitable treatment. Fair and equal distribution of societal resources. veracity conformance to the facts, accuracy How do you apply principles of bioethics to clinical care situations? Interaction between professional and patient to bring them into the same ethical context? The nurse must use ethical reasoning and clinical judgment. Difference between ethical conduct and legal conduct. "conformance with values vs following the rules" How to problem solve an ethical dilema 1. Problem Identification - who, where, what 2. Values Identification - the 8 values - rank them appropriately 3. The Options - identify options for resolution of the problem 4. Identify the consequences of the options that you choose What resources are available for resolving ethical dilemmas? 1. Nurse Process - assessment, clarifying, helping the patient, supporting their decision 2. ethics committees 3. Florida bioethics network 4. Kennedy institute of ethics at Georgetown origin of conflict in healthcare - what was the early focus on? What kind of role does conflict play for the nurse? What do recent studies suggest about the dissatisfaction of nurses and the role of conflict? 1. Early focus on malpractice, union disputes, and other structural conflicts 2. Conflict plays a central role in the daily life of the nurse 3. Recent studies about the dissatisfactions of nurses clearly support the centrality of conflict