ATI Fundamentals Review
Chapter 1; Health Care Delivery Systems Regulatory
Agencies
- U.S. Department of Health and Human Services
- U.S. Food and Drug Administration (FDA)
- State and local public health agencies
- State licensing boards ensure health care providers& agencies comply w/ state regulations
- The Joint Commission to set quality standards for accreditation of health care facilities
- Professional Standards Review Organizations to monitor health care services provide
- Utilization review committees to monitor for appropriate diagnosis and treatment of hospitalized clients
Health Care Financing Mechanisms
• Public Federally Funded Programs
- Medicare; clients 65 years + & those w/ permanent disabilities.
Part A: hospital stays, home health, and hospice
Part B: outpatient and provider services (voluntary & requires a monthly premium)
Part C: A Medicare advantage or supplement plan (covering parts A and B, and sometimes D)
Part D: Medication coverage eligible, requires a monthly premium
- Medicaid; for low incomes; federally &state funded; Individual states determine eligibility requirements.
• Patient Protection and Affordable Care Act of 2010; federal statute aimed at increasing access to health
care for all individuals and instituting an individual mandate for health insurance, decreasing health care
costs, & providing opportunities for uninsured people to become insured at an affordable cost
- State Children’s Health Insurance Program: Coverage for uninsured children up to age 19 Private
Plans; Traditional insurance reimburses for services on a fee-for-service basis
- Managed care organizations (MCOs): Primary care providers oversee comprehensive care for enrolled
clients; focus on prevention and health promotion
- Preferred provider organizations (PPOs): Clients choose from list of contracted providers & hospitals; Usin
non-contracted providers increases out-of-pocket costs
- Exclusive provider organizations (EPOs): Clients choose from list of providers and hospitals w/in a
contracted organization with no out-of-network coverage
- Long-term care insurance: A supplement for long-term care expenses Medicare does not cover
Levels of Health Care
• Preventive health care focus on educating & equipping clients to reduce and control risk factors for disease;
i.e.. immunization, stress management, occupational health, and seat belt use
• Primary health care emphasizes health promotion, includes prenatal and well-baby care, family planning,
nutrition counseling, and disease control; i.e.. office or clinic visits, community health centers, and scheduled
school- or work-centered screenings (vision, hearing, obesity)
• Secondary health care diagnosis and treatment of acute illness and injury; i.e.. care in hospital settings
(inpatient and emergency departments), diagnostic centers, and urgent and emergent care centers
• Tertiary health care, or acute care, provision of specialized & highly technical care; i.e.. intensive care,
oncology centers, and burn centers
• Restorative health care intermediate follow-up care for restoring health & promoting self-care; i.e.. home
health care, rehabilitation centers, and skilled nursing facilities
,• Continuing health care addresses long-term or chronic health care need; i.e.. end-of-life care, palliative care
hospice, adult day care, assisted living, and in-home respite care
,Chapter 2; The Interprofessional Team
Interprofessional Personnel (Non-Nursing)
- Spiritual support staff: Provides spiritual care (pastors, rabbis, priests)
- Registered dietitian: Assesses, plans, educates nutrition needs. Designs special diets, supervises meal prep
- Laboratory technician: Obtains specimens of body fluids and performs diagnostic tests
- Occupational therapist: Assesses, plans for clients to regain activities of daily living (ADL) skills, especially
motor skills of the upper extremities
- Pharmacist: Provides, monitors, and evaluates medication
- Physical therapist: Assesses and plans for clients to increase musculoskeletal function, especially of the
lower extremities, to maintain mobility
- Provider: Assesses, diagnoses, and treats disease and injury. Providers include medical doctors (MDs),
doctors of osteopathy (DOs), advanced practice nurses (APNs), and physician assistants (PAs). State
regulations vary in their requirements for supervision of APNs and PAs by a physician (MDs and DOs)
- Radiologic technologist: Positions clients and performs x-rays and other imaging procedures for providers to
review for diagnosis of disorders of various body parts
- Respiratory therapist: Evaluates respiratory status and provides respiratory treatments including oxygen
therapy, chest physiotherapy, inhalation therapy, and mechanical ventilation
- Social worker: Works with clients and families by coordinating inpatient and community resources to meet
psychosocial and environmental needs that are necessary for recovery and discharge
- Speech-language pathologist: Evaluates and makes recommendations regarding the impact of disorders or
injuries on speech, language, and swallowing. Teaches techniques and exercises to improve function
Nursing Personnel
- Registered nurse (RN); lead team member, soliciting input from all nursing team members and setting
priorities for the coordination of client care; Perform assessments; establish nursing diagnoses, goals, and
interventions; and conduct ongoing client evaluations; Develop interprofessional plans for client care; Share
appropriate information among team members; initiate referrals for client assistance
- Practical nurse (PN); Work under the supervision of RN; Collab within nursing process, assist with plan of
care, consult with other team members, and recognize need for referrals to assist with problems
- Assistive personnel (AP; includes certified nursing assistants (CNAs) and certified medical assistants
(CMAs), and non-nursing personnel (dialysis technicians, monitor technicians, and phlebotomists); Work
under the direct supervision of an RN or PN; Tasks can include feeding clients, preparing nutritional
supplements, lifting, basic care (grooming, bathing, transferring, toileting, positioning), measuring and
recording vital signs, and ambulating clients
Expanded Nursing Roles
- Advanced practice nurse (APN): great deal of autonomy; minimum of a master’s degree in nursing (or
related field), advanced education in pharmacology & physical assessment, certification in specialized area
- Clinical nurse specialist (CNS): Typically specializes in a practice setting or a clinical field
- Nurse practitioner (NP): Collaborates with one or more providers to deliver nonemergency primary health
care in a variety of settings
- Certified registered nurse anesthetist (CRNA): Administers anesthesia and provides care during procedures
under the supervision of an anesthesiologist
- Certified nurse‐midwife (CNM): Collaborates with one or more providers to deliver care to
maternalnewborn clients and their families
, - Nurse educator: Teaches in schools of nursing, staff development departments in health care facilities, or
client education departments
- Nurse administrator: Provides leadership to nursing departments within a health care facility - Nurse
researcher: Conducts research primarily to improve the quality of client care
Chapter 1; Health Care Delivery Systems Regulatory
Agencies
- U.S. Department of Health and Human Services
- U.S. Food and Drug Administration (FDA)
- State and local public health agencies
- State licensing boards ensure health care providers& agencies comply w/ state regulations
- The Joint Commission to set quality standards for accreditation of health care facilities
- Professional Standards Review Organizations to monitor health care services provide
- Utilization review committees to monitor for appropriate diagnosis and treatment of hospitalized clients
Health Care Financing Mechanisms
• Public Federally Funded Programs
- Medicare; clients 65 years + & those w/ permanent disabilities.
Part A: hospital stays, home health, and hospice
Part B: outpatient and provider services (voluntary & requires a monthly premium)
Part C: A Medicare advantage or supplement plan (covering parts A and B, and sometimes D)
Part D: Medication coverage eligible, requires a monthly premium
- Medicaid; for low incomes; federally &state funded; Individual states determine eligibility requirements.
• Patient Protection and Affordable Care Act of 2010; federal statute aimed at increasing access to health
care for all individuals and instituting an individual mandate for health insurance, decreasing health care
costs, & providing opportunities for uninsured people to become insured at an affordable cost
- State Children’s Health Insurance Program: Coverage for uninsured children up to age 19 Private
Plans; Traditional insurance reimburses for services on a fee-for-service basis
- Managed care organizations (MCOs): Primary care providers oversee comprehensive care for enrolled
clients; focus on prevention and health promotion
- Preferred provider organizations (PPOs): Clients choose from list of contracted providers & hospitals; Usin
non-contracted providers increases out-of-pocket costs
- Exclusive provider organizations (EPOs): Clients choose from list of providers and hospitals w/in a
contracted organization with no out-of-network coverage
- Long-term care insurance: A supplement for long-term care expenses Medicare does not cover
Levels of Health Care
• Preventive health care focus on educating & equipping clients to reduce and control risk factors for disease;
i.e.. immunization, stress management, occupational health, and seat belt use
• Primary health care emphasizes health promotion, includes prenatal and well-baby care, family planning,
nutrition counseling, and disease control; i.e.. office or clinic visits, community health centers, and scheduled
school- or work-centered screenings (vision, hearing, obesity)
• Secondary health care diagnosis and treatment of acute illness and injury; i.e.. care in hospital settings
(inpatient and emergency departments), diagnostic centers, and urgent and emergent care centers
• Tertiary health care, or acute care, provision of specialized & highly technical care; i.e.. intensive care,
oncology centers, and burn centers
• Restorative health care intermediate follow-up care for restoring health & promoting self-care; i.e.. home
health care, rehabilitation centers, and skilled nursing facilities
,• Continuing health care addresses long-term or chronic health care need; i.e.. end-of-life care, palliative care
hospice, adult day care, assisted living, and in-home respite care
,Chapter 2; The Interprofessional Team
Interprofessional Personnel (Non-Nursing)
- Spiritual support staff: Provides spiritual care (pastors, rabbis, priests)
- Registered dietitian: Assesses, plans, educates nutrition needs. Designs special diets, supervises meal prep
- Laboratory technician: Obtains specimens of body fluids and performs diagnostic tests
- Occupational therapist: Assesses, plans for clients to regain activities of daily living (ADL) skills, especially
motor skills of the upper extremities
- Pharmacist: Provides, monitors, and evaluates medication
- Physical therapist: Assesses and plans for clients to increase musculoskeletal function, especially of the
lower extremities, to maintain mobility
- Provider: Assesses, diagnoses, and treats disease and injury. Providers include medical doctors (MDs),
doctors of osteopathy (DOs), advanced practice nurses (APNs), and physician assistants (PAs). State
regulations vary in their requirements for supervision of APNs and PAs by a physician (MDs and DOs)
- Radiologic technologist: Positions clients and performs x-rays and other imaging procedures for providers to
review for diagnosis of disorders of various body parts
- Respiratory therapist: Evaluates respiratory status and provides respiratory treatments including oxygen
therapy, chest physiotherapy, inhalation therapy, and mechanical ventilation
- Social worker: Works with clients and families by coordinating inpatient and community resources to meet
psychosocial and environmental needs that are necessary for recovery and discharge
- Speech-language pathologist: Evaluates and makes recommendations regarding the impact of disorders or
injuries on speech, language, and swallowing. Teaches techniques and exercises to improve function
Nursing Personnel
- Registered nurse (RN); lead team member, soliciting input from all nursing team members and setting
priorities for the coordination of client care; Perform assessments; establish nursing diagnoses, goals, and
interventions; and conduct ongoing client evaluations; Develop interprofessional plans for client care; Share
appropriate information among team members; initiate referrals for client assistance
- Practical nurse (PN); Work under the supervision of RN; Collab within nursing process, assist with plan of
care, consult with other team members, and recognize need for referrals to assist with problems
- Assistive personnel (AP; includes certified nursing assistants (CNAs) and certified medical assistants
(CMAs), and non-nursing personnel (dialysis technicians, monitor technicians, and phlebotomists); Work
under the direct supervision of an RN or PN; Tasks can include feeding clients, preparing nutritional
supplements, lifting, basic care (grooming, bathing, transferring, toileting, positioning), measuring and
recording vital signs, and ambulating clients
Expanded Nursing Roles
- Advanced practice nurse (APN): great deal of autonomy; minimum of a master’s degree in nursing (or
related field), advanced education in pharmacology & physical assessment, certification in specialized area
- Clinical nurse specialist (CNS): Typically specializes in a practice setting or a clinical field
- Nurse practitioner (NP): Collaborates with one or more providers to deliver nonemergency primary health
care in a variety of settings
- Certified registered nurse anesthetist (CRNA): Administers anesthesia and provides care during procedures
under the supervision of an anesthesiologist
- Certified nurse‐midwife (CNM): Collaborates with one or more providers to deliver care to
maternalnewborn clients and their families
, - Nurse educator: Teaches in schools of nursing, staff development departments in health care facilities, or
client education departments
- Nurse administrator: Provides leadership to nursing departments within a health care facility - Nurse
researcher: Conducts research primarily to improve the quality of client care
