NUR 164 FINAL EXAM Questions and Answers
Paying For Healthcare: Out Of Pocket: This simple method of financing is increasingly rare
because today most families cannot afford the high costs of health care
Paying For Healthcare: Individual Private Insurance: Personal health care can be financed
by private insurance through large, nonprofit, tax-exempt organizations or through smaller,
private, for-profit insurance companies. To be insured, members pay monthly premiums either
by themselves or in combination with employer payments. These plans are called third-party
payers because the insurance company pays all or most of the cost of care. The premiums on
private insurance plans tend to be higher than those for managed care plans, but members can
choose their own health care providers and services desired.
Paying For Healthcare: Employed Based Insurance - most common source of health care
coverage in the United States
- Employees who worked part time were less likely to be offered coverage from their employer
than were employees working full time
Paying For Healthcare: Government Financing: Medicare: - The 1965 Medicare amendments to
the Social Security Act established national and state health insurance programs for older adults
under Title XVIII.
- People who receive Medicare pay both a deductible cost and a monthly premium for full
insurance coverage.
- Part A of Medicare, which pays most inpatient hospital costs, is paid by the federal
government.
- Part B of Medicare, which is voluntary, is paid by a monthly premium; it covers most
outpatient costs for physician visits, medications, and home health services.
- In 2007, based on changes in DRGs made by the CMS, the criteria for reimbursement to
hospitals became severity of illness and projected cost of care. The plan pays only the amount of
money pre-assigned to a treatment for the diagnosis (e.g., an appendectomy); if the cost of
hospitalization is greater than that assigned, the hospital must absorb the additional cost. If the
cost is less than that assigned, the hospital makes a profit. In addition, Medicare no longer
reimburses hospitals for conditions that result from preventable errors and lead to increased
costs.
Paying For Healthcare: Government Financing: Medicaid: - established in 1965 under Title XIX
of the Social Security Act. Medicaid is a federally funded public assistance program for people
of any age who have low incomes; for the blind, older adults, and disabled covered by
supplemental security benefits; and for beneficiaries of Aid to Families with Dependent
Children. This coverage depends on individual state regulations.
,Paying For Healthcare: Government Financing: Children's Health Insurance Program (CHIP):
- was created by the Balanced Budget Act of 1997, was enacted as Title XXI of the
Social Security Act, and has allocated about $20 billion over 10 years to help states insure low-
income children who are ineligible for Medicaid but cannot afford private insurance.
- States receive an enhanced federal match (greater than the state's Medicaid match) to provide
this coverage. In 2007 the program was extended, and in 2009 was reauthorized by Congress and
signed by President Obama. Together, Medicaid and CHIP serve more than 42 million children
who would otherwise not have access to regular medical care.
- While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level
in more than two decades, many more children are eligible but not covered as of yet.
Paying For Healthcare: Government Financing: Veterans Health Administration (VHA): - home
to the United States' largest integrated health care system, consisting of 152 medical centers,
nearly 1,400 community-based outpatient clinics, community living centers, veterans' centers,
and domiciliaries.
- Together these health care facilities and the more than 53,000 independent licensed health care
practitioners who work within them provide comprehensive care to more than 8.3 million
veterans each year.
- The VHA has an annual medical care appropriation of more than $47 billion.
Levels Of Healthcare: Primary Healthcare: - Treatment of common health problems
- 1st level, wellness & prevention, longer relationship
- Ex: Family practice physicians, Nurse practitioners, Midwives
- Practice sites: Family planning centers, Primary care centers, Urgent care centers, Employment
health centers
Levels Of Healthcare: Secondary Healthcare: - Treatment of problems requiring more
specialized clinical expertise
- Ex. Cancer treatment, care for broken bones, sudden infections, Physicians in specialties such
as internal medicine, pediatrics, neurology, psychiatry, Advance practice nurses
- Practice sites: Hospital-based clinics, Emergency departments, Hospitals, Psychiatric institutes,
Same-day surgery units
Levels Of Healthcare: Tertiary Healthcare: - Management of rare and complex disorders
- Ex: Sub-specialist physicians such as cardiovascular surgeons, pediatric hematologists,
Advance practice nurses
- Practice sites: Tertiary care medical centers
Role Of Nurse In Primary Care Center: - Advanced practice registered nurses (APRNs),
nurse practitioners, midwives, and clinical nurse specialists work independently or
collaboratively with physicians to make assessments and care for patients who require health
maintenance or health promotion activities.
- Depending on state regulations, APRNs may have their own offices and clinics to provide
primary care and treatment to patients and refer only complex health problems to a physician.
Role Of Nurse In Hospital Setting: - Direct care providers
- Manager of other members of health care team
- Administrator
- Nurse practitioner
- Clinical nurse specialist
- Patient educator
- In-service educator
, - Researcher
Role of the Nurse in Community-Based Care: - 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.
- Manage acute or chronic illness.
- Promote self-care.
- Patient advocate
- Coordinator of services
- Patient and family educator
ISBARQ Method Of Patient Hand-Off: - I - Introduction
- S - Situation
- B - Background
- A - Assessment
- R - Recommendation
- Q - Question and answer
1.Allow for face-to-face handoffs whenever possible.
2.Ensure two-way communication during the handoff process.
3.Allow as much time as necessary for handoffs.
4.Use both verbal and written means of communication.
5.Conduct handoffs at the patient bedside whenever possible. Involve patients and families in the
handoff process. Provide clear information at discharge.
6.Involve staff in the development of handoff standards.
7.Incorporate communication techniques, such as SBAR, in the handoff process. Require a
verification process to ensure that information is both received and understood.
8.In addition to information exchange, handoffs should clearly outline the transfer of patient
responsibility from one provider to another.
9.Use available technology, such as the electronic medical record, to streamline the exchange of
timely, accurate information.
10.Monitor use and effectiveness of the handoff. Seek feedback from staff.
ISBARQ: I: Introduction: People involved in the handoff identify themselves, their roles, and
their jobs
ISBARQ: S: Situation: Complaint, diagnosis, treatment plan, and patient's wants and needs
ISBARQ: B: Background: Vital signs, mental and code status, list of medications, and lab
results
ISBARQ: A: Assessment: Current provider's assessment of the situation
ISBARQ: R: Recommendation: Identify pending lab results and what needs to be done over the
next few hours and other recommendations for care
ISBARQ: Q: Question & answer: An opportunity for questions and answers
Continuity Of Care: - Process by which health care providers give appropriate, uninterrupted
care and facilitate the patient's transition between different settings and levels of care
- Ensures a smooth transition between ambulatory or acute care and home health care or other
types of health care settings in the patient's community.
- Depends on excellent communication as patients move from one caregiver or health care site to
another.
Guidelines For Discharge Planning: - Assess and identify health care needs.
Paying For Healthcare: Out Of Pocket: This simple method of financing is increasingly rare
because today most families cannot afford the high costs of health care
Paying For Healthcare: Individual Private Insurance: Personal health care can be financed
by private insurance through large, nonprofit, tax-exempt organizations or through smaller,
private, for-profit insurance companies. To be insured, members pay monthly premiums either
by themselves or in combination with employer payments. These plans are called third-party
payers because the insurance company pays all or most of the cost of care. The premiums on
private insurance plans tend to be higher than those for managed care plans, but members can
choose their own health care providers and services desired.
Paying For Healthcare: Employed Based Insurance - most common source of health care
coverage in the United States
- Employees who worked part time were less likely to be offered coverage from their employer
than were employees working full time
Paying For Healthcare: Government Financing: Medicare: - The 1965 Medicare amendments to
the Social Security Act established national and state health insurance programs for older adults
under Title XVIII.
- People who receive Medicare pay both a deductible cost and a monthly premium for full
insurance coverage.
- Part A of Medicare, which pays most inpatient hospital costs, is paid by the federal
government.
- Part B of Medicare, which is voluntary, is paid by a monthly premium; it covers most
outpatient costs for physician visits, medications, and home health services.
- In 2007, based on changes in DRGs made by the CMS, the criteria for reimbursement to
hospitals became severity of illness and projected cost of care. The plan pays only the amount of
money pre-assigned to a treatment for the diagnosis (e.g., an appendectomy); if the cost of
hospitalization is greater than that assigned, the hospital must absorb the additional cost. If the
cost is less than that assigned, the hospital makes a profit. In addition, Medicare no longer
reimburses hospitals for conditions that result from preventable errors and lead to increased
costs.
Paying For Healthcare: Government Financing: Medicaid: - established in 1965 under Title XIX
of the Social Security Act. Medicaid is a federally funded public assistance program for people
of any age who have low incomes; for the blind, older adults, and disabled covered by
supplemental security benefits; and for beneficiaries of Aid to Families with Dependent
Children. This coverage depends on individual state regulations.
,Paying For Healthcare: Government Financing: Children's Health Insurance Program (CHIP):
- was created by the Balanced Budget Act of 1997, was enacted as Title XXI of the
Social Security Act, and has allocated about $20 billion over 10 years to help states insure low-
income children who are ineligible for Medicaid but cannot afford private insurance.
- States receive an enhanced federal match (greater than the state's Medicaid match) to provide
this coverage. In 2007 the program was extended, and in 2009 was reauthorized by Congress and
signed by President Obama. Together, Medicaid and CHIP serve more than 42 million children
who would otherwise not have access to regular medical care.
- While Medicaid and CHIP have helped bring the rate of uninsured children to the lowest level
in more than two decades, many more children are eligible but not covered as of yet.
Paying For Healthcare: Government Financing: Veterans Health Administration (VHA): - home
to the United States' largest integrated health care system, consisting of 152 medical centers,
nearly 1,400 community-based outpatient clinics, community living centers, veterans' centers,
and domiciliaries.
- Together these health care facilities and the more than 53,000 independent licensed health care
practitioners who work within them provide comprehensive care to more than 8.3 million
veterans each year.
- The VHA has an annual medical care appropriation of more than $47 billion.
Levels Of Healthcare: Primary Healthcare: - Treatment of common health problems
- 1st level, wellness & prevention, longer relationship
- Ex: Family practice physicians, Nurse practitioners, Midwives
- Practice sites: Family planning centers, Primary care centers, Urgent care centers, Employment
health centers
Levels Of Healthcare: Secondary Healthcare: - Treatment of problems requiring more
specialized clinical expertise
- Ex. Cancer treatment, care for broken bones, sudden infections, Physicians in specialties such
as internal medicine, pediatrics, neurology, psychiatry, Advance practice nurses
- Practice sites: Hospital-based clinics, Emergency departments, Hospitals, Psychiatric institutes,
Same-day surgery units
Levels Of Healthcare: Tertiary Healthcare: - Management of rare and complex disorders
- Ex: Sub-specialist physicians such as cardiovascular surgeons, pediatric hematologists,
Advance practice nurses
- Practice sites: Tertiary care medical centers
Role Of Nurse In Primary Care Center: - Advanced practice registered nurses (APRNs),
nurse practitioners, midwives, and clinical nurse specialists work independently or
collaboratively with physicians to make assessments and care for patients who require health
maintenance or health promotion activities.
- Depending on state regulations, APRNs may have their own offices and clinics to provide
primary care and treatment to patients and refer only complex health problems to a physician.
Role Of Nurse In Hospital Setting: - Direct care providers
- Manager of other members of health care team
- Administrator
- Nurse practitioner
- Clinical nurse specialist
- Patient educator
- In-service educator
, - Researcher
Role of the Nurse in Community-Based Care: - 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.
- Manage acute or chronic illness.
- Promote self-care.
- Patient advocate
- Coordinator of services
- Patient and family educator
ISBARQ Method Of Patient Hand-Off: - I - Introduction
- S - Situation
- B - Background
- A - Assessment
- R - Recommendation
- Q - Question and answer
1.Allow for face-to-face handoffs whenever possible.
2.Ensure two-way communication during the handoff process.
3.Allow as much time as necessary for handoffs.
4.Use both verbal and written means of communication.
5.Conduct handoffs at the patient bedside whenever possible. Involve patients and families in the
handoff process. Provide clear information at discharge.
6.Involve staff in the development of handoff standards.
7.Incorporate communication techniques, such as SBAR, in the handoff process. Require a
verification process to ensure that information is both received and understood.
8.In addition to information exchange, handoffs should clearly outline the transfer of patient
responsibility from one provider to another.
9.Use available technology, such as the electronic medical record, to streamline the exchange of
timely, accurate information.
10.Monitor use and effectiveness of the handoff. Seek feedback from staff.
ISBARQ: I: Introduction: People involved in the handoff identify themselves, their roles, and
their jobs
ISBARQ: S: Situation: Complaint, diagnosis, treatment plan, and patient's wants and needs
ISBARQ: B: Background: Vital signs, mental and code status, list of medications, and lab
results
ISBARQ: A: Assessment: Current provider's assessment of the situation
ISBARQ: R: Recommendation: Identify pending lab results and what needs to be done over the
next few hours and other recommendations for care
ISBARQ: Q: Question & answer: An opportunity for questions and answers
Continuity Of Care: - Process by which health care providers give appropriate, uninterrupted
care and facilitate the patient's transition between different settings and levels of care
- Ensures a smooth transition between ambulatory or acute care and home health care or other
types of health care settings in the patient's community.
- Depends on excellent communication as patients move from one caregiver or health care site to
another.
Guidelines For Discharge Planning: - Assess and identify health care needs.
