AG-ACNP - Issues, Trends, and Health Policy

Crisis/Acute Grief Communication Answer- Acknowledge feelings Offer self Crisis Intervention Answer- Boundaries Security if necessary, NOT police Establish trust/rapport Advance Directive Answer- Written statement of patient's intent regarding medical treatment The Patient Self-Determination Act of 1990 Answer- All patients in a hospital setting are required to be advised of their right to execute an advance directive Living Will Answer- Compilation of statements that specify which life-prolonging measures one does and does not want if they become incapacitated Durable Power of Attourney Answer- Individual designated in the living will that is authorized to make medical decisions in the event patient is incapacitated Title I of HIPPA Answer- Protects health insurance coverage for workers and their families in the event they change or lose their jobs COBRA COBRA Answer- protects health insurance coverage for workers and their families in the event worker loses or changes jobs Who enforces HIPPA Answer- Office for Civil Rights Patient Safety Rule Answer- Protects patient information to analyze patient safety events and improve True or False: A patient has the right to see their medical record Answer- True The Privacy Rule: Patient's Rights Answer- See/have their medical record Corrections added to medical record Patient Safety and Quality Improvement Act (PSQIA) Answer- Voluntary reporting system improve patient safety outcomes through anonymous reporting by providers of patient safety outcomes and events Duty to Warn Answer- Patient's condition may endanger others overrides confidentiality Patient is diagnosed with HIV. Duty to Warn applies how? Answer- Can notify providers not family Invasion of Privacy Answer- Damaging one's reputation as a result of sharing patient information without their permission When can invasion of privacy charge not be made Answer- in good faith accurate information receiver has valid reason to obtain information Initiating any change in heathcare Answer- Begin at most local level and expand outward What comes first when treating a patient with a medical and psychosocial condition Answer- Medical condition strongest method to evaluate teaching Answer- returned demonstration when to transfer to teritary care facility Answer- seriously ill or injured patients that cannot be cared for at your institution stabilize and ship Patient reluctant to undergo procedure. you should? Answer- Fully educate patient and tell them why Primary care screening exams that are not emergent Answer- do not delay hospital discharge refer to PCP most powerful data collected from patient Answer- subjective or data you observed as the np RN calls you as the night shift NP and states patient is decompensating. You would? Answer- Call primary MD when patient status changes Code goes bad and all involved are talking badly about it on the unit. You should? Answer- Hold a one time debriefing with everyone invovled What is a response that would suggest admitting a patient to a SNF would be the best action? Answer- Needing assistance with ADLs Goals of Healthy People 2020 Answer- increase the quality and years of healthy life eliminate health disparities among americans Healthy People 2020 purpose Answer- used to understand health status of the nation and plan prevention programs NP must notify department of health with what dx Answer- Gonorrhea Chlamydia Syphillis HIV TB NPs must report to state Answer- Criminal acts and injury from dangerous weapon (GSW) Gonorrhea Chlamydia Syphillis HIV TB Animal bites Suspected/actual child abuse Domestic violence Physical Therapy Answer- Strength training coordination Occupational Therapy Answer- ADLs Medicare Answer- Third party payers sets the standard for reimbursement and cutting costs 65 yo. Disabled Medicaid Answer- Third party payers Poverty Medicare A Answer- Covers inpatient hospitalizations SNF home health hospice 65 yo. Medicare B Answer- Covers physician services outpatient hospital services labs/diagnostic procedures medical equipment Pay premium NPs 85% physician scheduled fee Medicare B pays how much of bill Answer- Medicare pays 80% and patient pays 20% Medicare D Answer- Limited prescription drug coverage Monthly premium required Co-pay on each prescription required Incident-to-Billing Answer- Services billed under MD provider number to get the full physician fee Under MD direct supervision Does direct supervision require MD to be physically in the room with NP to be eligible for incident-to-billing Answer- no same office suite and easily accesible does incident-to-billing apply to the inpatient hospital setting Answer- No. NP must bill under their NPI in the hospital setting Root Cause Analysis Answer- Tool for identifying prevention strategies to ensure safety Culture of safety and not culture of blame Root Cause Analysis involves Answer- Interdisciplinary experts those who are most familiar with the situation continually asking why at each level of cause and effect Identifying changes Impartial process Debriefing after an event is an example of Answer- root cause analysis Sentinel Events Answer- Unexpected occurrences involving death or serious physical injury or psychological injury or risk thereof immediate investigation and response Sentinel Event and medical error Answer- not synonymous not all sentinel events occur because of an error not all medical errors result in a sentinel event Response to Sentinel Event Answer- Root Cause Analysis Scope of Practice Answer- Based on legal allowances in each STATE Provides guidelines for nursing practice How can the ACNP demonstrate and advocate for full scope of practice? Answer- ACNP bills independently State Practice Acts Answer- STATE Board of Nursing grants authority includes title, authorization of scope including prescriptive authority, disciplinary grounds What dictates the nurse practitioners prescriptive authority Answer- State Nurse Practice Acts State Board of Nursing Credentials Answer- Encompass required education, licensure and certification to practice as an NP Establish MINIMAL levels of acceptable performance Licensure Answer- GOVERNMENT STATE BOARD OF NURSING Establishes a person is qualified to perform Certification Answer- NONGOVERNMENTAL AGENCIES ANCC Establishes a person has met certain standards which signify mastery of specialized knowledge and skills Licensure vs. Certification Answer- Government state board of nursing vs. nongovernmental agencies ancc Credentialing and Privileging Answer- Process by which a nurse practitioner is granted permission to practice in an inpatient setting Hospital Credentialing Committee Answer- Comprised of physcians Credentialing with hospital privileges grant Most common method of documentation in Risk Management Answer- Incident Reports Medical Futility Answer- Interventions that are unlikely to produce any significant benefit for the patient Quantitative Futility Answer- Where the likelihood that an intervention will benefit the patient is extremely poor Qualitative Futility Answer- Where the quality of the benefit an intervention will produce is extremely poor Competence Answer- Decisional capability State in which patient can make personal decisions about their care Informed Consent Answer- Patient has received adequate instruction or information regarding aspects of care to make a personal choice Informed Consent includes Answer- discussing all risks and benefits Ethics Answer- The study of moral conduct and behavior Nonmaleficence Answer- Duty to do no harm Utilitarianism Answer- Produce the greatest good for the greatest number Beneficence Answer- Prevent harm and promote good Justice Answer- To be fair Fidelity Answer- to be faihtful Veracity Answer- to be truthful autonomy Answer- Respect an individuals thoughts and actions Duration of time to keep medical records after closing a practice Answer- Minimum five years Reasoning for movement of NPs into inpatient setting Answer- Managed care Hospital restructuring Decreases in medical residency programs Four Roles of NPs Answer- Clinician Consultant/collaborator Educator Researcher Nonexperimental Research Answer- No experiment design Descriptive research Answer- Describe situations, experiences, and phenomena as they exist Ex Post Facto/Correlational Research Answer- Examines relationships among varables Cross sectional research Answer- Population with a very similar attribute but differ in one specific variable Relationships between variables at specific point in time Cohort Answer- Compares one outcome in groups of individuals who are alike but differ in one characterisitc Longitudinal study Answer- Multiple measures of a group over an extended period of time Experimental Research Design Answer- Manipulation of variables using randomization and control groups to test the effects of an intervention or experiement Quasiexperimental Research Answer- Manipulation of variable but lacks randomization and control group Qualitative Research Answer- Case studies Open ended questions field study participant observations Used to explore through detailed descriptions of people, events, situations or observed behavior Drawback of qualitative research Answer- researcher bias Level of significance Answer- p value the probability of false rejection of the null hypothesis in a statistical test p value Answer- level of significance t value Answer- the mean of two groups Reliability Answer- Degree to which an instrument measures the same way over time p .05 Answer- experimental and control groups are considered to be significantly different Validity Answer- Degree to which a variable measures what it is intended to measure ANCC is creating questions for boards and is trying to make sure that these questions they are asking are correctly for ACNP's. Is this reliability or validity? Answer- Validity. The degree to which a variable measures what it is intended to measure Liability Answer- Legal responsibility that a nurse practitioner has for actions that fail to meet the standard of care Standards of care Answer- criteria to measure whether negligence has occured Negligence Answer- Failure of an individual to do what a REASONABLE person would do resulting in injury to the patient NP fails to do an EKG on a patient presenting with chest pain. This is an example of Answer- negligence Malpractice Answer- Failure to render services with the degree of care, diligence and precaution that another member of the same profession under same circumstances would do to prevent injury to patient Malpractice involves Answer- professional misconduct unreasonable lack of skill illegal/immoral conduct Assault Answer- threatening gesture Shaking a fist at someone or making the motion of injecting someone against their will is an example of Answer- assault Battery Answer- Violent contact Striking a person, pulling on clothes or anything in which they have contact is an example of Answer- battery can someone commit assault on an unconscious person Answer- no Defamiation Answer- Communication that causes someone to suffer a damaged reputation Libel Answer- defaming through written material Slander Answer- spoken defamiation Can NPs order restraints? Answer- Yes. Document why restraints are being ordered Degree to which an instrument works the same way over time Answer- reliability How is an advanced directive different from a living will? Answer- Advance directive a component of a living will Living will designates power of attourney Can you tell the wife the husband has HIV Answer- no you have to say "if you were her, wouldnt you want to know" ICU patient is improving but fails the swallow evaluation. What is your next action? Answer- Patient does not need ICU. Transfer to sub-actue not med-surg Hispanic M does not speak english and you are evaluating pain. What do you use? Answer- Visual pain scale 25 yo. M s/p MVC and cannot feed himself. Who do you consult? Answer- Occupational Therapy What is the best way for a NP to get involved with policy change? Answer- Join a hospital committee Family is struggling with their father's decompensating condition. Before you consult palliative care, you should? Answer- Find out if the patient has an advance directive Your patient is worried about insurance coverage. What should you do? Answer- Consult case management What is the best way to ensure better outcomes for a patient? Answer- Get everyone under a standardized treatment plan What is the most important variable in determining significance of research before implementing the findings? Answer- Sample size Who grants a NP permission to practice in the inpatient setting? Answer- Hospital Credentialing Committee An ACNP notices an MCV and stops at the scene to offer assistance. Which of the following statutes protects the CNP from malpractice in this situation? Answer- Good Samaritan statute The Federal 1999 Balanced Budget Act allowed for: Answer- Medicare reimbursement for advanced practice nurse services The ACNP is involved in outcomes research. All of the following are examples of patient outcomes EXCEPT: a. patient satisfaction b. length of stay c. mortality statistics d. peer review Answer- D. Peer review is not a patient outcome The nurse practitioner role in research includes: Answer- Utilizing research findings in implementation of guidelines for patient care The Patient Self-Determination Act: Answer- assures patient's rights to participate in and direct their healthcare decisions The ethical principle of "first do no harm" is called: Answer- nonmaleficence 35 yo. M is admitted to the hospital with viral PNA. During his hospitalization, a HIV test is drawn and it is positive. Pt is married with two small children and states that he will not tell his wife or you have to do it. What is the most appopriate next step in the management of his care? Answer- Explain to him the importance of informing his wife and offering support. Telling the wife would be a breach of confidentiality. The Medicare program is administered by the: Answer- Health Care Financing Agency A healthcare plan in which nurse practitioners and MDs are employed directly by the health plan is: Answer- a staff-model health maintenance organization (HMO) Which of the following services are reimbursed by Medicare: a. home health aids b. physical therapy c. skilled nursing services d. all of the above Answer- D. all of the above Health Maintenance Organizations (HMOs): Answer- provide both inpatient and outpatient services through a referral system The most common mental illness in young adults: Answer- schizophrenia