ANCC Study Guide
HITECH Act (Health Information Technology for Economic & Clinical Health)
• Promote meaningful use of health information technology
o Privacy/security of PHI
o Improve quality, safety, efficiency and reduce healthcare disparities
o Improve care coordination, population health and public health
o EHR (electronic health record) can engage patients and family
• 2009 – Transition from paper to electronic charting, incentives to convert by 2015
• CDS – Clinical Decision Support
• Best practice alert – based on clinical guidelines
• Red Text – for abnormal results and VS
• Condition-specific order sets/protocols
American Telemedicine Association Practice Guidelines
• Follow federal, state & local regulations & licensure requirements
• Providers shall ensure that the patient is physically located in a jurisdiction in which the
provider is duly licensed and credentialed.
• Providers shall practice within the scope of their licensure and shall observe all applicable
state and federal legal & regulatory requirements
• Helpful for patients in rural areas with decreased access to care
State Practice Act
• NP’s legal right to practice is derived from state legislature
• Dictate level of prescriptive authority allowed
• Determines scope of practice, mandated education and requirements in each state
State Board of Nursing
• Enforces state’s nurse practice act, statutory authority to regulate nursing practice
• Legal authority to License, monitor and discipline nurses
Emergency Medical Treatment & Labor Act (EMTALA)
• Prevent inappropriate transfers and “patient dumping” for indigent patients
• Requires hospitals to assess & treat patients regardless of ability to pay and provides
specific provision for when transfers are allowed.
Consensus Model for Advanced Practice Registered Nurse (APRN)
• Allow NP to practice as the fullest extent of their training and certification
• National Counsel of the state BON in conjunction with numerous professional organizations
• Advocates for the APRN title, independent prescriptive authority & establishes certain
minimum standards for NP’s
1
, • ***NP’s are not required to have collaborating physician supervision under the
consensus model
Relative Risk
• Probability of disease occurring between 2 groups (unexposed divided by exposed)
• (Ex: lung CA in smokers vs non-smokers)
Incidence = new cases of disease (i.e. new outbreak of malaria), Prevalence = current cases of disease
Sensitivity = Yes, Rule in, True positive, Specificity = No, Rule out, True negative
Medicaid: government aid to low income. Funded by federal & state. Coverage varies in each state (if
you move to a new state, coverage may change!)
Medicare: 65 & older. ONLY federally funded. ESRD pts.
o A: Inpatient –Hospital, includes pscyh, hospice, SNF, home health
o B: Outpatient—Primary care, ER visits, health screening, DME (Durable medical
equipment), custodial care (nursing home, ADLs in home), smoking cessation, vaccines
o C: “Extra”—dental (dentures), vision (prescription glasses), hearing
o D: “Drugs”—prescription drugs, non-formulary patient must pay
DME (Durable Medical Equipment)
• Wheelchair, hospital bed, nebulizer machine, glucometer
• Documentation requires provider had a face-to-face exam with pt in <6 months, with
evaluation for specific condition requiring DME
Research Hierarchy –Level of Evidence –MS REC CEO
• Meta-Analysis (Cochrane, Medline, Pubmed, CINAHL, Strongest*, statistical)
• Systematic Review – general review, no stats
• RCT – Double-blind (no selection bias)
• Experimental –control vs experimental but not double-blind randomization
• Cohort –Retrospective/prospective, no experiment – study of patients
• Case Study –case of 1 person
• Editorial –“Letter to editor”
• Opinion –“consensus statement”
Reliability =Consistency (Repeat research and get same result over and over)
Validity =Accuracy (Measures what it is supposed to measure; Reproducible)
Internal Validity:
• Threat in research itself. Confounding variables.
• Achieved by using controls/ random assignment (only independent variable should
affect dependent variable)
2
,External Validity:
• Threat outside the research.
• Can you generalize the research? (apply to other populations and situations)
• Threatened by selection bias (only one culture of people), drop outs, bad history and
reliability measures.
Independent Variable = Can be manipulated/changed.
Dependent Variable = Depends on independent variable.
Ex: Weight loss (dv) is dependent on exercise (iv). Diet pills are confounding variable.
Statistical Terms
• T test – compares one variable between 2 groups (statistical difference)
• P value- statistical hypothesis, probability of error or chance, level of significance (ideal is
<0.01, bad is >0.5)
• Standard deviation- average deviation from the mean
• Confidence Interval- reliability of an estimate (probability of parameter estimated)
• N= total size of sample
• n= total number of subjects in sub-group
• Normal curve= bell-shaped curve
• Quantitative – deductive reasoning (Top Down, General Specific)
o Experimental- randomization and control group
o Quasi-experimental –no comparison group or randomization
o Non-experimental- Descriptive & correlational
• Qualitative –inductive reasoning (Bottom Up, Specific General)
o Case studies, field observations, interview
Selection bias: systematic difference between two groups at baseline; happens when you are still
selecting subjects
Institutional Review Boards (IRBs)
• Designed to ensure the rights of the human subjects who are participating in research studies
in their hospital or clinic. Have the rights and responsibilities to approve or reject the project.
Tuskegee Syphilis Experiment
• 600 African American Sharecroppers (1932 to 1972) from Alabama. Men tested for syphilis –
those positive were not informed or treated. Many suffered and infected others without
their knowledge
• Laws were passed to protect human subjects’ rights and mandate informed consent.
Infant Mortality Rate: # of deaths of infants <12 mos per 1000 live births.
Nurse Practitioner History
• Loretta Ford, Henry Silver – First program U of Colorado in 1978, pediatric program
3
, Quality Assurance = Patient Outcomes
Ex. Problem of diabetic neuropathy; outcome measure is A1C
• Improve quality of care and patient satisfaction
• Decrease pt complications, hospitalizations, mortality, system errors,
Risk Management = Patient Safety
Ex. Fall Prevention, preventing medication errors, hospital-acquired infections
Root Cause Analysis (RCA): process to identify contributing factors of sentinel events; focus on system
and not on blaming individuals
Sentinel Event: patient safety event that results in death, permanent injury and/or severe harm with
intervention required to sustain life
Swiss Cheese Model
• Goal of Patient safety = adequate safeguards to prevent error (rather than trying to
correct behavior)
• Holes are opportunities for the process to fail, each layer is an opportunity to stop an error
• Systems approach rather than person approach (humans are fallible- errors are to be expected
Motivational Interviewing – goal to create change
• encourage pt to be active in change process
• Collaborative, non-confrontational, promote empathy
Stages of Change (Transtheoretical Model of Change) – PCP in the AM
• Pre-contemplation –no desire to change, denial
• Contemplation—considers change, recognizes behavior
• Preparation—states ready to make change
• Action—taking steps to change
• Maintenance—relapse prevention
Lewin’s Change Model
• Unfreezing –assess barriers/reason for change, plan for change
• Driving Forces –redesign roles/responsibilities, new training, change happens
• Refreezing—pay/reward, measurement, change becomes habit/standard
Kotters 8-Step Change Model
• Create a sense of urgency
• Build a guiding coalition - assembling a group with the power & energy to lead and support a
collaborative change effort (i.e. NP’s creating a task force to address scope of practice
concerns)
• Form a strategic mission & initiative (develop goals for organization)
• Enlist a volunteer army (get other team members on board)
4
HITECH Act (Health Information Technology for Economic & Clinical Health)
• Promote meaningful use of health information technology
o Privacy/security of PHI
o Improve quality, safety, efficiency and reduce healthcare disparities
o Improve care coordination, population health and public health
o EHR (electronic health record) can engage patients and family
• 2009 – Transition from paper to electronic charting, incentives to convert by 2015
• CDS – Clinical Decision Support
• Best practice alert – based on clinical guidelines
• Red Text – for abnormal results and VS
• Condition-specific order sets/protocols
American Telemedicine Association Practice Guidelines
• Follow federal, state & local regulations & licensure requirements
• Providers shall ensure that the patient is physically located in a jurisdiction in which the
provider is duly licensed and credentialed.
• Providers shall practice within the scope of their licensure and shall observe all applicable
state and federal legal & regulatory requirements
• Helpful for patients in rural areas with decreased access to care
State Practice Act
• NP’s legal right to practice is derived from state legislature
• Dictate level of prescriptive authority allowed
• Determines scope of practice, mandated education and requirements in each state
State Board of Nursing
• Enforces state’s nurse practice act, statutory authority to regulate nursing practice
• Legal authority to License, monitor and discipline nurses
Emergency Medical Treatment & Labor Act (EMTALA)
• Prevent inappropriate transfers and “patient dumping” for indigent patients
• Requires hospitals to assess & treat patients regardless of ability to pay and provides
specific provision for when transfers are allowed.
Consensus Model for Advanced Practice Registered Nurse (APRN)
• Allow NP to practice as the fullest extent of their training and certification
• National Counsel of the state BON in conjunction with numerous professional organizations
• Advocates for the APRN title, independent prescriptive authority & establishes certain
minimum standards for NP’s
1
, • ***NP’s are not required to have collaborating physician supervision under the
consensus model
Relative Risk
• Probability of disease occurring between 2 groups (unexposed divided by exposed)
• (Ex: lung CA in smokers vs non-smokers)
Incidence = new cases of disease (i.e. new outbreak of malaria), Prevalence = current cases of disease
Sensitivity = Yes, Rule in, True positive, Specificity = No, Rule out, True negative
Medicaid: government aid to low income. Funded by federal & state. Coverage varies in each state (if
you move to a new state, coverage may change!)
Medicare: 65 & older. ONLY federally funded. ESRD pts.
o A: Inpatient –Hospital, includes pscyh, hospice, SNF, home health
o B: Outpatient—Primary care, ER visits, health screening, DME (Durable medical
equipment), custodial care (nursing home, ADLs in home), smoking cessation, vaccines
o C: “Extra”—dental (dentures), vision (prescription glasses), hearing
o D: “Drugs”—prescription drugs, non-formulary patient must pay
DME (Durable Medical Equipment)
• Wheelchair, hospital bed, nebulizer machine, glucometer
• Documentation requires provider had a face-to-face exam with pt in <6 months, with
evaluation for specific condition requiring DME
Research Hierarchy –Level of Evidence –MS REC CEO
• Meta-Analysis (Cochrane, Medline, Pubmed, CINAHL, Strongest*, statistical)
• Systematic Review – general review, no stats
• RCT – Double-blind (no selection bias)
• Experimental –control vs experimental but not double-blind randomization
• Cohort –Retrospective/prospective, no experiment – study of patients
• Case Study –case of 1 person
• Editorial –“Letter to editor”
• Opinion –“consensus statement”
Reliability =Consistency (Repeat research and get same result over and over)
Validity =Accuracy (Measures what it is supposed to measure; Reproducible)
Internal Validity:
• Threat in research itself. Confounding variables.
• Achieved by using controls/ random assignment (only independent variable should
affect dependent variable)
2
,External Validity:
• Threat outside the research.
• Can you generalize the research? (apply to other populations and situations)
• Threatened by selection bias (only one culture of people), drop outs, bad history and
reliability measures.
Independent Variable = Can be manipulated/changed.
Dependent Variable = Depends on independent variable.
Ex: Weight loss (dv) is dependent on exercise (iv). Diet pills are confounding variable.
Statistical Terms
• T test – compares one variable between 2 groups (statistical difference)
• P value- statistical hypothesis, probability of error or chance, level of significance (ideal is
<0.01, bad is >0.5)
• Standard deviation- average deviation from the mean
• Confidence Interval- reliability of an estimate (probability of parameter estimated)
• N= total size of sample
• n= total number of subjects in sub-group
• Normal curve= bell-shaped curve
• Quantitative – deductive reasoning (Top Down, General Specific)
o Experimental- randomization and control group
o Quasi-experimental –no comparison group or randomization
o Non-experimental- Descriptive & correlational
• Qualitative –inductive reasoning (Bottom Up, Specific General)
o Case studies, field observations, interview
Selection bias: systematic difference between two groups at baseline; happens when you are still
selecting subjects
Institutional Review Boards (IRBs)
• Designed to ensure the rights of the human subjects who are participating in research studies
in their hospital or clinic. Have the rights and responsibilities to approve or reject the project.
Tuskegee Syphilis Experiment
• 600 African American Sharecroppers (1932 to 1972) from Alabama. Men tested for syphilis –
those positive were not informed or treated. Many suffered and infected others without
their knowledge
• Laws were passed to protect human subjects’ rights and mandate informed consent.
Infant Mortality Rate: # of deaths of infants <12 mos per 1000 live births.
Nurse Practitioner History
• Loretta Ford, Henry Silver – First program U of Colorado in 1978, pediatric program
3
, Quality Assurance = Patient Outcomes
Ex. Problem of diabetic neuropathy; outcome measure is A1C
• Improve quality of care and patient satisfaction
• Decrease pt complications, hospitalizations, mortality, system errors,
Risk Management = Patient Safety
Ex. Fall Prevention, preventing medication errors, hospital-acquired infections
Root Cause Analysis (RCA): process to identify contributing factors of sentinel events; focus on system
and not on blaming individuals
Sentinel Event: patient safety event that results in death, permanent injury and/or severe harm with
intervention required to sustain life
Swiss Cheese Model
• Goal of Patient safety = adequate safeguards to prevent error (rather than trying to
correct behavior)
• Holes are opportunities for the process to fail, each layer is an opportunity to stop an error
• Systems approach rather than person approach (humans are fallible- errors are to be expected
Motivational Interviewing – goal to create change
• encourage pt to be active in change process
• Collaborative, non-confrontational, promote empathy
Stages of Change (Transtheoretical Model of Change) – PCP in the AM
• Pre-contemplation –no desire to change, denial
• Contemplation—considers change, recognizes behavior
• Preparation—states ready to make change
• Action—taking steps to change
• Maintenance—relapse prevention
Lewin’s Change Model
• Unfreezing –assess barriers/reason for change, plan for change
• Driving Forces –redesign roles/responsibilities, new training, change happens
• Refreezing—pay/reward, measurement, change becomes habit/standard
Kotters 8-Step Change Model
• Create a sense of urgency
• Build a guiding coalition - assembling a group with the power & energy to lead and support a
collaborative change effort (i.e. NP’s creating a task force to address scope of practice
concerns)
• Form a strategic mission & initiative (develop goals for organization)
• Enlist a volunteer army (get other team members on board)
4
