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Management Of Care- Kaplan Flashcards

CLIENT’S BILL OF RIGHTS
“A. Privacy”
“B. Respectful care”
“C. Current information”
“D. Informed consent”
“E. Confidentiality”
“F. Refusal of treatment”
“G. Reasonable response to a request for services”
“H. Right to know hospital/ clinic regulations”
Bill Of Rights:
*Informed Consent*
Informed consent is client’s agreement to have procedure performed after explanation of risks, benefits, expectations, and alternatives, *can be withdrawn at any time* nurse ensures it is signed and attached to chart
Bill Of Rights:
*Informed Consent: Minor*
Minors who can provide own consent for treatment
a. Married minors
b. Over a specific age (e.g., 12) for STDs, HIV testing, AIDS treatment, drug and alcohol treatment
c. Emancipated and mature minors
d. Minors seeking birth control services
e. Minors seeking outpatient psychiatric services or inpatient voluntary admissions to a psychiatric facility
f. Pregnant minor: Can sign consent for themselves and the fetus after delivery the mother retains right to provide consent for infant
*Mother that is a minor cannot give own consent unless she fits into one of other exemptions*
*Ex. Minor who just gave birth but is married or emancipated*
Bill of Rights:
*Refusal of Treatment*
Self-determination act— federal law requiring health care facilities to provide written information to adult clients about their rights to make health care decisions. *They can refuse any care, which includes aggressive treatments to save their life*, may have living will, or power of attorney.
Bill of Rights:
*Confidentiality*
1. Right to privacy of records
2. Information used only for purpose of diagnosis and treatment
3. Not released to others without permission;
*verify identity of persons asking for information*
Managed Care
System for planning and monitoring care of person from time of contact through discharge to ensure standard care is given and costs are minimized
MANAGED CARE:
*MANAGED*
1. *Goal is reduced health care costs*
2. Focuses on client outcomes and maintenance of quality
3. Uses an interdisciplinary approach
4. Emphasizes costs; approval needed for diagnostic tests
5. Critical pathways (care maps) used as foundations for activities and guide services that clients receive for specific health conditions
MANAGED CARE:
*SUCCESSFUL*
*For managed care to be successful we need*
1. Support from health care providers, nurses, administrators
2. Qualified nurse managers
3. Collaborative practice teams
4. Quality management system
5. All professionals are equal members of the team (one discipline doesn’t determine interventions for another discipline)
6. Members agree on final draft of critical pathways, take ownership of client outcomes, accept responsibility and accountability for interventions and client outcomes
MANAGED CARE:
*Variance*
1. *Deviations from specific plans (individual receives more, less, or different services)*
2. Information is included in a database and is used to evaluate services provided
3. Continuous quality improvement (CQI) strategies are used to monitor variances
Health Care Financing
Three primary ways healthcare services are paid for are
Direct payment by client using own money
Private Insurance
Government programs
Managed Care: *PPO*
*Preferred Provider Organization*
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network.
Managed Care: *HMO*
*Health Maintenance Organization*
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage
Managed Care: *POS*
*Point of Service Plans: Combines HMO & PPO*
A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.
Delegation
1. Responsibility and authority for performing a task (function, activity, decision) it is transferred to another individual who accepts that responsibility and authority
2. *Delegator remains accountable for task*
3. Delegatee is accountable to delegator for responsibilities assumed
4. Can only delegate tasks for which the nurse is responsible
5. Definitions:
Responsibility— obligation to accomplish a task
Accountability— accept ownership for results or lack of results
6. *In delegation, responsibility is transferred; in accountability, it is shared*
Delegation:
*Rights of Delegation*
a. Right task
b. Right person (knowledge, skills, abilities)
c *Right time (not in a crisis)*
d. Right information
e. Right supervision (is task being performed correctly?)
f. Right follow-up
Delegation:
*Rules of Determining a Delegatee*
Delegate to lowest person on hierarchy who has the required skills and abilities and who is allowed to do the task legally and according to the organization
Delegation:
*Levels of Delegation*
a. Gather information for delegatee so you can decide what needs to be done
b. List alternate courses of action and allow delegatee to choose course of action
c. *Have delegatee perform part of task and obtain approval before proceeding with the rest of the task*
d. Have delegatee outline entire course of action for the task and approve it before proceeding
e. Allow delegatee to perform entire task using any preferred method, and report only results
Delegation:
*Reassigned RN*
Factor in the nurses knowledge and skill level include knowledge of equipment and procedures that are part of the care required. Incorporate acuity of clients and complexity of care required. All of these figure into the decision of which clients to assign to a nurse from another unit
Would be best to assign
*STABLE* clients with *PREDICTABLE* outcomes
Delegation:
*LPN*
May assist with implementation of care
Perform procedures
Differentiates normal from abnormal
Cares for *STABLE* clients with *PREDICTABLE* outcomes
Has knowledge of asepsis and dressing changes
May administer medications according to educational background and state nurse practice acts
Allocation of Health Care Resources
Decisions regarding how health care resources will be distributed there is a finite number of resources in health care that must be used wisely and efficiently. *Primary purpose is to provide the greatest good for the greatest number of people*
Quality Assurance
Quality assurance in nursing is about ensuring adherence to quality standards as mandated by nursing regulatory bodies. Quality assurance in nursing assesses what healthcare processes are in place and what else needs to be implemented to better the system.
Legal Nursing Responsibilities:
*Risk Management*
*Legal paralle to quality assurance* The focus on preventing harm, injury, disability or death to clients visitors and staff by preventing accidents and financial loss to the institution
Healthcare Barriers
Poverty
High cost of care
Inadequate or no insurance coverage
Lack of availability of services
Lack of culturally competent care
Healthcare Barriers:
*Impact*
*Barriers to Healthcare can cause*
Unmet health needs
Delays in receiving appropriate care
Inability to get preventive services
Financial burdens
Preventable hospitalizations
Organ Donation
When matching donor organs to recipients, the computerized matching system considers issues such as the severity of illness, blood type, time spent waiting, other important medical information, and geographic location. The recipient’s financial or celebrity status or race does not figure in. There is no cost, all religions support organ donation.
Team Building
Goal is to create a type of synergy in which the effect of everyone working together toward the shared goal, results in greater total effect than could be achieved by the sum of the efforts of everyone working individually
Team Building: *Competence*
Are you a good listener
Do you communicate ideas clearly
Can you accept criticism
Do you support others
Do you ask good questions and contribute
Are you a team player
Can you deal with change and conflict
Are you self motivating
Nurse Practice Act
Defines *reasonable care* in each state
scope of nursing practice
roles, rules, educational requirements, licensure requirements
Legal Terms:
*Assault*
Intentional threat to cause harm or offensive unwanted contact
Legal Terms:
*Battery*
Intentional touching without consent
Power Types:
*Coercive*
Involves using threats or punishment to enforce desired behaviors.
*Ex. board of nursing will revolk license if nurse is not using safe nursing practice*
Power Types:
*Legitimate*
Power you derive from your formal position or office held in the organization’s hierarchy of authority. Based upon perception and reality. It is based on the reality that a person holds a particular position in an organization.
*Ex. Police officer or Nursing Director*
Power Types:
*Referent*
Is gained by an individual because others like and admire that person or what the person symbolizes
Power Types:
*Expert*
Involves having specialized skills and abilities that serve to accomplish desired goals or influence others to follow ones leadership. The individual with particular skills, knowledge, and ability will have power in the area where these skills are important
Power Types:
*Informational*
Exists when an individual possesses information that others need or want to accomplish a goal.
*Ex. The person who has access to information about the units budget*
Power Types:
*Reward*
Can be seen anytime one individual rewards another with positive statements or compliments
Power Types:
*Connection*
The cumulative effect of more than one individual working toward a goal. Responsible for the effectiveness seen in networking.
Good Samaritan Laws
Limit the liability of professionals in emergency situations when they are off duty. *On duty professionals are liable*
Legal Terms:
*Malpractice*
Professional negligence involving misconduct or lack of skill in carrying out professional responsibilities. Required elements
1. *Duty* – legal relationship between nurse and client
2. *Breach of duty*
3. *Causation – nurse conduct causes injury*
Substance Abuse:
*Nurse & Staff*
*Indications that a nurse is abusing alcohol or other habit forming drugs include*:
isolation
changes in appearance, and or mood
behavior, difficulties such as excessive tardiness, absences, missed schedules and deadlines
multiple accidents at work
excuses for unavalability while on duty
resistant to change
defensive when questioned about client complaints
increased irritability
blaming others
Change Theory:
*UnFreezing*
Recognizing need for change
Change Theory:
*Movement*
Actually implementing the change
Change Theory:
*Refreezing*
Incorporating new changes into behavior and stabilizing them
Legal Term:
*Negligence*
Unintentional failure of individual to perform an act that a reasonable person would or would not perform in similar circumstances; can be act of omission or commission
Spiritual Considerations
Essential to consider in planning and delivering care;
Priority areas to consider include spiritual beliefs or practices that directly and immediately affect the physical body, such as
diet; beliefs about illness, treatment, and death
Teaching/Learning
Consider specific knowledge needed and whether which type of learning needed is
cognitive,
psychomotor, and/or affective;
Assess motivation of client, anxiety level, attitude and beliefs
Care Planning
Developing a formalized plan of care that extends from admission through discharge and provides a *written guide for health care goal attainment*; which includes
assessment
nursing diagnoses, & problems
short and long term goals
outcomes
interventions
& evaluations
Conflict Resolution
*Steps of conflict resolution include*
Determining facts,
Identify problem,
Ask for suggestions from those involved
Determine solution,
Evaluate results,
Evaluate conflict resolution
Care Delivery Models
Management system designed to determine numbers and types of nursing personnel to be used to accomplish the most cost-effective, safe, and proficient care of clients. *Ex. Staffing needs*
Nurse/Client Relationship : Therapeutic
“1. Professional”
a. Client-centered
b. Responsible
c. Goal-oriented
d. Ethical
“2. Characterized by genuineness”
“3. Nurse acts as a role model”
” 4. Nurse copes with own feelings”
“5. Protected relationship”— nurse or client cannot be forced to reveal communication between them unless person who would benefit from relationship agrees to reveal it
Time Management:
*Principles*
Plan activities
Prioritize list of activities
Delegate those tasks that can be passed on
Take time to do things right the first time
Limit distractions
Take needed breaks
RESTRAINTS:
*NURSING CONSIDERATIONS*
1. Assess and document need for restraints (risk for falls, risk of injury to others, potential for removal of IV lines or other equipment)
2. Consider and document use of alternative measures
3. *Doctors order is required specifying duration and circumstances under which restraints should be used*
4. *Cannot order restraints to be used PRN*
5. Monitor client closely, periodically reassess for continued need for restraints, document
6. Remove for skin care and range of motion exercises
7. *Use alternative measures FIRST before use of restraints (reorientation, family involvement, frequent assistance with toileting)*
Nurses Responsibility in Critical Thinking
Nursing responsibilities
1. Observe
“2. Decide what data is important”
“3. Validate and organize data”
“4. Look for patterns and relationships”
5. State problem
“6. Transfer knowledge from one situation to another”
7. Decide on criteria for evaluation
8. Apply knowledge
9. Evaluate according to criteria established
Phases of Decision Making
Phases
1. Define objectives
2. Generate options
3. Analyze options
a. Identify advantages and disadvantages
b. Rank options
4. Select option that will successfully meet the defined objective
5. Implement the selected option
6. Evaluate the outcome
DOCUMENTATION:
*Purpose*
1. Promotes communication
2. Maintains a legal record
3. Meets requirements of regulatory agencies
4. Required for third-party reimbursement
Documentation:
*Characteristics*
1. Legible
2. Accurate, factual, no summarizing data
3. Timely
4. Thorough
5. Well organized and concise
6. Confidential
7. Proper grammar and spelling
8. Authorized abbreviations
Documentation:
*Change in Clients Condition*
*When you notice a change in clients condition*
1. Assess, client’s
vital signs
symptoms
behaviors
complaints
responses to treatments
“2. Notify health care provider” if client’s physiological status and functional abilities change significantly
3. Notify interdisciplinary team of changes in medical plan
4. Notify family or significant other about changes in client’s condition and plan of care,
Document
*Nature of change*
*Why changes were made*
*Actions undertaken to provide needed care for client*
*List of revisions on medical plan of care*
*Responses by family*
Incident Report
Agency record of *unusual occurrance or accident and physical response*. Accurate and comprehensive report on any unexpected or unplanned occurrence that affects or could potentially affect a client, family member, or staff person
Incident Report:
*Purpose*
1. Documentation and follow-up of all incidents
2. Used to analyze the severity, frequency, and cause of occurrences
3. Analysis is the basis for intervention
Incident Report:
*Charting*
1. Don’t include a reference to the incident report
2. Don’t use words such as “error” or “inappropriate”
3. Don’t include inflammatory words or judgmental statements
4. If there are adverse reactions to incident, chart follow-up note updating client’s status
5. *Documentation of client’s reactions should be included as status changes and should be continued until client returns to original status*
Incident Report:
*Common situations that require an incident report*
1. Medication errors— omitted medication, wrong medication, wrong dosage, wrong route
2. Complications from diagnostic or treatment procedures (e.g., blood sample stick, biopsy, x-ray, LP, invasive procedure, bronchoscopy, thoracentesis)
3. Incorrect sponge count in surgery
4. Failure to report change in client’s condition
5. Falls
6. Client is burned
7. Break in aseptic technique
8. Medical— legal incident a. Client or family refuses treatment as ordered and refuses to sign consent b. Client or family voices dissatisfaction with care and situation cannot be or has not been resolved
ETHICS: Definition
1. Principles of right and wrong, good and bad
2. Governs our relationship with others
3. Used to identify solutions to problems arising from conflicts
4. Based on personal beliefs and cultural values that guide decision- making and determine conduct
5. *As cultural diversity increases, the need to understand ethical principles increases*
Legal Nursing Responsibilities: *Advocacy*
*Goal is help the client become more independent and make the system more responsive to clients* Representing the client or the community as if you were the client. Being your clients voice. Acting to protect rights of clients to be informed and to participate in decision making process regarding their health care.
Legal Nursing Responsibilities: *Beneficence*
*Do good*
Duty to help others by doing what is best for them;
Client advocacy for refusal of care
*Autonomy overrides beneficence*
Veracity
Communicate truthfully and accurately
Legal Term: *Justice*
Use available resources fairly and reasonably
Fidelity
Following through on what the nurse says will be done; Carefully attending to the details of the client’s care. *Keep promises*
Legal Term:
*Nonmaleficence*
*Do no harm*
Act with empathy toward client and staff without resentment or malice; violated by acts performed in bad faith or with ill will, or when making false accusations about client or employee

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