2400 Final Exam Study Guide
Team Nursing - ANS-A care delivery model that assigns staff to team that then are
responsible for a group of patients
Primary Nursing - ANS-A care delivery model that clearly delineates the responsibility
and accountability of the RN and deignates the RN as the primary provider of care to
patients
Functional Nursing - ANS-Divides nursing work into functional roles that are then
assigned to one of the team members. Each care provider has specific duties or tasks
for which they are responsible
Total Patient Care - ANS-The nurse is responsible for the total care for assigned
patients for the shift worked. The RN has several patients for whom she is responsible.
The LPN and NAP may help but they are not assigned to a specific group of patients.
Managed Care - ANS-A structure that allows health
insurance organizations contract with health
care providers and medical facilities to provide
care for members at reduced costs.
These providers make up the plan's network.
How much of the patient cost of care will be
reimbursed depends on the network's rules.
Restrictive plans generally cost less. More
flexible plans cost more.
The health care is managed by the federal,
state, local, and private organization
PPO - ANS-*Preferred Provider Organization*
usually pay more if the patients
get care within the network, but they
still pay a portion if they go outside
HMO - ANS-*Health Maintenance Organization*
usually only pay for care within
the network. Patient chooses a
primary care doctor who coordinates
most of your care.
POS - ANS-*Point of Service* Plan
lets patients choose between an HMO or
a PPO each time they need care
DRG - ANS-*Diagnosis-Related Groups*
Used as groupings of patients to which a nursing acuity is assigned based on past
organizational experience.
---Are patient groupings established by federal government for reimbursement purposes
---Sorted by patient disease or condition
Purpose of Managed Care - ANS-Managed care is a structure that allows health
insurance organizations contract with health care providers and medical facilities to
provide care for members at reduced costs. These providers make up the plan's
network. How much of the patient cost of care will be reimbursed depends on the
network's [Link] plans generally cost less. More flexible plans cost more. The
health care is managed by the federal, state, local, and private organization
Principles of Managed Care - ANS-•*Focus on outcomes* - both costs & quality are
analyzed. Less costly treatments may not save money. Care Paths
•*Quality of care* - most agencies now demand quality improvement activities & want
results for evidenced-based care.
•*Accreditation* - some facilities are questioning whether JCAH is best agency for
accreditation
RN's Role in Managed Care - ANS-•*ADN vs. BSN* -currently agencies do not
discriminate between ADN & BSN grad's but BSN prepared nurse is appointed to a
managerial role faster than an AND.
•*Floating* - is expected of todays RN's, who must be aware of their strengths and
limitations.
Profit vs Non-Profit - ANS-For profit and non profit organization exist within the private
sectors and the government. They provide access to cost effective and quality health
care. A wide range of services (regulated) are provided at a controlled cost
Role of the Nurse Case Manager - ANS-•Focuses on patient while patient is
hospitalized or while at rehabilitation
•May specialize in types of diagnoses/conditions
•Ensures that patient receives appropriate care and is discharged appropriately so as to
prevent future frequent hospital admissions.
•Try to improve quality of care while decreasing costs.
Five Rights of Delegation - ANS-Right Task
Right Circumstance
Right Person
Right Direction/Communication
Right Supervision
Prioritization of Care - ANS-•Use to address immediate priorities
•*1st*-ABCs-Include breathing and circulation concerns, abnormal vital signs, airway
problems, evidence of low oxygenation
•*2nd* - Need immediate intervention after 1st level priorities are addressed - mental
status changes/acute anxiety, acute pain, acute urinary elimination problems, medical
problems that require immediate attention for example insulin for a diabetic patient,
abnormal lab values, risk to safety security or infection (for both the patient and for
others)
•*3rd* -Care problems which don't fit into the above categories-lack of rest, teaching
needs, family coping, activity
Benner's Model of Novice to expert - ANS-Novice
Advanced beginner
Competent
Proficient
Expert
Novice - ANS-Task oriented and focused on the rules, need a directing
Advanced beginner - ANS-Still focus on rules, but begin to demonstrate marginally
acceptable independent performance
Competent - ANS-developed the ability to see their action as part of the long-range goal
set for their patient
Proficient - ANS-perceives the entire situation rather than a series of tasks, develop
plan of care and guide patient from A to B
Expert - ANS-Intuitively know what is going on with the patient. They can quickly assess
what needs to be delegated
Principles of Strategic Planning - ANS-Philosophy
Mission Statement
Vision Statement
Strategic Planning
Shared Governance
Philosophy - ANS-Statement of beliefs based on core values and rational investigation
of the truths and principles of knowledge, reality, and human conduct
Mission Statement - ANS-A formal expression of the purpose or reason for the
existence of the organization
Vision Statement - ANS-Vision of what the organization wants to be
Strategic Planning - ANS-A process that is designed to achieve goals in dynamic,
competitive environments through the allocation of resources
Shared Governance - ANS-Situation where nurses and managers work together to
define their roles and expected outcomes, holding everyone accountable for their role
and expected outcomes.
--A nurse might prefer to work under this type of organization because it fosters
autonomous decision making and professional nursing practices
Beneficence - ANS-to do good to others and to maintain a balance between benefits
and harm
Nonmaleficence - ANS-to do no harm
Justice - ANS-principle of fairness that is served when an individual is given that which
he is due, owed, deserves or can legitimately claim
Autonomy - ANS-respect for an individual's fights to self-determination; respect for
individual liberty
Fidelity - ANS-the duty to keep one's promise or word
Respect of others - ANS-the right of people to make own decisions
Veracity - ANS-obligation to tell the truth
Ethical Dilemma - ANS-conflict between two or more ethical principles for which there is
no correct decision
Ethics Committee - ANS-Interdisciplinary, including members from clinical nursing,
administration, medicine, clergy, clinical social service, nutritional service, pharmacy,
and legal profession - when there is no right or wrong answer this committee can help
make decisions
Forming Stage - ANS--Interpersonal relationships develop & members become oriented
w/ each other
-Formulate their goals and role expectations and also set boundaries
Storming Stage - ANS--Conflict may arise in this stage due to different personalities,
opinions, and ways to approach the goal
-Conflicts need to be addressed openly and honestly
Norming Stage - ANS-- Members learn to respect each other so that they can progress
forward as a whole
-Cooperation is key to be able to communicate ideas, opinions, and information
Performing Stage - ANS--Group becomes solidified and work more closely and
cooperatively
-Personal opinions are set aside so ultimate goal can be achieved
-Are trusting each other to uphold their responsibilities and complete their tasks
Adjourning Stage - ANS--Goals & Activities are met and the team is terminating
-Evaluation of outcome review
-Team leader summarizes the group's accomplishments
-Team reflects & evaluates each person's role & contributions
What makes an effective Team Leader - ANS--Understand various learning styles,
cultural diversity & personality differences
-Good communication skills
-Conflict resolution skills
-Leadership skills
-Communication is key
Whistle Blowing - ANS-the act in which an individual discloses information regarding a
violation of a law, rule, or regulation, or a substantial and specific danger to the public
health or safety
RN role in Whistle Blowing - ANS--File a qui tam lawsuit in secret court
-Do not let the agency or hospital know you filed a lawsuit
-Serve a copy to the complaint department of Justice with a written disclosure of all the
info you have concerning the fraud
-If the government decides to go forward with the lawsuit, the government will bear
responsibility for litigating the lawsuit, and the government will pay for it.
Expert Power - ANS-Power derived from the knowledge and skills the nurse possesses
Legitimate Power - ANS-Power derived from the position a nurse holds in a group and
indicates the nurses degree of authority
Referent Power - ANS-Power based on trust and respect people feel for a group or
individual to which they are associated
Reward Power - ANS-Power comes from the ability to reward with valued materials in
order to influence or change a behavior
Coercive Power - ANS-Power through punishment or disciplinary actions
Connection Power - ANS-Power that comes from personal and professional
relationships that enhance ones resources in the capacity for learning and information
sharing
