question

IOM's mission

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to improve health by providing unbiased, evidence based, and authoritative information and advice concerning health and science policy to policy makers, professionals, and leaders in every sector of society, and the public at large -uses experts to examine problems and then publishes reports on the results and its recommendations

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IOM reports

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the center of the current restructuring of healthcare systems and the movement toward inter professional team collaboration, and they influence funding from research, education and health policy agencies and professional organizations

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5 core competencies needed for health care professionals

answer

1. provide patient centered care 2. work in interdisciplinary teams 3. employ EBP 4. apply quality improvement 5. utilize informatics

question

core competency: patient centered care

answer

identify, respect, and care about patients' differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health

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core competency: work in interdisciplinary teams

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cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable

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core competency: employ EBP

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integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible

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core competency: apply quality improvement

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identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; design and test interventions to change processes and systems of care, with the objective of improving quality

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core competency: utilize informatics

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communicate, manage knowledge, mitigate error, and support decision making using information technolog

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Quality Chasm report recommendations: overarching vision for all programs and institutions engaged in the education of health care professionals

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all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics

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ANA's position statement on safety and quality

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"future direction and focus of practice of nursing, as well as the articulation of nursing's unique contributions to consumers and health policy makers, depends on clearly measuring nursing's impact on patient safety and quality of care"

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ANA's four strategies

answer

-educate policy makers and the public on the effects of downsizing, restructuring, and reorganizing that can lead to breakdowns in safety and quality -work with other healthcare organizations to identify and correct system errors that lead to patient injuries -support the role of the professional nurse in correcting system errors through quality improvement initiatives, and protect the nurse by enacting whistle blower legislation -educate regulators and accrediting bodies on the dangers of the criminalization of healthcare errors

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6 national quality aims

answer

1. safety 2. effectiveness 3. patient centeredness 4. timeliness 5. efficiency 6. equity

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To Err is Human 5 critical principles

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1. provide leadership 2. respect human limits in process design 3. promote effective team functioning 4. anticipate the unexpected 5. create a learning environment

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Quality

answer

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

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3 elements of quality

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1. structure 2. process 3. outcomes

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priority areas criteria

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1. impact or extent of burden 2. improvability or extent of the gap between current practice and evidence based practice 3. inclusiveness or relevance of an area to a broad range of individuals

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Healthcare disparity report 4 measurements

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1. socioeconomic status 2. access to healthcare system 3. healthcare services and quality 4. geographic disparities in health care

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health literacy

answer

the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health

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"safety net"

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the default system of care for more than 44 million low income Americans with no or limited health insurance as well as many Medicaid beneficiaries and people who need services -care is provided to the uninsured, Medicaid patients, and vulnerable populations

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6 government programs

answer

1. Medicare 2. Medicaid 3. State Children's Health Insurance Program (SCHIP) 4. Department of Defense (DOD) 5. Tricare & Tricare for Life programs 6. Veterans Health Admin (VHA) - examined for quality enhancement processes and serve aprox a third of all Americans

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federal government healthcare delivery role

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-regulator of acceptable performance standards -purchaser of care (largest) -provider to veterans, military personnel, their dependents, and Native Americans -research sponsor for health service research

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mission of health people 2020

answer

-identify nationwide health improvement priorities -increase public awareness and understanding of determinants of health, disease, disability, and opportunities for progress -provide measurable objectives and goals applicable at national, state, and local levels -engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge -identify critical research evaluation and data collection needs

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leading indicators and objectives from Healthy People 2020 (overarching goals)

answer

-attain high-quality, longer lives free of preventable disease -achieve health equity; eliminate disparities -create social and physical environments that promote good health -promote quality of life, healthy development,a nd healthy behaviors across life stages

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The Interprofessional Education Collaborative (IPEC)

answer

1. values/ethics for interprofessional practice 2. roles/responsibilities 3. interprofessional communication 4. teams and teamwork

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Team based competencies: building a shared foundation for education and clinical practice

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1. communication and dissemination 2. development of interprofessional faculty and resources 3. strenghtening of metrics and research 4. development of new collaborative academic practices and new collaborations with community learning sites 5. advance policy changes

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clinical practice guidelines (CPG)

answer

statements that include recommendations and an assessment of the benefits and harms of alternative care options

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systematic reviews (SR's) focus on comparative effectiveness research (CER)

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the generation of synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care

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standards for ensuring high quality SR's

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-initiating a systemic review -finding and assessing individual studies -synthesizing the body of evidence -reporting systematic reviews (through publication) *setting standards minimize bias in identifying, selecting, and interpreting evidence

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health informatics (HIT)

answer

method for improving quality, safety, and efficiency

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2 skills required by ehealth

answer

-general skills -specific skills

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general skills for ehealth

answer

number of different contexts and settings and include traditional literacy (reading, writing, and numeracy), media literacy (media analysis skills), and information literacy (information seeking and understanding)

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specific skills for ehealth

answer

computer literacy (IT skills), health literacy (health knowledge comprehension), and science literacy (science process and outcome)

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6 major concerns for direct care in nursing

answer

1. monitoring patient status or surveillance -surveillance is purposeful and ongoing acquisition, interpretation, ans synthesis of patient data of clinical decision making, different from assessment. 2. physiologic therapy -most common visible nursing intervention performed 3. helping patients compensate for loss of function - performed by UAP's and RN's 4. emotional support -critical for patients and families 5. education for patients and families -difficult due to work conditions and staff shortages 6. integration and coordination of care -care provided my multiple providers can lead to a high risk of failure in communication, inadequate collaboration, leading to increased risk of errors

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4 areas discussed in "keeping patients safe"

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-work design -safety and the central role of the nurse -quality -the nursing shortage

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8 recommendations: nurses become leaders in change to improve and advance health care

answer

1. remove scope of practice barriers 2. expand opportunities for nurses to lead and diffuse collaborative improvement efforts 3. implement nurse residency programs 4. increase the proportion of nurses with a baccalaureate degree to 80% by 2020 5. double the number of nurses with a doctorate by 2020 6. ensure that nurses engage in lifelong learning 7. prepare and enable nurses to lead change to advance health 8. build an infrastructure for the collection and analysis of interprofessional health car workforce data

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Preventing childhood obesity for population & individuals

answer

population: -reduction in the incidence & prevalence of childhood and adolescent obesity -reduction of mean population BMI levels -improvement in the proportion of children meeting dietary guidelines for Americans -achieving physical, psychological, and cognitive growth and development goals individuals: -health weight traectory as defined by CDC & Prevention BMI charts -healthful diet (quality and quantity) -appropriate amounts and types of physical activity -achieving physical, psychosocial, and cognitive growth and development

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aging population: retooling for an aging America

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patients age 75 or older average three chronic conditions and may take four or more medications

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relieving pain in America: chronic pain

answer

affect 116 million US adults cost $560-635 billion annually

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5 core competencies involved in the education of health care professionals

answer

1. provide patient centered care; focus on the patient rather than the disease or the clinician 2. work in interprofessional teams; use the best healthcare professionals for the needs of the pt and work together to accomplish effective patient care outcomes 3. employ evidence based practice; integrate best research results, clinical expertise, and patient values to make patient care decisions 4. apply quality improvement (QI) measures and make them effective 5. use informatics; apply it to reduction of errors, management of knowledge and information, decision making, and communication

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4 main components of transforming care at the bedside (TCAB)

answer

1. safe and reliable care 2. vitality and teamwork 3. patient centered care 4. value added care processes

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transforming care at the bedside (TCAB) 8 step process

answer

1. clarify the current state by observations, include those involved 2. understand the root problem to be solved 3. select a process to focus on 4. design a prototype (plan, do, check, act or PDSA) 5. begin small and rapidly move and test 6. identify failures quickly and reject them 7. determine possible improvements and quickly broaden the test of change 8. determine definite "just do its" and quickly implement them

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NDNQI's (national database nursing quality indicatiors): "nursing sensitive" indicatiors

answer

reflect: -structure: supply of nursing staff, skill level, and education/certification -process indicators: measure aspects of nursing such as assessment, intervention, & RN satisfaction -outcomes: improve if there is greater quantity or quality of nursing care (pressure ulcers, falls, IV infiltrations).....frequency of primary C-sections and cardiac failure are not "nursing sensitive" examples

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HHS (department of health and human services): transformation recommendations

answer

1. define a 21st century vision 2. foster adaptability and alignment 3. increase effectiveness and efficiency of the US healthcare system 4. strengthen the HHS and US public health and healthcare work forces 5. improve accountability and decision making

question

HHS (department of health and human services)

answer

the largest federal government agency, based on budget, impacts every American

question

quality chasm series

answer

-quality -EBP -patient centered care -healthcare informatics; workforce issues; need for more research; the integrative public health agenda; diversity and disparity; aging population; increase in chronic illness; the need for health promotion and prevention and more.....

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HHS: strategic plan for 2010-2015

answer

1. transform health care 2. advance scientific knowledge and innovation 3. advance health, safety, and well being of the American people 4. increase efficiency, transparency, and accountability of HHS 5. strengthen the nation's health and human services infrastructure and workforce

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nursing social policy statement: the essence of the profession (ANA,2010)

answer

recognizes that nursing has an obligation to the public or the community. these social concerns influence how we practice and our authority to practice

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social concerns in health care and nursing

answer

-organization delivery, and financing of quality health care -provision for the public's health -expansion of nursing and healthcare knowledge and appropriate application of technology -expansion of healthcare resources and health policy -definitive planning for healthcare policy and regulation -duties under extreme conditions

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definition of nursing's relationship to pt centered care (connected to the IOM quality initiative

answer

"nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury , alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and population" (ANA, 2010)

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standards based on tenets characteristic of nursing practice

answer

1. nursing practice is individualized 2. nurses coordinate care by establishing partnerships 3. caring is central to the practice of the registered nurse 4. registered nurses use the nursing process to plan and provide individualized care to their healthcare consumers 5. a strong link exists between the professional work environment and the registered nurse's ability to provide quality health car and achieve optimal outcomes

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2 types of standards of ANA standards

answer

-standards of professional nursing practice -standards of professional performance

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standards of professional nursing practice

answer

describe the competent level of nursing care as demonstrated by the critical thinking model known as the nursing process: standard 1: assessment standard 2: diagnosis standard 3: outcome identification standard 4: planning standard 5: implementation standard 6: evaluation

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standards of professional performance

answer

a competent level of behavior in the professional role, including activities related to ethics, education, EBP and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental health

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guide to code of ethics for nurses (9 provisions)

answer

the profession's public expression of those values, duties, and commitments, includes 9 provisions (review pg. 53-52)

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provision 1

answer

practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual regardless of social or economic status, personal attributes, or nature of health problems

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provision 2

answer

primary commitment is to the pt, whether an individual, family, group, or community

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provision 3

answer

promotes, advocates for, and strives to protect the health, safety, and rights of pts

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provision 4

answer

responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum pt care

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provision 5

answer

owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth

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provision 6

answer

participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action

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provision 7

answer

participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development

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provision 8

answer

collaborates with other health professionals and the public in promoting community, national, and international efforts to met health needs

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provision 9

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the nursing profession is represented by associations and their members are responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy

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nurse ethicist

answer

educates about ethics, provides formal ethics consults, and discusses ethical concerns with nurses informally

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decentralization

answer

allows decision making to be made closer to the pt and reinforces more autonomy at lower levels of an organization, but it can lead to variations in care from unit to unit and fragmentation of services

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assessment

answer

should be a beginning point for pt centered care and the first step in the therapeutic nurse to pt relationship

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self management support/self care

answer

the systematic provision of education and supportive interventions to increase pts skills and confidence in managing their health problems -especially important in chronic illness such as diabetes and asthma, becomes more complex with multiple health problems

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medication reconciliation

answer

intervention that can be used to educate patients and their families, prevent errors, and help them improve their self management

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disease management

answer

involves: self management care coordination inter-professional teamwork patient centered care (those chronically ill will benefit the most)

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goal of disease management

answer

to improve quality of life, decrease disease progression, and reduce hospitalizations

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nurse navigator

answer

works with the pt and family to guide them through the complex healthcare system to ensure better outcomes, clinical nurse leaders (CNL's often serve in this role)

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arthritis

answer

most common cause of disability, with nearly 19 million Americans reporting activity limitations

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diabetes

answer

continues to be the leading cause of kidney failure, non traumatic lower extremity amputations, and blindness among adults

question

self management support

answer

care and encouragement provided to people with chronic conditions to help them understand their central role in managing their illness, make informed decisions about care, and engage in healthy behaviors -chronic care model is a useful approach

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chronic care model, a patient centered approach (2 principles)

answer

1. the community should have resources and health policies that support care for chronic illnesses 2. the health system should have healthcare organizations (HCOs) that support self-management, recognizing that the pt is the source of control (pt centered) -identifies clear roles for staff in relationship to chronic illness care; decision support with EB guidelines integrated into daily practice; and clinical information systems to ensure rapid exchange of information and reminder and feedback systems

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Improving chronic illness care organization

answer

dedicated to assessing and developing strategies to improve chronic illness are in the US and to help people with chronic illness to lead healthier, quality lives

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IOM major issues related to chronic illness

answer

-health care providers do not have enough time to provide effective care -failure to implement established practice guidelines -lack of active follow up to ensure the best outcome -pt's inadequately trained in self management (a priority are identified by IOM)

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what to consider when applying diseases management to chronic illness

answer

-pt's should understand basic information about their disease (even if pt already has info, students should confirm and be prepared to share info if requested) -understand the importance of self management and development of skills required to effectively self manage care -recognize the need for ongoing support from members of the practice team, family, friends, and community

question

safety net hospitals

answer

treat poor and underserved pts, often reimbursed by medicaid for care, but many pts may have no way to pay for their care -rely on medicaid and other sources -serve vulnerable population -level of care is below other hospitals which is directly related to health care disparities -these hospitals are performance based, therefore do not receive adequate funding they need to improve

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EMTALA emergency medical treatment and labor act

answer

ensures that anyone who comes to an emergency department, regardless of their insurance status or ability to pay, must receive a medical screening exam and be stabilized -resulted in an increase in uninsured pt's visiting the ED

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disparities in rural areas

answer

-poverty rates are 2-3 times higher for minorities than for whites -less likely to receive preventive care -HPSA's (health professional shortage areas

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diversity and the Joint Commission

answer

practical guide that health care organizations can utilize to improve programs and services that accommodate the needs of diverse populations -build a leadership driven foundation - collect and use data to assess community and culture -accommodate needs of specific populations (staff training, education, pt education) -establish internal and external collaborations with local community to share info and resources necessary to meet the needs of diverse pts

question

AHRQ agency for healthcare research and quality focus

answer

1. what is the status of healthcare quality and disparities in the US? 2. how have healthcare quality and disparities changed over time? 3. where is the need to improve healthcare quality and reduce disparities greatest?

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quality framework: component of quality care

answer

effectiveness safety timeliness patient/family centeredness access efficiency

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cultural competences

answer

set of policies, behaviors, attitudes, and practices that enable individuals and organizations to work effectively in cross cultural situations -the ability of systems to provide care to pts with diverse values, beliefs, and behaviors, including the tailoring of delivery to meet pts social, cultural, and linguistic needs -attitude, knowledge, and skills

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AACN (American association of colleges of nursing) cultural competence toolkit 5 competencies

answer

1. apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts 2. use relevant data sources and best evidence in providing culturally competent care 3. promote achievement of safe and quality outcomes of care for diverse populations 4. advocate for social justice, including commitment to the health of vulnerable populations and the elimination of health disparities 5. participate in continuous cultural competent development

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campinha-bacotes's model of cultural competence 5 constructs

answer

1. cultural awareness - self examination of one's own biases toward other cultures 2. cultural knowledge - seeks and obtains sound information on cultural and ethnic groups 3. cultural skill - ability to conduct a cultural assessment, collect relevant cultural information 4. cultural encounters - face to face interactions with culturally diverse populations to modify existing beliefs and prevention of stereotyping 5. cultural desires - the desire to seek engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful

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health literacy (IOM)

answer

the ability to read, understand, and act on healthcare information -COMMUNICATION is a critical element and plays a major role in disparities -should be carefully considered in the creation and use of teaching materials for pts and families

question

investigation of the relationship between health literacy and adherence to clinical outcomes revealed...

answer

-people who have a low literacy are 1.5-3 times more likely to have adverse outcomes than those with higher literacy -medicare enrollees with lower literacy have a greater chance of never having a pap smear, not getting a mammogram within the past 2 yrs, and not receiving influenza and pneumococcal immunizations than those with higher health literacy -lower literacy is associated with increased risk for hospitalization

question

major barriers to quality health care associated with health literacy

answer

inability to: access care manage illness process information -PATIENT ADVOCACY IS ESSENTIAL IN HELPING PATIENTS AND FAMILIES EXPERIENCING HEALTH LITERACY -one of health people 2020's goals is to improve health literacy

question

limited health literacy

answer

lead to: higher outpatient medication errors possible complications increased costs inability to reach positive outcomes

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accessing care: health literacy

answer

critical issues are obtaining health insurance, finding healthcare providers, and knowing when to seek health care -finding contact info, making appointments, and keeping a record of appointments may be difficult for someone who cannot read or write

question

managing illness: health literacy

answer

may involve complicated prescription recommendations, testing schedules, appointments with different providers at different places, healthcare transition (handoffs) to different providers increase the risk of errors and also require the pt to adapt to changes and new providers

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process information: health literacy

answer

informed consents and other documents are often written in a manner that is difficult to understand, especially in stressful situation, family is helpful in these situations, medical bills can also be difficult read to understand, this can result in major problems and increased stress

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The Joint Commission: improving health literacy

answer

-pt's require both oral and written information that they can understand -create patient centered environments where the pt is involved in decision making and safety processes -increase awareness and understanding of health literacy -ensure that interpreters are available -develop cultural competence -understand how communication affects quality care -teach consumers how to better access the care they need -review and improve informed consent materials and processes -use a disease management approach to better individualize care and reduce errors -standardize handoffs -give pts clear info

question

pt assessment of health literacy

answer

make sure this is included in the plan of care

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rapid estimate of adult literacy in medicine (REALM)

answer

a standardized tool that takes only 5 min to administer and is an effective method to utilize

question

pain management: health literacy

answer

116 million adults in the US experience common chronic pain conditions (annual cost $560-$635 billion)

question

pain (IOM)

answer

can be conceptualized as a public health challenge for a number of important reasons having to do with prevalence, seriousness, disparities, vulnerable populations, the utility of population health strategies, and the importance of prevention at both the population and individual levels -healthy people 2020 includes this objective in increasing the safety and effectiveness of it -problems with understanding medication instructions contribute to an estimated 1.5 million preventable adverse drug events that occur each year

question

patient education

answer

critical intervention, one that directly involves nurses, nurses have an important role in providing care for pts with pain and describing pain management -nurses should also be involved in research to improve care for pain, particularly interprofessional research

question

IOM recommendations (relieving pain in America blueprint)

answer

this report describes the picture of pain, identifying the many different types of people with pain, recommendation include: 1. promote and enable self management of pain 2. develop strategies for reducing barriers to pain care 3. provide education opportunities in pain assessment and treatment in primary care 4. support collaboration between pain specialists and primary care clinicians, including referral to pain centers when appropriate 5. revise reimbursement policies to foster coordinated and evidence based pain care 6. provide consistent and complete pain assessments

question

end of life and palliative care

answer

according to the IOM the healthcare system continues to under-recognize, under-diagnose, and under-treat patients who experience significant suffering from their illness

question

palliative care

answer

focuses on addressing the control of pain and other symptoms, as well as psychological, social, and spiritual distress

question

6 major skill sets of complete palliative care according to the IOM (patient centered care)

answer

1. communication 2. decision making 3. management of complications of treatment and the disease 4. symptom control 5. psycho-social care of the dying 6. care of the dying

question

consumer dimension: the need to monitor healthcare quality (IOM)

answer

staying healthy getting better living with illness or disability coping with the end of life

question

privacy, confidentiality, HIPPA

answer

-relate to pt centered care -the critical issues is that the pt makes decisions about his or her health care -providers share their expertise and recommendations, but they do not make the decisions

question

patient advocate

answer

-the pt navigator, both in its aim to help and guide patients to make well informed decisions about their health for the best outcomes and in its quest to create more effective systems and policies

question

patient advocacy

answer

-respect for pts values, preferences, and expressed needs -coordination and integration of care among providers and healthcare institutions -information, communication, and education tailored to patients needs -physical comfort, especially freedom from pain -emotional support to reduce the fear and worry associated with illness and treatment -involvement of family and friends in care giving and decision making -planning for transition and continuity to ensure that patients continue to heal after they leave the hospital

question

3 overreaching goals of pt advocacy

answer

-pt centered care -safer medical systems -increased pt involvement *PT INVOLVEMENT & PT-PROVIDER IS NECESSARY FOR THE SUCCESS OF THESE GOALS

question

safety: pt advocacy

answer

is critical, and there is greater need to bring the pt into the safety process -pt's have critical information they need to share and have to be involved in the decision making in regards to their care

question

individual level

answer

the central level which emphasizes informing pts -the more pts know about their health and illness, the better they can participate in their care decisions and care

question

interpersonal level

answer

supports and empowers patients by connecting them with people who can help them and from whom they can get information -provider, family, and friends are important at this level -providers are concerned with biological, psychosocial, social, cultural, and financial factors

question

organizational and community level

answer

transforms the healthcare culture as to where, when, and how care is delivered

question

policy level

answer

consumer's voices are translated into policy and law to ensure that patient advocacy is maintained

question

3 key strategies to meet the pt advocacy goals

answer

1. understanding what pts are doing now and what providers can do to support them 2. improving providers ability to communicate and create relationships 3. transforming hospital and medical school culture (and nursing schools) to support pt and family centered care *nurses should be a part of this strategy

question

pt etiquette

answer

demonstrates respect for the pt and the pts values and preferences, would put professionalism and pt satisfactions at the center of the clinical encounter -asking pt's for permission before entering their room and waiting for an answer -introducing yourself -shaking hands if appropriate -sitting down -smiling as appropriate -briefly explaining your role on the team -asking pts how they are feeling and how they feel about their illness and the care they have received

question

areas that require pt education according to IOM

answer

-tobacco -alcohol -high fat foods -firearm injuries health literacy must be considered when pt education is planned, implemented, and evaluated

question

pt education

answer

must be culturally sensitive because the meanings of health, illness, and death are not the same everywhere, pt must be kept at the center of care, we need to consider what is important to the pt by listening to them -muslims believe this life is just one level of existance, resuscitation is not as improtant as honoring the predestination of life events -some believe (Indians) in saving locks of hair or pictures of babies that are ill, other believe that this will bind the child to this earthly world and do not allow the child to reach the next level

question

family or care giver role: family centered care

answer

directly related to patient advocacy and pt centered care -a partnership approach to the planning, delivery, and evaluation of health care and is grounded in a belief that each participant in a clinical encounter brings valuable experience to the table -pt must be asked prior to involving the family

question

core principals of family centered care

answer

dignity and respect information sharing participation collaboration -the overall goal is better pt outcomes

question

family centered care

answer

-increasingly linked to: -improved health outcomes -lower healthcare costs -effective allocation of resources -reduced medical errors and litigation -greater pt, family and professional satisfaction -increased pt/family self efficacy (producing a desired result)/advocacy -improved medical/health education

question

pt centered medical home model

answer

every person should have access to a medical home - a person who serves as a trusted adviser and provider supported by a coordinated team with whom they have a continuous relationships -delivering primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective

question

gerontology

answer

there is a growing need to educate staff so that they can effectively care for this population

question

interdisciplinary/interprofessional teams

answer

cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable

question

NCSBN the national council of state boards of nursing reported...

answer

when newly licensed nurses did not work effectively with a healthcare team or did not know when and how to call a pts physician, they were more likely to report being involved in pt errors -both knowledge and experience is needed when working on teams -teamwork is difficult when we continue to separate healthcare education by profession, this leads to not understanding different roles and responsibilities and thus do not know how to make the most of what each profession can offer

question

care coordination: clinical integration

answer

the extent to which pt care services are coordinated across people, functions, activities, and sites over time so as to maximize the value of services delivered to pts -students need to understand care coordination

question

interprofessional collaborative teams: precursors to collaboration

answer

individual clinical competence and mutual trust and respect -requires shared understanding of goals and roles, shared decision making and conflict management

question

transformational leadership

answer

IOM reports consider it the best leadership approach -not easy to implement -need to understand how to be a leader and a follower -students should be leaders by serving on student committees, planning student activities, etc.

question

allied health providers include

answer

-services related to the identification, evaluation, and prevention of diseases and disorders -dietary and nutrition services -health promotion services -rehabilitation services -health system management services

question

communication (4 aspects that typically cause problems)

answer

-team communication -written communication -verbal abuse among staff -patient-clinician communication

question

team communication

answer

-critical element in meeting pt needs, providing quality care, and reaching effective pt outcomes -intertwined in healthcare professional roles, ability to work with others, recognition that the team is the best method for reaching required goals, and willingness to compromise, collaborate, and coordinate together -has a major impact on errors

question

written communication

answer

-helps the entire healthcare team communicate the plan of care, what has been done, and outcomes -not only important to healthcare providers, ut it also provides data for quality improvement and is essential to reimbursement -has important legal implications

question

verbal abuse

answer

-one of the reasons that nursing is such a stressful profession -students need guidance on how to respond and examples of the strategies that some HCO's (healthcare organization) are using to prevent verbal abuse

question

pt-clinician communication 7 basic principals

answer

1. mutual respect 2. harmonized goals 3. a supportive environment 4. appropriate decision partners 5. the right information 6. transparency and full disclosure 7. continuous learning

question

ineffective communication

answer

the Joint Commission noted it the most cited category of root causes of sentinel events due to: -nursing shortages -pts who may not be able to concentrate -higher acuteness of pt conditions -short lengths of stay -highly stressful healthcare environment that does not allow much time for staff even to talk with pts and families

question

the Joint commission

answer

strongly supports effective communications, which is critical to protect the safety of pts across the continuum of care

question

staff retention issues that may arise during first year of employment

answer

need for stress management, assertiveness, and problem solving ability

question

nurse externships (for nursing students) and residencies (take place after graduation)

answer

these programs help new grads transition to practice and offer a host of opportunities to expand their competencies -some facilities use these programs to increase recruitment and retention of new grads, decrease costs related to orientation and turnover, and increase quality of care

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transition to practice model: NCSBN the national council of state boards of nursing

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integrates the IOM core competencies: -pt centered care -communication and teamwork -EBP -quality improvement -informatics includes: practice, education, regulation (license renewal)

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work hours and risks

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extended work hours contributes to high levels of worker fatigue and reduced productivity (Joint Commission)

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fatigue and it's effect on work

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-slowed reactions -diminished attention to detail -errors of omission (failure to perform, leaving something out) -compromised problem solving -reduced motivation and decreased vigor for successful completion of required tasks -the circadian rhythm (physical, mental and behavioral changes that follow a roughly 24-hour cycle) -reactions to working a night shift and how shift work is arranged -adjusting to changing hours -impact on personal lives

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insufficient quality of sleep can lead to:

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-lapses in attention and inability to stay focused -reduced motivation -compromised problem solving -confusion -irritability -memory lapses -impaired communication -slowed or faulty information processing and judgment -diminished reaction time -indifference and loss of empathy

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inconsistent scheduling and staff fatigue

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increases the risk of errors, affects patient centered care, teams, and quality improvement

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factors that add to staff fatigue

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-mandatory overtime, shifts, and stress

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keeping pts safe (IOM) recommends...

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that nurses not work more than 12 hours in any 23 hr period or more than 60 hrs in any 7 day period, emphasizing that 12 hr shifts increase risk of errors and staff injuries

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delegation

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is related to all 5 core competencies, it identifies what team members will be doing -the pt must understand staff roles and responsibilities -pts can then appreciate why certain staff may be providing certain care

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5 core competencies of delegation

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-quality improvement: ensureing that care is provided as needed and is effective, safe, and efficient to meet outcomes -informatics: applied both to communicating among team members and to documenting work that is done which are parts of delegation -EBP: and evidence based management provide evidence about what must be done, and may also provide evidence about who can best provide which type of care (intervention) to pts

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learning organizations: magnet hospitals

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have a high level of training and education for their staff and are more successful in recruitment and retention

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students that are more successful in their first job are...

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experienced in working on working with a team, delegating, prioritizing, managing conflict, and critical thinking and clinical reasoning and judgment

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preceptors

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can help students gain important competencies, confidence, and better understanding of professional roles and teamwork

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interprofessional learning experiences

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act as a bridge to better professional teamwork

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training in teams: interprofessional education (IPE)

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the world health organization, recognizing the importance of interprofessional teams in health care published the framework for action on interprofessional education and collaborative practice -students involved in a code or simulation are given the opportunity to work as a team, gain better understanding of different roles, increase communication competency, and work on problem solving

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simulation

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interprofessional experiences where students or staff learn their role in high stress, high risk interventions that helps when real life situations arise

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interprofessional continuing education recommendations

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continuing education methods, interprofessional education, lifelong learning, and workplace learning as well as the major stakeholders, education, practice, and regulatory

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continuing education

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-the process by which health professionals keep up to date with the latest knowledge and advances in health care -current system is flawed and cannot properly support the development of health professionals -this has become structured around health professional participation instead of performance improvement -health professionals are unprepared to perform at the highest levels consistently, putting into question whether the public is receiving care of the highest possible quality and safety

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